Posted by never2late on February 18, 2012, at 15:30:13
In reply to lamicital with AD starting up, posted by never2late on February 16, 2012, at 22:22:32
Thanks for the input everyone!
I checked the "soft bipolar" signs. Copying and pasting them here:
The patient has had repeated episodes of major depression (four or more; seasonal shifts in mood are also common).
The first episode of major depression occurred before age 25 (some experts say before age 20, a few before age 18; most likely, the younger you were at the first episode, the more it is that bipolar disorder, not "unipolar", was the basis for that episode).
A first-degree relative (mother/father, brother/sister, daughter/son) has a diagnosis of bipolar disorder.
When not depressed, mood and energy are a bit higher than average, all the time ("hyperthymic personality").
When depressed, symptoms are "atypical": extremely low energy and activity; excessive sleep (e.g. more than 10 hours a day); mood is highly reactive to the actions and reactions of others; and (the weakest such sign) appetite is more likely to be increased than decreased. Some experts think that carbohydrate craving and night eating are variants of this appetite effect.
Episodes of major depression are brief, e.g. less than 3 months.
The patient has had psychosis (loss of contact with reality) during an episode of depression.
The patient has had severe depression after giving birth to a child ("postpartum depression").
The patient has had hypomania or mania while taking an antidepressant (remember, severe irritability, difficulty sleeping, and agitation may -- but do not always -- qualify for "hypomania").
The patient has had loss of response to an antidepressant (sometimes called "Prozac Poop-out"): it worked well for a while then the depression symptoms came back, usually within a few months.
Three or more antidepressants have been tried, and none worked.
The only criterium that hit are the first two items and the last.
AD tried Prozac, Lexapro, Zoloft, Wellbutrin.
Now I am on effexor. My doc said that Prozac, lexapro, and Zoloft were all in the same family (SSRI) and wellbutrin is atypical basically just poor mans stimulant). I feel like the fact that I was prescribed the SSRIS by my GP and then the wellbutrin by my former quack PDoc is not really a good indicator that I have tried 3 or more and failed. So the last item is questionable.
Also the 9th point regarding symptoms of hypomania severe irrability difficulty sleeping, and agitation occured when I was using Cocaine in my early twenties and was unmedicated and when I placed on Welbutrin in combo with adderall.
There have been no real other signs of Mania in my life aside from the ones described above.
Most of my mood shifts revolve around depression and anxiety. I sink into depression at points during the day and get very nervous that my life decisions are all wrong and I am just going to repeat past patterns of behavior that caused me to fail which makes me hate myself.
That is the issue that the lamictal is trying to minimize, making the low points not as low. When I feel good, it is not a top of the world I am God feeling that I assume a manic episode would be like. Mine are more of just an at peace feeling that I am ok, and what I doing is the right thing to do, and that I am a good person. I feel content.
I hope the lamictal does the trick.
Curiously some of you mentioned 300 mg effexor being the "sweet spot" my doc actually said he might considered lowering the effexor dosage contingent with a positive response to lamictal.
It is an interesting hypothesis aboUt lamictals effects on DA. My doc did not mention this to me at all. I hope that it does because I feel like my part of my restless feelings are due to some kind of faulty reward mechanism in my psyche. I can complete a task or get an A on an exam, have a positive interpersonal interaction with someone and still feel unfufilled. I dont know if this is a chemical problem or something to be adressed with CBT, but it is a concern. It helps that I have a busy schedule and have lots to do because never feeling like anything is good enough keeps me really busy trying to fill that void that never seems to be filled.
I apologize for the lengthy post. I know no one likes to read a whole page. Thank you also for the reassurance that I have a good Pdoc, the last one took me for a ride.
Thanks again for everyones input. Again any questions or thoughts are much appreciated.