Posted by Blue Cheer 1 on February 16, 2002, at 13:30:40
In reply to Re: Puzzle[s] » Blue Cheer 1, posted by Elizabeth on February 15, 2002, at 10:36:09
> > I've never known anyone who was diagnosed as bipolar II.
>
> That's surprising -- they're really easy to find (hard to avoid, I'd say :-} ).Probably so, and it would only lead to more problems. Except for a couple of manic "character" friends I used to hang out with, I'd rather not get involved with or even talk to other bipolars. It seems like it always comes down to a contest over who had the craziest manic episode. :) I never was interested in NDMDA groups, either, because you don't learn anything. I don't want to listen to other people talk about what it's "like." I already know. If it was one-to-one, it'd be different. Plus, you can't pick up a book about bipolar disorder without having to read all kinds of "crazy" tales of people's episodes. I've even known psychiatrists who have their "favorite" stories about other patients! Like this one guy who took his life savings ($5,000. at the time) and went from pet shop to pet shop buying exotic birds. Then, he gathered them all up, went out to a park, and let them all fly away.
>
> > I know that in the lithium clinic where I was treated for 7 years, we were just plain "bipolar." I assumed everyone had at least one manic episode, but then I never asked.
>
> Did you get to know the other patients? Or did you all just take lithium? ("Lithium clinic" -- what a weird concept.)No, it was open two days a week, and everyone was really just there to see the doctor. The clinic was actually one psychiatrist's office (later a part of the Depression Research Unit; first come, first served), where he talked to you and drew your blood right at his desk. I'm not sure when he started the clinic, but he introduced lithium to Philadelphia and helped get it into medicinal form. Most people were on lithium, but they tried other mood stabilizers as they became available. The first time I heard of a "Lithium Clinic" was in Fieve's _Moodswing_ (1974 or so).
>
> > All these numbers after the diagnosis don't seem justified.
>
> Well, I think the reason for them is to diagnose a whole lot of people who don't have manias with bipolar disorder (and therefore, to give them Depakote).
>
> > Two helpful links: http://www.mhsource.com/bipolar/insight0128gha.html http://www.mhsource.com/bipolar/insight0126gha.html
>
> The problem is, as Ghaemi says, that nobody knows just what counts as "hypomania." And some clinicians and researchers think that a lot of the things he classifies as bipolar NOS or "soft signs" should count as bipolar II. I'm rather at a loss to see how, e.g., atypical depression with no history of mania or hypomania (which isn't all that uncommon) could be considered bipolar.Yes, that makes no sense unless they're counting a *family* history of mood elevation.
>
> > > (The docs never seem to care much about that aspect of mood disorders, do they?)
> >
> > You mean the time?
>
> Yes, the lost time.
>
> > LOL.. Yeah, you're lucky what you experienced didn't happen in the 70's or earlier. Your "agitation" might've been treated with antipsychotics.
>
> In fact, I did have shrinks trying to give me Zyprexa and Risperdal, not just Depakote and Lamictal. (The Risperdal, in particular, sucked.) Oh, and I once got prescribed Mellaril for insomnia. (!)
>
> > Yeah, that's what I meant to say -- "priority" - mood stabilization is prioritized.
>
> That makes sense, I guess, although in severe mixed states I'd wonder if perhaps eliminating suicidal ideas should fall higher on the list. Is this something that would happen naturally with "mood stabilization," do you think?Oh, I think I just meant that treatment of the bipolar disorder takes priority over a comorbid anxiety disorder, but anytime there's suicidal ideation, then that would take precedence over anything else. No, I don't think you could wait for someone to be "stabilized" with a mood stabilizer when they might kill themselves first. Personally, I'm lucky that I've never been suicidal. I think some people are genetically predisposed to suicide. You see people killing themselves over *one* incident (e.g., getting fired for stealing and fearing that you can't provide for your family) that could've been resolved somehow, and in a short time -- not suffering for months or years, I mean. (And sometimes they don't even appear to be depressed.)
>
> > I was never "mixed" until I had serial high-dose trials of Prozac, Zoloft, Luvox, Paxil, Effexor, Parnate, Deprenyl, etc. - for about 4 years straight (with lithium).
>
> This strikes me as paradoxical, that mixed states frequently seem to occur in response to antidepressants.I don't follow you here. Paradoxical in what sense? But you know, I've never even thought about (not that I have the knowledge or ability) the biological changes in the brain that cause "mixed states" or rapid cycling. Come to think of it, it was probably lithium discontinuation in my case. I remember reading articles (e.g., one by Suppes et al.) at the time about lithium d/c-induced cycle acceleration and mixed states. I was trying every new drug as it came on the market, but the TCAs were in the past (pre-1987).
Is that why there are no tricyclics on your list? TCAs seem to have a reputation for causing mixed/dysphoric mania more often than MAOIs.
>
> > Then, when there was no response, the headcase psychiatrist decided to take me off lithium (after 20+ years and no consultation with my primary psychiatrist who'd been prescribing it!).
>
> Uh-oh.
>
> > Well, you know the rest of the story... anyway, that's how I became mixed. My present psychiatrist tries to tell me I'm a rapid cycler, too, but I guess he hasn't seen it defined in the DSM yet. :)
>
> Uh, how does he justify this diagnosis?It's absurd. I asked him at our first appointment following my hospitalization, and he said he'd seen me "act mixed here" (in his office), and he also said that he's told me before, in his office, when I was rapid-cycling. I really don't pay much attention to him anymore. (VA = free meds, except Trileptal) In fact, it was my bipolar specialist who had to *tell* him in July, 2000 that I was "mixed, cycling". She wrote it on a prescription for him. When I go into the VA, my "action profile" (a paper with you personal data, dx, etc.,that you give to you psychiatrist each visit, has 3 diagnoses for me (296.6, 296.4, 296.5). Believe it or not, he was on the APA's panel to write the practice guidelines for bipolar disorder, back in 1987 or so.
>
> > Actually, he wrote it up in an admissions note when I was going to have ECT (along with about a dozen other lies - all designed to justify me *having* ECT and relieving him of liability in case things went, ahem, "wrong."
>
> Well, if people weren't constantly sueing each other left and right, doctors probably wouldn't be so paranoid. But yeah, medical records always seem to be full of mistakes and/or lies. I once read a note which said "sertraline" instead of "selegiline;" imagine what problems this could cause if someone happened to take it seriously.Yeah, tell me about it. Now, each VA psych. has a computer in his office, and they enter the note from your visit. Well, he knew I was burned-up over all the lies in the admissions note (I'd instant messaged him about it), so when I saw him after going "AMA disciplinary", I was voicing my displeasure, and he said, "Let's take a look at it in the computer." Nearly every lie was changed or deleted!! It simply wasn't the same report my wife and I read! It was CYA time -- no two ways about it. I didn't say anything; I was just dismayed. I wished I had done what I was going to do when we were in the cafeteria. That is, to take the admissions note across the street and to the biomedical library to photocopy it. It would've taken about 20 minutes max. He knows I don't appreciate all that's happened. (He knew I had d/cd lithium and had been on Lamictal monotherapy for over a year prior to the onset of the mixed state.) Of course, *that* wasn't in the admissions note. But truthfully, I really do like him. He's gone way out of his way for me, and I put myself in his position. And I didn't have ECT after all, and learned that it's not for me. Plus, I think the bipolar specialist is going to take over (the VA doc suggested that after I told him the recommendation in that letter) it that way
>
> > I'll never forgive him for making up these lies. (He had my wife walk me over to the inpatient unit, and we stopped at the cafeteria where we both read the note. (I never would've bothered except for a parting remark he made: "Of course, if you try to sign out, they'll commit you." That was uncalled for since it was a voluntary admission, and not the kind of send-off one would expect!!
>
> That sort of threat is an abuse of the law, IMHO. Yet doctors do it routinely.Yes, and if I thought this was the appropriate place, I'd name the outrageous lies and distortions. I don't even have them written down because they're indelibly emblazoned in my memory. I look at it like this: I saw my first psychiatrist less than 6 months after JFK was assasinated (essentially for behavioral problems), and I've had some of the "best" psychiatrists, and others to whom I was just a chart and another face in a VA hospital. Still, I'm here and doing reasonably well. (Just being born in this country is lucky, IMO.) :)
>
> > He *even included* an e-mail I'd sent him the night before, in which I said I wanted ECT. From the initial consideration and discussion of ECT through the hospitalization (18 days), it was one lie after another. Finally, I refused to sign the informed consent and walked out.
>
> Did you change your mind about the ECT? Or just didn't want to entrust your life to this doctor who kept making things up about you? (Or something else?) I know how you feel; some of the things that hospital doctors do and say are just unconscionable.Well, the only thing my doctor said that turned out to be true was that I was going to 7 West to have ECT. I kept changing my mind - sometimes twice in one day. The morning we were to have a "family meeting" where I was to sign the informed consent, I made up my mind not to have it. Even the night before, I was for it. Believe me, though. No one in his right mind would've gone through with it under the circumstances. First, the hospital had become a rathole, understaffed, no funding, most of the nursing staff won't get up out of their chairs, everything run-down, beat up. You get the wrong medicines sometimes, or the wrong dose, or the morning dose at night. The two doctors caring for me were friends of my doctor. They're all professors at the university across the street and publish articles and books together. Although the one who was going to administer the ECT was in the Association for Convulsive Therapy, she didn't know anything about affective disorders. She and the Chief were addiction and schizophrenia specialists. She didn't know what AED meant. She told me the first time I talked to her that trying Depakote with Lamictal might be a good idea. I agreed it could be, but then on the 13th day, she told me that I must have Depakote following ECT. I told her I used Depakote twice and couldn't tolerate it (not even at 125 mg/day with Lamictal). I couldn't get the antidabetic I'd been taking - even though they could've ordered it, and the lying resident said he was going to call my diabetologist across the street, who told me he'd gladly fax over any records they needed. I'd been in this hospital in 1974 for one day (amphetamines and hypomania), then shipped up to the VA neuropsychiatric hospital in Coatesville. The other time for 17 days in 1981 for thrombophlebitis. It was a nice hospital that turned into a dump. I had all the X-rays for ECT one day (from about 25 angles), and the next day they said I had to return -- some didn't turn out or something. When I got a few more, I was about to go, and they said I had to have another chest X-ray. I told them I just had one the day before, and they said they lost it! So I walk towards the machine, and you know how they tell you to put your shoulders forward and sometimes position you? Well, before my shoulders even touched the stupid machine, the girl clicks the button. I said what the he**?? And I'm thinking to myself how this ECT machine is going to break down or the anesthesiologist might take a coffee break, you know.. And I swear, they called this hospital a medical United Nations about 15 years ago. Well now, it looks like the U.N. headquarters has moved to ... well, I don't want to say it. I could go on and on. They tried to use the 72 hour thing on me. Oh, the ECT doc came into my room one day and went into a tirade -- yelling stuff like, "Who do you think you are taking up a bed in *this* hospital for 13 days (actually it was 14)?? Are you COMFORTABLE with having ECT in THIS hospital??? Why don't you sign out if you don't like it here?? But when I was going to, she said I *couldn't* leave unless I was taking Depakote, and at a therapeutic blood level (I think she wanted me at 2,500 mg/day) -- a drug I couldn't tolerate at any dose. So,I played their little game - still going back and forth with the ECT decision. Finally, I refused it, had the meeting with my wife, the ECT doc, and a couple residents (more lies - like 90% who get ECT respond). That's a lie,and I know where she got the figure from: the Mayo Clinic's study that asked the ECT patients whether or not they'd *have it again*, not if they responded. And when did they ask then this?? It was during their treatments! Like they knew any better! Anyway, I called my wife on a Fri. night, and told her to come in to visit the next afternoon. Luckily, I had "privileges" to go down to the ground floor to the canteen. So, I snuck into a mens room, changed out of my pajamas into street clothes in about 30 seconds, got in the car and drove the **** out of there. The VA Police were there at the entrance checking ID's since it wasn't long after 9-11, but only for people coming in. As soon as I got back up on LTG and OXC, and my head cleared up, I went to bazelon.org and printed out the psychiatric advance directives. -- Never again..
>
> > I've taken every AD ever marketed in the U.S. and some abroad (with the exception of Serzone), and they just weird me out and agitate me.
>
> Really? *All* the tricyclics??? (What a waste.)Every single one. In a HUP/VA study, I tried dothiepin (Prothiaden), too. Also, nomifensine (Merital) until if was withdrawn, but that wasn't a tricyclic, I think. I had multiple trials of many of the TCAs.
>
> > I can't tolerate them at all now. Not until I read this board did I see that I wasn't the only bipolar who'd never responded. The psychiatrist who dragged me through all the AD trials used to say that I "got side effects no one else gets," and that "you get the same ones with every drug." He made it sound as though it were *my* fault I was a non-responder.
>
> They do that a lot. Really helpful, huh?
>
> > I'd like to try Dexedrine with Lamictal and Trileptal - if I get in a bad depression again.
>
> Hopefully you won't have to. The stimulant-anticonvulsant combo is a weird one, though; how'd you come up with that?I started thinking about it after I couldn't tolerate Mirapex, but I don't know what I can tolerate anymore. I just don't want to get into another protracted, retarded depression.
>
> > I just d/cd lithium last night (started on 1/23) because it was somehow making me depressed again.
>
> Again: uh-oh!I'm still taking Lamictal and Trileptal. I think adding lithium was too much; I don't know. It seems like I started to getting more depressed and it was causing some mild dyskinesias. Btw, the dyskinesias I get -- you'll never see them in the VA computer, even though I have them documented in a report by a neurologist.
>
> > I only wanted it for its neuroprotective/neurotrophic properties, but not at the expense of worsening depression. Plus, it was causing some dyskinesias.
>
> That sucks. I've been lucky enough to avoid that (well, I've also made a point of staying away from the typical antipsychotics, except for that one time I tried using Mellaril).
>
> > That's strange you had a seizure. I read about that here, I think, but it's vague. I'm concerned about their affect on cognition, and maybe the liver.
>
> I'm not sure that the AEDs had anything to do with it, but it's one thing that could have contributed. On the other hand, I had at least one seizure when I was taking desipramine (which I wasn't metabolizing normally or something, so my serum level was on the high side).
>
> Trileptal is ****ing expensive. I've been thinking that maybe I should switch to Tegretol. I don't know. Waffle, waffle.I tried Tegretol only once in 1987, and I forget what blood problem it caused. It didn't matter, though, because I couldn't tolerate it. If you haven't tried Tegretol yet, I think you'll notice a world of difference between it and Trileptal.
>
> > Yeah, I side with the "splitters." You're right: just as it was lithium in the 70's that uncovered so many "bipolars" (many of whom dropped out of treatment, I *know*, after discovering that they weren't really bipolar), now I think another generation is getting the BD diagnosis, in part, due to the advent of AEDs.
>
> Tegretol was always here (well, it's old enough, anyway), but now the AEDs have the power of drug ads behind them.
>
> > I've been hospitalized with some people who had no depression or mood elevation, or even a history of mood problems, but when they were assigned to psychiatrists who specialized in mood disorders, they were asked all kinds of questions about mood. Even when they said that's not me, you know, they were pressed.
>
> They didn't have any mood problems? That's kind of weird; what were they in the hospital for? Most psych disorders have *some* effect on mood, at least.It was in the Institute of PA Hospital, and there were a lot of anxiety disorders and, I guess, personality disorders,or so it seemed. There were a few alcoholics, but I got to know some people who were treated by my doctor and another, who was like an associate, and they both were affective disorder specialists. One guy, in particular, had a paraphilia, and my psychiatrist kept asking him if he was depressed, and told him that he *might* be manic-depressive -- even though he said he was nothing like that.
>
> > At least most people with bipolar disorder aren't being misdiagnosed with schizophrenia - like in the 70's and before that.
>
> I've heard it said that schizophrenia was the wastebasket diagnosis not too long ago, yeah.
>
> > I was depressed on and on for 10 years before getting a bipolar diagnosis. It's not fun going into a VA hospital for 8 months, in a severe depression, and getting dx'd as schizophrenic (sometimes by FMG's who did their residencies in OB-GYN at Bombay U. or somewhere); then getting bombarded with high-dose antipsychotics - which actually *did* make you appear to be withdrawn and schizophrenic.
>
> They don't help much with the depression, either. Some people say that *low*-dose antipsychotics help (even the typicals), but I didn't get much out of the DA antagonists I tried (up to 10 mg of Zyprexa).Yeah, I tried Risperdal, but couldn't take even 1 mg. h.s. I think I tried 5 mg. of Zyprexa (maybe it was 1/2 of a 10 mg. because I split it), but I can't tolerate any APs at any dose now. I mean they destroy me. I'm like a zombie until the late afternoon, the next day. But my brain is probably burned out from so many psychotropics. I'm lucky I can take AEDs.
>
> > Back then, in retrospect, I think you wouldn't get a manic-depressive dx unless you were maybe an ultra rapid cycler, or had clear-cut manias. I remember only one guy dx'd as manic-depressive (before lithium). You'd see him out on open ward one day, talking a mile-a-minute and multiplying 3-digit numbers in his head, super-personable, and then the next morning you'd wonder where he was -- and he was back on the locked end so bad off he had to be spoon-fed.
>
> Really blatant and clear-cut, in other words. Whereas now, there doesn't have to be any evidence of anything resembling mania! As usual, the truth probably lies somewhere in between.Yeah, it makes you wonder about how disorders will be diagnosed in the future, if things can change so much in 20 years. Sometimes, I forget or don't realize how long ago it was when I was getting treated in what was really a different era.
Blue
>
> -e
poster:Blue Cheer 1
thread:92727
URL: http://www.dr-bob.org/babble/20020215/msgs/94425.html