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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 10 to 34 of 54. Go back in thread:
Posted by katia on June 4, 2003, at 18:17:43
In reply to Re: Antidepressants and Bipolar Disorder? » katia, posted by Ron Hill on June 4, 2003, at 1:44:56
Hi,
Thanks for your long message. I was never properly diagnosed. I think i heard the words double depression last summer, but that was the first of many pdoc I'd go through in two different clinics. But no one has questioned me re: bipolar or not. I was always under the assumption that bipolar was accompanied with those wonderful euphorias people talk about with no need to sleep and tons of energy. I've never quite experienced classic "mania" so I always off the bat told the pdocs that I was definitely NOT manic depressive. and they believed me.I do have an appt. with a wellknown good pdoc on June 16th. I've waited over a month for it. I'm just paying out of pocket for it. and it's damn pricey. But I can't take this clinic anymore; I'm not getting proper care and as you said that can be worse than no care at all.
The last visit I had about two months ago, I suggested to the pdoc Serzone or Remeron. Since the samples they had were Serzone that's what he gave me. Great reasoning huh? that's about par for the course in my care for the past year. So I started on it and went hypomanic, I'm quite sure. stopped it, fell down a straight chute to hell; so started it again at a measly 50mg (people starting don't even start at this level). It seems to be working some what. I am moody, but at least I'm not depressed like I was.
so we'll see. Do you know anything about Cyclothymia? Isn't this a mild form of BPII? I'm sure there's more to my dx than just unipolar depression, just not sure what that what else is.
thanks.
Katia
p.s. what is : Enada NADH in conjunction with 250 mg/day of TMG ??
Posted by McPac on June 6, 2003, at 23:17:34
In reply to Re: Antidepressants and Bipolar Disorder? » katia, posted by Ron Hill on June 4, 2003, at 1:44:56
>>>>>>>Ron, is it very common that if a bipolar were to be put on ONLY an anti-depressant (MONOtherapy) that the bipolar would have a very bad reaction---such as SEVERE anger/irritability/agitation?
Is that a "tip-off" to a shrink, that if someone who did NOT know whether they were unipolar OR bipolar, took ONLY an anti-dep., and then reacted TERRIBLY to it with terrible anger/agitation/irritability---would that be a "tip-off" that that person was bipolar and not just unipolar?
Finally, WHY is it that an anti-dep. in monotherapy makes many bipolars completely "lose it" and become much worse? (I understand why they would get the euphoric 'high' but why do anti-dep's in monotherapy cause incredible rage/anger/worsening of symptoms?"Further, some bipolar folks can’t tolerate an SSRI or TCA add-on"
>>>>>>>> So, are you aying that EVEN WHILE ON a mood stabilizer that some bipolars get anger/temper/irrit./agitation when adding on an SSRI or TCA?
I'd heard that some or many bipolars had trouble with SSRI's but didn't know that they had trouble with an ssri while also being on a mood stabilizer.
I didn't know that the TCA's bothered some bipolars, I thought it was just an SSRI thing.
"I’ll try not to bore you with my life story, but let me tell you a little because it illustrates the risks associated with a bipolar patient taking ADs without a moodstabilizer. In 1996, I was enjoying my well established career as an engineer but I was having trouble staying focused on my work (even more than usual) after a heart wrenching break-up with an ex-girlfriend. So I went to a pdoc to discuss my distractibility. The pdoc misdiagnosised me as ADHD and sent me home with a script for Ritalin.
For the first few weeks the Ritalin was phenomenal! Almost euphoric. And I could focus like never in the past. However, after about ten weeks, I started having wide mood swings with severe irritability".>>>>>>>>Very interesting that AT FIRST you felt fine and that only after a while did the bipolar symptoms (severe irrit.) surface (similar to an experience of mine).
"To make a long story short, the pstim, and especially the SSRI, pushed me into a full blown mania, I lost my job, and generally speaking, I acted really weird".
>>>>>>>>>Ron, when you say "pushed you into a full blown mania", do you mostly mean symptoms like rage/anger/irrit./agitation? You don't mean euphorically happy, do you?
"The wrong medicine can end up being much worse than no medicine".
>>>>>>>Damn that's true!
?However, the other side of that same coin is that the correct medicine can make life much richer, fuller, and more productive".
>>>>>>Also very true!
"The lithium controls my hypomania very well"
>>>>>>>re: your hypomania, is your hypomania more the anger/irrit/agitation kind Ron...rather than the "extra-happy, super-joy" feeling?
"but it does little or nothing for my depressive side".
>>>>>>>I wonder if perhaps a higher dose might?
"In case you are wondering, I currently take 600 mg/day of Lithobid for my hypomania.......
and 250 mg/day of niacin (vitamin B3) to control my dysphoric mood states (irritability to the tenth power)".>>>>>>>>Ron, again, might a higher dose of lithium control your hypomania and irritability?
"In addition to doing a great job on my irritability, niacin has antidepressant qualities. I’m told that niacinamide (another form of vitamin B3) is even better than niacin for irritability. Therefore, I may conduct a trial of niacinamide (either with or without niacin)".
>>>>>>>>>Bummer for me...can't take niacin/niacinamide....long story.
I know your post wasn't intended for me Ron but it sure did help me too!
Posted by Ron Hill on June 7, 2003, at 13:18:37
In reply to Re: Antidepressants and Bipolar Disorder? » Ron Hill, posted by katia on June 4, 2003, at 18:17:43
Hi Katia,
Sorry to take a couple days to get back to you.
> I was always under the assumption that bipolar was accompanied with those wonderful euphorias people talk about with no need to sleep and tons of energy. I've never quite experienced classic "mania" so I always off the bat told the pdocs that I was definitely NOT manic depressive. and they believed me.
As you now know, classic mania is usually associated with bipolar I, whereas the "manic" phase of bipolar II is generally limited to hypomania.
> I do have an appt. with a wellknown good pdoc on June 16th
Excellent.
> The last visit I had about two months ago, I suggested to the pdoc Serzone or Remeron. Since the samples they had were Serzone that's what he gave me. Great reasoning huh?
Your experience is not unusual. Unfortunately, the current state-of-the-art in psychiatric pharmacology includes a lot of trial-and-error.
> So I started on it and went hypomanic, I'm quite sure.
Antidepressant medication induced hypomania is a possible diagnostic indicator of BP II or BP III.
> Do you know anything about Cyclothymia? Isn't this a mild form of BPII?
I think you are correct, but it's been so long since I've read the definition of cyclothymia that I don't recall the specifics. Enter the word “cyclothymia” in your search engine and you’ll find plenty of information. However, I think you are bipolar (I hope I’m not offending you by being so bold with my opinion).
> I'm sure there's more to my dx than just unipolar depression, just not sure what that what else is.
Between now and the 16th, do some reading on bipolar II and see if you see yourself in the reflection.
> p.s. what is : Enada NADH in conjunction with 250 mg/day of TMG ??
NADH (coenzyme 1) is involved directly in the formation of dopamine and other neurotransmitters as well as being involved in a plethora of other essential biochemical reactions within the human body. Enada NADH is a patented stabilized form of NADH which is suitable for oral administration. It is available at most local nutritional stores under various brand names and it comes in two forms; 10 mg sublingual (under the tongue) tablets (ENADAlert), and 2.5 mg and 5 mg enteric coated (down the hatch) tablets (Enada NADH).
I started taking Enada NADH about five months ago to treat the atypical depressive phase of my bipolar disorder and, so far, it’s doing a great job. However, too high of a dosage causes me to become very irritable. It is my opinion that my atypical depressive phase (characterized by anhedonia, anergy, low motivation, hypersomia, apathy, negative self-talk, etc) is dopaminergic in nature. Therefore, when I read that NADH stimulates tyrosine hydroxylase, the key enzyme for the production of dopamine, and that NADH is already present in every living cell, I decided it was worth a trial. Indeed it was, as it turns out.
TMG (trimethylglycine) is an excellent methyl donor in many biochemical reactions in the human body. Larry Hoover can tell you better than I regarding the biochemical reaction mechanisms. Ancetdotally speaking, TMG works in a synergistic fashion with Enada NADH in treating my atypical depression. Specifically, 250 mg/day of TMG seems to extend the effectiveness of the Enada NADH. This affords me the opportunity to reduce my dosage of Enada NADH from 2.5 mg twice a week down to 2.5 mg once per week, which in turn, reduces the irritability caused by the Enada NADH.
As a side note, subsequent to my adding the TMG, I have added 250 mg of niacin which does wonders in treating my irritability. As a result, I can now take my 2.5 mg dose of Enada NADH twice a week (if I feel like I need it) without getting irritable.
Here are some of the links discussing Enada NADH:
http://www.healthwell.com/hnbreakthroughs/mar98/nadh.cfm?path=hw
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8101444&form=6&db=m&Dopt=b
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9247090&form=6&db=m&Dopt=b
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9013405&form=6&db=m&Dopt=b
http://www.wholehealthmd.com/refshelf/substances_view/1,1525,10047,00.html#Cautions
http://www.nadh.com/site7/SYSact20.htm#Top
http://www.nadh.com/site7/RSdprs05.htm#Top
http://www.smart-drugs.com/article-JamesSouth-NADH.htm
http://www.nadh-priceinfo.org/
http://qualitycounts.com/fpnadh.html
http://www.immunesupport.com/library/showarticle.cfm/id/3118/T/Both/
http://www.immunesupport.com/library/powersearch2.cfm (Note: enter “NADH” as keyword)
Posted by Ron Hill on June 7, 2003, at 17:40:19
In reply to Ron, Re: Antidepressants and Bipolar Disorder?, posted by McPac on June 6, 2003, at 23:17:34
Hi McPac,
> Ron, is it very common that if a bipolar were to be put on ONLY an anti-depressant (MONOtherapy) that the bipolar would have a very bad reaction---such as SEVERE anger/irritability/agitation?
For some bipolar patients this is their primary reaction to SSRI mono-therapy. For example, Colin Wallace falls into this category. You might want to talk to him. For me, however, SSRI mono-therapy causes rapid cycling and the hypomanic phase is primarily the euphoric variety, but some periods of dysphoric hypomania (anger/irritability/agitation) also occurs.
> Is that a "tip-off" to a shrink, that if someone who did NOT know whether they were unipolar OR bipolar, took ONLY an anti-dep., and then reacted TERRIBLY to it with terrible anger/agitation/irritability---would that be a "tip-off" that that person was bipolar and not just unipolar?
Yes, AD induced hypomania (either euphoric or dysphoric) is a possible diagnostic indicatior of bipolar disorder. If you have not already, please read what Dr. Phelps says regarding the controversy surrounding bipolar patients taking ADs.
http://www.psycheducation.org/bipolar/controversy.htm
> Finally, WHY is it that an anti-dep. in monotherapy makes many bipolars completely "lose it" and become much worse? (I understand why they would get the euphoric 'high' but why do anti-dep's in monotherapy cause incredible rage/anger/worsening of symptoms?
I don’t know the pharmacological mechanism(s) at work, but as I understand it, the general consensus is that SSRIs can cause mood instability in some bipolar patients, and this instability can express itself as euphoric, dysphoric, or other unwanted mood states.
> So, are you aying that EVEN WHILE ON a mood stabilizer that some bipolars get anger/temper/irrit./agitation when adding on an SSRI or TCA? I'd heard that some or many bipolars had trouble with SSRI's but didn't know that they had trouble with an ssri while also being on a mood stabilizer.Again I refer you to the link to Dr. Phelps’ web site. I will likely continue to have a bias against the use of SSRI's to treat bipolar II depression (even with a moodstabilizer in place). I can say without hesitation that SSRIs do not work for me. However, I need to allow for the fact that not all BP II's have the same response to SSRIs. Even with a good functioning moodstabilizer, the slightest pinch of an SSRI gives me a couple days of hypomania (euphoric type), followed by a couple days of normal non-depressive state, and then it turns me into what my wife affectionately calls her "do nothing boy". In the latter state, I'm not really depressed and I'm not irritable. But I have no motivation, my energy is low, and I'm completely numb emotionally. When I'm healthy (i.e.; not depressed and not on an SSRI), I am an emotional person.
For me, of all the SSRIs, Prozac is the least offensive and Paxil is the worst. I attribute these adverse SSRI side effects to the fact that; “Chief among the brain’s reactions to artificially elevated serotonin levels is a compensatory drop in dopamine.” I took this quote from page 20 of the introduction in a book entitled “"Prozac Backlash"” by Joseph Glenmullen, M.D. He is a clinical instructor in psychiatry at Harvard Medical School, is on the staff of Harvard University Health Services, and is in private practice in Harvard Square. His credentials look impressive, but he appears to be somewhat extreme in his views regarding the dangers of SSRIs. If you want, you can read the Introduction and Chapter 1 in their entirety for free at the following link or at the Amazon link provided above:
http://www.glenmullen.com/prozacBacklash.html
I thought it was worth the time I spent scanning the available portions of his book. There have been numerous discussions on this board regarding the issue of SSRIs adversely affecting dopaminergic pathways and, thereby, inducing atypical depressive symptoms. However, this is the first time that I personally have seen a doctor state this in print (I'm sure there are others, however, that I have not come across).
I suspect that the main reason I cannot tolerate even a pinch of an SSRI add-on these days is because I took a ton of the stuff prior to getting the correct dx. In the time period between 1996 and 1999 my initial pdoc had me labeled ADHD and was feeding me a bunch of Ritalin and SSRIs (primarily Paxil). At one point, I was taking 80 mg/day of Paxil! Boy, I wish I knew then what I know now about mental disorders and medications. I don't know a lot about these issues even today, but I knew almost nothing when I went to my initial pdoc appointment. Never again will I subject myself to a doctor’s care without first doing my homework!
> I didn't know that the TCA's bothered some bipolars, I thought it was just an SSRI thing.I have never taken a TCA, so I have no experience to share. Dr. Phelps seems to think that if a bipolar patient absolutely must take an antidepressant, then the MAOIs tend to work better, generally speaking, that the SSRIs and TCAs because the latter two tend to cause mood instability. However, this is controversial and definitely not a hard and fast rule. Examples of exceptions to this rule is Barbara Cat, a bipolar patient getting good results with lithium and a TCA, and Colin Wallace, doing well on Lamictal and a low dose of an SSRI.
> Ron, when you say "pushed you into a full blown mania", do you mostly mean symptoms like rage/anger/irrit./agitation? You don't mean euphorically happy, do you?Yes, primarily euphoric, but I also periodically cycled into dysphoric mood states.
>> The lithium controls my hypomania very well but it does little or nothing for my depressive side.
> I wonder if perhaps a higher dose might?
At higher lithium dosages I start to get side effects (lethargy, rash, etc). I am convinced from the research that at low blood levels lithium provides neuroprotective properties. At high blood levels, however, lithium is toxic. Therefore, I like lithium but I insist on keeping my blood levels in the lower end of the therapeutic range.
>> In addition to doing a great job on my irritability, niacin has antidepressant qualities. I’m told that niacinamide (another form of vitamin B3) is even better than niacin for irritability. Therefore, I may conduct a trial of niacinamide (either with or without niacin)".
> Bummer for me...can't take niacin/niacinamide....long story.
I’ve got time to read it if you have time to write it. Tell me your story.
> I know your post wasn't intended for me Ron but it sure did help me too!
Good! The goal here in pbabbleland is to help one another. We all owe Dr Bob a heart-felt thank you for providing the forum. This site sure has helped me.
-- Ron
Posted by McPac on June 7, 2003, at 22:56:45
In reply to Re: Antidepressants and Bipolar Disorder? » McPac, posted by Ron Hill on June 7, 2003, at 17:40:19
First off, thank you so much for the outstanding response to my previous questions!
>> In addition to doing a great job on my irritability, niacin has antidepressant qualities. I’m told that niacinamide (another form of vitamin B3) is even better than niacin for irritability. Therefore, I may conduct a trial of niacinamide (either with or without niacin)".
> Bummer for me...can't take niacin/niacinamide....long story.
I’ve got time to read it if you have time to write it. Tell me your story.
>>>>>>>>>>>>>>> What I was referring to above, is that I currently go to the Pfeiffer Treatment Center. In addition to taking my medications, I also take a slew of supplements that Pfeiffer has me on as determined by their testing. I was found to have VERY high histamine levels (among other things). So, one of Pfeiffer's main goals with me is to lower those histamine levels. Niacin and folic acid are both used by the body to make histidine, which then produces histamine. So niacin and folic acid are definite no-no's for me. If not for that, I'd love to try them. I'll be returning to Pfeiffer near the end of this month for follow-up testing. Take care Ron!
Posted by katia on June 8, 2003, at 1:59:51
In reply to Re: Antidepressants and Bipolar Disorder? » McPac, posted by Ron Hill on June 7, 2003, at 17:40:19
Good! The goal here in pbabbleland is to help one another. We all owe Dr Bob a heart-felt thank you for providing the forum. This site sure has helped me.
-- Ron
Here here!!!
Katia
Posted by katia on June 8, 2003, at 2:01:33
In reply to Re: BP II and Enada NADH and TMG and Niacin » katia, posted by Ron Hill on June 7, 2003, at 13:18:37
Wow.
What a wealth of knowledge you are and so willing and patient to give it as well.I'll keep doing my research and I"ll look at some of the links and respond.
thanks so much.
katia
Posted by Ron Hill on June 8, 2003, at 11:14:41
In reply to Ron, Re: Antidepressants and Bipolar Disorder?, posted by McPac on June 7, 2003, at 22:56:45
McPac,
> What I was referring to above, is that I currently go to the Pfeiffer Treatment Center. In addition to taking my medications, I also take a slew of supplements that Pfeiffer has me on as determined by their testing. I was found to have VERY high histamine levels (among other things). So, one of Pfeiffer's main goals with me is to lower those histamine levels. Niacin and folic acid are both used by the body to make histidine, which then produces histamine. So niacin and folic acid are definite no-no's for me. If not for that, I'd love to try them. I'll be returning to Pfeiffer near the end of this month for follow-up testing.
Interesting. I have never had a histamine blood level test done, but when I read the Pfeiffer information, I seem to fit best into the category that includes high histamine levels. And yet niacin works great for me (as treatment for my irritability).
-- Ron
Posted by lillabelle on June 8, 2003, at 11:18:34
In reply to Ron, Re: Antidepressants and Bipolar Disorder?, posted by McPac on June 6, 2003, at 23:17:34
In my experience there are many kinds of manias and many degrees of manias, (especially for bipolar2's,which is me) and antidepressants in monotherapy, bring them on full blast. There is full blown euphoric mania, which I experienced to the max, years ago on 120mgs of nardil. At the time, and due to inexperience (I had no idea I was bipolar in fact had never really heard of it), I felt soooo great that I prolonged the 'ride'for two whole years! Obviously, my doc (not pdoc) was a quack as never seemed to notice but then she only saw me every 2 to 3 months at a time. In retrospect this mania almost killed me. I lost my job, my flat, many of my friends and to put it mildly my reason and sanity. Even years on I look back to that period and cringe. After that, and swearing off all psycho-meds my mood swings got worse. I experienced crippling depressions alternating with mild to severe hypomanias. In comparison to the 'lows' the 'highs' felt good, but in my humble opinion mania ,whether mild or severe is always destructive and should not be confused with healthy normal wellness and energy. Also along with the 'high'manias I began to have more irritable or dysphoric mania. Manias of rage, anger, irritability and racing thoughts. Observing that my moods seemed to be getting worse with age and because I still thought I suffered from depression only, having never been dxed, I asked my doc for an SSRI anti'd, which he readily handed out. Prozac gave me the worst dysphoric mania of my life, effexor worsened the mood swings sending me into compulsive spending sprees and unaccountable anger outbursts. Zoloft flattened me and made me hypomanic at the same time. Zoloft and wellbutrin combined sent me into major hypomania. I lost some 12 thousand bucks during the 6 months I endured this combo. and almost divorced my husband in the process. Then, on this board, I read about mood stabilizers other than lithium, (which I am adverse to taking due to side effect profile,) and I went for them. Gabapentin and topomax didn't work for lots of side effect reasons. Depakote and tegretol I really disliked. Finally I 'found'lamictal and it's a godsend. I've added serzone with no manias. I feel energetic but not manic. When I shop I take my time and guard my money. I don't develop outlandish ideas or run around like a chicken with it's head cut off. I'm not laughing one minute and shouting the next. I no longer abuse alchohol. It's not perfect, but for now it works. The moral of my story is I've learnt two important lessons. First, that mania is as destructive as depression, even mild hypomania and second, for bipolar's anti-d's without mood stabilizers worsen mood disorder and can have dangerous results. That's my story for now, take it as you will. As for the bio-chemistry, I'm an English major so am in the dark on the why's and wherefore's If anyone has a biochemical answer for my experiences I'd like to hear it. Best to all........... lillabelle
Posted by Ron Hill on June 8, 2003, at 13:24:13
In reply to Antidepressants and Mania, posted by lillabelle on June 8, 2003, at 11:18:34
Lillabelle,
You and I have travelled similar roads.
-- Ron
--------------------------------
> In my experience there are many kinds of manias and many degrees of manias, (especially for bipolar2's,which is me) and antidepressants in monotherapy, bring them on full blast. There is full blown euphoric mania, which I experienced to the max, years ago on 120mgs of nardil. At the time, and due to inexperience (I had no idea I was bipolar in fact had never really heard of it), I felt soooo great that I prolonged the 'ride'for two whole years! Obviously, my doc (not pdoc) was a quack as never seemed to notice but then she only saw me every 2 to 3 months at a time. In retrospect this mania almost killed me. I lost my job, my flat, many of my friends and to put it mildly my reason and sanity. Even years on I look back to that period and cringe. After that, and swearing off all psycho-meds my mood swings got worse. I experienced crippling depressions alternating with mild to severe hypomanias. In comparison to the 'lows' the 'highs' felt good, but in my humble opinion mania ,whether mild or severe is always destructive and should not be confused with healthy normal wellness and energy. Also along with the 'high'manias I began to have more irritable or dysphoric mania. Manias of rage, anger, irritability and racing thoughts. Observing that my moods seemed to be getting worse with age and because I still thought I suffered from depression only, having never been dxed, I asked my doc for an SSRI anti'd, which he readily handed out. Prozac gave me the worst dysphoric mania of my life, effexor worsened the mood swings sending me into compulsive spending sprees and unaccountable anger outbursts. Zoloft flattened me and made me hypomanic at the same time. Zoloft and wellbutrin combined sent me into major hypomania. I lost some 12 thousand bucks during the 6 months I endured this combo. and almost divorced my husband in the process. Then, on this board, I read about mood stabilizers other than lithium, (which I am adverse to taking due to side effect profile,) and I went for them. Gabapentin and topomax didn't work for lots of side effect reasons. Depakote and tegretol I really disliked. Finally I 'found'lamictal and it's a godsend. I've added serzone with no manias. I feel energetic but not manic. When I shop I take my time and guard my money. I don't develop outlandish ideas or run around like a chicken with it's head cut off. I'm not laughing one minute and shouting the next. I no longer abuse alchohol. It's not perfect, but for now it works. The moral of my story is I've learnt two important lessons. First, that mania is as destructive as depression, even mild hypomania and second, for bipolar's anti-d's without mood stabilizers worsen mood disorder and can have dangerous results. That's my story for now, take it as you will. As for the bio-chemistry, I'm an English major so am in the dark on the why's and wherefore's If anyone has a biochemical answer for my experiences I'd like to hear it. Best to all........... lillabelle
Posted by katia on June 8, 2003, at 15:29:19
In reply to Antidepressants and Mania, posted by lillabelle on June 8, 2003, at 11:18:34
Hi Lillabelle!
first off, I LOVE your name. very beautiful and unique. I don't know if you've been following the threads with my posts, esp. the one here with Ron, but I'd like to ask you some questions. If you've been following the posts for me then you may already know this, but I'll repeat it. In short, in the past year (almost exactly) due to a suicidal VERY crippling depression I was in in combo with life crisis, I started addressing what I thought to be a life long depression. But over the course of the year, I've been on four ADs and none of them really working(ed). I started on Celexa - did nothing for me. then effexor and felt (what I know now to be probably hypomania); only at first. I was racy and high feeling periodically like i'd just drunk a couple cups of Peets' coffee (a strong coffee). But similtn. I slept like crazy - night sweats, woke up yelling, crazy dreams - the typcial like most people experience on Effexor. I was slowly starting to crash back down to a slowed depression and eventually my side effects consisted of those electrical brain zaps you hear about. So I stopped gradually while going onto Zoloft. I stayed on Zoloft for three months and was an absolute zombie - did nothing for me except instead of a sharp piercing pain, I had a dull numbing pain. got off that - had worse w/drawals then on Effexor and went for two weeks with nothing. Simultaneously i moved house, got really into painting and decorating my new room and ended up buying about $4000 worth of stuff including a brand new king size bed custom made in Germany. I really feel like all theses buys are justified; but reading the board here....makes me think. In those two weeks, I alternated between intense focus on projects, like painting my room three different colors and building bookcases, etc. (and shopping) then i started Serzone. I started on the starter pack with 100mg for one week, then 150 mg ,then 200 up to 400mg. I think i went hypomanic if I wasn't before. But this time with worsening mood swings alter. b/t irritable, rageful, and crying. It just got worse as the Serzone went on. So after 3 1/2 weeks on Serzone, I stopped. (by the way during this time, I have stopped going to the clinic where i was tossed around to about 7 different pdocs in one year, no one followed or concentrated on my case. I've got an appt. in 8 days with a wellknown pdoc in the area). So when I stopped Serzone, I went "crazy". I had severe severe drops - shorts bursts of crisis and despair. I scared myself so I began taking just 50mg of Serzone for the past two weeks and it seems to be helping me. I definitely feel bouts of irritability and moodiness, but I'm better than before. So after all this, I am thinking that I may be BPII as well. so I have a few questions for you.>>Also along with the 'high'manias I began to have more irritable or dysphoric mania. Manias of rage, anger, irritability and racing thoughts.
How did this rage and anger manifest itself in your life?
>Observing that my moods seemed to be getting worse with age and because I still thought I suffered from depression only, having never been dxed, I asked my doc for an SSRI anti'd, which he readily handed out.
I too have never been properly dxed; I've just assumed that a unipolar depression for me b/c I've never experienced a euphoric long term high.>> I'm not laughing one minute and shouting the next. I no longer abuse alchohol.
When you say laughing one minute and shouting the next (that is my life story). Would you say that this is indicative of dysphoric hypomania?
Also, you say that you no longer abuse alcohol. In retrospect when did you notice you abused it more? When you were depressed or manic? I've been doing some serious reflecting about my life and I've had so many many years of depression sometimes mixed with a wild energy that I so often curbed by drinking and then of course that would lead to trouble - affairs, pregnancy etc.
which would (I thought) lead to depressions....god I've got quite a life story.I'd appreciate some feedback.
Thanks so much.
Katia
Posted by McPac on June 8, 2003, at 20:06:52
In reply to Re: Niacinamide raises histamine levels? » McPac, posted by Ron Hill on June 8, 2003, at 11:14:41
I seem to fit best into the category that includes high histamine levels. And yet niacin works great for me (as treatment for my irritability).
>>>>>>>>>Ron, I'm sure that a supplement could work for one thing while simultaneously being a culprit of something else. For me, right before I first went to Pfeiffer I began taking folic acid. Although I was taking multiple supplements at the time, I felt like the addition of folic acid had me feeling better. Yet after my tests came back Pfeiffer said no more folic acid. Even though it may have helped in one sense, it would have hurt in another. And my very high histamine level needed to come down. The more I'd read about Pfeiffer's ideas the more things began to make sense to me, pertaining to my own case. I also have pyroluria, which causes one to lose vitamin B-6 and zinc (yes, I was zinc deficient also; further, my copper levels were also VERY high). I go back in about 3 weeks (after 6 months on their supplement treatment plan) for my follow-up testing. It will be interesting to compare the test results. As for the niacinamide, it may have been a very good supplement to take for my allergic rhinitis (hay fever) as well. Reports of it working very well for some folks with that problem as well. Take care Ron!
Posted by Dr. Bob on June 9, 2003, at 1:32:55
In reply to Re: Antidepressants and Bipolar Disorder? » Ron Hill, posted by katia on June 8, 2003, at 1:59:51
Posted by lillabelle on June 9, 2003, at 3:47:49
In reply to Re: Antidepressants and Mania » lillabelle, posted by katia on June 8, 2003, at 15:29:19
Katia, Ron and others, thanks so much for responding to my posts.
To Katia: I can relate to what you have described extraordinarily well. For more years than I care to count I was the classic 'drama queen'. Like you my relationships were intense, histronic and short. My mother is Irish and has always suffered from a mood disorder which has never been recognized, except by me (it's takes one to know one). So I always used to say, I'm just like my mother wild and firery, read: not boring and dull.
But wild and firery was not fun. I would rage at people and find out later how much I had offended them. I argued with my family. Boyfriends would shake their heads at my moodiness and unpredictibility. I was often told I was 'different'. Men told me they had never met anyone like me before, which I chose to translate as positive when I really knew it meant 'weird'. One boyfriend said I was two people, then he said, make that three. I was always getting into big dramatic fights with boyfriends. I would have fits of irrationality and anger that I could not control. And always, I would try and put it down to my celtic, firery background (yeah, right).
Like so many others out there I associated 'manic depression' with long euphoric highs, sometimes accompanied with voices and grand dilusions, followed by month long crashes often needing hospitalization.
I love to read biographies of people with mood disorers but most of the ones I have read concern bipolar I, so although fascinating i could not relate.
With regards to alchohol, I found that I drank more when i was manic and not when I was depressed as one might assume. (Kay Redfield and others have agreed with this observation.) My first drink brought on a rush of mania, a high I felt compelled to chase. I would go up and up, becoming wilder and wilder. It's not that I drank more than anybody else it's just that it affected me more. I don't think I have ever seen someone act out as crazily on booze as I did. Like you I did and said things I deeply regreted later. The problem was I got to the point were I never remembered anything beyond the first few drinks, but I did not have the mercy of passing out. Like the energizer bunny, I'd keep on going. The classic, 'thing that wouldn't leave the party.'
As for you Katia, I am not a pdoc but like Ron i suspect you may have bipolar2 or possibly bipolar3. Are you extremely impatient in lineups? Do you find long airplane trips make you angry and very agitated? Have you ever suffered from prolonged insomnia interspaced with oversleeping? Do you sometimes find it impossilbe to control rage and anger? Do you throw yourself into projects only to abandon them or go on wild shopping sprees? In the long run i think that you need to be properly dxed with a very good, reputable pdoc.
As for mood stabilizers, everyone has a different reaction. I found the traditional ones:lithium, depakote and tegretol to be too flattening as well as fattening! Really they made me feel zombilike. However they are first line meds for bipolar and millions have had life-changing results with them. The new line stabilizers, gabapentin, lamictal and topamax have mixed results. Topamax in my humble opinion being the worst (at least for me). Like all meds it is a matter of trial and error.
If you find your mood swings are interfering with your life then you really do need to find something to sort that out. Life is too short to be miserable. It's hard to be optomistic when meds don't work but that is the beauty of this board. Somewhere to find others like us. Before I found this site I truly thought there was no one out there like me.
To Ron: Thanks for your advice on insomnia with supplements. I am going to follow that up for sure. Also you wrote in one post, that an extreme reaction of mania to an anti-d can permenantly screw up your brain chemistry. I would agree with that. Before my nardil induced mania experience I had taken some pstims such as ritalin for ADD. My experience was positive and typical. I stopped the rit and went onto nardil and into florid mania. After that I tried the rit again as it had worked in the past. This time the result was disasterous. I was overcome with nervousness and had narcoleptic reactions for the first time in my life. Now I have the same reaction to all pstims which I know i did not have before the nardil. I personally feel the nardil mania altered my brain chemistry.
Peace and love sisters and brothers......lillabelle
Posted by katia on June 9, 2003, at 13:47:51
In reply to Re: Antidepressants and Mania, posted by lillabelle on June 9, 2003, at 3:47:49
> >I would have fits of irrationality and anger that I could not control. And always, I would try and put it down to my celtic, firery background (yeah, right).
Hi Lillabelle - yes I know these "fits". In my last relationship which ended extremely disastrously, we were in counseling briefly before the tragic ending. This was in Scotland and this "counselor" was more of a "healer - energy worker". She asked me to name that "part" of me that is irrational and angry and I said "bleeding heart tornado". and then my boyfriend (at the time) said, "no, more like a bloody nuclear bomb - and that's being polite". This was also in the midst of a serious serious depression (maybe mixed state)(which wasn't dxed at the time!) which I feel angry about. the amount of "counselors" that I've seen over the years, so many of them have not brought this up with me when I have been so obviously in need of medication (in retrospect). it's taken my own research and initiative.
> Like so many others out there I associated 'manic depression' with long euphoric highs, sometimes accompanied with voices and grand dilusions, followed by month long crashes often needing hospitalization.
>
> I love to read biographies of people with mood disorers but most of the ones I have read concern bipolar I, so although fascinating i could not relate.likewise likewise! I remember reading Kay Redfield Jamison's autobiography in 1996 when it came out! and I was drawn to it for a reason. But like you, did not completely relate, but related on other levels. I've read just about all there is.
> With regards to alchohol, I found that I drank more when i was manic and not when I was depressed as one might assume. (Kay Redfield and others have agreed with this observation.) My first drink brought on a rush of mania, a high I felt compelled to chase. I would go up and up, becoming wilder and wilder. It's not that I drank more than anybody else it's just that it affected me more. I don't think I have ever seen someone act out as crazily on booze as I did. Like you I did and said things I deeply regreted later. The problem was I got to the point were I never remembered anything beyond the first few drinks, but I did not have the mercy of passing out. Like the energizer bunny, I'd keep on going. The classic, 'thing that wouldn't leave the party.'
>that's me. In fact, alcohol I think, exacerbates this wild energy. I've gotten totally out of control and wild on alcohol.
> As for you Katia, I am not a pdoc but like Ron i suspect you may have bipolar2 or possibly bipolar3. Are you extremely impatient in lineups?yes!!!!!! and it's definitely shown up in the past two months. I get claustrophobic and hot, can't stop fidgeting - playing with my hair etc. in fact within minutes, I could go from feeling ok to nearing a complete breakdown.
Do you find long airplane trips make you angry and very agitated? No, I just endure here in some meditative state.
Have you ever suffered from prolonged insomnia interspaced with oversleeping? yes.
Do you sometimes find it impossilbe to control rage and anger? yes.
Do you throw yourself into projects only to abandon them?I get involved in things and don't follow through.
or go on wild shopping sprees? Besides this past two months, no I don't go on "shopping sprees". I don't really know what's considered as such b/c when I go out and buy things I really do need them. I don't think I've ever had this happen for me. The only "wild shopping sprees" that I can equate would be buying a ticket to a foreign country at the drop of a hat and moving.In the long run i think that you need to be properly dxed with a very good, reputable pdoc.
>
that'll be on the 16th.> As for mood stabilizers, everyone has a different reaction. I found the traditional ones:lithium, depakote and tegretol to be too flattening as well as fattening! Really they made me feel zombilike. However they are first line meds for bipolar and millions have had life-changing results with them. The new line stabilizers, gabapentin, lamictal and topamax have mixed results. Topamax in my humble opinion being the worst (at least for me). Like all meds it is a matter of trial and error.
yes, I am interested in maybe trying lamictal or what Ron is on the lithobid?
>
> If you find your mood swings are interfering with your life then you really do need to find something to sort that out. Life is too short to be miserable.
In the past year I'm realizing that I can do someting to sort myself out.It's hard to be optomistic when meds don't work but that is the beauty of this board. Somewhere to find others like us. Before I found this site I truly thought there was no one out there like me.
likewise.
What are you taking now - medication-wise?
also, you mentioned that you are dxed with ADD? How is that different than bipolar 2?
thanks.
Katia
Posted by Ron Hill on June 9, 2003, at 15:57:42
In reply to Re: Antidepressants and Mania » lillabelle, posted by katia on June 9, 2003, at 13:47:51
Katia,
May I jump in?
> also, you mentioned that you are dxed with ADD? How is that different than bipolar 2?
BP II patients are often misdiagnosed as ADHD because the hypomania can look a lot like ADHD. Here is an article that briefly discusses some of the difference between BP II and ADHD. Read the section titled "What is the difference between ADHD and COBPD?":
http://www.healthieryou.com/bipolarch.html
While I’m here, let me leave you with a couple other links. If you like to listen and/or watch presentations check out the following two links. The first is from the Stanley Center and the second is Dr. Bob’s Grand Rounds:
http://www.wpic.pitt.edu/stanley/2ndbipconf/poster.htm
http://psychiatry.uchicago.edu/grounds/
Finally, before your pdoc appointment on the 16th, you may want to investigate some treatment options (i.e.; medications). To that end, the following document has some good information:
http://www.psych.org/clin_res/bipolar_revisebook_index.cfm
There is a lot of information in these links, so don’t get overwhelmed; just pick and choose.
-- Ron
Posted by lillabelle on June 10, 2003, at 4:13:01
In reply to Re: Differences between BP II and ADHD » katia, posted by Ron Hill on June 9, 2003, at 15:57:42
Ron and Katia thanks for your post.
Rereading my last post I see that a lot of the symptons I mentioned for BP2 sound a lot like ADD.
I know I am definitely BP2 but in the last year I suspect strongly that I may also have adult ADD. It is somewhat difficult to differentiate the two, in my limited experience.
I think part of the problem is that in the past I have always associated ADD with children's ADHD, which primarily affects boys. I know I was not an ADHD child and I'm not sure if I was ADD either, apart from excessive daydreaming.Because I have a relatively high level of education (MA), and because I read constantly at a fairly intellectual level I always assumed that I could not have adult ADD. However as was previously posted much of my behaviour could be dxed as ADD and perhaps (not sure) educational achievement is no indicator of this disorder.
At present I cannot get to the bottom of this as i live in, for all intents and purposes, in a third world country where pdocs, for all intents and purposes, don't exist. Also pstims are banned, banned, banned. Anyway as I also wrote I can no longer tolerate pstims, at least ritalin, and phentermine (since the nardil overload).
The good news is I am going home to Toronto, Canada in two weeks. For the first time ever (I've been away 12 years) I hope to find a reputable and sympathetic pdoc. However, adderall and cylert are not available in Canada which is, as always, just my luck.
Back to you Katia; it doesn't sound like you have ADD, but who am I to tell. As for BP, that is for you and your pdoc to discern. Do you think you have ever experienced hypomania in any form? Did you get 'high' from AD's?
Ron, I really appreciate your research. There is so much to learn in this field and in spite of all the stinky things that have happened to me and the med disasters I still have hope that I will find lasting peace of mind.
Final word, at present I take 100mg of lamictal, 200mg of serzone and 50mg of trazadone at night to sleep. Bear in mind however that it took me a very long time to reach these levels. In the beginning I could not have tolerated such high dosages of any of the above.
PS (in previous post I mentioned gaba as being involved in my meds, I ment glutamate!!) (add??)
Posted by katia on June 10, 2003, at 14:56:56
In reply to Re: Differences between BP II and ADHD, posted by lillabelle on June 10, 2003, at 4:13:01
HI,
Which country are you in if you don't mind me asking?
That's right I remember now that you mentioned your med cocktail earlier which is why I was drawn at first. I'm on 50mg of Serzone waiting 'til I see the pdoc on the 16th. and I'd been thinking of Lamictal. I also have a supply of Trazadone for sleep as needed. I haven't had to take it in months though, which is good. I took some benedryl the other night and that worked some. So we may end up having similar cocktails! (not the fun kind).I've not done any research but it would seem to me that academic achievement would not be indicative of ADD or ADHD or absence of. just my thoughts...
yes, I do get racy on ADs. The Serzone, which is why I dropped it to 50mg; and got racy on Celexa and Effexor; not on Zoloft. Zoloft means zombie for me.
It doesn't feel healthy, but I kinda like it. It gives me inspiration. or maybe inspiration is just coming to me from other sources..(nothing drug related).The reason why I question ADD or ADHD is that I'm in graduate school and have lots of readings and it takes me forever to read sometimes. It doesn't click what I'm reading; and have to focus really hard. But once the flow happens I'm in and focused.
welcome home! (soon) even though I'm not up north there but down here in Cal.
Katia
Posted by cybercafe on June 11, 2003, at 2:18:41
In reply to Re: Differences between BP II and ADHD » lillabelle, posted by katia on June 10, 2003, at 14:56:56
> I've not done any research but it would seem to me that academic achievement would not be indicative of ADD or ADHD or absence of. just my thoughts...well i am bipolar + adhd and the strange thing is..... while i did worse than i might have, i did overall end up doing quite well in school... and i think many ADHDers find school easier (more stimulating) than work ... comments?
> The reason why I question ADD or ADHD is that I'm in graduate school and have lots of readings and it takes me forever to read sometimes. It doesn't click what I'm reading; and have to focus really hard. But once the flow happens I'm in and focused.
yeah i have that problem too...
today i was at a bus stop with a friend, and i noticed that other people didnt' seem to mind waiting for a bus whereas it drove me nuts ...... so looking back, it's surprising it took me six years to get diagnosed as ADHD
good luck guys
Posted by katia on June 11, 2003, at 14:37:10
In reply to Re: Differences between BP II and ADHD, posted by cybercafe on June 11, 2003, at 2:18:41
>
> > I've not done any research but it would seem to me that academic achievement would not be indicative of ADD or ADHD or absence of. just my thoughts...
>
> well i am bipolar + adhd and the strange thing is..... while i did worse than i might have, i did overall end up doing quite well in school... and i think many ADHDers find school easier (more stimulating) than work ... comments?
>
> > The reason why I question ADD or ADHD is that I'm in graduate school and have lots of readings and it takes me forever to read sometimes. It doesn't click what I'm reading; and have to focus really hard. But once the flow happens I'm in and focused.
>
> yeah i have that problem too...
>
> today i was at a bus stop with a friend, and i noticed that other people didnt' seem to mind waiting for a bus whereas it drove me nuts ...... so looking back, it's surprising it took me six years to get diagnosed as ADHD
>
> good luck guysWhat you describe above at the busstop is also indicative of BP, no?
Posted by cybercafe on June 11, 2003, at 15:25:23
In reply to Re: Differences between BP II and ADHD » cybercafe, posted by katia on June 11, 2003, at 14:37:10
> > today i was at a bus stop with a friend, and i noticed that other people didnt' seem to mind waiting for a bus whereas it drove me nuts ...... so looking back, it's surprising it took me six years to get diagnosed as ADHD
> >
> > good luck guys
>
> What you describe above at the busstop is also indicative of BP, no?
>that i'd like to know .... i don't know what a bipolar reaction would be... but i think only an ADHD person would feel overwhelming boredom ... ummm.. i know this because i react differently depending on how recently i took my ritalin dose
Posted by katia on June 11, 2003, at 18:54:21
In reply to Re: Differences between BP II and ADHD, posted by cybercafe on June 11, 2003, at 15:25:23
> > > today i was at a bus stop with a friend, and i noticed that other people didnt' seem to mind waiting for a bus whereas it drove me nuts ...... so looking back, it's surprising it took me six years to get diagnosed as ADHD
> > >
> > > good luck guys
> >
> > What you describe above at the busstop is also indicative of BP, no?
> >
>
> that i'd like to know .... i don't know what a bipolar reaction would be... but i think only an ADHD person would feel overwhelming boredom ... ummm.. i know this because i react differently depending on how recently i took my ritalin doseOk so that might be an indicator right there. I've never felt bored; just wanting to crawl out of me skin - like I wanted my actions to match the raciness of my energy.
who knows!
I still need to look at those links Ron gave me. that'll probably give me a better idea.
Posted by Viridis on June 12, 2003, at 1:56:41
In reply to Re: Differences between BP II and ADHD » cybercafe, posted by katia on June 11, 2003, at 18:54:21
I have ADD and am a university professor with a PhD. If I had to guess, I'd say a substantial proportion of professional academics (at least the ones I know) have ADD, probably higher than in the general population. In some ways there's more freedom to work at your own pace, in your own style, than in many occupations, and there's lots of diversity in what you do, especially if you do research and teach, etc. You do have to produce though, which means following through on some things even when your interest has shifted to something else.
I have periods of intense interest in certain subjects and projects, but also have a lot of trouble staying organized and meeting deadlines. It's very important for me to surround myself and collaborate with people who have different organizational skills; I think that's how I've survived. And the meds help a lot too, both for focus/concentration (Adderall), and the anxiety associated with high expectations and frequent semi-chaos (benzos).
Posted by jemma on June 12, 2003, at 12:31:32
In reply to Re: Differences between BP II and ADHD, posted by Viridis on June 12, 2003, at 1:56:41
I have ADD and I'm in the film business. Now there is a study of functional ADD at work. Writers, directors, producers, designers, actors, musicians, makeup artists, cinematographers - all with acute ADD deficits. And strengths too - creativity, the ability to hyperfocus, extreme sensitivity to sound, light, language, design, what have you. The only way it works is to have a comprehensive team of non-ADD people to keep it all on track. Production managers for budget, co-ordinators to generate constant itineraries and schedules to keep everybody on track, a first AD to crack the whip on set and keep everybody focussed, a second AD to break down schedules, and a team of third ADs to round everybody up and make sure they're where they're supposed to be. Not to mention the transport co-ordinator who keeps all the people and equipment going to where they're supposed to be going, and a team of drivers to get them there.
When it works, it's a thing of beauty - eighty or so people, half of whom are wandering in a creative daze, focused on their roles, hair, costumes, lighting, whatever, and the other half of whom are organizing the first half so that it all runs like clockwork. It always amazes me that films get made at all.
- Jemma
Posted by Ron Hill on June 13, 2003, at 0:34:02
In reply to Re: Differences between BP II and ADHD » cybercafe, posted by katia on June 11, 2003, at 18:54:21
Hi Katie,
> Ok so that might be an indicator right there. I've never felt bored; just wanting to crawl out of me skin - like I wanted my actions to match the raciness of my energy.
> who knows!May I tell a short story that might help distinguish between a BP II and an ADD (ADHD) dx?
<beginning of story>
"A Bipolar II Husband and His ADD Wife Waiting for the Bus"
My wife is slightly-to-moderately ADD and I'm moderately BP II. If my wife wanted to catch the bus, she would arrive at the bus stop a couple minutes early, and she would get bored within the first few minutes of waiting. She would turn into what I affectionately call my "little far-away girl". I’m not sure where she goes exactly, but I know when she’s gone. It would never cross her mind to be frustrated or angry about the wait for the bus. Instead she’s just bored.
My response to the same situation would be much different. First of all, I have a very hard time gauging how long it will take to accomplish any given task. Therefore, although I intend to arrive right on time, or maybe 30 seconds before the bus is scheduled to arrive, I notoriously run late (arriving early would be an inefficient use of my time). So, before I even get to the bus stop, I’m frustrated because I’m running late. I’m frustrated with myself (self-talk: Why can’t I ever be on time) and I’m frustrated with the idiots that made me late (i.e.; the people dilly-dallying on the sidewalk while I’m trying to speed walk to the bus stop, the idiots that set the timing sequence of the traffic lights such that the DON’T WALK greets me at every intersection, etc). In summary, on route to the bus stop I’m feeling guilty ‘cause I was supposed to be on time and I’m feeling angry and frustrated because I’m afraid I’ll miss the bus.
Once I round the last corner and see the people waiting for the bus, I’m monetarily relieved that I did not miss it. I arrive at the stop and patiently wait for about 90 seconds. If the bus does not show up within the first 90 seconds or so, I start to get angry again. This time I’m mad at the idiots who run the bus company for wasting my time. Further, I’m frustrated by all the idiots whizzing by in there cars with only one occupant, wasting precious natural resources, and polluting the air solely to move their carcass from point A to point B. I’m also angry with our national government’s lack of leadership to advance mass transit. After all, here I am trying to do the right thing by taking the bus instead of driving my car, and what do I get? Inefficiency, delay, and frustration!
<end of story>
I’ve slightly exaggerated in this story for illustrative purposes. Also, I asked for and obtained permission from my wife to discuss her ADD in the story.
-- Ron
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