Posted by Peter on October 25, 2003, at 19:34:02
Hi everyone:
I need some help at clarification:
Quick background info: Starting taking meds 8 years ago; my pdoc initially diagnosed me with 'mild' bipolar disorder, took me off the paxil that my GP had precribed me, and started me up on Depakote. He has 'updated' my diagnosis numerous times over the years to the point that his judgments have seemed outright contradictory. After being on depakote for a while, I just became very depressed and tired all the time, and my anxieties were becoming more apparent. So my new diagnosis became 'mild' bipolar/panic disorder/social anxiety. He started me on klonopin 5 years ago and I still take it. He began to try a number of different SSRI's on me, as well as effexor, moclobemide, and wellbutrin, but he never used to allow me to take these antidepressants without my also taking a mood-stabilizer. So I've also taken a number of different anticonvulsant mood-stabilizers aside from depakote (neurontin, lamictal) and also Lithium. His initial reason for not allowing me to take AD's without an MS was for fear of my having a hypomanic episode, which, to this day, neither my family, friends, nor myself have been aware of any sign of in me. He thought that his diagnosis of 'mild bipolarity' was proven by my reactions to SSRI's; they would help for a while, but then they would induce alcohol/drug cravings in me and my overall anxiety levels would increase. At first, he said this was proof that I am bipolar, because these cravings and the drug/alcohol sprees that would result were indicative of a type of SSRI-induced hypomania. But then things began to changed; about 2 years ago, we reviewed my history, and he said it is likely that I have a form of adult ADHD on top of everything else. So he put me on various stimulants, sometimes combined with mood-stabilizers and/or AD's. Then he went thru a sort of 'experimental' stage with me and put me on various other meds like dopamine-agonists, beta-blockers, strattera, u name it. During this time, I decided to get some second opinions from other good pdocs: some told me I DO in fact fall somewhere within the bipolar spectrum ('otherwise unspecified'), others told me there are no signs of my being bipolar in any way but that I have an extreme case of 'depressive-anxiety.' Some said I have ADHD, others said I don't. So I decided to just stick with my original pdoc since he knows me the best; but he seemed to begin to be less adamant about my needing a mood-stabilizer. So we kept trying to find the right combo.
My latest combo was: lexapro+adderall+klonopin+restoril(for sleep). I began lexapro about 8 weeks ago, went through a slew of side-effects, and am currently unsure as to whether it has really helped my fundamental depression and anxiety. Whenever it seems like it has begun to work, I end up crashing into depression, getting socially withdrawn again, etc. So, first he thought the adderall was masking possible lexapro benefits and had me taper off the adderall; but i was completely lethargic/depressed/unable to follow through on any tasks. So he switched me to a few long-acting stimulants until we found the one that seems to have the least negative effects on me - dexadrine spansules. So now I'm taking everything I listed above, except dex instead of adderall.
Then I started feeling physically ill - my ears kept getting blocked up and I felt gross and tired all the time. I went to a GP, who said he didn't see any signs of infection, but he put me on a week-long trial of antibiotics to treat and prevent any possible underlying, chronic sinus condition.
My pdoc, meanwhile, has proposed to me a game plan which I find very confusing. He said that usually when someone taking a fixed dose of an SSRI for many weeks only responds partially (feels only slight, sporadic improvements), a higher dose is called for. But, he said that many people suffer underlying chronic sinus disorders that could also make them depressed and cause low energy. He proposed that we first wait for a few days of my taking the antibiotic to see if I begin to feel more consistently better; if so, that would tell us that a sinus condition was indeed to some degree responsible for my continued depression. If I do not feel better, we could increase the lexapro dose. Ok, so it all makes sense so far. But then he said something that I can't wrap my head around: he said that if I find that I feel better for 3-4 days in a row and then my mood switches to depression/anxiety for another 3-4, then that is a sign of bipolar cycling and would call for my adding some depakote to the regime. On the other hand, if my moods are variable every day, that is a sign that I am on too low a dose of lexapro. In other words, the answer lies in the AMPLITUDE of my mood swings - if it is very large, it is more likely that I have bipolar cycling and need to add a mood-stabilizer, but if it is shallow, I might just need a lexapro increase. But then he said we might end up adding depakote AND increasing both the lexapro AND the dexedrine - that sort of confused me. He said the next 3-4 days on the antibiotic will make everything more clear.
Here is where I have difficulties: I can see how 3-4 days on the antibiotic will tell us whether an underlying sinus condition has been contributing to my mood lability. But how on earth will another 3-4 days tell us the the general amplitude of my mood inconsistencies?? Furthermore, I would think he would have already figured out if I am bipolar or not after 8 years of seeing him.
I try to keep a daily mood journal, and I've found it very hard to pinpoint if I go thru overarching bipolar mood-cycling, or if my moods are variable each day. Then there's the synergy between the stim and the SSRI, which adds a whole new factor that could be contributing to my mood lability. There are just too many factors at work here, and it is overwhelming. I don't want to do the wrong thing because I've misinterpreted the nature of my moods; it's almost as if it is all being left up to me! I don't want to increase the lexapro unless I 'need' to, because this would undoubtedly result in an increase of SE's, like sexual dysfunction and apathy. And I do not want to unecessarily add depakote again to my regime, as it has never done anything but given me a lethargic, 'wet-blanket' effect.
I'm very sorry for the length of the post, but I'm really frustrated and would very much appreciate any feedback. Thanks a lot,
Peter
poster:Peter
thread:273316
URL: http://www.dr-bob.org/babble/20031025/msgs/273316.html