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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 3 to 27 of 27. Go back in thread:
Posted by Phillipa on March 5, 2016, at 11:23:44
In reply to Re: Triggers » J Kelly, posted by SLS on March 5, 2016, at 10:37:42
Jade I know I remember you from the past on here. Could you babblemail me and refresh my memory? Thanks Phillipa
Posted by Jeroen on March 5, 2016, at 11:37:03
In reply to Triggers, posted by J Kelly on March 5, 2016, at 9:27:07
my psychologist was talking about this recently, the answer is YES
Posted by J Kelly on March 5, 2016, at 13:22:10
In reply to Re: Triggers » J Kelly, posted by SLS on March 5, 2016, at 10:37:42
> > Hello.
> >
> > I've had two distinct depressive episodes in my life. Both immediately followed trips out of the country. I felt happy and energized during both vacations. I'm wondering if a pre-disposed person, as a result of change in environment, can go into a manic or hypomanic state that looks normal to others. And could that mania trigger a depressive episode?
> >
> > Jade
> >
>
> 1. In bipolar disorder, the common pattern of mood changes is:
>
> normal -> mania -> depression
>
> * If you can prevent the mania, you can often prevent the depression.
>
> 2. Only for a minority of people does the pattern follow:
>
> normal -> depression -> mania
>
> Based upon your description here, you might be able to take a mood stabilizer alone long-term and prevent mood switches. First, you need to take care of the depression, of course.
>
>
> - ScottHi Scott,
Do you believe that mania can be triggered in a pre-disposed person, simply by a change in environment or circumstance? Or do you believe it to be a random assault on ones brain chemistry?
Jade
Posted by J Kelly on March 5, 2016, at 13:46:48
In reply to Re: Triggers » SLS, posted by J Kelly on March 5, 2016, at 13:22:10
>
> Hi Scott,
>
> Do you believe that mania can be triggered in a pre-disposed person, simply by a change in environment or circumstance? Or do you believe it to be a random assault on ones brain chemistry?
>
> Jade
ps-I'm excluding episodes caused by med changes.
Posted by J Kelly on March 5, 2016, at 15:20:11
In reply to YES, posted by Jeroen on March 5, 2016, at 11:37:03
> my psychologist was talking about this recently, the answer is YES
Hi Jeroen,
can you elaborate?
thanks,
Jade
Posted by J Kelly on March 5, 2016, at 15:26:06
In reply to Re: Triggers, posted by Phillipa on March 5, 2016, at 11:23:44
> Jade I know I remember you from the past on here. Could you babblemail me and refresh my memory? Thanks Phillipa
Hi Phillipa,
I'm actually trying to figure out how to turn off/change my babblemail. I need to use a different acct.
Hope you are well.
Jade
Posted by SLS on March 5, 2016, at 15:30:22
In reply to Re: Triggers » SLS, posted by J Kelly on March 5, 2016, at 13:22:10
> Do you believe that mania can be triggered in a pre-disposed person, simply by a change in environment or circumstance? Or do you believe it to be a random assault on ones brain chemistry?
Can you describe exactly what you experience when you are traveling? What were your sleep habits?
There is a phenomenon called "kindling" that is sometimes used to explain mania. If you find traveling particularly stimulating, you might become more and more excited and kindle a mania or hypomania. The more kindled episodes that are allowed to occur, the easier it is to trigger them. Of course, I don't know if this is happening to you.
- Scott
Posted by SLS on March 5, 2016, at 15:34:54
In reply to Re: Triggers » Phillipa, posted by J Kelly on March 5, 2016, at 15:26:06
> I'm actually trying to figure out how to turn off/change my babblemail. I need to use a different acct.
http://www.dr-bob.org/cgi-bin/pb/settings.pl
- Scott
Posted by Jeroen on March 5, 2016, at 15:36:35
In reply to Re: YES » Jeroen, posted by J Kelly on March 5, 2016, at 15:20:11
hi, my psychologist told me if someone moves country to a new location, it is possible to develop a psychosis or alike condition more likely, there were studies confirmed of this explenation she said in australia or somewhere...
so ... she might be right, i was shocked when she said this, i didn't knew
Posted by J Kelly on March 5, 2016, at 16:37:59
In reply to Re: Triggers » J Kelly, posted by SLS on March 5, 2016, at 15:30:22
> Can you describe exactly what you experience when you are traveling? What were your sleep habits?Hmm. I feel myself getting excited and apprehensive at the same time. Will I be able to "deal" with being "on" for weeks at a time? I not only rise to the occasion but I actually enjoy myself and feel somewhat "normal". Sleep is disrupted but I keep going.
When I try forcing myself into activity at home it usually backfires. Sleep was a real issue this time when I got home. Severe jet lag, little sleep for days on end etc.
>
> There is a phenomenon called "kindling" that is sometimes used to explain mania. If you find traveling particularly stimulating, you might become more and more excited and kindle a mania or hypomania. The more kindled episodes that are allowed to occur, the easier it is to trigger them. Of course, I don't know if this is happening to you.Well I'll look into that. Thanks :)
>
>
> - ScottJade
Posted by J Kelly on March 5, 2016, at 16:49:49
In reply to Re: YES, posted by Jeroen on March 5, 2016, at 15:36:35
> hi, my psychologist told me if someone moves country to a new location, it is possible to develop a psychosis or alike condition more likely, there were studies confirmed of this explenation she said in australia or somewhere...
>
>
> so ... she might be right, i was shocked when she said this, i didn't knewI wonder if some of it can be explained as a result of changing time zones. That's got to be jarring to anyone. Not to mention ppl prone to depression/anxiety etc.
Thanks,
Jade
Posted by baseball55 on March 5, 2016, at 18:30:16
In reply to Re: Triggers » SLS, posted by J Kelly on March 5, 2016, at 16:37:59
Your being "up" when traveling doesn't mean mania. Most people are up when traveling. New things to do, see, different environment, lots of activities scheduled. It may be that you just crashed when coming home. This has happened to me a couple of times. I've been moderately depressed twice, went on a vacation out of the country, felt great, came home and ended up in the hospital. A lot of people with depression, I would imagine, have some degree of mood reactivity and can be pulled out of the low mood under circumstances where the mind is fully engaged elsewhere. If I have a major project due at work, I can get myself out of bed long enough to focus and finish it, then collapse afterward. I guess this is called atypical depression.
> Hmm. I feel myself getting excited and apprehensive at the same time. Will I be able to "deal" with being "on" for weeks at a time? I not only rise to the occasion but I actually enjoy myself and feel somewhat "normal". Sleep is disrupted but I keep going.
>
> When I try forcing myself into activity at home it usually backfires. Sleep was a real issue this time when I got home. Severe jet lag, little sleep for days on end etc.
>
>
Posted by herpills on March 5, 2016, at 22:05:25
In reply to Triggers, posted by J Kelly on March 5, 2016, at 9:27:07
> Hello.
>
> I've had two distinct depressive episodes in my life. Both immediately followed trips out of the country. I felt happy and energized during both vacations. I'm wondering if a pre-disposed person, as a result of change in environment, can go into a manic or hypomanic state that looks normal to others. And could that mania trigger a depressive episode?
>
> Jade
>The last time I traveled out of the country, I'm pretty sure I became hypomanic and then when I got back fell into a pretty bad depression. I don't think it was the traveling itself that caused it, but the disruption in sleep. I didn't have any control over the schedule, I remember leaving late at night, then upon arrival had to go to work all day. I can't sleep on planes...so I basically missed a sleep cycle and that can cause all kinds of mood problems if you are prone to them. After I got back it felt like jet lag but lasted weeks instead of days. I went into a major depression.
In my experience, in wasn't the traveling itself but I think the disruption in sleep which set off the mood instability. The next time I ever have to travel across so many time zones, I'll be making sure I do whatever it takes to maintain my sleep cycle.
Posted by J Kelly on March 6, 2016, at 5:40:25
In reply to Re: Triggers » J Kelly, posted by baseball55 on March 5, 2016, at 18:30:16
Hi there.
> Your being "up" when traveling doesn't mean mania. Most people are up when traveling. New things to do, see, different environment, lots of activities scheduled. It may be that you just crashed when coming home. This has happened to me a couple of times. I've been moderately depressed twice, went on a vacation out of the country, felt great, came home and ended up in the hospital. A lot of people with depression, I would imagine, have some degree of mood reactivity and can be pulled out of the low mood under circumstances where the mind is fully engaged elsewhere. If I have a major project due at work, I can get myself out of bed long enough to focus and finish it, then collapse afterward. I guess this is called atypical depression.
>
>I wasn't hospitalized but it sure felt like I was headed there. Its hard for me to figure out exactly what my trigger was this time because I was also sick when I got home. And off all meds. Ugh.
Jade
Posted by J Kelly on March 6, 2016, at 5:52:55
In reply to Re: Triggers » J Kelly, posted by herpills on March 5, 2016, at 22:05:25
Exactly!!
>
> The last time I traveled out of the country, I'm pretty sure I became hypomanic and then when I got back fell into a pretty bad depression. I don't think it was the traveling itself that caused it, but the disruption in sleep. I didn't have any control over the schedule, I remember leaving late at night, then upon arrival had to go to work all day. I can't sleep on planes...so I basically missed a sleep cycle and that can cause all kinds of mood problems if you are prone to them. After I got back it felt like jet lag but lasted weeks instead of days. I went into a major depression.
>
> In my experience, in wasn't the traveling itself but I think the disruption in sleep which set off the mood instability. The next time I ever have to travel across so many time zones, I'll be making sure I do whatever it takes to maintain my sleep cycle.
>
>I feel like I wrote this...its all starting to make sense. I, too, am going to make sure I keep a proper sleep schedule from now on. Even when traveling.
Jade
ps-I cant sleep on planes either. One of my flights was 14 hours.
Posted by J Kelly on March 6, 2016, at 6:10:03
In reply to Re: Triggers » J Kelly, posted by SLS on March 5, 2016, at 15:30:22
>
> There is a phenomenon called "kindling" that is sometimes used to explain mania. If you find traveling particularly stimulating, you might become more and more excited and kindle a mania or hypomania. The more kindled episodes that are allowed to occur, the easier it is to trigger them. Of course, I don't know if this is happening to you.
>
>
> - Scott
Hi Scott,I was thinking about what you said here and was reminded of something that happened on my trip. My niece said something to me that I found to be funny. It was the middle of the night I think. I could not stop laughing. It felt a little manic to me. I never laugh like that at home.
In any case, I'm at the point where no trip/vacation is worth weeks of deep depression. Not a good outcome.
Jade
Posted by SLS on March 6, 2016, at 8:52:01
In reply to Re: Triggers » SLS, posted by J Kelly on March 6, 2016, at 6:10:03
Hi Jade.
Well, you answered my question about your sleep habits while traveling. I'm not surprised. Sleep deprivation by itself can precipitate mania. I hate to see you limit your traveling. Strategic use of sleeping medication can prevent the sleep deprivation and jet lag. You can also use chronotherapy to regulate and gradually adjust your sleep cycle.
At this point, I don't think your short-term plans should depend on understanding the kindling model or even producing a firm diagnosis. I would simply assume that your illness lies somewhere along the bipolar spectrum and treat it accordingly. This means the use mood stabilizers and/or antipsychotics to function as antimanics. You might even be able to eventually discontinue the antidepressants and take Lamictal and perhaps Trileptal or low-dose lithium if your depression hasn't lasted too long or there have been multiple episodes - maybe 3 or more.
There is one MAJOR caveat that applies to Nardil. It often happens that it works perfectly for someone for an extended period of time. The decision is then made to discontinue Nardil. The patient might feel well for months before relapsing. When depression becomes serious enough to restart Nardil, it no longer works or works less well. I do not have any statistics to present you with, but the frequency with which this happens is not at all rare.
Just so that we are clear, how many episodes of depression have you had in the past, and how long has your current episode lasted? Have all of your episodes been associated with traveling?
- Scott
Posted by J Kelly on March 6, 2016, at 11:12:11
In reply to Re: Triggers » J Kelly, posted by SLS on March 6, 2016, at 8:52:01
Hi Scott.
> Sleep deprivation by itself can precipitate mania.
I suspect that I am VERY sensitive to changes in my sleep patterns. I think I'm sensitive to change in general, now that I think about it.
>I would simply assume that your illness lies somewhere along the bipolar spectrum and treat it accordingly. This means the use mood stabilizers and/or antipsychotics to function as antimanics
I'm currently taking Zyprexa and not doing that well so maybe its time to add a mood stabilizer and possibly Nardil. No current mania, however, so should I try Nardil first?
>You might even be able to eventually discontinue the antidepressants
A girl can dream...
>and take Lamictal and perhaps Trileptal or low-dose lithium if your depression hasn't lasted too long or there have been multiple episodes - maybe 3 or more.
I have been in some state of depression for years. Sometimes I can function. I've had two major depressive episodes where I really could barely get out of bed. The first lasted at least a few months, this second time I am at the 2 month+ mark I would say. This current episode started as soon as I returned from travel the end of December. I felt recently improved after this recent episode but now find myself slipping. Both followed trips out of the country. Coincidence? Maybe. I'm thinking the lack of sleep and sleep disruption definitely contributed, especially with this recent episode, but considering everything (see below) it's probably not that simple.
>
> Just so that we are clear, how many episodes of depression have you had in the past, and how long has your current episode lasted? Have all of your episodes been associated with traveling?A total of two major depressive episodes. Years of a milder depression. Current (second) episode 2+ months. Yes both major episodes occurred upon return from travel.
>
>
> - ScottPS-I'm about to muddy the waters further. In preparation for my trip, and at the recommendation of my pdoc, I dc'd the meds I was taking. I now see how ill-advised this was. I weaned off 10mg Zyprexa, 3mg Klonopin, and 90mg Ritalin. I did this over a period of months. I felt relatively okay during that time. I was done with Zyprexa in November, Ritalin in September, and took my last .5mg/day klonopin the day before I left which was Dec 9th.
I can hear you all the way over here "WELL NO SH*T"
I'm wondering, as I'm sure are you, if in addition to the sleep deprivation/disruption I was experiencing protracted withdrawal. But wait, there's more. A couple of weeks after my return, I went to my GP and told her how I was feeling. Physically lousy/bad fatigue. She did blood work and later called to say my tests came back positive for Mono.
I restarted Ritalin early January, I added back in .5 klonopin and 10mg Zyprexa mid February. I thought I was feeling much better by late feb but now I feel I'm slipping. Help.
Jade
Posted by SLS on March 6, 2016, at 11:54:45
In reply to Re: Triggers » SLS, posted by J Kelly on March 6, 2016, at 11:12:11
If you can tolerate the depression for the moment, I would ask your doctor about starting Lamictal. Be sure to follow the titration guidelines to avoid getting a rash-reaction. Put off the Nardil for now if you can.
I hope other people can offer you some feedback.
- Scott
Posted by J Kelly on March 6, 2016, at 14:11:57
In reply to Re: Triggers » J Kelly, posted by SLS on March 6, 2016, at 11:54:45
> If you can tolerate the depression for the moment, I would ask your doctor about starting Lamictal. Be sure to follow the titration guidelines to avoid getting a rash-reaction. Put off the Nardil for now if you can.
>
> I hope other people can offer you some feedback.
>
>
> - ScottWow. You get a hero badge for even reading that last post. What a mess I am. I will definitely ask for the Lamictal. I hope to start Nardil in the not too distant future :)
Thanks for your help,
Jade
Posted by SLS on March 6, 2016, at 15:20:57
In reply to Re: Triggers » SLS, posted by J Kelly on March 6, 2016, at 14:11:57
> Thanks for your help,
:-)
- Scott
Posted by Tabitha on March 6, 2016, at 18:33:57
In reply to Triggers, posted by J Kelly on March 5, 2016, at 9:27:07
> Hello.
>
> I've had two distinct depressive episodes in my life. Both immediately followed trips out of the country. I felt happy and energized during both vacations. I'm wondering if a pre-disposed person, as a result of change in environment, can go into a manic or hypomanic state that looks normal to others. And could that mania trigger a depressive episode?
>
> Jade
>I get moodswings from travel. I go to festivals that last 3-5 days. Usually I'm high by the end, then switch to an angry state for several days. It's not my usual depressive cycle so I didn't recognize it as bipolar stuff until like the third time it happened.
I think it's related to having all my usual routines interrupted, plus being forced to interact with others all day. My pdoc thinks it's mainly sleep disturbance that triggers it, which makes sense, especially when you add jet lag into the mix.
The funny thing is I thought the travel experience had, like, magical powers to make me happy, and then when I returned home I thought I was just uniquely insightful about how cr*ppy normal day-to-day life was. Which is maybe 10% true, but 90% just moodswings.
Posted by J Kelly on March 7, 2016, at 6:52:46
In reply to Re: Triggers » J Kelly, posted by Tabitha on March 6, 2016, at 18:33:57
>> I get moodswings from travel. I go to festivals that last 3-5 days. Usually I'm high by the end, then switch to an angry state for several days. It's not my usual depressive cycle so I didn't recognize it as bipolar stuff until like the third time it happened.So would this be considered "rapid cycling"? May I ask what your "usual depressive cycle" is like?
>
> I think it's related to having all my usual routines interrupted, plus being forced to interact with others all day. My pdoc thinks it's mainly sleep disturbance that triggers it, which makes sense, especially when you add jet lag into the mix.The more I think about it, how would a susceptible person not be triggered by all that.
>
> The funny thing is I thought the travel experience had, like, magical powers to make me happy, and then when I returned home I thought I was just uniquely insightful about how cr*ppy normal day-to-day life was. Which is maybe 10% true, but 90% just moodswings.
>Yes this is me too!
Jade
Posted by Tabitha on March 7, 2016, at 19:25:18
In reply to Re: Triggers » Tabitha, posted by J Kelly on March 7, 2016, at 6:52:46
> So would this be considered "rapid cycling"? May I ask what your "usual depressive cycle" is like?I'm not sure if it meets the definition of rapid cycling or not. But my usual cycle is slower, that's for sure-- depression that lasts months with infrequent hypomania. This post-trip cycle was unique in that I was unusually euphoric then it switched quickly into a really angry, withdrawn state.
>
> >
> > The funny thing is I thought the travel experience had, like, magical powers to make me happy, and then when I returned home I thought I was just uniquely insightful about how cr*ppy normal day-to-day life was. Which is maybe 10% true, but 90% just moodswings.
> >
>
> Yes this is me too!
>Amazing how I'm still fooled by my thoughts that seem so true but are mostly mood-related.
The travel experience has gotten better for me. I think it helps just being more aware of the possibility of moodswings. I'm also starting to avoid events that I know will be overwhelming.
Posted by J Kelly on March 8, 2016, at 8:32:01
In reply to Re: Triggers » J Kelly, posted by Tabitha on March 7, 2016, at 19:25:18
>my usual cycle is slower, that's for sure-- depression that lasts months with infrequent hypomania.
I can really relate to that.
>This post-trip cycle was unique in that I was unusually euphoric then it switched quickly into a really angry, withdrawn state.
>
Yes me too, except I don't get angry, I get depressed and very withdrawn.
> Amazing how I'm still fooled by my thoughts that seem so true but are mostly mood-related.
>
> The travel experience has gotten better for me. I think it helps just being more aware of the possibility of moodswings. I'm also starting to avoid events that I know will be overwhelming.I'm happy for you that traveling has become a better experience :)
It frustrates me that I have to plan everything around how it might trigger me. I'm learning that some things, like traveling across many times zones, are not healthy for me.
Jade
This is the end of the thread.
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