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Re: Help! Calling Rapid Cyclers and other Bipolars! » Mr.Scott

Posted by Larry Hoover on December 4, 2003, at 7:42:21

In reply to Re: Help! Calling Rapid Cyclers and other Bipolars!, posted by Mr.Scott on December 3, 2003, at 15:07:24

>
>
> Thanks for your kind words and input.

You're welcome. I'm glad my words helped. I was very worried. I'm down to just worried now....

> Basically you would think I was a chronic depressive somewhere in between dysthymia and Major Depressive with Atypical features predominating along with panic snd anxiety.

I know diagnoses are simplifications.....little cubbyholes to slot people into.....but I are confused....not bipolar?

I have dysthymia and major depression (they are not mutually exclusive diagnoses; when I'm not majorly depressed, my mood set point is not euthymia, it is dysthymia). I have had episodes of agitation and panic and anxiety as well. We may be birds of a feather.

In any case, the disorder is best thought of as bipolar spectrum, regardless of where on the scale you tend to be found. When I get "humming" (analogous to somewhat hypomanic), I can be elated, or irritable as all get out. Yet, I never meet all the diagnostic criteria for true hypomania. That is a flaw in the diagnostic guidelines, IMHO. Don't let words for what you have distort your perception of what challenges you face, okay?

> Then you toss in an Antidepressant without a stabilizer. Here it gets confusing as to whether I have side effects to the AD, something on the BP spectrum, or what I don't know.

It's an interaction. You can't separate them.

> While the depression may improve, simultameously emerging are signs of mild mania or a mixed product and the end result is really not much prettier than depression. If the AD is really pushed you begin to see hypersexuality, flagrant drug and alcohol abuse, poor impulse control, intense anger, 'excessive mind noise', inappropriate hilarity, etc.

Been there. Got more than one t-shirt. We are birds of a feather....

> This mixed affair passes and probably what is termed rapid cycling sets in (not sure) or a low grade continuous agited depression remains.

If you can't tell, then I'd suggest the latter may be true. Rapid cycling suggests that there are markedly different but brief periods of mood fluctuation.

> Bear in mind this may be hardly recognizable to most people who discard my behavior as odd or unique but not severe enough to be truly pathological.

It doesn't matter what others think....you are intelligent and gifted with language....people do not read your mind.....they cannot know what's in there. I suspect you "present well", which is an idiom that implies that you cope so efficiently, notwithstanding the internal distress, that others would not know of the distress at all.....even your physicians....without explicit and overt descriptions of what's inside. Again, birds of a feather.

> I end up playing alchemist with the meds and not really ever getting anything accomplished on that front.

May I suggest nutritional supps?

> I was prescribed Trileptal years ago and never took it. Now I'm on it at 600mg total daily and climbing plus .5mg klonopin daily. I want to add lamictal in there. I'm calm for the most part as the Effexor slips out with minimal withdrawal, but I am clearly depressed. I have very little hope and am relying on the numbness from the stabiler/benzo to keep me from severe/profound depression.

Don't trivialize that benefit, 'kay? That's a good outcome, though falling below the ideal one.

> Interestingly enough I can by placing myself in situations with good people to talk to kind of raise myself from despair.

Excellent! Just as you are doing here, eh?

That insight is invaluable. As a coping strategy, it should be on par with meds for you.

> Do you think it's Lamictal time from here or a different AD with the stabilizer?

You can safely add Lamictal. I wouldn't add AD withdrawal to your current struggle..... get stable, then tweak.

> My current doctor seems to think that for all the great research out there and heated debates between the Akiskals of the world, that trteating BP disorder today is essentially a crap shoot every time no matter what. And only trial and error can avail.

Prevail? Yes, I agree. Absolutely. It's a black art, guided by intuition. That's all we've got.

> What doesn't make sense is that the only stabilizers he has offered me have been Neurontin, Klonopin, and Gabitril (these are 4th tier!). This is odd, but it may be because he sees like what I described above...A state of chronic depression.

It is bizarre. Lithium is used purely as an antidepressant, for example, if family history suggests it may be useful. Consider the range of expressions of mood within your first degree and second degree relatives.....

There probably is "pure depression" as a diagnostic and prognostic entity....but I do not believe that applies to you. Bipolar spectrum does, IMHO.

> Anyways thanks for your help in this. It has taken me forever to write this because I'm low and I am going to print it out and give it to him when I see him next. Your help is one of the things thats keeping me wanting to move forwards and not standing still.

That is good news. Keep in touch, 'kay?

Take care of you,
Lar

 

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poster:Larry Hoover thread:285727
URL: http://www.dr-bob.org/babble/20031202/msgs/286455.html