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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 6035 to 6059 of 10407. Go back in thread:
Posted by helenag on January 6, 2004, at 16:16:52
In reply to hypomania, posted by Lyrical13 on January 5, 2004, at 22:22:46
I was very interested in your post; can identify with your "activities." I also go on spurts of house projects and spending sprees, but have a smaller pocket book. What am I saying??? I often "nickel and dime" us to those levels. I have sewing projects started and not finished, cans of paint bought, yards of material and trim. I've come home from work at 10pm and commenced to paint. Have spent hours and hours doing projects non-stop. After these feverish spells, I would crash into depressions.
The worst hypomanic spell I ever had was when I was on geodon. It threw me into a mania spell--I hardly slept, even though the stuff made me feel like I had a zombie woof behind my eyes after I took it. When the doc took me off it, I crashed so bad, I had to be hospitalized.
What I want to ask you, and of course, out of politeness I mean no disrespect but am asking out of curiosity and for my own diagnosis' sake: do you at all have any history of alcohol abuse?
My pdoc considered rapid cycling for me but then turned about and told me that the original depression/GAD and alcoholism stood, and that he saw borderline traits in me. He believed that alcohol use caused the mood swings. However, my mood swings were swinging way before I ever became an alcoholic.
I don't argue with my pdoc because I am an alcoholic and can't argue that fact. The meds I am on have stabilized my moods well. (topamax 300mg) (effexor xr 300mg) (seroquel 75mg)
But you know, my pdoc told me I made myself sick with my actions and emotions. That you can change your brain chemistry that way. I am still smarting from that "assessment." I don't think that he would have ever had said that if I wasn't an alcoholic.
Further, I was in the hospital six times between April and December. I am sure the insurance company was talking steady to him...like why is this woman not getting well?
I would really be interested if any other folks out there who are dual-diagnosed (as it's said in the trade) could share their experiences. Do you feel that your doctors look down on you because of your addictions?? I am in recovery, and I do have a rocky one, though it is progressing far better than it has in the past.
Well lyrical 13, didn't mean to get off track in responding to your post, but it sure hit a nerve with me. Thanks for sharing.
Posted by Lyrical13 on January 6, 2004, at 16:59:59
In reply to Re: lyrical 13 and hypomania » Lyrical13, posted by helenag on January 6, 2004, at 16:16:52
Hi
No problem at all about going off track..I do it constantly..I think that's how we arrived at the hypomania subject! But that's what I love about this site (and the various babbles) People talk about all different things that ring true for different people.re: alcohol. I don't drink. I never have really. I haven't even been drunk. I think I had a little bit of a buzz once in high school after maybe 2 drinks but that's it. I never really liked the taste of anything except margaritas and all the sugary drinks where you can't taste the alcohol. Wine gives me a headache. I'm hypoglycemic and alcohol really messes up my blood sugar so I rarely drink at all any more. Every once in a great moon I might have a margarita. the last time I remember having one was last June when I was visiting relatives out of town. Before that? Who knows..it's been several years. However, I do have a history of alcoholism in my family...my grandpa. My dad doesn't really drink..well, never used to. Now he's a social drinker with the guys down at the yacht club but I've only seen him drunk once in my life...on New Year's Eve when I was about 12. I think I never have gotten drunk because I never wanted to lose control. I was too worried about the terrible things that might happen to me if I wasn't in complete control and aware of my surroundings, etc etc.
RE: your docs comments about your alcoholism.. I think they're very rude and judgemental and condescending. Does he say things like that all the time? That's not his business really...to make you feel bad about something that you probably already feel bad about. I commend you for all the hard work I know you must have done and are doing to recover. Addictions are a very difficult thing. There are going to be setbacks. It's a chemical thing..you're fighting your own body chemistry just like you are with depression, anxiety etc. I have read that alcohol and drugs can permanently affect brain chemistry, but what's the point of shoving that down your throat? And there's no proof of causality. You could from birth have been destined to have difficulty with depression, anxiety, etc. Besides that, it could be the other way around...many many many people drink or drug to medicate their depression! Or to feel less anxious. The things your pdoc is saying sound abusive to me (I know I dont' have a whole picture but just the few things you've mentioned) You might think about finding a different doc if he says things like that or other hurtful things on a damaging basis. The pdocs job is to help you, not judge you.
Ok...off my soapbox now! Also, I'm glad you mentioned that about geodon. I have heard others say that it helped their bipolar.
Well, good luck on your road to recovery on all fronts! And just remember, don't let the turkeys get you down!
Posted by Lyrical13 on January 6, 2004, at 17:18:51
In reply to Re: hypomania, posted by Gummybear on January 5, 2004, at 23:00:36
> My doctor said that I may be bipolar or have rapid-cylcing bipolar. There has been no bipolar ever in my family history. I am not convinced that I have either of these because I mostly feel depressed or really scared (anxiety) - and the moments that I feel okay, I just feel normal. But I did go out on boxing day and buy pants, 2 pairs of shoes, and a top - all of which I kinda need. I don't have all that much money, would this be classified as overspending????
I wouldn't think that would be overspending. It sounds like you are depressed... when I am depressed I have very little energy. Want to sleep a lot, read, lay around. Think of lots of things I should do but just can't get it together enough to do any of them. Can't make a decision to save my life. Even when I think "This is not that big of a deal. No one cares which socks you wear today. Just pick one" I still can't do it. It's a MAJOR decision. And I can't concentrate on anything, very restless, VERY anxious. constantly feel like I'm falling apart..this constant sense of dread. I feel like I have a major exam that I completely forgot about and didn't study and it's happening in 5 minutes and I haven't the slightest clue about the info on it. A sense of constant panic. And I think that feeling panicky all day long does wear you out. It takes a lot of energy to be anxious all the time. And I can't handle changes in routine..it takes so much energy for me to just get through the day..I can't handle any errands after work...just go home. And I have to write down everything..one to remember...but also to help me get through the day..I write out a schedule for myself of all the things I need to do and when and then I cross them off. It's like the anxiety takes over my mind so much that there's no room for anything else. When things are really bad, I can't work at all. I'm crying if someone looks at me sideways or sobbing for no reason at all.
I resisted the dx of bipolar for a long time because my biggest problems were depression and anxiety. I knew I had spending problems but I always thought that people spend money when they're depressed sometimes too. But the thing is, for me, I didn't spend when I was depressed. I go into phases where I'm afraid to spend anything. The only checks I write are for bills. I have a lot of anxiety about money. Always have. Maybe it's partly because money was such a big issue in our family...we didn't have it. And my mom would get upset when I asked for things that I needed (contact solution, e.g.)...I hated to ask for anything. Then my parents put me in the middle of all these money battles (they're divorced of course). I'm sure that's at least part of all my money anxiety and problems.
But, I spend when I'm in a good mood. I was hospitalized several years ago and the pdoc there tried to tell me I was bipolar. But he only saw me for all of 30 min late at night shortly after I had passed out from low blood sugar and I was trying to tell him that he didn't have the whole picture and he yelled at me. Literally. Got in my face and yelled "you have to listen to me!" and I said "No I don't have to listen to you!" and left the room. I think that's a big reason why I have resisted this dx for so long. Also my mom, the nurse who thinks she knows everything, tried to shove that dx down my throat too. I really resented that.
so BP is a very hard thing for me to swallow. I never even considered it. But when my pdoc mentioned it last month after I expressed some concerns about things I had noticed (sleep patterns, spending, felt like I was running on adrenaline, talking non-stop, louder, faster etc) then I started looking into it. As I read info about BP2, I recognized myself. The phenomennon of thinking you are whatever you read about happens a lot...it happened to me before (I thought I was having a stroke back when I was doing my master's research on stroke! Turned out to be a pulled muscle! But I had numbness on the left side that didn't go away etc)
>
> I haven't had any urges to do any sort of "projects" but I think I may have developped an internet addiction. Mostly, I don't feel like doing anything except lying in bed and watching tv or surfing the net.
>
>
Posted by kattay on January 6, 2004, at 19:18:17
In reply to Re: hypomania » Gummybear, posted by Zellie on January 6, 2004, at 11:07:12
Posted by kattay on January 6, 2004, at 19:19:40
In reply to Re: hypomania » Gummybear, posted by Zellie on January 6, 2004, at 11:07:12
> Dear GummyBear:
>
> I have had quite a time throughout my life dealing with GAD and Depression, and with Panic Attacks in my earlier years.
>
> I feel for you. It feels like a life in shackles.
>
> I am 42 years old, and only this past year have had a formal diagnosis on the disorders (I also have OCD and ADHD). I began seeing psychiatrists when I was 9 to try to help with the anxiety and panic. I saw countless others throughout the many years that followed...was put briefly on imiprimine, and vallium to treat anxiety and depression at different times. I had given up hope that there was ever going to be help for me, so I had not gone to a psychiatrist since my mid twenties.
>
> I managed to push through in life, but it was taking a huge toll on my body, my family, and my life in general. I finally had symptoms that were like chronic fatigue, but the blood tests could not find anything out of order. I believe that it was my entire body shutting down from the intense stress it had gone through for so many years.
>
> As it turns out, my youngest child has many neuropsychological disorders, so the more I went to seminars to learn how to help him and the longer I took him to see his specialist, the more I was enlightened to my own dilemmas.
>
> I began seeing a psychiatrist last February, who specializes in adults with ADHD, GAD, Depression, etc. Following my diagnoses, he had me read up on and research various medications that would help with all of my particular disorders.
>
> The one we chose to try first was Effexor(XR), because it targets Anxiety, Depression, and ADHD, in particular (the ADHD once it reaches 150 mg).
>
> He had me titrate up at a snail's pace, to minimize side-effects, and to watch closely for any signs of Bi-Polar disorder. (He had already ruled out hypothyroid problems via blood tests, which can mimic depression).
>
> I was about a month at 37.5 mg, then 5 weeks at 75 mg, then about 6 or 7 weeks at 112.5, then after about 8 weeks I went to 150 mg. I am very, very grateful for having gone up so slowly, as it really served to dramatically minimize the side-effects. The down side of going up so slowly was that it took longer for me to be feeling better. Looking back, though, it was worth it.
>
> What I noticed was that the Effexor worked on the Anxiety first, minimizing it substantially. But I felt more depressed than ever. That's when I realized that I was not really more depressed, but rather, I was just feeling it more, now that the anxiety had been taken away. The anxiety had actually served the purpose of prodding me on through the depression all those years. Once the anxiety was taken away, the Depression reigned.
>
> Once I got up to about 112.5, the depression was starting to lift. By 150mg, not only was the depression gone almost all of the time, but it also started to have an effect on the ADHD.
>
> I still feel a little depressed during PMS. Other than that, I am free of depression and GAD.
>
> In November, my pdoc started me on 100 mg Wellbutrin as well, to further target the ADHD. He had me try Concerta first, but it brought back some of the anxiety. So then we talked about trying Dexedrine (another stimulant medication for ADHD, and one that my youngest son takes), but again, because of the GAD, we opted for the Wellbutrin. It is not as effective in controlling ADHD, but given my anxiety and depression, we opted for the Wellbutrin.
>
> I have, indeed, been able to be much, much more productive.
>
> However, it is not the meds alone that has been helping. I have been learning countless strategies also, to help me get and stay motivated to do daily tasks. I am part of a support group at a Mental Health centre in Toronto, and I am currently part of a study for Light Therapy. Light Therapy has been found to be successful in alleviating symptoms of Season Affective Disorder, Depression, and PMS. The study I am involved in is to see if people with ADHD also find a reduction in their symptoms.
>
> Because it is known to be effective in Depression and PMS, I thought it could only help! I'll let you know as the month progresses.
>
> I also joined Flylady.com, which is a wonderful website for the disorganized and unmotivated. Although it is mainly designed for at-home women (I do work when I am able), I make it work for me, too. It has been a Godsend in helping me keep my home in order, and keep from being overwhelmed. Because of a life of overwhelmedness, I had a house full of clutter left in its wake. I am now able to work my way through it, at a slow but very steady and productive (encouraging) rate.
>
> I no longer wish I were dead. This is the first time in my life I have EVER been able to say this. I am calmer, at peace, steady, more fun to be with (my husband is grateful!), not agitated and irritable, not discouraged and hating myself.
>
> This is largely the result of the medication. The other things help me be more productive, but I could never be a part of the other things (support groups, studies, etc.) if it weren't for the meds. I was completly crippled a lot of the time, and unable to work.
>
> Needless to say, I am very, very grateful to be able to rise above my own disorders now, so I can help my family more, and help out others, too, who are numerous out there.
>
> As for the panic attacks, I haven't had one since I was 27. At that time, I opened up about all the "sins" and deeds I felt guilty about, and got it all out into the open. It's not that my sins were likely any worse than most other people's, but because I was hiding them and trying to portray myself as being "together," the pressure it put on me sent me into horrendous panic attacks that I'd had since being a child. At times I had been unable to eat for many days, for fear of dying whilst swallowing, I often couldn't breathe, because my throat became so tight and constricted. It was living hell.
>
> I didn't know that coming open about who I was would take the pressure off me. I learned to be who I really am, without trying to cover it up. I confessed it all in order to become a Christian, not because I thought it would end my panic.
>
> A few times I have had twinges of a panic attack beginning, when I am in a situation where I feel there is a lot at stake in making a good impression on those around me. As soon as I feel that, I stop and think "who am I trying to impress here?" Then I strive to be more who I really am and not fret about what they think about me. By removing the pressure, there is nothing to make me panic.
>
> That's my story, anyhow. I hope that maybe something in it somewhere will encourage you to keep working hard at freeing yourself from the bondage of your disorders.
>
> By the way, there are a few side-effects I must contend with (sexual drive is low, climax is slow or absent, sweats sometimes, heart-rate increase at times), but I am monitored closely by my pdoc. I will gladly put up with the side-effects, in order to finally be able to enjoy life, for the first time ever!
>
> Kindest regards,
> Zellie
>
>
>
>
>
>
>
> > That's a very intriguing glimpse into hypomania - I am 23yr old female and have GAD with panic attacks and depression. All this only struck me about a little over a month ago.... and now EffexorXR....
> > My life has done a full 360 degrees.
> >
> > My doctor said that I may be bipolar or have rapid-cylcing bipolar. There has been no bipolar ever in my family history. I am not convinced that I have either of these because I mostly feel depressed or really scared (anxiety) - and the moments that I feel okay, I just feel normal. But I did go out on boxing day and buy pants, 2 pairs of shoes, and a top - all of which I kinda need. I don't have all that much money, would this be classified as overspending????
> >
> > I haven't had any urges to do any sort of "projects" but I think I may have developped an internet addiction. Mostly, I don't feel like doing anything except lying in bed and watching tv or surfing the net.
> >
> > I have been very slow to responding to the Effexor XR treatment.... and have severe mood swings from feeling okay to being depressed and crying to racing thoughts of suicide which throw me into a panic attack.
> >
> > Does anybody know the symptoms of rapid cycling bipolar?? I am concerned I may have it particularily since Effexor XR is proving to be a very slow slow remedy.... not quite sure it's working.
> >
> > Thanks,
> > G.bear.
>
>
Zellie.
Reading your post has given me hope. I have been dx as bipolar II, adhd, gad, pmdd by various dr.'s. The dx that i agree with all except the BPll. I just can't see it and i've done alot of reading on it over and over and just don't see it. I've been on all of the ssri's, tryciclics(sp?) and now am weaning off of lexapro and starting effexor xr. Oh, and i'm on wellbutrin xl. I have become depressed over my trouble with finding the right dr and the right meds and the right dx. My latest pdoc says that i concentrate on the symptoms(side effects)too much. I journal everything now. My memory is non existent so i have to. Oh, and he'll bring up something i said two weeks ago during a phone conversation and expect me to remember. I can't say if i said that or not. I don't remember. I had an episode with a very high pulse. I also had a panic attack. Now, he wont try any stimulants on me cuz of the pulse. It's back down now. He can't keep his stories straight. I'm beginning to think that he thinks i'm bipolar ll(dx of bipolar ll wasn't from current pdoc but he knows about it) His reasons for not giving me a stimulant keeps changing. I just started on effexor xr and he wanted me to wean off of lexapro first but i talked to my pharmacist and he said that i shouldn't have to. I'm sick of these know it all pdoc and i wish i could find a good one. But i live in a small town and there's no other pdoc's around. The other one's are in the same office as the ones i've seen. So, I don't know how that works. I don't want the one's i've seen filling the new one's with bs.
I would like to thank you for posting such an inspiring post. It gives me hope. I love what you typed:
"Don't worry, you are "normal" - what ever the heck that means (I am convinced it doesn't exist)."
Kathi
Posted by Lyrical13 on January 6, 2004, at 20:42:26
In reply to Re: hypomania, posted by kattay on January 6, 2004, at 19:19:40
IMHO...those of us in tx are the normal ones. The rest of the world who are going about acting so crazy (no offense intended if any of you are sensitive to that term..I know sometimes it bothers me)...it's the rest of the world that is so dysfunctional..if they're not bothered by the state of things and this non-stop chaos and hectic pace of today,then what's wrong with them?
Posted by Lyrical13 on January 6, 2004, at 20:52:38
In reply to Re: hypomania, posted by kattay on January 6, 2004, at 19:19:40
How far are you from another area? It sounds like your current doc is confusing you not helping you. If you really have a bad feeling about your pdoc, trust your gut. I just changed pdocs and am so glad that I did. It has made a world of difference. I am in kind of a small town...not tiny..and I was thinking about driving to a doc that was recommended to me who is 45 min away. I don't really want to drive but if a good doc is there that can help me feel better and finally figure out the right med etc. then it's worth it to me. Fortunately before I had to go to the far away doc, I found out about a doc in my hometown who is fairly new to this area and was reportedly very good..the reports were right. He's been great!
Good luck
L13
Posted by kattay on January 6, 2004, at 21:48:03
In reply to pdoc problems, posted by Lyrical13 on January 6, 2004, at 20:52:38
I think i might give the effexor a trial and see what happens. as far as the pdoc goes, well, if the effexor does the trick then i wont have to see him much. I also see a counselor and she's pretty good. i'm actually going to see her tomorrow and we'll see how that goes. i'm going to bring up what the pdoc said. i'll post tomorrow and let ya'll know what came of it.
Posted by Zellie on January 6, 2004, at 22:44:56
In reply to pdoc problems, posted by Lyrical13 on January 6, 2004, at 20:52:38
I agree, with Lyrical13. Kattay, if you have serious reservations about your pdoc, you may wish to consider finding another one. There could be a treasure out there waiting for you.
I saw countless pdocs over the years, and gave up for the longest time on finding one that could help.
The pdoc I now see, whom I very much appreciate, is 45 minutes north of Toronto (I live in the greater Toronto area). It is well worth the drive. I have a friend who now also is going up there to see him.
It can get confusing, finding the right doc. Some docs seem to have conflicting ideas about medications. Some contradict one another outright (I suggested to a friend that she approach her doc about going on Wellbutrin. She is fairly overweight, and didn't want to gain more. Her Mdoc told her she'd put on weight with Wellbutrin, so he put her on Effexor, which he said would not cause her to gain. When she saw a pdoc in the same clinic 2 weeks later, he said the Mdoc should have started her on Wellbutrin, since it is not known for putting on weight! Also, this same Mdoc told her that what I am on, Effexor and Wellbutrin, is fatal!!! Oops! Pinch me...am I really here, or did I die??!)
My pdoc specializes in the disorders I have, and his passion is biochemistry, so he understands exactly what the drug interactions with the body can be.
Having said that, at the same time, because all people are so different in their body chemistry and no two people seem to have exactly the same medication experiences, a lot of the treatment is often trial and error as you journey towards the "optimum" treatment. "Optimum" to me means, most of my debilitating symptoms are under much better control, and I can live with the side-effects I experience.
Bottom line is, educating yourself is key to finding the best doc for you, and the best ("Optimum") treatment(s) for you.
This journey is not for the faint of heart! Mind you, I am addressing a group of people here who are far from that, although we often feel weak and faint. We are perseverers, strengthened and enriched by our experiences and our sufferings. We are stronger in character than we think. We've had to claw and dig for help, for answers, for energy, for hope, for health...which pays off richly by giving us a good, solid fighting spirit underneath the fatigue.
I wish for you to experience some great peace one day, once your symptoms get under control. It is surely to happen, if you do not give up.
Kindest regards,
Zellie> How far are you from another area? It sounds like your current doc is confusing you not helping you. If you really have a bad feeling about your pdoc, trust your gut. I just changed pdocs and am so glad that I did. It has made a world of difference. I am in kind of a small town...not tiny..and I was thinking about driving to a doc that was recommended to me who is 45 min away. I don't really want to drive but if a good doc is there that can help me feel better and finally figure out the right med etc. then it's worth it to me. Fortunately before I had to go to the far away doc, I found out about a doc in my hometown who is fairly new to this area and was reportedly very good..the reports were right. He's been great!
>
> Good luck
> L13
Posted by Zellie on January 6, 2004, at 22:51:10
In reply to Thank you so much for that post-Zellie, posted by Jaynee on January 6, 2004, at 12:52:05
Thank you back! It delights me to know what a help we all are to one another. Is that not the essence of life, when everything else is boiled away? If, by our experiences, each of us can help even one other person, then collectively we will have touched and changed a whole lot of lives on this earth, for the better.
Kindest regards,
Zellie
> Wow, I could really relate to your post. It was very encouraging. So much of what you described really hit home for me. Although effexor's side-effects were just to much for me, I am doing okay on Celexa. I could do better so I will discuss other options with my pdoc.
>
> Thanks again.
Posted by Zellie on January 6, 2004, at 23:05:10
In reply to Re: THANKS.... orig...hypomania » Zellie, posted by Mercedes on January 6, 2004, at 13:03:43
Mercedes:
I hope you find as much success with FlyLady.com as I have! My home is as different as night and day, as I allow her e-mails to prompt and coach me. My pdoc told me to go to her site.
Her technique is to never overwhelm us. She tells us to simply delete whatever e-mails we cannot handle or don't have time for. She reminds us in every e-mail that we are not behind...just jump in wherever you are at!
She also doesn't overwhelm us by saying that today we have to clean the house. Instead, she'll assign us a small task in a particular room, and have us spend often just 15 minutes on the task. By doing lots of different tasks in just 15 minute increments, by George, my house is getting completely decluttered! Dinner is ready at a reasonable time. My fridge is cleaned out and organized...my laundry is done...all my Christmas decorations are put away, the tree down, and the house in order.
Who stole my house? Whoever did, I don't want it back! I much prefer the new one.
Honestly, I never could have begun to accomplish what I have, without her site, and without the meds as well.
By the way, I took her advice to be good to myself by having frequent breaks (once per hour). It really helps me not get depleted.
She is a wise ol' gal.
I have so much to be grateful for.
Thanks for your encouragement!
Kindest regards,
Zellie> Zellie, thanks for your very interesting story. Also, thanks for sharing the flylady.com. I went to the site and already joined. Gosh, I need something to motivate me. I seem to just "think" of what I need to do, and get nothing done.
>
> Thanks again, very inspiring story.
>
> Mercedes
Posted by zinya on January 7, 2004, at 2:41:30
In reply to re: docs and info about meds, posted by Lyrical13 on January 4, 2004, at 7:24:59
If you didn't see this, i thought this might interest almost all of you...
A Doctor's Toxic Shock
By NANETTE GARTRELL
January 4, 2004
NY Times MagazineHow could a psychiatrist in practice for 27 years fail to recognize an anxiety attack? I was interviewing a new patient when the first surge of adrenaline hit, but I couldn't identify the sensation. The patient continued talking about her lifelong struggle with depression. I broke into a sweat and wondered whether I was having a hot flash. I glanced at the clock -- 20 minutes to go. As I summarized the pros and cons of various antidepressants, my voice trembled. Did the patient notice? I felt as if I were disintegrating. I reached for a prescription pad, trying to steady my shaking hand.
I had never been seriously depressed or anxious before. Even after my sister's death and my father's suicide, I hadn't needed drugs to cope. But recently, as a close friend was dying of liver cancer, I began to dread going to work. I felt weighed down by my patients and their pain. I asked myself, Was I in worse shape than they were? My partner Dee, who is also a psychiatrist, suggested an antidepressant. She recommended bupropion, since, unlike some antidepressants, it doesn't cause a sleepy, fuzzy brain. I had prescribed it frequently -- including to patients who were physicians themselves -- with favorable results.
Within 10 days, I developed insomnia, agitation and tremors. I lost the ability to distinguish between sadness and the drug's side effects. When the panic attacks started, I worried I would end up like my father, who took his life after years of anxiety. Initially, I checked in with Dee once each day. Soon I was calling her hourly between patients. I needed every ounce of energy to concentrate at work.
Usually it takes six weeks for antidepressants to work. I developed a new appreciation for patients who quietly and calmly suffer, waiting for their meds to kick in. I was terrified that I might feel worse if I stopped the bupropion or changed drugs. I was determined to stick it out despite my deteriorating physical and mental health; I was following the advice I had given hundreds of patients. I forced myself to eat but still lost 10 pounds. Sometimes I felt paranoid, and I wondered if I was delusional. When I wasn't working, I was curled in a fetal position, contemplating whether I should hospitalize myself.
At last, I called a couple of friends who are psychiatrists. Dee and I couldn't figure out whether the bupropion was helping or hurting, so I asked for their input. Their experience prescribing antidepressants was similar to mine. We had had patients who did poorly on one medication or another, disliked this or that side effect. In most cases, we were able to switch to another medication that worked. I dragged out books and journals and scoured the Internet for information. I knew that 10 percent of patients stopped treatment because of intolerable side effects when bupropion was initially being tested. But nothing I read helped me compare my experience with those of other patients who had quit taking it.
So I called another friend. She put me in touch with a journalist who had taken bupropion after his girlfriend died. He was a former cocaine user, and he told me he couldn't stand how bupropion made him feel. His symptoms were similar to mine. He said it was like coming off a coke high, that he would choose grief any day over bupropion. I found something that connected the dots in a press release about a Stanford study on antidepressant side effects. The researchers had identified a genetic marker that explained why some people couldn't tolerate specific medications. I suspected that I was one of those people.
After four weeks, I had had enough, so I tapered off the bupropion. My symptoms -- the insomnia, lack of appetite, agitation and panic attacks -- continued for three weeks after I took my last tablet. I felt weak for a month, as if I had just recovered from the flu. Yet for some mysterious reason, I haven't been depressed since. I don't quite understand how or why I continued to work through it all. I had convinced myself that I was just one of many physicians who went to work every day, in sickness or in health, upbeat or laid low. I hate to think of how many other people may be suffering similar side effects without knowing the cause of their misery. If finding useful information was so difficult even for a physician like me, how do most people with antidepressant toxicity fare? In my case, a former cocaine user was more helpful than books, journals or even colleagues.
After taking bupropion, I describe potential side effects to my patients in much greater detail. Even though I continue to prescribe it, I'm hypervigilant about any signs of distress. If a patient complains of symptoms similar to mine, I switch meds immediately. In the past, I would have encouraged the patient to stick it out, anticipating that most side effects would eventually pass. I wonder where I'd be now if I had followed my own advice.
Nanette Gartrell is an associate clinical professor of psychiatry at University of California, San Francisco.
Posted by ann72 on January 7, 2004, at 7:39:37
In reply to Re: hypomania, posted by kattay on January 6, 2004, at 19:19:40
your story had inspired me also. I am trying to figure out if i am bpII or what. It seems all the meds Ive taken dont have in the long run. I am taking effexor xr and started because of anxiety issues, now i'm very depressed and even wish i were dead sometimes...i wish i could find the right pdoc and cure for me..i just have to hang in there and so do u.
Posted by Zellie on January 7, 2004, at 7:44:00
In reply to well, well, well: Shrink takes own medicine!, posted by zinya on January 7, 2004, at 2:41:30
Wow! What an encouragement, to see the humility of that physician...her desire to share her very humbling experience. I will copy it and take it to my pdoc, who will super appreciate it. He loves learning about what his patients go through, so he can be even more helpful.
Thanks so much.
Kindest regards,
Zellie
Posted by T_R_D on January 7, 2004, at 11:21:06
In reply to Re: Brain zappage after missing just one day?, posted by Lyrical13 on January 5, 2004, at 4:56:10
> I don't think I've experienced this brain zap that many people have mentioned. What does it feel like?
I describe my experience as my brains feeling like scrambled eggs being thrown against a brick wall. I used to get really bad "jolts" if you will...
Posted by LenoreW on January 7, 2004, at 11:21:17
In reply to Womanly Question, posted by Gummybear on January 4, 2004, at 16:28:01
One thing they know Effexor can do is raise prolactin levels, which I'm guessing could have effects on estrogen and other hormones even if the drug doesn't effect them directly. (I personally think Effexor does effect estrogen directly, based on my own experience with it.)
Posted by KimberlyDi on January 7, 2004, at 11:34:19
In reply to loved the sentence about normal also, posted by Lyrical13 on January 6, 2004, at 20:42:26
did tx mean Texas?
Heck yes, we're the only normal ones! From the wide open spaces to the ever-changing weather, it keeps a person humble.
LOL, Colorado is beautiful also though.
Posted by zinya on January 7, 2004, at 11:51:14
In reply to Re: Womanly Question, posted by LenoreW on January 7, 2004, at 11:21:17
I'm with Lenore here. I've mentioned previously on the board here my own view - sorry i don't know where/how to link to it - but i detailed my own carpal tunnel recurrence on Effexor and the only previous time i had carpal tunnel was 3 yrs ago when my HRT had been totally upended (by insurance companies deciding my form was no longer a "formulary" -- blech! - and obliging me to try a different brand they saw as equivalent -- it WASN"T ...
And in the throes of that experience, i discovered at least some studies that already had linked carpal tunnel to estrogen, studies which had been triggered by seeing the high incidence of carpal T during menopause...
Such things as sweating -- which some of us experienced in buckets on Effexor -- is definitely regulated at least in part by hormones.
I have to say: For at least a decade, i've had little patience with doctors who say "Ohhhh hormones [or whatever] have no connection to ... [fill in the blank]" .... Geez. Wake up to holistic understandings of body processes, mds, not to mention adding in the body-mind connection too.
The adrenal glands are pivotal, manufacturing site for hormones, for obviously adrenalin, and there's no way an impact on production of one adrenal output is not going to affect its production of others... Just narrow-minded poppycock...
It's been a while since i recommended this book here, so perhaps it's timely to do so again. To me, it's a veritable Bible -- or Atlas? -- or encyclo (pick your religious or secular metaphor :) -- of vital such info from a very enlightened woman doctor (from Maine, as i recall) -- This is, imho, a "must-buy" for all women. How's THAT for an endorsement? :)
Christiane Northrup's "Women's Bodies, Women's Wisdom""
(once more with feeling - i'm trying Dr. Bob's system here to link to amazon but it's saying Amazon doesn't have it. Yet i can see it right on amazon's site - Something's wrong with the amazon link here but anyway it's available, $13 new, $8 used... :))
She's an advocate of naturalistic "solutions" whenever possible, she's a guru on the types and key distinctions of types of estrogen and HRT in general, as well as the pivotal role of the adrenal gland -- which nobody ever learns enough about, imo -- hence my thinking of her again in this context...
Posted by Jaynee on January 7, 2004, at 13:27:46
In reply to Re: hypomania, posted by ann72 on January 7, 2004, at 7:39:37
Ann, have you tried anything other than Effexor? I tried Effexor xr for about 5 weeks, and it made me so incredibly depressed and anxious. I cried for about 4 hours a day on Effexor and I haven't cried in 2 years. I quit the effexor and started back on Celexa and I am doing "way" better.
Maybe effexor isn't working for you?
Posted by melley on January 7, 2004, at 16:54:15
In reply to loved the sentence about normal also, posted by Lyrical13 on January 6, 2004, at 20:42:26
Just thought I'd check back in. I've been off effexor since June. What a difference! I think effexor is truly an evil drug. I am now on lexapro--a nice gentle drug that still leaves you with feelings. I think with effexor affecting two parts of your brain it is no wonder it is a dangerous drug.
Posted by Lyrical13 on January 7, 2004, at 19:45:55
In reply to Re: THANKS.... FlyLady.com » Mercedes, posted by Zellie on January 6, 2004, at 23:05:10
I'm curious about this flylady. I jotted down the website but haven't checked it out yet. I too have tons of clutter to work through. I started on it last spring when I was a bit hypomanic and I started pitching stuff and downsizing and organizing like crazy. But I would like to have a more calm consistent approach to getting to a more orderly organized clutter-free state and maintaining that. I have so much clutter from years of packrat existence that the task of weeding through it is overwhelming at times. I try to break it down into small manageable tasks..and it helps.. the thing is, I really need help on managing things the most during my depressed phases...that's when things really get out of control and I can't find the motivation or brainpower or energy to do anything.
Does it cost to join this site? Does she e-mail you personally or is it kind of a newsletter kind of thing? It sounds very interesting and helpful.
Also, have any of you ever heard of crazy lady organizers? A friend on mine had one...it's like a day planner but it has pages geared more towards managing a household. Very nifty. Also had purses that looked very functional...help to keep things organized without hauling around a suitcase... I looked for them on the web but haven't been able to find them.
ONe more question. Do any of you watch Clean Sweep on TLC? I love that show. It is inspiring me to de-clutter my life and get rid of stuff. It's on weeknights from 6-7pm Eastern and on Saturday nights...I think at 10pm Eastern. I'm not sure when else. It has a carpenter, organizer and interior designer plus a team of workers. They go to a couple's house and help them clean and organize 2 rooms that are just out of control with clutter and mayhem. THey move everything out onto their lawn and they have to sort all the stuff into "KEEP", "TOSS" or "SELL" piles. AFter the couple does the initial sort, the organizer comes out and helps them get the KEEP pile pared down some more. They go to a hotel overnight and usually have some kind of organizing task like sorting their photos into categories or thinning out and organizing their files. The next day they come back and have a yard sale. Whatever doesn't get sold is carted off to charity. Meanwhile, the clean sweep team completely redecorates and organizes the 2 rooms and at the end you get to see the finished rooms. I've gotten a lot of great organizing ideas and also gotten some guidelines on how to weed through all my stuff. I've started taking a clean sweep approach to small areas of my house at a time. I'm slowly building a pile of stuff for a yard sale next summer and pitching a lot of stuff and figuring out how to better organize the stuff I am keeping.
Anyway, I thought that related to the flylady discussion and perhaps could be helpful to some of you.
TTFN as Tigger would say!
L13
Posted by Lyrical13 on January 7, 2004, at 20:02:31
In reply to Re: hypomania, posted by ann72 on January 7, 2004, at 7:39:37
I just thought of something else. I am on 225mg of Effexor XR. At first it was wonderful.. actually for probably 8 or 9 months after I got to a therapeutic level. But then my next cycle of depression hit. That's when I was increased eventually to 225mg but was still having so much trouble. very very depressed and thinking that I just wanted to crawl under a rock and die. I switched docs because my old one kept telling me to "wait" and I was falling apart at work..crying for no particular reason... sobbing and sobbing and I didn't even know why.
My new pdoc told me that for my type of depression where I've tried several different ADs and have even maxed out a couple of them but was still having difficulty one med alone wouldn't do it. He said we needed to augment the Effexor in one of 4 ways (boost its effectiveness):
1. Another AD that worked on a different chemical
2. Thyroid medication
3. Mood stabilizer
4. Atypical API wanted to do thyroid because of very few side effects. But it would take quite a while to get up to a therapeutic level and I was barely hanging on. So I started SEroquel..an atypical AP because it would start working quickly. BAsically, a dose for a schizophrenic or other type of problem APs are prescribed for would be on a dose of 400-500mg. But for augmenting an AD teh max dose would be about 100mg. I started at 25mg. Within about 3 days I was significantly improved. By the end of the first week, I was about 200% better. AFter 2 weeks I increased to 50mg and now I am wonderful. That's my dose now. I made it through the holidays feeling better than I remember feeling since I was a small child. Usually at the end of vacation I feel a little bummed about going back to work. This time I felt perfectly fine...sometimes even cheerful. Still have normal range of emotions. I'm a bit hypomanic now, but I think that's because my true dx is BP2. But the above approach is designed to work for unipolar depression which is what I thought I was for the past 13 years.
HOpe this helps.
L13
Posted by Lyrical13 on January 7, 2004, at 20:04:47
In reply to Re: loved the sentence about normal also » Lyrical13, posted by KimberlyDi on January 7, 2004, at 11:34:19
But I did live in TExas for 12 years... :)
Posted by Lyrical13 on January 7, 2004, at 20:12:26
In reply to Re: Womanly Question, posted by zinya on January 7, 2004, at 11:51:14
Thank you! I've been saying the same thing for a long time! How can it NOT be related? Everything that happens with our bodies impacts other parts of our bodies. I have that book but my sis has it right now. I want to go back to it and read about the adrenal glad because I have always thought that mine must be messed up. I have anxiety and I also have hypoglycemia and the adrenal gland is very much involved in regulating blood sugar. I also have endometriosis and a hx of ovarian cysts. I've always thought that they must be inter-related. Basically my endocrine system is FUBARed.
also, I wonder about your mention of carpal tunnel. I've been having a lot of problems with that lately and also a lot of stiffness in my hands. I thought it was related to how much time I've been spending on the computer...but it doesn't seem like it's incredibly excessive though it could play a part. And I know the ergonomics of my desk are all wrong. I've been trying to compensate...put the keyboard down on the middle drawer, put the mouse down on another pulled out draw with a book on top of the drawer, raise the monitor by putting a couple books under it (good thing I have a lot of books!) But I know it's still not quite right.
Hmmm.. could you elaborate on the Effexor and carpal tunnel angle? Thanks
Posted by Zellie on January 7, 2004, at 20:48:17
In reply to flylady info, posted by Lyrical13 on January 7, 2004, at 19:45:55
Dear Tigger (Lyrical13):
You will LOVE the FlyLady site, based on what you've shared. It is well-paced, sensible, consistent, and wise in its de-cluttering and organizational methods.
It is free! I am already signed up with Yahoo, (which also was free to join), so when I went to sign up for FlyLady, my same password and user name signed me up automatically.
It is way awesome. No, the e-mails are not individualized...but they are sent out daily to all. If there are any that you do not have time to read or do, then you are urged to simply delete them, so you never feel "behind." Although the e-mails are not personalized, it feels as though they are, since they are so pertinent! This woman knows the things that plague we organizationally and motivationally impaired individuals!
Let me know what you think, if you join, once you've worked with it for a few days or for a week or so. For me, it has been such a blessing. My husband loves the changes it is making in my life and in our home. So do I.
Kindest regards,
Zellie
> I'm curious about this flylady. I jotted down the website but haven't checked it out yet. I too have tons of clutter to work through. I started on it last spring when I was a bit hypomanic and I started pitching stuff and downsizing and organizing like crazy. But I would like to have a more calm consistent approach to getting to a more orderly organized clutter-free state and maintaining that. I have so much clutter from years of packrat existence that the task of weeding through it is overwhelming at times. I try to break it down into small manageable tasks..and it helps.. the thing is, I really need help on managing things the most during my depressed phases...that's when things really get out of control and I can't find the motivation or brainpower or energy to do anything.
>
> Does it cost to join this site? Does she e-mail you personally or is it kind of a newsletter kind of thing? It sounds very interesting and helpful.
>
> Also, have any of you ever heard of crazy lady organizers? A friend on mine had one...it's like a day planner but it has pages geared more towards managing a household. Very nifty. Also had purses that looked very functional...help to keep things organized without hauling around a suitcase... I looked for them on the web but haven't been able to find them.
>
> ONe more question. Do any of you watch Clean Sweep on TLC? I love that show. It is inspiring me to de-clutter my life and get rid of stuff. It's on weeknights from 6-7pm Eastern and on Saturday nights...I think at 10pm Eastern. I'm not sure when else. It has a carpenter, organizer and interior designer plus a team of workers. They go to a couple's house and help them clean and organize 2 rooms that are just out of control with clutter and mayhem. THey move everything out onto their lawn and they have to sort all the stuff into "KEEP", "TOSS" or "SELL" piles. AFter the couple does the initial sort, the organizer comes out and helps them get the KEEP pile pared down some more. They go to a hotel overnight and usually have some kind of organizing task like sorting their photos into categories or thinning out and organizing their files. The next day they come back and have a yard sale. Whatever doesn't get sold is carted off to charity. Meanwhile, the clean sweep team completely redecorates and organizes the 2 rooms and at the end you get to see the finished rooms. I've gotten a lot of great organizing ideas and also gotten some guidelines on how to weed through all my stuff. I've started taking a clean sweep approach to small areas of my house at a time. I'm slowly building a pile of stuff for a yard sale next summer and pitching a lot of stuff and figuring out how to better organize the stuff I am keeping.
>
> Anyway, I thought that related to the flylady discussion and perhaps could be helpful to some of you.
>
> TTFN as Tigger would say!
>
> L13
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