![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 55. This is the beginning of the thread.
Posted by jmb2012 on April 30, 2011, at 20:21:15
Hi. New poster, long-time site user.
Me: 29 y/o non-traditional Pre med student with a pretty high amount of innate and stress-induced agitated-depression. Diagnosed about two years ago but definitely been with me since early childhood. On low dose lexapro to prevent the "darkness" from taking over.
The lex was effective at limiting the severe drops in mood. Never suicidal but experienced cycles of excessive worry/over thinking--> fried-brain depression--> pretty serious anger and aggression (the only "lift" in mood)--> back to "fried brain" depression and so on. Ruined some potentially incredible life experiences.
I don't handle chronic, unavoidable, non physical stress well. IF I had to climb a mountain or fend off a bear I'd do much better. But having to wake up and face something that is unremittingly unpleasant, and totally unavoidable is not my strong suit. It's why I am in therapy.
The lex wasn't cutting it alone.
We tried buspar then lamictal. Nothing
Then we tried gabapentin. At first nothing. Went off for 4 months, forgotten until last winter break. In a desperate attempt to slow my brain and relax I took a larger dose of gabapentin-(gp) from 300mg to 1200mg.
GABAPENTIN:THE GOOD:
Profound improvement of mood and a slowing of my brain. I felt normal, above normal, I felt good. I was able to focus, socialize and enjoy pretty much whatever I was doing. I was the best, most functional, most charming, considerate and peaceful version of my self. If I could be like that all the time, I thought, I could face anything. It was incredible. I had never felt so normal and able to enjoy life. In other words I was on a drug. I wish my brain naturally was more like this. Alas. Over time the extremely short active life of GP began causing a roller coaster effect during the day. I would take it, 1-2 hours later I felt the lift of mood and increase of happiness/positivity. 2-3 hours after that I felt myself begin to plunge back into my normal state of blah/moodiness/keyed up adrenaline response. So I'd take it again and the cycle continued. A moderate tolerance developed but it was ok. Getting tears in my eyes while working the pediatric unit in the hospital had is drawbacks.THE BAD: Psychological, physical, both or otherwise- dependence has developed. I have NEVER been addicted to anything. I understand the process and condition much better now. You are free of your defective mind when high. The better part of you is able to rise and express itself. GP gets you functionally high. I get it now when junkies say " I'm sick man. I need my medicine". While I have not experienced any serious somatic (body) symptoms- jitteryness, some dizziness maybe-- I have DEFINITELY experienced psychological ones. It's either the contrast between my natural, base, mental state and my GP elevated state, straight up physical withdrawal symptoms or a combo of both but when that stuff wears off I am not happy. Everything comes rushing back in with the force of a torrent breaking through a dam.
*Briefly*: the mechanism of GP is still somewhat in question right? Recent studies however have identified it's activity on voltage gated ion channels- exerting a membrane potential and anti-"kindling" stabilizing effect. They also discovered it acts on a number of enzymes, the net result of which supposedly reduce GLUTAMATE synthesis and release while increasing GABA production and slowing or inhibiting its breakdown. GP's activity on glutamate metabolism strikes the strongest note with me. IT FEELS, no proof, that when the GP wears off the brain compensates for it's reduced glutamate load. That or like benzos the brain becomes unable to properly regulate the GABA/GLUTAMATE inhib/excitatory balance. AGAIN THIS IS ALL SPECULATION. PLEASE SOUND OFF ON THIS IF ANY ONE CARES.
FINAL: I am in love with this drug. I am in love with the way it brings out my best. It's like meditation/happiness in a pill. I will not be able to tolerate it's kinetics though so I am doing two things: 1. Getting an rx for Lyrica. This is not something I do lightly. I know that I am going to have the same if not worse dependence issues on pregab as I am having with GP. BUT I cannot function without some effective form of brain brakes. I have ordered some Dilantin in a last ditch effort to avoid going on a gaba drug. The scant evidence for low dose ( 100-150mg) efficacy in brain impulse control is appealing but un-conclusive. We will see.
That's it really. PLEASE comment or ask me questions. This is a huge post and I only burden this site with it because I have not seen many detailed GP/Agitated depression experiences posted.
I pray that that the road I have traveled so far can offer some assistance to others. If you are walking a similar path in similar shoes please comment. This is an incredible, horrible drug but I seem to need it.
Thanks and blessings to those who listened. Our modern life is not natural. It puts stresses on our system we have not had time to evolve into. I pray that peace comes to all of us.
Posted by mtdewcmu on April 30, 2011, at 23:49:44
In reply to PLEASE READ.Pro/con:Gabapentin-agitated depression, posted by jmb2012 on April 30, 2011, at 20:21:15
> Hi. New poster, long-time site user.
> Me: 29 y/o non-traditional Pre med student with a pretty high amount of innate and stress-induced agitated-depression. Diagnosed about two years ago but definitely been with me since early childhood. On low dose lexapro to prevent the "darkness" from taking over.Are you planning to go to med school? I would not attempt that with my preexisting psych issues. I read that a lot of previously healthy people become suicidal in response to all the pressure and competition.
> The lex was effective at limiting the severe drops in mood. Never suicidal but experienced cycles of excessive worry/over thinking--> fried-brain depression--> pretty serious anger and aggression (the only "lift" in mood)--> back to "fried brain" depression and so on. Ruined some potentially incredible life experiences.
> I don't handle chronic, unavoidable, non physical stress well. IF I had to climb a mountain or fend off a bear I'd do much better. But having to wake up and face something that is unremittingly unpleasant, and totally unavoidable is not my strong suit. It's why I am in therapy.
> The lex wasn't cutting it alone.
> We tried buspar then lamictal. Nothing
> Then we tried gabapentin. At first nothing. Went off for 4 months, forgotten until last winter break. In a desperate attempt to slow my brain and relax I took a larger dose of gabapentin-(gp) from 300mg to 1200mg.
> GABAPENTIN:
>
> THE GOOD:
> Profound improvement of mood and a slowing of my brain. I felt normal, above normal, I felt good. I was able to focus, socialize and enjoy pretty much whatever I was doing. I was the best, most functional, most charming, considerate and peaceful version of my self. If I could be like that all the time, I thought, I could face anything. It was incredible. I had never felt so normal and able to enjoy life. In other words I was on a drug. I wish my brain naturally was more like this. Alas. Over time the extremely short active life of GP began causing a roller coaster effect during the day. I would take it, 1-2 hours later I felt the lift of mood and increase of happiness/positivity. 2-3 hours after that I felt myself begin to plunge back into my normal state of blah/moodiness/keyed up adrenaline response. So I'd take it again and the cycle continued. A moderate tolerance developed but it was ok. Getting tears in my eyes while working the pediatric unit in the hospital had is drawbacks.
>There is a time-release gabapentin now. It wasn't developed for psychiatric use, but maybe you would find it useful anyway.
> THE BAD: Psychological, physical, both or otherwise- dependence has developed. I have NEVER been addicted to anything. I understand the process and condition much better now. You are free of your defective mind when high. The better part of you is able to rise and express itself. GP gets you functionally high. I get it now when junkies say " I'm sick man. I need my medicine". While I have not experienced any serious somatic (body) symptoms- jitteryness, some dizziness maybe-- I have DEFINITELY experienced psychological ones. It's either the contrast between my natural, base, mental state and my GP elevated state, straight up physical withdrawal symptoms or a combo of both but when that stuff wears off I am not happy. Everything comes rushing back in with the force of a torrent breaking through a dam.
>I found gabapentin pleasant at first, but the effect quickly diminished to where I could not tell if I had taken any. Ergo, I wasn't that impressed with it. But my history is not free from "real" recreational drug use. So, presumably, I've had better.
> *Briefly*: the mechanism of GP is still somewhat in question right? Recent studies however have identified it's activity on voltage gated ion channels- exerting a membrane potential and anti-"kindling" stabilizing effect. They also discovered it acts on a number of enzymes, the net result of which supposedly reduce GLUTAMATE synthesis and release while increasing GABA production and slowing or inhibiting its breakdown. GP's activity on glutamate metabolism strikes the strongest note with me. IT FEELS, no proof, that when the GP wears off the brain compensates for it's reduced glutamate load. That or like benzos the brain becomes unable to properly regulate the GABA/GLUTAMATE inhib/excitatory balance. AGAIN THIS IS ALL SPECULATION. PLEASE SOUND OFF ON THIS IF ANY ONE CARES.
>
> FINAL: I am in love with this drug. I am in love with the way it brings out my best. It's like meditation/happiness in a pill. I will not be able to tolerate it's kinetics though so I am doing two things: 1. Getting an rx for Lyrica. This is not something I do lightly. I know that I am going to have the same if not worse dependence issues on pregab as I am having with GP. BUT I cannot function without some effective form of brain brakes. I have ordered some Dilantin in a last ditch effort to avoid going on a gaba drug. The scant evidence for low dose ( 100-150mg) efficacy in brain impulse control is appealing but un-conclusive. We will see.
>Why Lyrica? It appears to have about the same half-life as gabapentin. I have not heard of Dilantin being used in psychiatry, so I assumed it was dangerous or had some unbridgeable issue.
Do you think you may be investing more power in gabapentin than it really has? Maybe it's not doing all that much for you.
Even though gabapentin is no heroin or crack, it concerns me how you are describing your relationship to this med. It sounds like you could be a full-blown drug addict waiting to happen. Are you sure you want to move up to Lyrica, which is actually a controlled-substance (if barely)? I think you would be better served to nip the potential addiction problem in the bud and look for non-addicting meds that may work. Since you have had some success with anticonvulsants, perhaps try some others that are used in psychiatry, like Depakote or Topamax (I haven't tried those, they just came to mind). Anticonvulsants are not often used as monotherapy outside bipolar, so maybe experiment some more with antidepressants.
I don't like to be a wet blanket, and I don't expect to be live a completely clean life in the future. But while you still haven't experienced a serious drug problem and thus have a choice, you should probably give some thought to whether you want to blindly feed this need for a chemical escape hatch, or if you should go the other route and look for meds/solutions that are less, not more, likely to become an obsession. Just feel like it needed to be said.
> That's it really. PLEASE comment or ask me questions. This is a huge post and I only burden this site with it because I have not seen many detailed GP/Agitated depression experiences posted.
>
> I pray that that the road I have traveled so far can offer some assistance to others. If you are walking a similar path in similar shoes please comment. This is an incredible, horrible drug but I seem to need it.
> Thanks and blessings to those who listened. Our modern life is not natural. It puts stresses on our system we have not had time to evolve into. I pray that peace comes to all of us.
>Hope you stick with us. It was an entertaining post.
Posted by Phillipa on May 1, 2011, at 0:11:08
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression » jmb2012, posted by mtdewcmu on April 30, 2011, at 23:49:44
I agree about med school as the stress involved could possible put you over the edge. Medicine has become so stressful. Was a nurse it put me over the edge and I loved my job. Phillipa
Posted by jmb2012 on May 1, 2011, at 0:15:18
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression » jmb2012, posted by mtdewcmu on April 30, 2011, at 23:49:44
I appreciate your candor. Is my need for something to slow my thoughts and ease my tendency towards anxiety more troubling than a person on benzodiazepines? On Dr's orders I have been taking Stavzor over the past week , 500mg in an attempt to see comparable mind calming results but so far nothing. Not sure how long it'll take.
Any idea what the name of the time release gabapentin is? I know there's one in the pipeline. Didn't know one was out yet.
Posted by mtdewcmu on May 1, 2011, at 1:05:28
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression, posted by jmb2012 on May 1, 2011, at 0:15:18
> I appreciate your candor. Is my need for something to slow my thoughts and ease my tendency towards anxiety more troubling than a person on benzodiazepines? On Dr's orders I have been taking Stavzor over the past week , 500mg in an attempt to see comparable mind calming results but so far nothing. Not sure how long it'll take.
> Any idea what the name of the time release gabapentin is? I know there's one in the pipeline. Didn't know one was out yet.It looks like there's one called Gralise and another one called Horizant. Not sure if you can buy them yet.
I'm not judging you or your use of gabapentin. But it sounds like you are having trouble taking enough gabapentin to maintain the effect due to tolerance, and the gabapentin and its crash or withdrawal has become a preoccupation. If it was working well for you, I'd be happy for you.
Drug addiction is a state of mind. If you are at peace with the drug and its limitations, then you're not in the danger zone. It may not be physically possible to have a serious problem with gabapentin, but if you are conditioned to relate to chemicals in an unhealthy way, you could run into trouble if you come across a potentially more harmful drug somewhere down the line.
Posted by Christ_empowered on May 1, 2011, at 4:24:57
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression » jmb2012, posted by mtdewcmu on May 1, 2011, at 1:05:28
If you like gabapentin, get that Lyrica script ASAP. Maybe you'll be able to get better results w/ less sedation? One thing I noticed about gabapentin...over time, it made me stupid. Since Lyrica is stronger, maybe you'll be able to get even better results w/o cognitive impairment (?).
Personally, I'd just take a low-dose, high-potency BZD...cheaper, proven effective, etc. etc. But that's just me.
I wouldn't worry too much about addiction. Some people find gabapentin pleasant; that's really not a big deal. I mean, who said psychiatric treatment HAS to be an unpleasant experience? As long as you're keeping up with your program and able to function, keep poppin' the Neurontin (or Lyrica).
Good luck.
Posted by SLS on May 1, 2011, at 5:11:14
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression, posted by Christ_empowered on May 1, 2011, at 4:24:57
> If you like gabapentin, get that Lyrica script ASAP. Maybe you'll be able to get better results w/ less sedation? One thing I noticed about gabapentin...over time, it made me stupid. Since Lyrica is stronger, maybe you'll be able to get even better results w/o cognitive impairment
I agree. There is no guarantee, of course, but Lyrica also inhibits alpha2delta calcium channels in the same way as Neurontin.
> I wouldn't worry too much about addiction. Some people find gabapentin pleasant; that's really not a big deal. I mean, who said psychiatric treatment HAS to be an unpleasant experience? As long as you're keeping up with your program and able to function, keep poppin' the Neurontin (or Lyrica).
I agree - again. Judge the result and not the theory. Cognitive impairment is a possible side effect of both Neurontin and Lyrica. Since there are no long-term irreversible side effects reported for either drug, I would consider a trial with Lyrica if Neurontin has plateaued for you. The pharmacokinetics of the two drugs are very different. Lyrica gets into the brain to a greater extent.
http://www.ncbi.nlm.nih.gov/pubmed/20818832
Good luck.
- Scott
Posted by SLS on May 1, 2011, at 5:36:38
In reply to PLEASE READ.Pro/con:Gabapentin-agitated depression, posted by jmb2012 on April 30, 2011, at 20:21:15
Hi.
> Briefly*: the mechanism of GP is still somewhat in question right? Recent studies however have identified it's activity on voltage gated ion channels- exerting a membrane potential and anti-"kindling" stabilizing effect. They also discovered it acts on a number of enzymes, the net result of which supposedly reduce GLUTAMATE synthesis and release while increasing GABA production and slowing or inhibiting its breakdown. GP's activity on glutamate metabolism strikes the strongest note with me. IT FEELS, no proof, that when the GP wears off the brain compensates for it's reduced glutamate load. That or like benzos the brain becomes unable to properly regulate the GABA/GLUTAMATE inhib/excitatory balance. AGAIN THIS IS ALL SPECULATION. PLEASE SOUND OFF ON THIS IF ANY ONE CARES.
Your speculation is very logical. Do you think you could find any literature describing the enzymatic activity? I don't think Neurontin inhibitsl sodium channels, so I am interested in what other ways it reduces glutamate and increases GABA.
Do you feel a brief lifting of mood immediately upon dosage reduction?
I experienced a significant improvement in depression and anxiety any time I would start Neurontin that would fade within a few hours to a few days.
Someone raised some concerns regarding your psychological component to returning to Neurontin repeatedly. Although there is some physiological accommodation to the effects of Neurontin, withdrawal is usually uneventful if tapered gradually. In other words, dependence is generally not an issue. However, you very well could be attached to Neurontin emotionally in a rollercoaster fashion (approach-avoidence). I imagine you are somewhat impulsive and impatient when self-medicating. It will difficult to change your approach toward treatment. I believe you must be methodical in choice of drug and choice of trial period.
Are you a perfectionist or somewhat obsessive?
- Scott
Posted by linkadge on May 1, 2011, at 19:25:48
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression » jmb2012, posted by mtdewcmu on April 30, 2011, at 23:49:44
>Are you planning to go to med school? I would >not attempt that with my preexisting psych >issues. I read that a lot of previously healthy >people become suicidal in response to all the >pressure and competition.
Thanks for the encouraging words! I wouldn't call it a right off just because of existing mental issues. I was told the same thing with the math degree I took. There are many other factors involved. That being said, klonazepam made me a real idiot.
Linkadge
Posted by mtdewcmu on May 1, 2011, at 20:15:11
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression, posted by linkadge on May 1, 2011, at 19:25:48
> >Are you planning to go to med school? I would >not attempt that with my preexisting psych >issues. I read that a lot of previously healthy >people become suicidal in response to all the >pressure and competition.
>
> Thanks for the encouraging words! I wouldn't call it a right off just because of existing mental issues. I was told the same thing with the math degree I took. There are many other factors involved. That being said, klonazepam made me a real idiot.
>I didn't mean to be discouraging to all people with a psych diagnosis, but that's how I feel about me. I worked at a teaching hospital, and the new physicians I met all seemed to be functioning at a higher level of mental health than I was. If my ADD issues had been treated, then maybe. I don't think of math as being all that high pressure. Assuming you are talking about undergraduate. I made it through undergraduate computer science, although not without experiencing florid MH problems and being somewhat scarred by the experience.
Posted by B2Chica on May 2, 2011, at 12:39:27
In reply to PLEASE READ.Pro/con:Gabapentin-agitated depression, posted by jmb2012 on April 30, 2011, at 20:21:15
Hi.jmb2012
have aggitated depression/BP mixed whatever they feel like calling it. sometimes its psychotic depression...
ANYWAY.
am on gabapentin now.
like you between 600mg -1500/day.
depending on anxiety.i feel in about 20min a slight effect. i dont get the relaxed feeling till i swear 2 hours later. then it lasts for about 2 hours and i need to take again.
i normally take 600 in morning, and 300 thereafter.every 4 hours till late afternoon/evening.i dont know if its a tolerance so much as my anxiety getting better and worse. so i adjust meds to compensate.
and i think i only notice (addictive qualities) at night trying to sleep. my body is used to either gaba or xanax (or both) for sleep. and if i take less or none i have real difficulties.
i do get "addicted" to that high i feel about 2 hours after taking. but i dont like the lethargy it leaves me with. when my anxiety is high i like it because it FORCES my body to relax. but when anxiety is lower i dont like to take as much or any if i can avoid it cuz then i get too tired.
i dont know if i relate or not, but there's my experience with it.
Thanks for posting!
b2c.
Posted by Jmb2012 on May 2, 2011, at 13:07:59
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression » jmb2012, posted by B2Chica on May 2, 2011, at 12:39:27
Thank u b2c. Just came back from dr. After explaining situation he wrote me an rx for 1000mg Depakote er. I'll search the site for experiences and advice. One thing that sprung to my obsessive mind is that Depakote and many other anticonvulsants are known to raise insulin levels causing hyperinsulinemia. This is thought to b a possible cause of weight gain and, potentially, hair loss-- seeing that excess Insulin raises testosterone which downstream can cause hairloss. Any one want to sound off on that? Also thinking neurotically abou medicine as I do, was wondering if metformin or even cinnamon, the first being s treatment for hyperinsulinemia , would help ameliorate the anticonvulsant Induced high insulin.
Hopefully some of the really smart people I have seen on this site will put their .02$ in.
Posted by mtdewcmu on May 2, 2011, at 14:18:26
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression, posted by Jmb2012 on May 2, 2011, at 13:07:59
> One thing that sprung to my obsessive mind is that Depakote and many other anticonvulsants are known to raise insulin levels causing hyperinsulinemia. This is thought to b a possible cause of weight gain and, potentially, hair loss-- seeing that excess Insulin raises testosterone which downstream can cause hairloss. Any one want to sound off on that? Also thinking neurotically abou medicine as I do, was wondering if metformin or even cinnamon, the first being s treatment for hyperinsulinemia , would help ameliorate the anticonvulsant Induced high insulin.
Interestingly enough, Depakote does seem to be capable of causing hair loss (alopecia). A quick way to check side effects is rxlist.com. Did you already know that, or were you predicting it from its effects on hormones? It seems a tad speculative to recommend an add-on, especially for a side effect that you have not yet demonstrated trouble with.
Thinking a little more about your situation -- if this latest trial does not do the trick, maybe you have been barking up the wrong tree with anticonvulsants. Gabapentin sounds like it is giving you an alcohol-like buzz. Anything that causes euphoria will tend to make your problems go away. However, I don't think that can be taken as evidence that you will respond to a non-euphoric anticonvulsant. Maybe you should go back to trying more standard psychiatric meds. I don't recall your exact symptoms, but it sounded like an anxiety disorder. There are other med classes that have better established records in anxiety disorders.
Posted by B2chica on May 2, 2011, at 14:31:49
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression, posted by Jmb2012 on May 2, 2011, at 13:07:59
my pdoc told me about the hairloss with depakote cuz i was experiencing it with pristiq so he told me to take centrum silver. it is shown to work in people taking depakote...
Posted by linkadge on May 2, 2011, at 15:19:21
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression » linkadge, posted by mtdewcmu on May 1, 2011, at 20:15:11
>I didn't mean to be discouraging to all people >with a psych diagnosis, but that's how I feel >about me. I worked at a teaching hospital, and >the new physicians I met all seemed to be >functioning at a higher level of mental health >than I was.
IQ is an important factor that mitigates the interaction of learning and stress. A friend of mind suffered severe MDD, but it wasn't really stress induced. In addition, his ability to learn highly complex concepts on the first pass ultimately made law school manageable for him in spite of MDD (and epilepsy).
>If my ADD issues had been treated, then maybe. I >don't think of math as being all that high >pressure. Assuming you are talking about >undergraduate.
Well, the school I went to had the highest rate of suicide in the math and computer science programs (apparently) in the provice I'm in. However, I found teachers college more stresfull since my associate teacher had a Ph.D. and there was a long drive to my school (and other factors)
>I made it through undergraduate computer >science, although not without experiencing >florid MH problems and being somewhat scarred by >the experience.
Thats exactly the point. Some people are scarred by even high school experiences. It depends on the how stressful the individual precieves the experience to be, and this depends on individual abilities, mental health issues, and many other factors (financial capacity, family supports).
According to an article on medscape, clinical depression is a big problem in med school. This doesn't mean that many of these people don't get through, however.
Linkadge
Posted by mtdewcmu on May 2, 2011, at 16:30:30
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression, posted by linkadge on May 2, 2011, at 15:19:21
> >I made it through undergraduate computer >science, although not without experiencing >florid MH problems and being somewhat scarred by >the experience.
>
> Thats exactly the point. Some people are scarred by even high school experiences. It depends on the how stressful the individual precieves the experience to be, and this depends on individual abilities, mental health issues, and many other factors (financial capacity, family supports).
>My ability to accept new concepts is highly dependent on my level of stress/anxiety. There was a class in my major where I just could not get into the subject matter at the time. I went on to learn about the subject on my own years later when I was not feeling the same stress and anxiety.
Posted by linkadge on May 3, 2011, at 17:03:02
In reply to School and psychiatric illness » linkadge, posted by mtdewcmu on May 2, 2011, at 16:30:30
>My ability to accept new concepts is highly >dependent on my level of stress/anxiety. There >was a class in my major where I just could not >get into the subject matter at the time. I went >on to learn about the subject on my own years >later when I was not feeling the same stress and >anxiety.
Of course the issue has a reflexive nature. I.e. stress can affect ability to learn *and* ability to learn could reduce stress (at least in university).
Linkadge
Posted by SLS on May 3, 2011, at 18:17:13
In reply to Re: School and psychiatric illness, posted by linkadge on May 3, 2011, at 17:03:02
High levels of stress compounded by irregular sleep-wake cycles can trigger mental illness in those who are vulnerable to them. Even if an MI is adequately treated, being subject to new stressors can induce treatment-breakthrough (relapse). Attending medical school is a prime example of this.
I was crushed when my doctors at the National Institutes of Health recommended against my going to medical school if I wanted to maximize my chances of getting well and staying well. Their recommendations applied specifically to me. They were not meant to apply globally to all cases of MI.
I decided to take their recommendations. Maintaining my mental health must take precedence over career choice.
- Scott
Posted by Phillipa on May 3, 2011, at 21:57:13
In reply to Re: School and psychiatric illness, posted by SLS on May 3, 2011, at 18:17:13
It was recommended at the time when only on off and on benzos that RN school wasn't a good idea for me by a very good pdoc in Ct. I went anyway and for me the best thing I ever did. Took my mind off any problems and first divorce. Didn't effect me for 15 years which I will never forget. Graduated Magna c*m Laude. So for me it helped. But I didn't have the long hours that being a doc requires. Phillipa
Posted by mtdewcmu on May 3, 2011, at 23:19:01
In reply to Re: School and psychiatric illness, posted by linkadge on May 3, 2011, at 17:03:02
> >My ability to accept new concepts is highly >dependent on my level of stress/anxiety. There >was a class in my major where I just could not >get into the subject matter at the time. I went >on to learn about the subject on my own years >later when I was not feeling the same stress and >anxiety.
>
> Of course the issue has a reflexive nature. I.e. stress can affect ability to learn *and* ability to learn could reduce stress (at least in university).
>Hence the vicious cycle that I get into.
Posted by mtdewcmu on May 3, 2011, at 23:22:11
In reply to Re: School and psychiatric illness, posted by SLS on May 3, 2011, at 18:17:13
> High levels of stress compounded by irregular sleep-wake cycles can trigger mental illness in those who are vulnerable to them. Even if an MI is adequately treated, being subject to new stressors can induce treatment-breakthrough (relapse). Attending medical school is a prime example of this.
>
> I was crushed when my doctors at the National Institutes of Health recommended against my going to medical school if I wanted to maximize my chances of getting well and staying well. Their recommendations applied specifically to me. They were not meant to apply globally to all cases of MI.
>
> I decided to take their recommendations. Maintaining my mental health must take precedence over career choice.
>Even practicing as a doctor probably doesn't go very well with highly chronic and recurring MI.
Posted by desolationrower on May 3, 2011, at 23:25:41
In reply to Re: School and psychiatric illness, posted by mtdewcmu on May 3, 2011, at 23:22:11
> > High levels of stress compounded by irregular sleep-wake cycles can trigger mental illness in those who are vulnerable to them. Even if an MI is adequately treated, being subject to new stressors can induce treatment-breakthrough (relapse). Attending medical school is a prime example of this.
> >
> > I was crushed when my doctors at the National Institutes of Health recommended against my going to medical school if I wanted to maximize my chances of getting well and staying well. Their recommendations applied specifically to me. They were not meant to apply globally to all cases of MI.
> >
> > I decided to take their recommendations. Maintaining my mental health must take precedence over career choice.
> >
>
> Even practicing as a doctor probably doesn't go very well with highly chronic and recurring MI.otoh, having a high-status job is strongly associated with better handling of stress, through enhanced sense of personal power and efficacy.
-d/r
Posted by SLS on May 3, 2011, at 23:32:00
In reply to Re: School and psychiatric illness, posted by desolationrower on May 3, 2011, at 23:25:41
http://emedicine.medscape.com/article/806779-overview
On average, the United States loses the equivalent of at least one entire medical school class each year to suicide (reliable estimates are as many as 400 physicians).
Sadly, physicians globally have a lower mortality risk from cancer and heart disease relative to the general population, presumably relating to self-care and early diagnosis; however, physicians have a significantly higher risk of dying from suicide, the end stage of an eminently treatable disease process. Depression is a leading risk factor for myocardial infarction in male physicians. Although, as a profession, physicians seem to have heeded their own advice about avoiding smoking and other common risk factors for early mortality, they are decidedly reluctant to address a significant risk of both morbidity and mortality that disproportionately affects them.
In all populations, suicide is usually the result of untreated or inadequately treated depression coupled with knowledge and access to lethal means. Depression is at least as common in the medical profession as in the general population, affecting an estimated 12% of males and 18% of females. Depression is even more common in medical students and residents, with 15-30% screening positive for depressive symptoms. Because of stigma, self-reporting likely underestimates the prevalence of the disease in both populations.
Perhaps due in part to knowledge of and ready access to lethal means, completed suicide is far more prevalent among physicians than the public, with the most reliable estimates ranging from 1.4-2.3 times the rate in the general population. More alarming is that, after accidents, suicide is the most common cause of death among medical students. Although female physicians attempt suicide far less often than their counterparts in the general population, completion rates equal those of male physicians and, thus, far exceed that of the general population (2.5-4 times the rate by some estimates). A reasonable assumption is that underreporting of suicide as the cause of death by sympathetic colleagues might well skew these statistics, so the real incidence of physician suicide is probably somewhat higher.
The most common psychiatric diagnoses among physicians who complete suicide are affective disorders (eg, depression and bipolar disease), alcoholism, and substance abuse. The most common means of suicide by physicians are lethal medication overdoses and firearms.
Posted by mtdewcmu on May 3, 2011, at 23:39:14
In reply to Re: School and psychiatric illness, posted by desolationrower on May 3, 2011, at 23:25:41
> otoh, having a high-status job is strongly associated with better handling of stress, through enhanced sense of personal power and efficacy.
>I would believe that they are correlated, but it would be difficult to determine which way causation points. People who handle stress better would be more likely to desire high status.
Posted by mtdewcmu on May 3, 2011, at 23:53:07
In reply to Re: School and psychiatric illness, posted by SLS on May 3, 2011, at 23:32:00
> More alarming is that, after accidents, suicide is the most common cause of death among medical students.
That statistic is not that alarming, because accidents and suicide are the leading killers of everyone at that age (http://www.cdc.gov/injury/wisqars/pdf/Death_by_Age_2007-a.pdf). I don't mean to rip on your article, Scott, but I hate dumb statistics.
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