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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 42. This is the beginning of the thread.
Posted by markwell on January 22, 2012, at 10:17:22
I am having such a difficult time with anxiety and depression. I feel like I have somewhat lost touch with reality. Could I possibly have psychotic depression? I don't know what the signs are. I'm not hearing voices or seeing things but when I have a conversation it's almost like someone else having the conversation...so strange. I don't know how this is diagnosed.
Mark
Posted by polarbear206 on January 22, 2012, at 10:21:14
In reply to agitated depression, posted by markwell on January 22, 2012, at 10:17:22
Go to psycheducation.org and click on link for soft signs of bipolarity in the upper left corner.
Posted by markwell on January 22, 2012, at 10:34:36
In reply to Re: agitated depression, posted by polarbear206 on January 22, 2012, at 10:21:14
I have already been diagnosed with bp1. Ill check the site also.
Mark
Posted by Phillipa on January 22, 2012, at 11:51:06
In reply to Re: agitated depression, posted by markwell on January 22, 2012, at 10:34:36
What have you changed medwise could be a reaction also could be signs of high anxiety. Phillipa
Posted by bleauberry on January 22, 2012, at 17:47:35
In reply to agitated depression, posted by markwell on January 22, 2012, at 10:17:22
I think that is part of the depressive spectrum not necessarily bipolar. Either way. What I'm saying is pretty much everybody experiences that detachment from the world, observing but not feeling connection, looking in from the outside or from a cage, with either depression or bipolar.
Anyway I think it would be a good move to rethink whatever med or herbal or lifestyle strategies you are doing and make some changes.
Posted by markwell on January 22, 2012, at 17:57:37
In reply to Re: agitated depression, posted by bleauberry on January 22, 2012, at 17:47:35
I'm getting a second opinion next week and hopefully will be adding something to my current med(tegretol). I'm just wondering if it's bipolar with psychotic features? I don't know what would constitute psychosis?
Mark
Posted by polarbear206 on January 22, 2012, at 21:56:32
In reply to Re: agitated depression, posted by markwell on January 22, 2012, at 17:57:37
Good for you. You got to be proactive. Good luck it will get better.
Posted by B2chica on January 23, 2012, at 11:37:56
In reply to Re: agitated depression, posted by polarbear206 on January 22, 2012, at 21:56:32
psychotic features normally include hallucinations, auditory and/or visual, delusions or the like.
you had derealization.i would think your issue is either med induced or from the anxiety.
especially if anx been bad lately.
i use low dose perphenazine, gabapentin and xanax for anxiety.
Best wishes to you.
Posted by Roslynn on January 23, 2012, at 11:50:52
In reply to agitated depression, posted by markwell on January 22, 2012, at 10:17:22
Hi,
I think (as a layman) this could be more due to anxiety or a combo of anxiety/depression. I've had those feelings before and I think it's referred to as derealization/depersonalization. I don't think it's psychosis. But it can be terrifying. Just my two cents. I hope it goes away soon. I know it's hard.
Roslynn
> I am having such a difficult time with anxiety and depression. I feel like I have somewhat lost touch with reality. Could I possibly have psychotic depression? I don't know what the signs are. I'm not hearing voices or seeing things but when I have a conversation it's almost like someone else having the conversation...so strange. I don't know how this is diagnosed.
> Mark
Posted by SLS on January 23, 2012, at 12:51:38
In reply to Re: agitated depression, posted by Roslynn on January 23, 2012, at 11:50:52
> I think it's referred to as derealization/depersonalization.
This is very possible. These things happen most often when depression and anxiety are both present, especially when the depression includes anhedonia.Mark, if you are psychotic, it is not obvious in your writing. DP/DR feels like losing touch with reality in that there is a remoteness from the things around you. You become a spectator of your own conversations as if you were looking down on yourself as you interact with your environment. It is not that easy to describe.
- Scott
Posted by phidippus on January 23, 2012, at 13:02:32
In reply to agitated depression, posted by markwell on January 22, 2012, at 10:17:22
Have you switched from Tegretol to Lithium? This will help a lot.
Depression and anxiety is a mixed presentation of bipolar disorder. The feeling you are having that you are losing touch with reality is called 'derealization' and is a common symptom of anxiety.
Also, the feeling you are detached from yourself in conversation, as if someone else is speaking is called 'depersonalization' and also comes as a consequence of high anxiety states. Depression can also cause this feeling.
Don't worry about being psychotically depressed-you'd be deluded or hallucinating.
You need a better mood stabilizer and something to help with your anxiety.
Eric
Posted by david blistein on January 23, 2012, at 17:22:18
In reply to Re: agitated depression, posted by Roslynn on January 23, 2012, at 11:50:52
I "lived" with this condition for almost two years, in the course of which it was given the following names: "agitated depression," "cyclothemia," "double depression," "borderline bipolar" "dysphoric mania" "bipolar with dysphoria instead of euphoria." With the word "psychosis" used occasionally. You get the idea.
I have my psychiatrist(s)' notes from the time and, on DSM Axis 5 (easy to find on the web), I hovered around 30+; i.e. about as crazed as it can get without hallucinations.
I often had that experience you talk aboutalthough I'd experience it as trying to "push out" or "juggle" a functioning personality while I cowered behind it.
Currently, I'm very successfully medicated with an anti-psychotic, anti-depressive, and occasional benzodiazepam. (I'm new to the board and am not sure whether we're supposed to list actual drugsbesides, it's different for everyone.)
I've also written fairly extensive about this, but am not sure re rules for posting links so let me know if you want to read more.
BUT what seems really important to me is that you insist to your psychiatrist (I assume you have one!) that you are not "just" depressed or not "just" anxious. If he/she hasn't dealt with this combination, I'd strongly urge finding someone who has. I'd been treated for depression before this episode and know that this is different. Good luck, Mark...it CAN be treated.
> Hi,
>
> I think (as a layman) this could be more due to anxiety or a combo of anxiety/depression. I've had those feelings before and I think it's referred to as derealization/depersonalization. I don't think it's psychosis. But it can be terrifying. Just my two cents. I hope it goes away soon. I know it's hard.
>
> Roslynn
>
>
>
> > I am having such a difficult time with anxiety and depression. I feel like I have somewhat lost touch with reality. Could I possibly have psychotic depression? I don't know what the signs are. I'm not hearing voices or seeing things but when I have a conversation it's almost like someone else having the conversation...so strange. I don't know how this is diagnosed.
> > Mark
>
>
Posted by Phillipa on January 23, 2012, at 18:15:58
In reply to Re: agitated depression, posted by david blistein on January 23, 2012, at 17:22:18
David welcome to babble!!!. As for posting actual meds that's okay you can. And links are allowed as long as civil and don't contain anything that could hurt someone. You sound like you have a lot to offer. Phillipa
Posted by morgan miller on January 23, 2012, at 19:04:51
In reply to Re: agitated depression, posted by david blistein on January 23, 2012, at 17:22:18
Sorry you are going through this Mark. I would stay away from antipsychotics and benzodiazepines for now and try a much better mood stablizer than Tegretol. I think a month or so of lithium or depakote would be worth a try. If you take depakote, supplement with l carnitine and l methylfolate. I personally think you should try Depakote first, and if you feel stabilized after a while but need an antidepressant, try an SSRI like Zoloft or Lexapro. I have been feeling more stable since starting LDN, just something to think about for the future.
Posted by morgan miller on January 23, 2012, at 19:04:56
In reply to Re: agitated depression, posted by david blistein on January 23, 2012, at 17:22:18
Sorry you are going through this Mark. I would stay away from antipsychotics and benzodiazepines for now and try a much better mood stablizer than Tegretol. I think a month or so of lithium or depakote would be worth a try. If you take depakote, supplement with l carnitine and l methylfolate. I personally think you should try Depakote first, and if you feel stabilized after a while but need an antidepressant, try an SSRI like Zoloft or Lexapro. I have been feeling more stable since starting LDN, just something to think about for the future.
Posted by david blistein on January 23, 2012, at 19:30:14
In reply to Re: agitated depression » david blistein, posted by Phillipa on January 23, 2012, at 18:15:58
> David welcome to babble!!!. As for posting actual meds that's okay you can. And links are allowed as long as civil and don't contain anything that could hurt someone. You sound like you have a lot to offer. Phillipa
Thanks for the welcome! The post after mine proves how different everyone is, but with that caveat...I sequed from Depakote and Valium to Lamictal and Clonazepam, slowly adding Cymbalta underneath. Even though it was 6 months before I could confidently say: "I'm back," I felt a little better fairly quickly and that gave me courage to carry on. Obviously, for others, Depakote is great.
Re link: I'm turning my experience into a book (may even have a publisher) but you can see a little at our local newspaper's site, if interested. http://www.commonsnews.org/site/site04/story.php?articleno=4371&page=1
Posted by morgan miller on January 23, 2012, at 20:30:47
In reply to Re: agitated depression, posted by david blistein on January 23, 2012, at 19:30:14
> > David welcome to babble!!!. As for posting actual meds that's okay you can. And links are allowed as long as civil and don't contain anything that could hurt someone. You sound like you have a lot to offer. Phillipa
>
> Thanks for the welcome! The post after mine proves how different everyone is, but with that caveat...I sequed from Depakote and Valium to Lamictal and Clonazepam, slowly adding Cymbalta underneath. Even though it was 6 months before I could confidently say: "I'm back," I felt a little better fairly quickly and that gave me courage to carry on. Obviously, for others, Depakote is great.
>
> Re link: I'm turning my experience into a book (may even have a publisher) but you can see a little at our local newspaper's site, if interested. http://www.commonsnews.org/site/site04/story.php?articleno=4371&page=1Hey David...Everyone is different, but if you are looking for the best chance of taking something long term with the least potential for harm, Depakote(with l carnitine and l methylfolate supplementation) and an SSRI would be safer long term-easier on the brain and body.
Morgan
Posted by morgan miller on January 23, 2012, at 20:37:05
In reply to Re: agitated depression, posted by david blistein on January 23, 2012, at 19:30:14
I just believe that AP's and benzos should be last resort, and we should try to tough it out for a while and see if we can stabilize on better medications before rushing into and getting hooked on medications that have the potential to do more harm down the road. Plus, benzos have a short half live, I just don't see how they ever will fit in to anybody's long term regimen if they are bipolar, with the exception being klonpopin.
Posted by Phillipa on January 23, 2012, at 21:11:41
In reply to Re: agitated depression, posted by morgan miller on January 23, 2012, at 20:37:05
Maybe not bipolar I don't know. I only know that when age 24 had two small children and panic attacks hit and nothing I could do stopped the catastrophic thoughts. Til I was then given valium 5mg three times a day and mepbrobamate. Mep is and was only taken til didn't need it anymore. But this combo saved my life at the time. Yes we are all so different. Phillipa
Posted by david blistein on January 24, 2012, at 7:48:12
In reply to Re: agitated depression, posted by morgan miller on January 23, 2012, at 20:37:05
> I just believe that AP's and benzos should be last resort, and we should try to tough it out for a while and see if we can stabilize on better medications before rushing into and getting hooked on medications that have the potential to do more harm down the road. Plus, benzos have a short half live, I just don't see how they ever will fit in to anybody's long term regimen if they are bipolar, with the exception being klonpopin.
Hey Morganagreed on the benzosClonazepam is a trade name of Klonopin. I now nibble a little piece once in a while (probably equivalent of less than .25), and can go a week without even thinking about it. Whereas the Valium was definitely addictive and Lorazepam I just didn't like (and is also more addictive) As far as the more harm with the anti psychoticsI thought Depakote was of more concern there 'cause of the liver thing? Is that why you suggest the supplements?
As far as Lamictal/Lamotrigine I thought the biggest concern was that odd potentially-fatal rash that occurs rarely, and hasn't with me. I didn't know of long-term concerns. So curious.
Thanks
Posted by SLS on January 24, 2012, at 8:21:40
In reply to Re: agitated depression, posted by david blistein on January 24, 2012, at 7:48:12
I never became addicted to any of the benzodiazepines I used. However, I did become physiologically dependent on them. For this reason, they were difficult to discontinue.
I would be wary of Xanax producing true addiction.
Addiction is not the same as physiological dependence. Addiction includes psychological dependence and cravings.
- Scott
Posted by morgan miller on January 24, 2012, at 12:48:37
In reply to Re: agitated depression, posted by SLS on January 24, 2012, at 8:21:40
> I never became addicted to any of the benzodiazepines I used. However, I did become physiologically dependent on them. For this reason, they were difficult to discontinue.
>
> I would be wary of Xanax producing true addiction.
>
> Addiction is not the same as physiological dependence. Addiction includes psychological dependence and cravings.
>
>
> - ScottPsychological dependence and cravings along with physiological dependence. This is what you are saying right Scott?
Posted by morgan miller on January 24, 2012, at 12:58:23
In reply to Re: agitated depression, posted by david blistein on January 24, 2012, at 7:48:12
Hey david, yeah I thought you said clonazepam, my bad. Did you specify that you just nibble on a little sometimes and go without it for a whole week? If not, that might be very valuable information for someone seeking help to know. Then at least they know that klonopin is not really what is helping to hold you together, and it may be something you want to do without completely at some point.
I do think L-Carnitine can help prevent liver issues. L-Carnitine plays a pretty major role in liver function and is depleted by Depakote. Folate is also depleted by Depakote. I believe we can eat right, supplement right, avoid toxins, and find a fairly low but still effective dose of Depakote and thrive for the rest of our lives-that is most of us at least. There are some that for whatever reason may be very sensitive to liver issues with Depakote. I just think mood stabilizers for the most part have less potential to do harm than antipsychotics.
Lamictal is a very powerful drug, more so than lithium and depakote I believe. It works great for many, and many do not notice much of anything as far as side effects go, but that sh*t is strong, I know it is. I just believe, after doing a little research, that it can have more potential to mess with one's mind over the long run, or the short run, than the other mood stabilizers. It appears that anectodal reports seem to show this-if you check out reviews on drug review websites I think you will find this to be the case.
Morgan
Posted by SLS on January 24, 2012, at 13:42:09
In reply to Re: agitated depression, posted by morgan miller on January 24, 2012, at 12:48:37
> > I never became addicted to any of the benzodiazepines I used. However, I did become physiologically dependent on them. For this reason, they were difficult to discontinue.
> >
> > I would be wary of Xanax producing true addiction.
> >
> > Addiction is not the same as physiological dependence. Addiction includes psychological dependence and cravings.
> >
> >
> > - Scott
>
> Psychological dependence and cravings along with physiological dependence. This is what you are saying right Scott?Yes. This is true of exogenous chemical substances. However, there can also be addiction without physiological dependence. Lots of behaviors are addicting. I guess one can make the argument that in these cases, there develops a dependence upon endogenous substances like endorphins and dopamine. I would have to wrestle with that idea for awhile, though.
- Scott
Posted by markwell on January 24, 2012, at 18:29:37
In reply to Re: agitated depression » morgan miller, posted by SLS on January 24, 2012, at 13:42:09
Thanks everyone for your input. I'm seeing a new doctor next week (second opinion). I'm hoping she suggests lithium. I think I have too much depression for depakote.
Mark
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