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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by brynb on June 27, 2015, at 12:06:58
Hi All-
I haven't been on here in quite some time. I'm doing ok-ish, though I'm at a bit of an introspective stand still and have had a decent amount of ups & downs (many more downs!) the past year, and feel like I need to rethink or address certain issues and questions I have. I'd love the community's feedback.
First, I use a pdoc in Manhattan who does IM Ketamine & TMS in office, as well as med management. I've been with him for about 3.5 years (my longest relationship ever w/ a pdoc) & while I have issues w/ him, he knows me very well, did my disability, and understands using "non psych" meds and thinking outside of the box for psych issues.
To be clear, I no longer do Ketamine treatments unless I'm really down, in a slump and need a kick start (imo that's what it's best for).
Here are some of my issues/questions:
-I never had a definitive diagnosis, tho' it seems I lean toward TRD, MDD w anxiety, or possibly some sort of Bipolar 2 w/ the prominent symptom being major depressive episodes.
While he never suggested it, other psych professionals over the years have asked if I've been dx'd with a personality disorder (borderline or histrionic), something that's crossed my mind many times too. Neither my doc nor I are too concerned w/ my DX (good, bad...?) but rather with the therapies & meds that work.After dealing (and not treating/dealing) with my illness for over 20 years, I've found less and simple goes much further for me with meds.
I'm currently doing my best (as far as functioning daily w few side effects) on Lexapro, Tramadol & Ativan. Lexapro & benzodiazepines have been in the picture forever & help depression & anxiety w the least side effects, tho' I'm at a high dose of Ativan and have started to very slowly lower the dose bc it's leaving me exhausted. Tramadol has been in my regimen for 4 years; it's a wonderful AD for me & helpful for inexplicable (horrible) leg and (sometimes) arm pain. It's considered fibromyalgia by omission. I've been tested for everything and I'm negative on every imaginable fronts.
As far as the DSMV goes & a bipolar 2 diagnosis, I believe I fit in the "hyper from certain meds" criteria. Several examples (and yes, I know some of the following are NOT psych meds):
-Neurontin: makes me manic in every definition of the word (speeding, over talking, hyper sexual, over spending, crying one minute over nothing...it continues).
-All pain meds, including sometimes my Tramadol, make me very up and talkative.
-AAP: I've been all over the board w/ unsavory reactions (anxiety, depression, exhaustion, etc.)
-Stabilizers: severe depression and anxiety
-Stimulants: very allergic to the entire group of meds & they all induce severe melancholia.(That's just a cursory, quick med rundown.)
Clearly, many meds are out of the picture, whic, as said, is fine bc less is more with me, but as much as I have improved quite a bit, if I simply miss a little over one day of my meds, I'm thrown into a tizzy; I become nasty, sick and have something akin to a blackout. I also become bed-bound.
That's why I'm sticking to the less is more approach and trying to incorporate some physical activity, yoga, meditation and being social if possible. That said, I still have a good many days where I'm too tired/unmotivated/depressed to leave home or my bed.
As far as rapid cycling goes, I suppose I can be hyper manic (irritable, anxious) and I absolutely have times when I don't or can't sleep, and I definitely have been having at least 4 or more severe depressive episodes where I'm home bound for at least a week. As I said, it seems like "rapid cycles."
Thus my questions and feeling like I could be doing better. I'd like to incorporate different therapies (perhaps a therapist, starting yoga & being physical, etc.). But, as much as I know what I can and *should* do to get better, I still often lack motivation, interest and have these episodes that hit me out of nowhere and I fear my world will be upside down w/ no warning on any random morning.
I guess I'd like feedback/responses/etc. re: what my dx might be according to the above, my reactions to meds, the rapid cycling, bipolar vs depression vs both w a personality disorder, etc., etc., etc. I feel I should be doing a lot better & I'm often sabotaging myself. I'll be 41 in a few days and am lonely since it's been a long time I've been in any serious relationship. And I just can't deal with my roller coaster of emotions. There seems to be no middle ground. Can anyone relate?
One last thing: I used to take klonopin. Not certain really egg I take Ativan instead now, but, if I'm not mistaken, can't klonopin provide mood stabilization? I vaguely remember being more social or motivated while on it, but that was years ago.
Thanks in advance, sorry for the novella, and I hope you're all faring well.
-b
Posted by SLS on June 27, 2015, at 14:36:00
In reply to Mania, med reactions, the DSMV + rapid cycling!, posted by brynb on June 27, 2015, at 12:06:58
Real quick:
As you already know, the new DSM 5 now qualifies as bipolar disorder cases in which depression is chronic except for drug-induced manic episodes. It can happen with Bipolar I or Bipolar II. I'm a Bipolar I, and my case follows this pattern.
Rapid cyclicity can actually appear or disappear as the natural course of bipolar illness. It can also either be triggered or dissipated by drug treatment. I was an ultra-rapid cycler with a very regular period of 11 days (8 depression; 3 euthymia). My cycling was abolished by the introduction of lithium. It left me in a chronic state of depression. Removing the lithium did not yield a return of cycling.
I am unclear as to what your questions are, if any. However, you might want to take a look at Trileptal (oxcarbazepine) or even Aptiom (eslicarbazepine) if you haven't already. Trileptal is an excellent anti-manic mood stabilizer. Some doctors are using:
Trileptal + Lamictal
This combination is particularly good for mixed states. Lamictal itself is a poor anti-manic. Even though it helps more with depression, there is some data that it can penetrate rapid-cycling after six months.
From what little I have seen, I might suggest adding to this:
+ Abilify for residual depression and perhaps mania.
+ Wellbutrin for remaining depression
+ lithium (Low-dose for depressive component only; high-dose for mania and mood stabilization).Just a few thoughts.
- Scott
Posted by Tomatheus on June 27, 2015, at 15:39:11
In reply to Mania, med reactions, the DSMV + rapid cycling!, posted by brynb on June 27, 2015, at 12:06:58
Bryn,
It's good to see you posting here. It's nice to hear that you can say that you're doing "ok-ish," even though you're also indicating that you'd like to be doing quite a bit better. I can't say that I have a whole lot to offer you as far as medication suggestions are concerned. I know that you asked about trying Nardil some time ago, and I do think that Nardil (perhaps with some augmentation) still might be worth trying, although the problem with that would be that you'd have to stop taking much of what you're currently taking and benefiting from. So, I can definitely understand if you wouldn't want to try the MAOI route. I think that Scott offered some interesting medication suggestions, which might be worth looking into if you haven't already tried them.
As far as ideas concerning what diagnosis might be most fitting for you are concerned, it's been a while since I've looked at the diagnostic criteria for mood disorders, but I tend to think that you'd likely fall somewhere into the bipolar spectrum based on what you've written about experiencing rapid cycling and manic symptoms with some medications. Having said what I've said, if depressive symptoms tend to dominate for you (and it sounds like they do), then I'm not convinced that adding large amounts of anti-manic medications would likely serve you well. Given what you wrote about your responses to mood stabilizers and antipsychotics, I tend to think that if another medication with anti-manic properties might benefit you, the benefits would probably be best with lower doses. But of course, I could be wrong.
So, I don't know how well I answered your questions, but I just wanted to write to say that I was glad to see your post here and also to give you a few ideas in response to the questions that you asked. I wish you the best in your ongoing pursuit of mental wellness.
Tomatheus
Posted by Lamdage22 on June 28, 2015, at 9:03:52
In reply to Re: Mania, med reactions, the DSMV + rapid cycling! » brynb, posted by Tomatheus on June 27, 2015, at 15:39:11
I got a psychotic reaction to Nardil. Quite severe.
Trying meds is not without risks. They may make you better, but also have the potential to make you worse.
I was kind of hooked on Nardil although it made me psychotic.
It wasnt fun.
Posted by Hugh on June 28, 2015, at 11:32:07
In reply to Mania, med reactions, the DSMV + rapid cycling!, posted by brynb on June 27, 2015, at 12:06:58
Have you tried d-cycloserine?
In case you missed this thread:
Posted by brynb on June 28, 2015, at 11:49:12
In reply to Re: Mania, med reactions, the DSMV + rapid cycling! » brynb, posted by SLS on June 27, 2015, at 14:36:00
Thanks for your thoughtful response, Scott.
Well, I certainly do fit into the category of chronic depression, where sometimes it's just not as bad. As for mania, the only very manic (textbook) reaction I had was from Neurontin. Other times it's hyper or shown in my sleep (or lack of) patterns.
I was put on a low dose of Lithium once, a few years ago, but nothing. No magic. Same with Trileptal, which I tried a few times. As for Lamictal, same; tried it twice, and both times it severely worsened my depression.
Thanks for your insight and response.
B
Posted by brynb on June 28, 2015, at 11:52:24
In reply to Re: Mania, med reactions, the DSMV + rapid cycling! » brynb, posted by SLS on June 27, 2015, at 14:36:00
Oh! SLS, one more thing: Wellbutrin made me a wild woman. Angry, mean, irratible--even at the low doses. And it wasn't good for anxiety:(. Thanks again.
Posted by brynb on June 28, 2015, at 12:03:53
In reply to Re: Mania, med reactions, the DSMV + rapid cycling! » brynb, posted by Tomatheus on June 27, 2015, at 15:39:11
Hi Tomatheus,
Nice to hear from you. Your response was thoughtful, thank you. I'm in agreement that while Nardil once was an idea, I no longer consider it. And yes, I simply can't justify using AAPs & stabilizers bc it's a crap shoot with me usually cr*pp*ng out hard.
I guess ok-ish is better than a lot of alternatives, I was just hoping as I got older, "this" would be a less prominent, not more prominent issue. I'll keep moving ahead and try to remain positive.
How are you? Hope all is well and many thanks.
B
Posted by brynb on June 28, 2015, at 12:27:26
In reply to Re: Mania, med reactions, the DSMV + rapid cycling!, posted by Hugh on June 28, 2015, at 11:32:07
Hi Hugh,
Thanks for your response and good to hear from you.
This is the first I heard of it. I need to re-read what you sent, I barely skimmed it.
In truth, I really want the most simple, clean routine as far as meds go with little reliance upon my pdoc, even tho that's far -fetched seeming right now.
I do think I personally could be doing more (exercise, meditation, yoga, tx, etc) but we all know how challenging that is when you're tired (and the motivation plays out well in my head--I just can't actually "do it "). I feel blocked.
Hope all is well and thanks again.
B
Posted by Tomatheus on June 28, 2015, at 14:05:35
In reply to Re: Mania, med reactions, the DSMV + rapid cycling! » Tomatheus, posted by brynb on June 28, 2015, at 12:03:53
Hi Bryn,
Thank you for your response. I know what you mean about the problems associated with your mood disorder turning out to be more prominent than you had hoped that they would be. It can sure be frustrating to initially expect certain problems to diminish in their intensity, only to see the problems remain or perhaps intensify as time goes on, but I think that you're taking the right approach to things in continuing to move ahead while trying to remain positive.
I'd say that I'm also doing more or less "ok-ish" at the moment myself (thanks for asking :)). I'm still taking Abilify for my psychosis and experimenting with different alternative treatments to improve my energy and concentration. So far, I haven't found anything to help with my energy and concentration in the long run, although I'm not doing badly right now on my current regimen (niacin, zinc, molybdenum glycinate, and curcumin, along with Abilify). If I do find something that helps any of my symptoms in the long run, I'll be sure to post about it, either here on the medication board or the alternative board.
Well, thank you again for replying, and I hope that the rest of your day will treat you well.
Tomatheus
Posted by brynb on June 28, 2015, at 14:25:10
In reply to Re: Mania, med reactions, the DSMV + rapid cycling! » brynb, posted by SLS on June 27, 2015, at 14:36:00
Hi again, Scott. I realized I want to ask you to clarify: if you're chronically suffering from MDD, yet have had only a few manic, hyper manic or mania induced (even only a few times) from psych meds, it's considered Bipolar 2?
Thanks again. Hope you're well!
Posted by SLS on June 28, 2015, at 16:50:54
In reply to Re: Mania, med reactions, the DSMV + rapid cycling! » SLS, posted by brynb on June 28, 2015, at 14:25:10
> Hi again, Scott. I realized I want to ask you to clarify: if you're chronically suffering from MDD
I suffer from chronic bipolar depression. The bipolar diagnosis is important because it helps to account for one's case history and treatment responses. Many people with bipolar disorder are originally diagnosed as MDD (unipolar). It isn't until mania first emerges - whether spontaneously or as a reaction to treatment - that the diagnosis must be revised. I am bipolar I because my manias are significantly more severe than those seen in bipolar II.
I'm sorry that you reacted so badly to Trileptal and Lamictal. I haven't had a hint of mania since beginning Abilify over 10 years ago. However, it has helped with depression.
For what it's worth, I am currently taking:
Parnate 100 mg/dsy
nortriptyline 100 mg/day
Lamictal 300 mg/day
lithium 300 mg/day
Abilify 10 mg/day
prazosin 30 mg/dayI glean a partial response to this, for which I am so very grateful, but it still leaves me below 50% improvement. Until new drugs come out, I will begin looking into varioius TMS (transcranial magnetic stimulation) treatments.
- Scott
Posted by bleauberry on July 6, 2015, at 11:58:53
In reply to Mania, med reactions, the DSMV + rapid cycling!, posted by brynb on June 27, 2015, at 12:06:58
Wow, I apologize in advance, but I have to say it again. I'm tired of saying it. It sounds nuts.
What you just described in your post, has already been written by millions of other people, almost word for word. Substitute different med names, but the stories are basically identical.
Those people I am talking about, are the ones that had Lyme disease and didn't know it. Or another similar stealth unsuspected hidden undiagnosable pathogen wreaking havoc in the brain. No matter, they all respond to the exact same treatment, so we need not even know for sure the name of the exact enemy. Just the family they are from. The family called "infection" is good enough.
Seriously, try surfing the web and check out some Lyme blogs, some Lyme chats, roam around, explore....LLMDs....I think you will find yourself being described with so many of those stories.
The key things I saw in your post that raised a red flag for infection were:
1)Chronic long time
2)Treatment not successful
3)Difficult to give it a diagnostic name
4)I bet you have lots of other symptoms you didn't mention
5)Cycling
6)Medication sensitivity that causes either bizarre side effects, can't take normal doses, or actually makes you worse than you were.All of this looks so complicated, so bizarre, so mysterious, no wonder MDs can't get you better!
My opinion is that you do not have a psychiatric condition. You have psychiatric symptoms. Caused by the poop, pee, enzymes, and toxins, contaminating serotonin and dopamine, blocking receptors.
My Lyme doctors both claimed that 9 out 10 of their chronically ill psychiatric patients (always inherited from failed MDs) got remarkably or completely better when the strategy was anti-infection anti toxin rather than anti depression. The depression just automatically disappears as population levels come down over time. Me...3 years treatment....most people 3-9 months.
I guess maybe to make a long story short, I could maybe phrase it this way:
WHEN PSYCHIATRIC MEDICINES FAIL, TRY ANTIBIOTICS!
It is 100% true the above statement saved my life from psychiatry. The best drugs man has, the best ECT man has....useless compared to antibiotics. My story. And millions of others. Probably 9 out 10 at psychobabble are consistent with this scenario.
IMO
Posted by Robert_Burton_1621 on July 7, 2015, at 11:19:33
In reply to Re: Mania, med reactions, the DSMV + rapid cycling!, posted by bleauberry on July 6, 2015, at 11:58:53
> Wow, I apologize in advance, but I have to say it again. I'm tired of saying it. It sounds nuts.
>
> What you just described in your post, has already been written by millions of other people, almost word for word. Substitute different med names, but the stories are basically identical.
>
> Those people I am talking about, are the ones that had Lyme disease and didn't know it. Or another similar stealth unsuspected hidden undiagnosable pathogen wreaking havoc in the brain. No matter, they all respond to the exact same treatment, so we need not even know for sure the name of the exact enemy. Just the family they are from. The family called "infection" is good enough.
>
> Seriously, try surfing the web and check out some Lyme blogs, some Lyme chats, roam around, explore....LLMDs....I think you will find yourself being described with so many of those stories.
>
> The key things I saw in your post that raised a red flag for infection were:
> 1)Chronic long time
> 2)Treatment not successful
> 3)Difficult to give it a diagnostic name
> 4)I bet you have lots of other symptoms you didn't mention
> 5)Cycling
> 6)Medication sensitivity that causes either bizarre side effects, can't take normal doses, or actually makes you worse than you were.
>
> All of this looks so complicated, so bizarre, so mysterious, no wonder MDs can't get you better!
>
> My opinion is that you do not have a psychiatric condition. You have psychiatric symptoms. Caused by the poop, pee, enzymes, and toxins, contaminating serotonin and dopamine, blocking receptors.
>
> My Lyme doctors both claimed that 9 out 10 of their chronically ill psychiatric patients (always inherited from failed MDs) got remarkably or completely better when the strategy was anti-infection anti toxin rather than anti depression. The depression just automatically disappears as population levels come down over time. Me...3 years treatment....most people 3-9 months.
>
> I guess maybe to make a long story short, I could maybe phrase it this way:
>
> WHEN PSYCHIATRIC MEDICINES FAIL, TRY ANTIBIOTICS!
>
> It is 100% true the above statement saved my life from psychiatry. The best drugs man has, the best ECT man has....useless compared to antibiotics. My story. And millions of others. Probably 9 out 10 at psychobabble are consistent with this scenario.
>
> IMOI'm pleased to hear of your story, and your correct diagnosis leading to the prescription of antibiotics (what kind?).
However, I would caution against universalising your experience, especially with the citation of purported statistical evidence for which you provide no reputable source.
It might also be instructive for you to be aware of what strikes me as the Americo-centric assumptions of your post. "Lyme disease" is not a pathology which, for instance, is a major - or even minor - medical burden in Australia, if it exists here at all.
You also omit to outline the acute physicial symptoms of lyme disease which point to bacteriological infection, in particular fever and erythema migrans. There is no evidence at all that such primary symptoms occur in depressive or other psychiatric illnesses, and are surely markers for differential diagnosis.
You also omit, in your recommendation of antibiotic treatment as a panacea for depression, to consider the vast overuse of antibiotics for conditions which they cannot treat, and the consequential phenomenon of antibiotic resistance which is becoming more serious in hospital settings.
Posted by SLS on July 11, 2015, at 6:25:33
In reply to Re: Mania, med reactions, the DSMV + rapid cycling! » bleauberry, posted by Robert_Burton_1621 on July 7, 2015, at 11:19:33
> It might also be instructive for you to be aware of what strikes me as the Americo-centric assumptions of your post. "Lyme disease" is not a pathology which, for instance, is a major - or even minor - medical burden in Australia, if it exists here at all.
Do you live in Melbourne? My doctor from the USA will be speaking there next week regarding the contribution of neuroinflammatory processes to psychiatric syndromes. He's real big on Lyme Disease and other tic-borne illnesses, so he might address that issue, too. What's nice is that he doesn't neglect diagnosing and treating the gamut of psychiatric illnesses. Using Google as a search engine, I found that some medical professionals believe that Lyme Disease does indeed exist in Australia. However, I don't know what statistics are available. Maybe it is an imported pathogen? There is still some debate as to the existence of Lyme in Australia. Until receently, I think Australia and Antarctica were considered the two continents free of Lyme Disease. I don't know.
https://www.google.com/?gws_rd=ssl#q=australia+lyme+disease
- Scott
Posted by brynb on July 11, 2015, at 17:45:22
In reply to Re: Mania, med reactions, the DSMV + rapid cycling! » brynb, posted by SLS on June 28, 2015, at 16:50:54
Thanks to everyone who contributed to my post.
Re: Lyme disease, I've been tested a few times and it was negative. I've been tested recently for that and other diseases but it all came up negative. Is it possible to have it and still test negative?
Thanks again for all of the feedback.
Posted by Robert_Burton_1621 on July 19, 2015, at 12:46:44
In reply to Re: Mania, med reactions, the DSMV + rapid cycling! » Robert_Burton_1621, posted by SLS on July 11, 2015, at 6:25:33
> Do you live in Melbourne? My doctor from the USA will be speaking there next week regarding the contribution of neuroinflammatory processes to psychiatric syndromes. He's real big on Lyme Disease and other tic-borne illnesses, so he might address that issue, too. What's nice is that he doesn't neglect diagnosing and treating the gamut of psychiatric illnesses. Using Google as a search engine, I found that some medical professionals believe that Lyme Disease does indeed exist in Australia. However, I don't know what statistics are available. Maybe it is an imported pathogen? There is still some debate as to the existence of Lyme in Australia. Until receently, I think Australia and Antarctica were considered the two continents free of Lyme Disease. I don't know.
>
> https://www.google.com/?gws_rd=ssl#q=australia+lyme+disease
>
>
> - ScottThanks, Scott. I am aware that the quarantine arm of the federal government here is definitely monitoring lyme disease; and there have been isolated reports of its occurence here. Apart from that, however, it is not (here) a condition which is so prevalent, or a condition whose contraction is a real statistical risk, that people suffering from depression ought be seriously sceptical that they have been incorrectly diagnosed and they are, thus, being treated with powerful medications which are inefficacious.
The neuroinflammatory hypothesis is, however, extremely interesting in itself, and I would be interested in reading your doctor's address if it happens to be published. I am not in Melbourne myself.
This is the end of the thread.
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