![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by Anna Laura on December 11, 2002, at 2:46:51
My new-pdoc is not returning my calls. The clinical psychopharmacologist who diagnosed bipolar II is always out at congresses. She was supposed to come back yesterday: i've been waiting an entire week to talk to her; i called the University Clinic yesterday and they told me she wasn't there yet.
Don't know where to turn. Anhedonia and apathy are worse then ever.
Bad news: SPECT scans showed basal ganglia hypoperfusion, which is consistent with my symptoms. i was surfing the net this morning and found an article about apathy syndrome, a distinct syndrome from depression where caudate, putamen and thalamus structures are involved (just like my case: those structures are "clouded" in my SPECT scan); this syndrome, which is similar to PD (Parkinson Desease) depression, showed up to be resistant to counseling and antidepressants therapy (my case as well). I recalled a phrase the psychopharmacologist said about PD's depression (she also believes my depression to be similar to PD's depression even though i don't have PD, thanks god). Somatosensory innervations start from there (that's why can't feel my body as a whole, nor pleasure or pain, it's like i were anesthetized).
I know i shouldn't have read it, didn't want to indulge in my suffering, quite the opposite, i was just trying to find some hope; i'm aware i seem to selectively pick the "worst cases" when i feel gloomy and the worst scenarios are depicting in my mind as a consequence.I leraned the "lesson": i won't be surfing on the net anymore, not in this period, 'cause makes me feel too bad.
I'd be happy if only i could return to my early depression period; i was depressed, felt desperate, but i could accept to live like that, 'cause i still had a few nice moments spared by illness.
I remember i used to light scented candles, put them on the floor, laying on the bed and listen to music, smelling the perfume, or having a cup of hot chocolate milk and a nice Camel cigarette and watching the starry night poking my head outside my window. I was suffering but i felt alive somehow. And i was pleased if friends would call or come visit. Perhaps i'm asking too much and those moments are gone forever, i don't know.
Tegretol and Mirapex augmenting failed. Mirapex made more depressed, and now i'm more miserable then a few weeks ago, when i started the new medication therapy.
Sorry for venting. I feel pathetic.
P.S.Don't worry: i don't feel suicidal.
Posted by Eddie Sylvano on December 11, 2002, at 10:19:35
In reply to NO HOPE, posted by Anna Laura on December 11, 2002, at 2:46:51
> Don't know where to turn. Anhedonia and apathy are worse then ever.
------------------------Man, that is the worst. Without those motivations, it's hard to care about anything.
I like your description of a starry night with cocoa and Camels, though. If that were possible at one time, it could well happen again.
Did your research reveal possible causes? Unless it was caused by something recently, it reasons that you've experienced happiness while still having this condition at some time in the past. The brain is relatively plastic, too. You can lose half of it and still get along fine. Maybe things will adjust, and get better eventually. Maybe a current or future drug will help alleviate the problem. There's at least some cause for hope.
Posted by ROO on December 11, 2002, at 12:26:31
In reply to Re: NO HOPE » Anna Laura, posted by Eddie Sylvano on December 11, 2002, at 10:19:35
Anna Laura--
I don't know exactly what to say about your post...but
I just wanted to respond because I've been thinking about
it all morning. It really struck a chord with me on a lot
of levels. I could totally relate to it for one thing. Sounds
a lot like me. Maybe we have the same thing, I don't know, but it
sounds very similar. I know what you mean about researching things on
the internet and it just bringing you down. I don't recommend that either...I
think it just makes things worse and makes you feel like there's no hope when
that might not be true at all. I don't want to believe that's true, Anna Laura.
Who are we to say what's true and what's not? We don't really know...even the most
brilliant doctors in the world don't know for sure. Even a brain scan doesn't prove
that something might be true FOREVER. Things can change. We can heal. The brain can heal,
and our spirits can heal. I've GOT to believe that or I'd do myself in. People with other
serious diagnoses such as cancer and so forth have healed....look at Lance Armstrong...
Maybe I'm getting on your nerves saying all this...I'm mostly saying it for myself, b/c your
post so strongly resonated with me and I've got to have hope.
There is one thing I feel like I know for sure....when it comes to disease and healing, there's an element
of mystery that NO ONE understands, and that people in seemingly impossible situations have managed to heal....
and I just wanna Bah Humbug any sort of dooming diagnoses like "apathy syndrome" that boxes someone up
and makes them feel doomed to a life of joylessness. Research and learn from it if you must, but don't give
up hope, but if researching it is just making you feel like you're doomed, I say stay away from it, it's just
dragging you down and making you feel hopeless. Maybe take a walk in the woods and smoke a camel under a tree
instead. Much Love, Roo
Posted by Ritch on December 11, 2002, at 12:35:16
In reply to NO HOPE, posted by Anna Laura on December 11, 2002, at 2:46:51
> My new-pdoc is not returning my calls. The clinical psychopharmacologist who diagnosed bipolar II is always out at congresses. She was supposed to come back yesterday: i've been waiting an entire week to talk to her; i called the University Clinic yesterday and they told me she wasn't there yet.
> Don't know where to turn. Anhedonia and apathy are worse then ever.
> Bad news: SPECT scans showed basal ganglia hypoperfusion, which is consistent with my symptoms. i was surfing the net this morning and found an article about apathy syndrome, a distinct syndrome from depression where caudate, putamen and thalamus structures are involved (just like my case: those structures are "clouded" in my SPECT scan); this syndrome, which is similar to PD (Parkinson Desease) depression, showed up to be resistant to counseling and antidepressants therapy (my case as well). I recalled a phrase the psychopharmacologist said about PD's depression (she also believes my depression to be similar to PD's depression even though i don't have PD, thanks god). Somatosensory innervations start from there (that's why can't feel my body as a whole, nor pleasure or pain, it's like i were anesthetized).
> I know i shouldn't have read it, didn't want to indulge in my suffering, quite the opposite, i was just trying to find some hope; i'm aware i seem to selectively pick the "worst cases" when i feel gloomy and the worst scenarios are depicting in my mind as a consequence.I leraned the "lesson": i won't be surfing on the net anymore, not in this period, 'cause makes me feel too bad.
> I'd be happy if only i could return to my early depression period; i was depressed, felt desperate, but i could accept to live like that, 'cause i still had a few nice moments spared by illness.
> I remember i used to light scented candles, put them on the floor, laying on the bed and listen to music, smelling the perfume, or having a cup of hot chocolate milk and a nice Camel cigarette and watching the starry night poking my head outside my window. I was suffering but i felt alive somehow. And i was pleased if friends would call or come visit. Perhaps i'm asking too much and those moments are gone forever, i don't know.
> Tegretol and Mirapex augmenting failed. Mirapex made more depressed, and now i'm more miserable then a few weeks ago, when i started the new medication therapy.
> Sorry for venting. I feel pathetic.
>
>
> P.S.
>
> Don't worry: i don't feel suicidal.
Anna, I don't want to sound too simplistic, but dexedrine is often used in Parkinson's patients. Perhaps a stimulant trial? It has helped me before. Mirapex sucked. It made me real nauseated and tired all the time.
Posted by Tabitha on December 11, 2002, at 13:28:11
In reply to NO HOPE, posted by Anna Laura on December 11, 2002, at 2:46:51
Anna, what you are going through sounds awful. It's so hard to function, think, and keep going when there's no pleasure. I do the same thing when my meds or therapy aren't helping-- I surf the net desperately looking for some explanation, usually an exotic disease or controversial diagnosis. So far it's always turned out to be just plain ol' depression, and I've been lucky to eventually find a med combination that works. I wish you the best.
Tabitha
Posted by gabbix2 on December 11, 2002, at 14:21:54
In reply to Re: NO HOPE, posted by Tabitha on December 11, 2002, at 13:28:11
Anna Laura what an awful thing too be slapped with.
I related to so much of what you said, right down to the Camels.
Ditto what Tabitha said about surfing the net, I do that too, or try to find a book to explain everything.The lack of pleasure is indescribably difficult.
I go through it frequently, and when I'm in it I think I actually prefer the depths of despair.
Somehow pain is at least something.I don't know what I'm trying to say
I guess when you can't feel hope, we have to hope for you till you can.
Posted by IsoM on December 11, 2002, at 15:26:59
In reply to NO HOPE, posted by Anna Laura on December 11, 2002, at 2:46:51
Anna Laura, I consider you one of my internet friends. I wish I could drop in & visit you but me being on the west coast of Canada & you in Italy makes it a little difficult.
I remember reading a sci-fi story many years ago where people had doors, 'portals', that could be set for any other place that also had a portal. One could step through it & emerge in your house through your door. How I wish that were so.
I'd bring my huge mug along with me to sip tea from, maybe my social girl kitty, & we'd sit up most of the night talking. I've been told I can brighten most people with my wildly. gesturing hands & shining eyes when I love what I'm talking about. But I can also sit quietly, simply listening & asking questions to understand better.
How I wish I coud just sit down & talk with you face-to-face in real time.
I'm saving all your emails you send me. I hope you don't mind. I'm blown away with the stories of your life. Anna Laura, have you ever had a chance to try stimulants like Dexedrine or anything similar? If so, have they ever made a
difference to the apathy you feel? You may feel crippled by apathy but I see an immensely rich & diverse personality under that numb layer. I'm going to answer your last letter to me tonight. Look for an email from me tomorrow morning, your time.
Posted by Anna Laura on December 12, 2002, at 6:24:05
In reply to NO HOPE, posted by Anna Laura on December 11, 2002, at 2:46:51
Dear Eddie, Judy, Gabbix, Tabitha, Ritch and Roo,
You're such incredible people. I wish i could meet you all.
I really would like to say more, but i feel somehow crippled (loosing mental focus). I wanted to wait, in order to answer every single post more throughly, but i can't wait 'cause dreadful afternoon is approaching: yesterday afternoon was horrible; I get relief just around late evening and i don't want to wait to thank you all.
I guess Tabitha was right when she said it might be plain old depression; may be it's winter blues, who knows. I'm still looking for the psychopharmacologist: i know she got back from the congress: i've been trying to find her this morning with no luck; hope i'll catch her later. I need to know wether i should be dropping Tegretol and start a new med; taking Xanax to alleviate negative racing thoughts for now.I called a friend of mine yeasterday who's bipolar I. He's entering the manic phase now (he won't take lithium, i've been insisting countless times, calling him on the phone, trying to convince him, saying he could be taking other meds but he wouldn't listen to me);
He was like: "Oh, Anna, i was thinking of you two days ago i swear: why did we break up, oh man! Hey listen, i'm going to drop in and we'll get laid, but i'm gonna go downtown to see my man first" (he's not gay, he meant the pot dealer).
I know i shouldn't have, but he made me smile.I have been a little bit selfish, i know, i should have been worrying about him (he wouldn't listen anyway);
i couldn't help myself : "feeling" his joy gave me a tiny little drop of optimism and i drank it.
Posted by wendy b. on December 12, 2002, at 7:44:01
In reply to Re: NO HOPE to everybody, posted by Anna Laura on December 12, 2002, at 6:24:05
> Dear Eddie, Judy, Gabbix, Tabitha, Ritch and Roo,
>
>
> You're such incredible people. I wish i could meet you all.
> I really would like to say more, but i feel somehow crippled (loosing mental focus). I wanted to wait, in order to answer every single post more throughly, but i can't wait 'cause dreadful afternoon is approaching: yesterday afternoon was horrible; I get relief just around late evening and i don't want to wait to thank you all.
> I guess Tabitha was right when she said it might be plain old depression; may be it's winter blues, who knows. I'm still looking for the psychopharmacologist: i know she got back from the congress: i've been trying to find her this morning with no luck; hope i'll catch her later. I need to know wether i should be dropping Tegretol and start a new med; taking Xanax to alleviate negative racing thoughts for now.
>
> I called a friend of mine yeasterday who's bipolar I. He's entering the manic phase now (he won't take lithium, i've been insisting countless times, calling him on the phone, trying to convince him, saying he could be taking other meds but he wouldn't listen to me);
> He was like: "Oh, Anna, i was thinking of you two days ago i swear: why did we break up, oh man! Hey listen, i'm going to drop in and we'll get laid, but i'm gonna go downtown to see my man first" (he's not gay, he meant the pot dealer).
> I know i shouldn't have, but he made me smile.I have been a little bit selfish, i know, i should have been worrying about him (he wouldn't listen anyway);
> i couldn't help myself : "feeling" his joy gave me a tiny little drop of optimism and i drank it.
>
Anna Laura,Sorry to interject on this thread. You have wonderful support from everyone here. I've missed talking to you - and glad to be reading you again, even if it is such a hard time again for you now...
But grabbing a drop of joy, even from somebody who's in a manic phase, is MORE THAN ok, it's wonderful. When we're manic (or hypo), we BPs can be loads of fun!
(Just be careful... I probably don't have to say this, but mania can induce hyper-sexuality in some people, and it may feel good now, but there'll be hell to pay later...)I think gaining optimism - however it's done - is the important thing. Grab it wherever you can find it. "Supplies are low"!
much love to you,
ciao, bella,Wendy
Posted by pfinstegg on December 12, 2002, at 9:40:43
In reply to Re: NO HOPE to everybody, posted by Anna Laura on December 12, 2002, at 6:24:05
Hi Anna Laura... I read about your SPECT scan, and was wondering what one might do about the hypoperfusion to the thalamus, etc. I haven't had a SPECT scan, which if I understand it correctly, is a measure of blood flow to various brain areas by means of radioactive glucose. I have had an MRI, which shows that the left hypothalamus and left pre=frontal areas are abnormally small- the MRI being a test that shows brain volumes, but not blood perfusion. I'm assuming that low brain volume and low brain blood flow co-exist, and are caused by the same basic abnormalities in brain chemistry.
So few people with MDD or BP have had these studies done, but I feel certain that when doctors start doing them more routinely as part of a diagnostic psychiatric workup, a huge percentage of people suffering from depression are going to be found to have these SPECT and MRI abnormalities.
I am reading a lot on Medline to try to find out what causes these brain changes. The big culprit seems to be prolonged stress, which can become self-perpetuating even when the original stressors are long in the past. Stress is now generally considered to be the trigger for depression (all types), with each person's genetic and environmental threshold being different. Once excessive stress is chronically present, the hypothalamic-pituitary-adrenal (HPA) axis goes into over-drive. The way to tell, physiologically, that this has happened, is when you have a normal T4, but a TSH at the upper limit of normal, or slightly above normal. Another test that becomes abnormal is the DST suppression test, or the slightly more sensitive version, the CRH-DST suppression test. What these tests show is that the hormones originating in the hypothalamus- TRF (thyroid-releasing-factor) and CRH (corticol-releasing-factor)- don't turn off normally even when there are adequate levels of thyroxine (T4) and cortisol in the bloodstream. This means that there begins to be a destructive "final common cascade" (to use the words I keep reading) of excessive amounts of TSH, ACTH, cortisol, and also mineralocorticoids (particularly glutamate), which act upon the receptors and transmitters of the hippocampus, amygdala, pre-frontal areas and basal ganglia in such a way that, although the cells in those areas are not thought to die off at an increased rate, new cells do not grow the way they do normally. The cells themselves are altered- they are much less active metabolically, with shrunken cell bodies and shortened dendrites- meaning less secretion and less uptake of all of the neurotransmitters- serotonin, dopamine and nor-epinephrine. It's supposed to be the shrunken, inactive state of these neurons which accounts for the findings of hypoperfusion and loss of brain volume. Because excess TSH, cortisol, and glutamate have these damaging effects on crucial parts the brain, the hippocampus especialy, it loses its down-regulating ability- it can no longer tell the hypothalamus to slow down its damaging hormone over-production, and a gradually worsening vicious cycle (HPA dysregulation) is established. Of course, you can have this just occasionally, just a litte, or a lot. It can progress, or stay quite stable.
I have been looking for articles on what interrupts this cycle. For some people, ADs of all the classes, but particularlu MAOis and tricyclics, do reverse the hypothalamic overactivity. For other people, ECT and TMS can do it. Psychotherapy itself can apparently also do it, but it has to be the kind that does not make stress worse- examples of the ones that work best include CBT and the relatively new two-person, or relational psychotherapy, which involves learning self-soothing techniques while improving one's object relatonships.
Well, this is as far as I've gotten! I have a medium degree of HPA dysregulation, and have chosen to try TMS, relational psychotherapy and the European tricyclic tianeptine. For add-ons, I take 2 gms. fish oil, plus two things which are supposed to lower cortisol: phosphadatylserine and alpha-lipoic acid. I'm presently doing all of this except for the TMS, which starts in January, but I notice some real improvements- considerably less apathy- and the suicidal thoughts are completely gone. I know I am really lucky to have been able to get all this treatment- and do hope that you will be able to obtain effective treatment, too. For me, the most helpful person was a neuro-endocrinologist- he sort of graciously pressured my internist and psychiatrist into taking a more serious and up-to-date approach, stressing the importance of maximal intervention NOW, before things progressed to a melancholic or psychotic form of depression, which he thought could happen.
I wish you the very best of luck. and hope to hear that you have also found a really effective treatment. It's seems to be difficult for doctors, unless they are very well-trained, to recognize how serious this illness is, because we can usually act perfectly normal in their presence!
Pfinstegg
Posted by Anna Laura on December 14, 2002, at 6:16:19
In reply to Re: NO HOPE to everybody » Anna Laura, posted by pfinstegg on December 12, 2002, at 9:40:43
> Hi Anna Laura... I read about your SPECT scan, and was wondering what one might do about the hypoperfusion to the thalamus, etc. I haven't had a SPECT scan, which if I understand it correctly, is a measure of blood flow to various brain areas by means of radioactive glucose. I have had an MRI, which shows that the left hypothalamus and left pre=frontal areas are abnormally small- the MRI being a test that shows brain volumes, but not blood perfusion. I'm assuming that low brain volume and low brain blood flow co-exist, and are caused by the same basic abnormalities in brain chemistry.
>
> So few people with MDD or BP have had these studies done, but I feel certain that when doctors start doing them more routinely as part of a diagnostic psychiatric workup, a huge percentage of people suffering from depression are going to be found to have these SPECT and MRI abnormalities.
>
> I am reading a lot on Medline to try to find out what causes these brain changes. The big culprit seems to be prolonged stress, which can become self-perpetuating even when the original stressors are long in the past. Stress is now generally considered to be the trigger for depression (all types), with each person's genetic and environmental threshold being different. Once excessive stress is chronically present, the hypothalamic-pituitary-adrenal (HPA) axis goes into over-drive. The way to tell, physiologically, that this has happened, is when you have a normal T4, but a TSH at the upper limit of normal, or slightly above normal. Another test that becomes abnormal is the DST suppression test, or the slightly more sensitive version, the CRH-DST suppression test. What these tests show is that the hormones originating in the hypothalamus- TRF (thyroid-releasing-factor) and CRH (corticol-releasing-factor)- don't turn off normally even when there are adequate levels of thyroxine (T4) and cortisol in the bloodstream. This means that there begins to be a destructive "final common cascade" (to use the words I keep reading) of excessive amounts of TSH, ACTH, cortisol, and also mineralocorticoids (particularly glutamate), which act upon the receptors and transmitters of the hippocampus, amygdala, pre-frontal areas and basal ganglia in such a way that, although the cells in those areas are not thought to die off at an increased rate, new cells do not grow the way they do normally. The cells themselves are altered- they are much less active metabolically, with shrunken cell bodies and shortened dendrites- meaning less secretion and less uptake of all of the neurotransmitters- serotonin, dopamine and nor-epinephrine. It's supposed to be the shrunken, inactive state of these neurons which accounts for the findings of hypoperfusion and loss of brain volume. Because excess TSH, cortisol, and glutamate have these damaging effects on crucial parts the brain, the hippocampus especialy, it loses its down-regulating ability- it can no longer tell the hypothalamus to slow down its damaging hormone over-production, and a gradually worsening vicious cycle (HPA dysregulation) is established. Of course, you can have this just occasionally, just a litte, or a lot. It can progress, or stay quite stable.
>
> I have been looking for articles on what interrupts this cycle. For some people, ADs of all the classes, but particularlu MAOis and tricyclics, do reverse the hypothalamic overactivity. For other people, ECT and TMS can do it. Psychotherapy itself can apparently also do it, but it has to be the kind that does not make stress worse- examples of the ones that work best include CBT and the relatively new two-person, or relational psychotherapy, which involves learning self-soothing techniques while improving one's object relatonships.
>
> Well, this is as far as I've gotten! I have a medium degree of HPA dysregulation, and have chosen to try TMS, relational psychotherapy and the European tricyclic tianeptine. For add-ons, I take 2 gms. fish oil, plus two things which are supposed to lower cortisol: phosphadatylserine and alpha-lipoic acid. I'm presently doing all of this except for the TMS, which starts in January, but I notice some real improvements- considerably less apathy- and the suicidal thoughts are completely gone. I know I am really lucky to have been able to get all this treatment- and do hope that you will be able to obtain effective treatment, too. For me, the most helpful person was a neuro-endocrinologist- he sort of graciously pressured my internist and psychiatrist into taking a more serious and up-to-date approach, stressing the importance of maximal intervention NOW, before things progressed to a melancholic or psychotic form of depression, which he thought could happen.
>
> I wish you the very best of luck. and hope to hear that you have also found a really effective treatment. It's seems to be difficult for doctors, unless they are very well-trained, to recognize how serious this illness is, because we can usually act perfectly normal in their presence!
>
> Pfinstegg
>
Hi Pfinstegg
Thank you for your technical info. I've taken TSH, cortisol ACTH, T3 and T4 blood check this Spring. TSH and cortisol levels showed up to be somehow low, just above normal. Prolactin was threshold high instead (just below the maximum). I read that HPA axis hyperactivity can reverse in to HPA underactivity after severe prolonged stress (which i had: i've been suffering a very serious form of agitated, psychotic depression, which has been replaced by a numbed, "quiet" dysphoria).
I've developed CFS a few years after that, (HPA it's believed to be underfunctioning in CFS ).
I'm going to repeat TSH, T3, T4 and cortisol tests as soon as possible; i was taking effexor and it could have been "masking" the results, even though it wasn't effective;
My ex-pdoc suggested to take TSH antibodies test as well.
I've read this interesting article on this site:http://www.biopsychiatry.com/prednisone.htm
Prednisone augmentation in treatment-resistant depression with fatigue and hypocortisolaemia: a case series
by
Bouwer C, Claassen J, Dinan TG, Nemeroff CB
Department of Psychological Medicine,
University of Otago University,
Dunedin, New Zealand.
colin.bouwer@stonebow.otago.ac.nz
Depress Anxiety 2000; 12(1):44-50
ABSTRACTAbnormalities of the hypothalamic-pituitary-adrenal (HPA) axis have long been implicated in major depression with hypercortisolaemia reported in typical depression and hypocortisolaemia in some studies of atypical depression. We report on the use of prednisone in treatment-resistant depressed patients with reduced plasma cortisol concentrations. Six patients with treatment-resistant major depression were found to complain of severe fatigue, consistent with major depression, atypical subtype, and to demonstrate low plasma cortisol levels. Prednisone 7.5 mg daily was added to the antidepressant regime. Five of six patients demonstrated significant improvement in depression on prednisone augmentation of antidepressant therapy. Although hypercortisolaemia has been implicated in some patients with depression, our findings suggest that hypocortisolaemia may also play a role in some subtypes of this disorder. In treatment-resistant depressed patients with fatigue and hypocortisolaemia, prednisone augmentation may be useful.
Posted by Anna Laura on December 14, 2002, at 6:34:55
In reply to Re: see, there is hope » Anna Laura, posted by wendy b. on December 12, 2002, at 7:44:01
> Anna Laura,
>
> Sorry to interject on this thread. You have wonderful support from everyone here. I've missed talking to you - and glad to be reading you again, even if it is such a hard time again for you now...
>
> But grabbing a drop of joy, even from somebody who's in a manic phase, is MORE THAN ok, it's wonderful. When we're manic (or hypo), we BPs can be loads of fun!
> (Just be careful... I probably don't have to say this, but mania can induce hyper-sexuality in some people, and it may feel good now, but there'll be hell to pay later...)
>
> I think gaining optimism - however it's done - is the important thing. Grab it wherever you can find it. "Supplies are low"!
>
> much love to you,
> ciao, bella,
>
> Wendy
Ciao Bellissima
It's nice to hear from you again. I'm a bipolar also, miserable bipolar type II stuck in depression (seems impossible to get out of this pit); my beautiful, long standing, seven years long gentle hypomania has been replaced by a twelve years long standing depression. I do cycle a little bit, but always beneath the "surface" if you know what i mean.
I'm aware that mania can induce hypersexuality in some people (thanks for telling me though); but i know the guy quite well, and he likes to joke and tell somehow "indecent" phrases just for the fun of it; he's mainly a "wanderer" during his manic phase : he likes to meet new people, talks a lot, walks a lot, travels a lot (like i did, even though i wasn't in a frenzy and didn't have the talking pressure he does).Thanks for posting
ciao
Posted by pfinstegg on December 16, 2002, at 1:03:59
In reply to Re: NO HOPE to Pfinstegg, posted by Anna Laura on December 14, 2002, at 6:16:19
Thanks for the information and the reference by Nemeroff et al. from Emory. He is such a highly respected scientist in brain-based depression research. I have that article in my file, but was not aware that you fall into the category of hypo-cortisolemic patients.
Just to be sure of what you said, I wasn't clear whether you have a high-normal or low-normal TSH. As you know, the range is about 0.4 to 5.5. If you have a normal free T4 (range .8-1.5) and a normal T3 (range 60-181) but a high-normal TSH, this can mean a relative blunting of the thyroid feedback system ("Serum TSH Concentration as an index of the Severity of Major Depression", Payan, Berlin, Corruble, Puech, Int. J. Neuropsychopharmacol 1999;2 (2); 105-110. Because of this research, plus the information about using T3 in depression (New England Journal of Medicine, 1999, cited earlier on PB, my endocrinologist said that he wanted my TSH down around 0.5, and wanted to get it there using a combination of T4 and T3 (synthroid and Cytomel). Have you done that? I think it helped me quite a lot in having higher energy levels.
Second, do you know what your 24-hour urinary cortisols are (range 12-103)? Do you know whether you suppress or not on the DST or CRH-DST tests? It's possible to be a non- or partial non-suppressor and still have very low 24-hour cortisols.
What you say about CFS and atypical depression is very insightful and knowledgeable- you know much more about this area than most of us. I have four articles, two written by NIH researchers, about the under-reactivity, or exhaustion of the HPA system in these illnesses, and how they should be considered as separate disorders from ordinary depression.
When there is hypoperfusion of the limbic, prefrontal and basal ganglia areas, SSRI's can be either ineffective or worsen symptoms. Agents which increase dopamine and nor-epinephrine are most likely to be helpful, with Wellbutrin leading the list. You've probably tried it, but I thought I'd mention it, in case you haven't. As to the Nemeroff article about using dexamethasone, I've never heard of it actually being used in clinical practice, but it could certainly be used safely for a short period. The problem would be that it is supplying steroids which your body can't provide, and presumably would only be helpful while you take it. Still, short-term use (? a week) might give you a lift which could then be better sustained with something like Wellbutrin.
In addition, you've probably read some of the many posts here about fish oil! It prompted me to take at least 1gm. of EPA- I think it has helped enough that I wouldn't want to run out of it- or forget to take it with me when I travel! I also would not want to be without high doses of B12 and folic acid.
You have had more thorough neuro-imaging and neuro-endocrine testing than anyone who has posted here- that I know of. I would be extremely interested to learn what treatment program your doctor is developing for you on the basis of all of this information. I will keep looking for your posts, and, in the meantime, wish you the very, very best in your search.
Pfinstegg
Posted by Anna Laura on December 17, 2002, at 6:31:43
In reply to next steps - Anna Laura, posted by pfinstegg on December 16, 2002, at 1:03:59
> Thanks for the information and the reference by Nemeroff et al. from Emory. He is such a highly respected scientist in brain-based depression research. I have that article in my file, but was not aware that you fall into the category of hypo-cortisolemic patients.
>
> Just to be sure of what you said, I wasn't clear whether you have a high-normal or low-normal TSH. As you know, the range is about 0.4 to 5.5. If you have a normal free T4 (range .8-1.5) and a normal T3 (range 60-181) but a high-normal TSH, this can mean a relative blunting of the thyroid feedback system ("Serum TSH Concentration as an index of the Severity of Major Depression", Payan, Berlin, Corruble, Puech, Int. J. Neuropsychopharmacol 1999;2 (2); 105-110. Because of this research, plus the information about using T3 in depression (New England Journal of Medicine, 1999, cited earlier on PB, my endocrinologist said that he wanted my TSH down around 0.5, and wanted to get it there using a combination of T4 and T3 (synthroid and Cytomel). Have you done that? I think it helped me quite a lot in having higher energy levels.
>
> Second, do you know what your 24-hour urinary cortisols are (range 12-103)? Do you know whether you suppress or not on the DST or CRH-DST tests? It's possible to be a non- or partial non-suppressor and still have very low 24-hour cortisols.
>
> What you say about CFS and atypical depression is very insightful and knowledgeable- you know much more about this area than most of us. I have four articles, two written by NIH researchers, about the under-reactivity, or exhaustion of the HPA system in these illnesses, and how they should be considered as separate disorders from ordinary depression.
>
> When there is hypoperfusion of the limbic, prefrontal and basal ganglia areas, SSRI's can be either ineffective or worsen symptoms. Agents which increase dopamine and nor-epinephrine are most likely to be helpful, with Wellbutrin leading the list. You've probably tried it, but I thought I'd mention it, in case you haven't. As to the Nemeroff article about using dexamethasone, I've never heard of it actually being used in clinical practice, but it could certainly be used safely for a short period. The problem would be that it is supplying steroids which your body can't provide, and presumably would only be helpful while you take it. Still, short-term use (? a week) might give you a lift which could then be better sustained with something like Wellbutrin.
>
> In addition, you've probably read some of the many posts here about fish oil! It prompted me to take at least 1gm. of EPA- I think it has helped enough that I wouldn't want to run out of it- or forget to take it with me when I travel! I also would not want to be without high doses of B12 and folic acid.
>
> You have had more thorough neuro-imaging and neuro-endocrine testing than anyone who has posted here- that I know of. I would be extremely interested to learn what treatment program your doctor is developing for you on the basis of all of this information. I will keep looking for your posts, and, in the meantime, wish you the very, very best in your search.
>
> Pfinstegg
>Hi Pfinstegg
The levels which you're reffering to are different from those in my country. Anyway, my THS is above low-normal line, as well as my T4, the lattest being just above the low-normal line. T3 is normal. (?!).
I'm going to repeat those tests anyway.
I've done testosterone test as well which showed up to be within the normal range but i never took that test before so that it might not be significative. I was worried about testosterone 'cause it's believed to play a role in females' libido as well, and i have got a low libido, almost not-existing. The strange thing is that when i lost my libido (around the sixth year of my depression) my muscles mass decreased dramatically as well (especially around my neck and shoulders; i never excercised or did sports whatsoever it was a natural, "genetic" muscle building and it was all gone in a matter of few months).
I developed social phobia as well; i felt like i turned in to a feeble, weak person, and i never really felt like that even when i was seriously depressed. I developed sensory clouding and anhedonia got worse.
The symptoms above seem to be related to a dopaminergic link. CFS might have a dopaminergic link as well.
I took high-dose Effexor for a year then i added Wellbutrin, i took that combo for a while, then i dropped Effexor and staied on Wellbutrin; i somehow felt less apathetic and my sensory clouding slightly improved, i experienced a small, short-lived relief of anhedonia and apathy, and the sensory system basic feelings such as smells and touch had returned as well: there's a pine-tree down the road where i live and i could smell the pine scent again. But that was short-lived unfortunately. My libido had improved as well even though it was too low still. My muscle mass increased as well (!!).
Anyway i quit researches after having being diagnosed bipolar II by a University Clinic psychopharmacologists' team 'cause i thought they'd know better. I somehow sensed i wasn't getting anywhere with my researches and sometimes i ended up being even more depressed; i strongly believed that Mirapex, being a dopamine agonist, was going to help me but it made me even more depressed and numb (like atypical AP'S). My Tegretol trial failed as well (no significant response). See what's next. I'm trying to keep my hope even if it's hard sometimes.Be well
Anna Laura
Posted by Pfinstegg on December 17, 2002, at 9:03:53
In reply to Re: next steps - Anna Laura, posted by Anna Laura on December 17, 2002, at 6:31:43
Hi.. It sounds like trying to raise the dopamine and nor-epinephrine is what you've been correctly focussing on; are there any new drugs, or promising drug trials that you can enter in Italy?
Even if you have normal, or even low normal TSH, T4 and T3, you can still benefit from very low doses of synthroid and Cytomel. I have always had normal readings, but have been helped a lot by these two drugs- mostly in having much more energy to get going in the mornings. I have a TSH every six months to be sure that it does not get too low- it is at the very bottom of the normal range, but never gets too low. Giving synthroid and Cytomel to depressed patients with normal TSH who are AD-resistant is becoming quite common in the US- in my own experience, it is very effective as an add-on to other medications. Are your doctors just checking your TSH, T3 and T4 and telling you they are normal? They can do much more than that!
Just to mention the fish oil again- have you read the threads on that in PB over the last couple of months? Reading that information conv inced me to take it in high doses- it took about a month before I thought they were helping, but I feel sure they are: I feel more alive and interested in my surroundings, and note that my problem-solving ability is better and quicker.
I know you really need an AD which works properly for you, but, while you are searching for that, you could safely add Synthroid, Cytomel and fish oil. Be sure to give them all at least a month's trial before you decide they aren't working!
Pfinstegg
Posted by Anna Laura on December 19, 2002, at 7:28:25
In reply to Re: next steps - Anna Laura, posted by Pfinstegg on December 17, 2002, at 9:03:53
> Hi.. It sounds like trying to raise the dopamine and nor-epinephrine is what you've been correctly focussing on; are there any new drugs, or promising drug trials that you can enter in Italy?
>
> Even if you have normal, or even low normal TSH, T4 and T3, you can still benefit from very low doses of synthroid and Cytomel. I have always had normal readings, but have been helped a lot by these two drugs- mostly in having much more energy to get going in the mornings. I have a TSH every six months to be sure that it does not get too low- it is at the very bottom of the normal range, but never gets too low. Giving synthroid and Cytomel to depressed patients with normal TSH who are AD-resistant is becoming quite common in the US- in my own experience, it is very effective as an add-on to other medications. Are your doctors just checking your TSH, T3 and T4 and telling you they are normal? They can do much more than that!
>
> Just to mention the fish oil again- have you read the threads on that in PB over the last couple of months? Reading that information conv inced me to take it in high doses- it took about a month before I thought they were helping, but I feel sure they are: I feel more alive and interested in my surroundings, and note that my problem-solving ability is better and quicker.
>
> I know you really need an AD which works properly for you, but, while you are searching for that, you could safely add Synthroid, Cytomel and fish oil. Be sure to give them all at least a month's trial before you decide they aren't working!
>
> PfinsteggHi Pfinstegg
sorry for answering late; i tried fish oil but those doses were too low probably and i didn't stick long enough also; i'll try them again. They won't prescribe me thyroid meds as Cytomel or Synthroyd; it could take months and longer tests to get to that point; the only knowledgeable pdoc who knows about thyroid, treatment resistant depression and bipolar II is A university clinic pdoc from my town who's tied with the psychoanalytical lobby which is very potent here in Italy; they'll be attaching you a personality disorder dx no matter what, just because you're depressed; they don't care if you succeded in obtaining long standing satisfying relationships and you're not self-centered; they don't care if you don't have anger fits, irritability or erratic behaviour; they'll be talking about subconscious feelings you're not aware of, self-sabotage and denial just because you're too sick to work; It's like the Inquisition; you'll have to go through amounts of pain, humiliation and lenghty medical tests just to get there; not to mention the fact they often prescribe high-dose Depakote and AP's as a baseline treatment and Cytomel and Syntroyd would just be an add on; how could i stand High doses of Depakote if 400 mg. of Tegretol, a "gentler" med, made me depressed? Atypical AP's make me depressed as well; I was thinking about going back to Effexor but i'm supposed to stay med-free 'cause i'll have to undergo a mood stabilizers' trial in another University Clinic far away (this one is psychoanalisis-free, thanks god).So I'm med-free at the moment and winter blues plus Tegretol and Mirapex induced depression are hitting hard. My next appointment with the University Clinic of Cagliari is due in late January; they can't do anything for me before that time; they're far away (gotta catch a plane) and they can't prescribe meds on the thelephone because of medical-ethical reasons. Benzos don't work.
Any advice on possible medication is welcome.sorry for ranting
Posted by Pfinstegg on December 19, 2002, at 10:13:08
In reply to Re: next steps - Anna Laura, posted by Anna Laura on December 19, 2002, at 7:28:25
I have read that psychoanalysis is pretty active in Italy, and obviously not always in a particularly helpful way! It seems to have fallen into disfavor here, and is generally considered to be a dinosaur. However, I have recently been finding out that it is getting resurrected here in a more up-to-date manner, under names such as relational psychoanalysis and attachment disorders theory. They are utilizing research on infant development done at great places like the Yale Child Study Center, and are also finally paying attention to the research on changes in brain development, neurotransmitters and endocrine function which occur during severe stress. I just read an article last night in a new journal called "Psychoanalytic Dialogues" in which Borderline Personality Disorder is identified as a particular form of PTSD occurring in childhood- what an advance in thinking!
Having had that diagnosis my entire life, I know it is the "diagnosis from hell". Doctors hate it, and think that you can never get better. However, I am proof that you can get a lot better with an interactive type of psychoanalytic therapy, which can replace some of the absent mothering, and also help you learn to deal in a calmer way with physical and sexual abuse. Before that therapy, I was in so much difficulty- getting involved in one sexual relationship after another, none of which were "right" or were able to modify the inner pain I was continually experiencing. Afterwards, I was so much calmer and happier, with many fewer episodes of severe emotional pain- and I felt that I had resources to deal with those episodes when they occurred. I was able to marry a great guy, and develop a satisfying career in which I felt I was really using my abilities well. I had energy to develop skills and interests, such as painting, botanical photography, mountain-climbing and horseback riding (dressage). I was able to raise a healthy son, who is now starting his own life- about to get his PhD in physics, and engaged to a wonderful girl. I think I can say that the generational cycle of pain and abuse really did stop with me. So, from my point of view, the right kind of interactive, relational psychoanalytic psychotherapy can be life-transforming. Don't let a diagnosis get to you- they are all out-of-date, anyway- and NO couches! Therapy needs to be face-to-face, and the analyst needs to be trained in the new way.
As much pain and hopelessness as you are enduring right now, try to remember that YOU can make the correct choices for yourself- you can ask for the synthroid (levothyroxine) and Cytomel (triiodothyroxine) supplementation, but you don't have to take any AD that you have a lot of doubts about. Over the last five months, I have relied on levothyroxine 0.05 mg. , triiodothyronine 5mcg. and enough fish oil to get 1 gm. of EPA daily, having stopped Prozac, Paxil, Wellbutrin and Zyprexa. I also take Tianeptine, a European tricyclic; it is not a strong AD, but has been shown to protect the hippocampus from damage from excess cortisol. Having had an MRI, I know that my left hippocampus and left pre-frontal areas are about 20% smaller than normal- the effect of too much stress hormone over a lifetime. Having looked, I know that I have HPA axis dysregulation by now- my hippocampus is supposed to tell my hypothalamus to down- regulate the production of CRH (Corticoid-Releasing Hormone), but it can no longer do that. It is also supposed to tell my hypothalamus to down-regulate the output of TRH (Thyroid-Releasing-Hormone), but it can't do that any longer, either. That is the rationale behind thyroid supplementation- it sends a stronger message to the hypothalamus to down-regulate; the triiodothyronine also has an antidepressant effect by itself. As you know, there isn't yet a CRH-antagonist anywhere near ready for use, although there are some in Phase 2 studies. For the most severe depressions, where the 24-hour urinary cortisol is above normal, there are very active studies using mefipristone in the US at Stanford and NIH. It is apparently very effective, and has been fast-tracked by the FDA. It's a short-term treatment- if it going to work, it apparently does so within a week, but I'm not sure what happens afterwards- it works by rapidly lowering cortisol levels to normal, but, would they stay there?
As you make your way through the system, don't forget that YOU are in charge of your own health, and YOU get to make the informed decisions!
Wishing you they very best...
Pfinstegg
Posted by Anna Laura on December 20, 2002, at 4:38:09
In reply to Re: next steps - Anna Laura, posted by Pfinstegg on December 19, 2002, at 10:13:08
> I have read that psychoanalysis is pretty active in Italy, and obviously not always in a particularly helpful way!
Yes, i suffered from major depression+anxiety (agitated depression) and i wasn't diagnosed for two years;
I was living with a guy i loved and that was the first stable relationship for the first time in my life (i was 21); no more anxiety or dependence issues; i was so glad for it. I felt calm and loving at the same time.
But my depression kept on getting worse no matter what; they thought it was just a neurosis and they kept on pushing me towards pyscho-therapy: i had been in therapy for two years with no relief.I eventually met a good pdoc who made the "right" dx (major depression") and gave me Tofranil; Tofranil halted my depression and reversed it somehow; psychotherapy helped also, i trusted him, thought he was good and caring man, but i've been suffering from you might call "residual depression" ever since.
You know what's funny? I met one of the greatest psychoanalists here in Italy, Romolo Rossi;
We talked for like two hours; do you think i have a personality disorder? i finally asked him.
And he went like: "No, not all! you suffer from depression, is quite evident, i don't understand why my collegues made such a terrible mistake"Another one thought i suffered from a variant of narcisistic personality disorder; when i tried to understand why he'd give me vague and enigmatic answers.
Another one talked about envy of the penis, saying i sounded just like Humphrey Bogart;Finally the psychopharmacologist from my town stated i was bipolar II and boarderline at the same time (which can't be, since they are distinct pathologies).
I visited a site on bipolar which focuses on bipolar II stating that borderline usually responds to psychotherapy to some extent whereas bipolar II doesn't :
www.psycheducation.org
I think that's true : even if i felt my "ancient" wounds were finally soothed my depression didn't change. Only Tofranil did that for me. I think it saved my life, even though Agop and Akiskal stated that you shouldn't give an AD to a depressed patient whose temperament is basically hyperthymic 'cause very treatment resistant depression might arise as a result ; (hope it's not my case).
A. Koukopoulos, one of the world leading expert in bipolar desease talks about "antidepressant induced treatment resistant dysphoria".See, i've been hyperthymic with hypomanic shifts throughout my early and late teens (seven years).
I entered my first depression when i was 8 years old; i recovered when i was 13: i've felt euphoric ever since (man seven years!) before i plunged in to depression.
So that's bipolar, no question about it;
Don't want to hear about therapy and personality disorders 'cause i've been there, done that; curing my old wounds and traumas didn't solve my depression;
so that's a dead end road for me.Sorry if i sounded a bit harsh and angry but psychoanalists ruined my life; i often think about all the misdiagnosis thing and i feel so bad. I recall going to therapy when i was young, trusty and humble, thinking they could solve my problem; my illness was degenerating instead, month after month, year after year, and they didn't realize it, they were blaming me stating i didn't want to heal.
O.K. ranting again, i'm sorry; i really appreciated your lenghty posts and your efforts: i think you're a good and understanding person, really, and i'm glad that you feel better and so forth but whenever i hear about psychoanalisis a bell rings inside my head, wether is an old or new method i know that stuff it's not for me.
I also believe deep changes are possible 'cause i've experienced them, and i know what it feels like; i know the grateful feeling for your therapist, and the sensation of being "free" and being finally blessed by new, unexpected emotions you thought you couldn't feel, like deep "real" love, without anxiety and concerns, but I also think absent mothering replacing can be done in many other ways other then psychoanalisis.
Nothing personal, really.blessing
Anna Laura
Posted by Pfinstegg on December 20, 2002, at 10:29:44
In reply to Re: next steps - Anna Laura, posted by Anna Laura on December 20, 2002, at 4:38:09
It's much clearer to me now what your situation is- sorry for the irrelevant stuff about psychoanalysis! It sounds to me as if some of those analysts are out of the dark ages, anyway- especially the one who talked about penis envy- what an ancient, useless concept. The psychoanalytic psychotherapy which helped me so much was nothing like what you are describing, but the main point for you is- it's not what you need anyway.
If I understand you correctly, you are bipolar, with a long hyperthymic period in your teens, followed by a long bout with depression lasting until now. You've had both AD's and mood stabilizers, didn't tolerate the mood stabilizers very well, didn't get relief from the AD's, and are also afraid that they may have contributed to your present anhedonia. Is this more or less correct? One of the reasons I stopped taking Prozac and Paxil was that, although they took away some of the pain of the depression; after a few years, the anhedonia became very noticeable and I felt that I wasn't myself at all. After 5 months off all of them, the anhedonia is almost completely reversed. How long have you been off of them?
It sounds like you are entering a drug study in February- is that right? Is it for a new mood stabilizer? I guess that if you are doing that, you can't begin adding on thyroid supplements right now. But you probably could take fish oil- at least between now and February. If you decide to do that, just be sure you take enough so that you get at least one gram of EPA per day. It will help your brain's metabolism on a lot of different levels. The parts of your brain which are hypo-perfused have an extremely sluggish, underactive metabolism, and while fish oil won't bring up the blood circulation, it will make the metabolism in those areas more active- more neurotransmitter secretion and uptake.
I would also wonder about your cortisol status, given the intensity of your depression. Do you know what your 24-hour cortisol is, and whether you are a DST suppressor or not?
Pfinstegg
Posted by Anna Laura on December 21, 2002, at 4:25:03
In reply to Re: next steps - Anna Laura, posted by Pfinstegg on December 20, 2002, at 10:29:44
> It's much clearer to me now what your situation is- sorry for the irrelevant stuff about psychoanalysis! It sounds to me as if some of those analysts are out of the dark ages, anyway- especially the one who talked about penis envy- what an ancient, useless concept. The psychoanalytic psychotherapy which helped me so much was nothing like what you are describing, but the main point for you is- it's not what you need anyway.
>
> If I understand you correctly, you are bipolar, with a long hyperthymic period in your teens, followed by a long bout with depression lasting until now. You've had both AD's and mood stabilizers, didn't tolerate the mood stabilizers very well, didn't get relief from the AD's, and are also afraid that they may have contributed to your present anhedonia. Is this more or less correct? One of the reasons I stopped taking Prozac and Paxil was that, although they took away some of the pain of the depression; after a few years, the anhedonia became very noticeable and I felt that I wasn't myself at all. After 5 months off all of them, the anhedonia is almost completely reversed. How long have you been off of them?
>
> It sounds like you are entering a drug study in February- is that right? Is it for a new mood stabilizer? I guess that if you are doing that, you can't begin adding on thyroid supplements right now. But you probably could take fish oil- at least between now and February. If you decide to do that, just be sure you take enough so that you get at least one gram of EPA per day. It will help your brain's metabolism on a lot of different levels. The parts of your brain which are hypo-perfused have an extremely sluggish, underactive metabolism, and while fish oil won't bring up the blood circulation, it will make the metabolism in those areas more active- more neurotransmitter secretion and uptake.
>
> I would also wonder about your cortisol status, given the intensity of your depression. Do you know what your 24-hour cortisol is, and whether you are a DST suppressor or not?
>
> Pfinstegg
I didn'have DST suppression test yet : my ex-pdoc thought it was unreliable; as i mentioned before i'm going to repeat TSH, cortisol and so forth; i'll have DST suppression included as well;
as far as anhedonia is concerned, it never went away;
feelings of guilt, worthelessness and even the worst obsessions, any problem i had to face were more or less easily dissipated : anhedonia didn't improve at all; it's always there, getting worse throughout the years, my own private unbeatable enemy.I've been on and off antidepressants (first time three years, second time one year and a half) with no significant relief: i felt more lively that's true, but that feeling wore off pretty quickly in a matter of few days.
See, I could accept the fact never to regain my hyperthymic self; i'd be glad just to return to the early times of my depression, when i still felt love for my friends and my fianceé and my libido and a few interests and beliefs were spared by the illness.I couldn't bear the idea of being stuck to the couch or being barely functional every time i get better, spending my days sitting in front of a computer and do house work for the rest of my life.
I was a very brilliant girl (Reading Freud at the age of 13, winning writing competitions ); but i never cared about ambition or success; my ambition, even before depression had always been life; my main occupation other then my studies were mainly sensations, feelings new emotions and experiencing new things, travelling and meeting new people and cultures; i'm aware it might sound a bit naive. (you know like Alice in Wonderland and the world is no wonderland indeed).
Anyway, my hope is to regain a just a tiny bit of life and sensations, enough to get out of this room anyway.The psychopharmacologist doctor from the University Clinic of Cagliari wanted to check my dopamine transporters and receptors, thinking a dysfunction in the dopamine system might be to blame.
She also believes an adequate mood-stabilizers trial would lift my depression.
I have decided to get back on Zyban (Bupropion); i need it just to get through the day; i've been progressively deteriorating since i started Tegretol; it made me feel a little better the first two weeks, but it eventually worsened my depression around the third week or so when Mirapex was added; after a five weeks trial they were both suspended but i kept on getting worse; during the last few days i felt like i was relapsing.
The university of Cagliari and the new pdoc from here are not returning my calls (very unprofessional); i've been waiting for like two weeks to talk to them with no avail: couldn't reach out for anyone; i didn't want to make any arbitrary or irresponsible choice, so when i realized i couldn't talk to any of them, i went to my GP doctor who told me that he couldn't prescribe anything except Xanax.
So i thought it over and chose Bupropion which is a quite safe med; it's the only AD that doesn't worsen cycling in bipolars, it's relatively fast-acting (at least for me) it doesn't have any side-effect and withdrawal when you stop it and it's excreted from your system within two days.
I think i made a good choice 'cause it's helping a little already. Now i feel lively enough to eat and wash myself and take a walk outside the house.
I'll get fish oil as well, as you suggested.
My appointment is due in January, 23; the only thing left to do now it's waiting;
Thanks for listening and caringblessings
Posted by Pfinstegg on December 21, 2002, at 13:21:13
In reply to Re: next steps - Anna Laura - waiting, posted by Anna Laura on December 21, 2002, at 4:25:03
Hi Ana Laura..I think bupropion was the best choice you could have made, for its boosting of dopamine and nor-epinephrine levels. It's so good to hear that you can feel a small spark of aliveness again.
I do remember now that you told me that your 24-hour cortisols were normal, even low normal, I think you said; that's very good news, as it means you aren't anywhere near a melancholic or psychotic depression( if you were, you probably would be feeling too ill to even post). I asked about the DST non-suppression, even though it is considered a bit unreliable- influenced by what your estrogen levels may be on a given day, among other things- because, if you turn out to be a consistent non-suppressor, this would make you a candidate for one of the few treatments available for that: TMS and mefipristone. These are being used for both bipolar and monopolar here in clinical trials, with favorable reports for both. The TMS is given daily for 2 weeks, sometimes a bit longer, and the mefipristone is given for 7-10 days. The complete remission rate is around 65% for both (why are all psychiatric treatment 65% effective?!), all the patients were also continued on low to moderate doses of various AD's and mood-stabilizers afterwards to prevent relapse. In addition to clinical remission, about half of the patients in both groups reverted to being DST suppressors, although it could take as long as a year for this to occur. When that happens, it is such good news, as it means, of course, that you no longer have HPA axis dysregulation, and that your brain is once again handling stress normally.
I didn't mention ECT here, although it is just as effective: it's just my bias, but I know you are young and brilliant, and there is always the small chance that you could be one of the relatively few people who develop cognitive deficits after it. From everything I have read, there is no risk of that from the other two treatments.
Anyway, I'm so glad to hear there is a tiny improvement- I hope it continues to become stronger and that you have a very good holiday.
with best wishes!
Pfinstegg
P.S. You can have the CRH-DST test done instead of the ordinary DST; it is much more accurate in detecting axis dysregulation
Posted by Anna Laura on December 22, 2002, at 6:10:27
In reply to Re: next steps - Anna Laura - waiting, posted by Pfinstegg on December 21, 2002, at 13:21:13
> Hi Ana Laura..I think bupropion was the best choice you could have made, for its boosting of dopamine and nor-epinephrine levels. It's so good to hear that you can feel a small spark of aliveness again.
>
> I do remember now that you told me that your 24-hour cortisols were normal, even low normal, I think you said; that's very good news, as it means you aren't anywhere near a melancholic or psychotic depression( if you were, you probably would be feeling too ill to even post). I asked about the DST non-suppression, even though it is considered a bit unreliable- influenced by what your estrogen levels may be on a given day, among other things- because, if you turn out to be a consistent non-suppressor, this would make you a candidate for one of the few treatments available for that: TMS and mefipristone. These are being used for both bipolar and monopolar here in clinical trials, with favorable reports for both. The TMS is given daily for 2 weeks, sometimes a bit longer, and the mefipristone is given for 7-10 days. The complete remission rate is around 65% for both (why are all psychiatric treatment 65% effective?!), all the patients were also continued on low to moderate doses of various AD's and mood-stabilizers afterwards to prevent relapse. In addition to clinical remission, about half of the patients in both groups reverted to being DST suppressors, although it could take as long as a year for this to occur. When that happens, it is such good news, as it means, of course, that you no longer have HPA axis dysregulation, and that your brain is once again handling stress normally.
>
> I didn't mention ECT here, although it is just as effective: it's just my bias, but I know you are young and brilliant, and there is always the small chance that you could be one of the relatively few people who develop cognitive deficits after it. From everything I have read, there is no risk of that from the other two treatments.
>
> Anyway, I'm so glad to hear there is a tiny improvement- I hope it continues to become stronger and that you have a very good holiday.
>
> with best wishes!
>
> Pfinstegg
>
> P.S. You can have the CRH-DST test done instead of the ordinary DST; it is much more accurate in detecting axis dysregulationThank you Pfinstegg
I Hope Buproprion keeps on being effective, at least until the end of January.
My obsessions and worries are vanishing and i feel stronger. I'd like to say more, but i don't want to talk about myself again; i can understand it could be boring and useless; my racing thoughts are not going to bring me anywhere. confrontation and self-interrogation could be useful sometimes; other times they're just obsessions in disguise leading you nowhere: it's plain useless, like a fountain re-cycling the same water. And i don't want you to get involved in my worries and concerns.
I just wanted to say - as long as i can before i turn indifferent again - that i feel grateful for the efforts you've spent and the hopes you tried to give me.blessings
Posted by Pfinstegg on December 22, 2002, at 11:49:57
In reply to THANKS, posted by Anna Laura on December 22, 2002, at 6:10:27
You're welcome, Ana Laura. It would be good to watch the racing thoughts carefully; being bipolar, it may not be the best thing to be on an AD, even an atypical one like bupropion, without being on a low dose of a mood stabilizer at the same time. I think you said Depakote and Tegretol didn't work well; how about a low dose of Lamictal?
It's not the way you think; here on the board people can say whatever they feel like saying, and there is someone who kind of "resonates" with it- both in understanding the feelings because they have had the same ones themselves, and because we can sometimes help one another approach our illnesses a little more objectively- as complicated problems to be solved, step by step. It's not a question of over-involvement, but rather of interest. I will say, I do hope you keep posting to let us know what is happening; however, it doesn't need to be directed at me.
Pfinstegg
Posted by Anna Laura on December 24, 2002, at 4:40:49
In reply to Re: THANKS » Anna Laura, posted by Pfinstegg on December 22, 2002, at 11:49:57
> You're welcome, Ana Laura. It would be good to watch the racing thoughts carefully; being bipolar, it may not be the best thing to be on an AD, even an atypical one like bupropion, without being on a low dose of a mood stabilizer at the same time. I think you said Depakote and Tegretol didn't work well; how about a low dose of Lamictal?
>
> It's not the way you think; here on the board people can say whatever they feel like saying, and there is someone who kind of "resonates" with it- both in understanding the feelings because they have had the same ones themselves, and because we can sometimes help one another approach our illnesses a little more objectively- as complicated problems to be solved, step by step. It's not a question of over-involvement, but rather of interest. I will say, I do hope you keep posting to let us know what is happening; however, it doesn't need to be directed at me.
>
> Pfinstegg
Hi Pfinstegg
I'm taking fish oil as you suggested at the moment.
This is my third day with Bupropion and I'm feeling better already; the racing thoughts i told you about are not being worsened by the drug at the moment: they're getting better actually, since i feel stronger and more capable to fight them back. I'll be watching over, though.
The thoughts i was reffering to are always the same; they started along with my depression long time ago and never went away really. They're like "realistic" obsessions like "I'll never recover" and so forth.
They're frantic semi-rational efforts to find a way out of this pit.
They got worse as my anhedonia and apathy got worse, like a compensation for my sensorial and emotional deprivation. I probably chose the wrong term when i used the word "getting involved"; i meant something like to bother or to annoy with an emotional component ; i don't know if ther's such a word in english, my mental dictionary is limited - i'm good only with words with a latin derivation; anyway, what i meant to say is that when i feel this way i just ruminate endlessly and i feel i can't be helped no matter what; i feel like it all depends on me, that i should start creating a little place for hope inside of me so that other people can work on that little spot and make it grow via emotional feed-back; and that's hard 'cause i feel emotionally detached; i began to feel that way around the sixth/seventh year of my illness.
How can you be helped if you're constantly emotionally detached?
; or may be you're right, it's just a matter of emotional resonation so that all i need is some emotional chords to be touched and vibrate and these "rational" thoughts are all false rationalizations leading me nowhere; may be they're plain old obsessions in disguise.
Posted by Pfinstegg on December 24, 2002, at 15:42:03
In reply to Re: THANKS, posted by Anna Laura on December 24, 2002, at 4:40:49
In haste- Christmas Eve. i do understand better now what you are referring to- not wanting to burden anyone with things you are thinking over and over. From my experience on these boards, this just doesn't happen. I think i have seen it happen with one poster who just wasn't able to hear any of the things people said to him. That's rare, though, and it's definitely not you. As an aside, i am amazed at how excellent and colloquial your english is- you sound just like us, which is rare for a European.
The anhedonia and apathy- it;s horrible- remeber that it has a physical base in the hypoperfusion of your basal ganglia and limbic structures. It's reversible, but you need the best experts you can find toc give you the right medications- these could include mefipristone- TMS too. It's an extremely difficult problem to solve, but it CAN be solved- people have done so before you. I guess the best bet is to stick with the best neurophysiologists you can find and keep on working with them. Remember, too that there are drugs like CRH antagonists in the pipeline which are going to address the basic neurophysiokogical defects of depression. What you are able to take now is going to seem so archaic compared to what will be available within a few years. But even now, there are enough good treatments for you to find one that is right-or right enough. It's awful, to be only 21, and be getting hit with such a severe depression.
Sorry for bad spelling- got to go!
Pfinstegg
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