Posted by Peter on August 28, 2003, at 8:07:30
In reply to Re: 'anticipatory anxiety' treatment-please help » Peter , posted by Jasmine Neroli on August 28, 2003, at 2:55:21
> Peter, you're a real gem. Your post perked me up no end :) Ha, Yep, I did see Bill Murray in "What About Bob?"...very, very funny and SOOO appropriate right now, LOL!
>>I loved that movie(o:
> I just wanted to share with you something I came accross where GAD and Bipolar 11 are compared to show very overlapping symptomology:
> Cognitive:GAD-worry, difficulty concentrating.
> BP2-free-floating anxiety, difficulty
> concentrating.
> Energy: GAD-keyed up, on edge.
> Restlessness/tension.
> Easily fatigued.
> Difficulty falling/staying asleep.
> BP2-motor agitation.
> restlessness
> extreme fatigue
> profound insomnia
>
> Mood: GAD- irritability
> BP2- dysphoria/irritability
>
> The article suggests that those diagnosed GAD who don't respond to AD's alone and the addition of mood stablizers improve the condition, must surely have a version of BP11. Apparently GAD's with the inability to concentrate + insomnia problems are the ones most likely to be improved by adding mood stabilizers.
>>Well, my doc thought from the beginning of treatment that I have a type of BP disorder combined with a lot of other stuff. He made the analogy of my 'mild Bipolar' segment of the disorder as being the 'engine' that drives all the other elements that are indicative of other disorders. So, for instance, he said when my general and social anxieties are prominent, it is most likely because my depression or hypomania stemming from my central' bipolar condition has precipitated these other symptoms. That's the tough thing about BPII and all it's subtypes: the hypomania can be so subtle as to be imperceptible by either the person experiencing it or those around him/her.(this is quite different from BPI, in which full-blown mania is much more evident and sometimes accompanied by psychotic symptoms). What makes it all even more complex is that a field of psychiatry now believes in a 'bipolar spectrum' which can go anywhere from an extremely subtle condition to a very severe condition. In the more subtle cases, it's sometimes difficult to differentiate between hypomania and a 'norma'l mood state. Hypomania often does not interfere with daily functioning, and someone experiencing it could just feel (and seem to others) like you're are in a naturally good, ebullient mood. That brings up the larger issue - how does ANYONE know for sure if they have a subtle bipolar condition or if they are just experiencing the natural ebbs and flows of human emotion?
>>So, in this sense, subtler bipolar disorders can overlap with many other conditions. Not only does BPII overlap in many ways with GAD as you showed, but it also overlaps with many ADHD symptoms. Some pdocs resort to just treating both simultaneously in cases that are hard to figure out what's what. This is what my pdoc has been doing for years.
>>He used to always have me on a mood stabilizer, no matter what AD or anti-anxiety agents he added to it. The mood stabilizers always made me feel dulled and down - I have NO IDEA if they were helping in some way in the background. Furthermore, I'd end up craving alcohol and getting more impulsive even if I was ALSO on a high dose of a mood stabilizer. And I read an article once that said many people who take SSRI's experience heightened impulsivity and lowered dopamine and tend to thus crave alcohol more - and these people are not diagnosed with BP. The pdoc I went to for a second-opinion verified this common SSRI effect, and she said it in no way proves my having bipolar disorder (and in the end, she said, in stark opposition to my pdoc, that I do not have BP disorder, just 'depressive-anxiety' - talk about frustrating!
Stangely enough, my regular pdoc now seems a lot less intent on my taking a mood stabilizer even though he claimed to diagree with the '2nd opinion doc.'
> Does that help you determine whether or not you fit the bipolar 11 criteria? It's hard to sort out, because you have to try and remember yourself in an unmedicated state. I mean, maybe your ADHD sympoms (focus/concentration problems, restlessness/agitation) are actually accounted for by GAD/Bipolar 2??? Then that would also explain your pdoc's 3rd hypothesis -SSRI induced hypomania.
>>Well, you know I've gotten to a point where I don't even bother to ask him what my diagnosis is, since it seems so complex - touching upon so many different areas - that I'm just trying to concentrate with him now on treatment that is aimed at whatever my most prominent symptoms are that are causing me the most distress. If I'm taking adderall in an 'off-label' manner to help my drive and motivation, the lack thereof possibly caused by high-dose klonopin, I try not to get all worked up about it anymore ('But what if I'm not an ADD'er! I shouldn't be taking adderall!, ETC.). Also, you're right that re-assesing my condition would require me to really remember how I was drug-free, and this is hard in my case. I've been on one substance or another since my mid teens, when I used to smoke pot all the time (unconsciously self-medicating to assuage an underlying condition? who knows). Then, in College, I got into heavier drugs (cocaine, even heroin). In '97, when I first saw my pdoc and he put me on depakote, which would be the first of hundreds of meds over the the proceeding years, I was just BEGINNING to recover from heroin addiction. I've often thought of coming off all meds for a time to get a more accurate diagnosis, etc., but everytime I've tried, I found that the ensuing anxiety symptoms were not worth my tolerating! At least now I'm on a minimal amount of meds, and I trust that my pdoc has kept my drug-infused past in mind through his judgement of my diagnosis. I find that always trying to understand everything (black&white thinking, 'all-or-nothing-at-all', perfectionism->that's all me) can be just more anxiety provoking than tolerating the ambiguity of not knowing.
(I'm beginning to think I might be BP2 too!!! Really - it's true.The Internet is a dangerous place!). The one thing I do know is, that there are always more questions than answers.
>>LOL. That's for sure. I've pretty much disgnosed myself with every condition known to man!! The web is awesome, but yes, dangerous as well(-:
> Let us know what your substitute doc thinks about Prozac/SSRI, but Sept. 2 is drawing closer...and it might be worth waiting to talk to your own doc.
>>Yes, you're right. The sub doc said what I had expected-that it's really not up to him to gimme a red/green light on a new med regime like that and that I should bring it up with my pdoc when he returns. I do find that he was right about sticking with the klonopin/adderall for a few days; the moodiness and anxiety has decreased, and, with the help of daily exercise and avoiding caffeine, my mood is smoother and the adderall 'crash' less bothersome.
> Good luck as always.
>>You too! hey how's that headache? Are you taking anything other than klonopin that could be causing it
? Does tylenol help? Splitting up the klonopin dose like you said you're doing might help in terms of minimizing acute fatigue from each dose, but you know, klonopin is so long-acting that the efects of the doses tend to overlap because each one lasts so long. That's good, in a way, 'cause it's smoother and makes sure you're 'covered' all day. Good luck talking to your pdoc about possibilities to help the lethargy.
>>Bill Murray
poster:Peter
thread:254453
URL: http://www.dr-bob.org/babble/20030828/msgs/254988.html