![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 35. This is the beginning of the thread.
Posted by beardedlady on June 6, 2002, at 15:32:44
Does anybody have one, and can you explain what it is?
beardy : )>
Posted by judy1 on June 6, 2002, at 19:12:32
In reply to Mood disorder, posted by beardedlady on June 6, 2002, at 15:32:44
Wow, I thought everyone on this board had one :-). According to the DSM, a mood episode refers to any period of time when a patient feels abnormally happy or sad. They include the following:
Major Depressive Episode- For at least 2 weeks, the patient feels depressed (cannot enjoy life) and has problems eating, sleeping, guilt feelings, loss of energy, and sometimes thoughts of death.
Manic episode- For at least one week (or less if hospitalized) the patient feels elated, irritable, grandiose, talkative, hyperactive and distractible. Bad judgement leads to marked social or work impairment or hospital.
Mixed Episode- At least one week of fulfilling criteria of both manic and depressive episodes,
Hypomanic- similar to manic but less severe (at least 4 days), does not lead to hospitalization.
These are the building blocks of mood disorders- unipolar or Major depression consists of a depressive episode; dysthymic disorder lasts much longer and is less severe.Bipolar 1- at least one manic episode (most have depessive episodes also)
Bipolar 2- at least one hypomanic episode plus at least one depressive episode
Cyclothymic Disorder- repeated mood swings but neither are severe enough.
Then BP3- hypomanic only from AD's, BP4- family history- This is mostly Akiskal's work, I don't believe it;'s in the DSM.I bet that's more than you ever wanted to know. Take care, Judy
Posted by wendy b. on June 6, 2002, at 22:19:27
In reply to Mood disorder, posted by beardedlady on June 6, 2002, at 15:32:44
Posted by beardedlady on June 7, 2002, at 5:42:26
In reply to Re: Mood disorder » beardedlady, posted by judy1 on June 6, 2002, at 19:12:32
That's a good start--good enough to tell I don't have one.
Here's the thing. Since I was at least 16 (at least 23 years), I have felt unable to feel happiness. I can get excited over something, but the feeling passes quickly, and I am grumpy and blah like I was before the good event. It has been much worse over the last few years. The feelings of joy don't last but a moment, and then worry of some sort sets in, or I just go back to being my irritable self.
Because I had nothing to talk about at therapy, I asked my therapist about whether this was the normal way to feel, whether most people feel like this, and he said no. He told me he would give me a test next week to see if I had a mood disorder.
Here's the thing: I'm not depressed. I function well. I have lots of hobbies. I laugh a lot when I am with friends. I love playing with my daughter. I love staring at her! I love shopping and outdoor parties and swimming and crabs. But I am uptight and grumpy, and I don't smile.
People who didn't know me would come up to me all the time and say, "Hey, it can't be that bad," just because of the look on my face. (I started to respond, "How do you know my mother didn't just die!?" They would either be terribly apologetic, or they would say, "Did she?" and I'd say, "It's none of your business. You don't know me!")
Still, I'm nice to people in line. I talk to strangers. I'm friendly. (I'm also confrontational, so don't park your car in front of the drive up mailbox, or I'll come into the post office to yell at you!) (Yes, I know I am going to get shot. Still, I worry about dying on a flight!)
I have decided that this is how I have to live, which is why I've never asked anyone about this. I am probably one of the types who really needed Prozac, but before I had the guts to do it (I told my OB that I wanted to go on it right after nursing, as I was feeling like a rabid dog), I got insomnia.
So what the hell is wrong with me? Is this just a bad personality? Or is there some label for this uptight grouch who rarely smiles?
beardy : )> whoops : (>
Posted by beardedlady on June 7, 2002, at 5:43:28
In reply to Re: Mood disorder? - why are you asking? (nm) » beardedlady, posted by wendy b. on June 6, 2002, at 22:19:27
Posted by Willow on June 7, 2002, at 10:59:39
In reply to Re: Mood disorder » judy1, posted by beardedlady on June 7, 2002, at 5:42:26
Gosh, where do I start? This is just me babbling about what I've observed with my children and with my siblings. We are born with different personality types, this I'm sure of. Each of my three were born with their own distinct character which was obvious right from the start. I could write a book giving examples, but I will not bore you with my motherly devotions and frustrations.
Then added to the various personalities is how each individual is molded by the experiences they have mixing with like and unlike individuals out in the world. And just for a twist, there are enviormental factors too.
Having said this, I believe once we reach a maturity level (the lucky souls who never do) where we can reflect on all this, and some of us like me use the assistance of psycoanalysis, we begin to understand all this hodgepodge. With understanding comes enlightenment and acceptance, and what we choose to do with this knowledge may depend on the personality type we were born with.
Whistling Willow
Posted by judy1 on June 7, 2002, at 11:37:24
In reply to Mood disorder, posted by beardedlady on June 6, 2002, at 15:32:44
I agree totally with Willow, this is your personality and you sound like for the most part you are happy with your life. To take a psychotropic med would be to change your personality, the essential 'you'. And I have no doubt a shrink would oblige and after his 15 min. eval say you have depression and give you an AD (it happens all the time and it's so WRONG). I guess I'm saying don't mess with perfection :-), and if you do want to deal with some problems- see a therapist. Take care, judy
Posted by beardedlady on June 7, 2002, at 11:43:32
In reply to Personality » beardedlady, posted by judy1 on June 7, 2002, at 11:37:24
My pdoc doesn't think I'm depressed; he thinks it's my personality. My therapist says the same thing, but he says there are therapeutic techniques that could help me experience more joy.
I have been reflecting on this aspect of my personality for many years, and it does really bother me. I would like to find out what the therapist advises.
By the way, everyone knows how much I hate meds, so no one would dare prescribe them!
beardy : )>
Posted by Tabitha on June 7, 2002, at 22:31:01
In reply to Re: Personality » judy1, posted by beardedlady on June 7, 2002, at 11:43:32
beardedlady,
I've gotten those kinds of comments too, people seeing some expression on my face I'm not really intending to project. I find it embarassing or annoying.
As far as therapy vs meds, you're lucky to have a therapist offering a clear alternative. Meds are kind of a sledgehammer approach to change.
Take care
Posted by wendy b. on June 8, 2002, at 0:17:15
In reply to Re: Personality » judy1, posted by beardedlady on June 7, 2002, at 11:43:32
> My pdoc doesn't think I'm depressed; he thinks it's my personality. My therapist says the same thing, but he says there are therapeutic techniques that could help me experience more joy.
>
> I have been reflecting on this aspect of my personality for many years, and it does really bother me. I would like to find out what the therapist advises.
>
> By the way, everyone knows how much I hate meds, so no one would dare prescribe them!
>
> beardy : )>
Beardy,With all respect, and try not to think of me as the woman who parks the car in front of the post-office box... But I think you might be dysthymic. Just low-level, chronic type of thing. And I truly do not understand, in a fundamental way, why you are so opposed to meds. Everyone knows how much you hate meds, so you have the doctors frightened enough so they wouldn't even mention it to you? What would be wrong with taking a minimum dose of prozac, or whatever, which someone who WASN'T afraid of you thought would be in your best interest to prescribe? (Bad grammar, but you know what I'm saying...) You think keeping your healthcare providers afraid to say things is GOOD? I say not. Respectfully, of course, don't want my head chewed off.
I mean, look at all the people on the meds board. OH! I get it now! You don't want to have to post on another board!!! :-]
Anyway, look at them. You think they're all a bunch of fools? You think you're 'different'? I don't know, just seems you might actually be able to enjoy yourself (or at least look like you do) if you gave something a trial.Ready for the bomb,
Wendy
Posted by judy1 on June 8, 2002, at 1:14:33
In reply to Re: Personality, posted by Tabitha on June 7, 2002, at 22:31:01
I liked Tabitha's image of a sledgehammer (and I won't address Wendy's post- I'll leave that for you) As I said before, medications are indicated for people with serious disorders (like major depression, bipolar, etc) and therapy for people who are somewhat dissatisfied with their lives or even have a mild depression- therapy has been found more effective then meds in that situation. When I saw your age- around 40?, I'm wondering if you have any symptoms of perimenopause, although psychological ones can happen before physical ones. I imagine that's why you're interested in the hormone discussion of the seminar I'm going to? It's also the reason I am taking a birth control pill with estradiol (despite just having a baby) I'm convinced my hormones are off or it could be because I did have a baby not too long ago. Anyway sorry for rambling. Take care, Judy
Posted by beardedlady on June 8, 2002, at 6:37:32
In reply to Re: Personally - on Personality » beardedlady, posted by wendy b. on June 8, 2002, at 0:17:15
Wendy:
I am already on a med—Serzone, and it's an anti-depressant. It works for my sleep, and when I sleep, life is fine. I have tried other meds--for many other conditions--and have had bad reactions to them (inability to think, inability to sleep, dizziness, allergy, etc.). Since I have a good life and have lived this way forever without having to take meds, I don't want to gum up the works at this stage in my life. I don't have the time to experiment.
I have not scared either of my doctors. My pdoc is on the trail of a replacement med in case the Serzone messes up my liver, and we've tried a few things, none of which have worked. My therapist is a natural kind of guy, and his first answer is not going to be meds with me because I haven't shown any sign to need them for anything other than sleep (and I think I'm not in an emergency situation, if you know what I mean). This is the first time we've discussed happiness.
I looked up dysthemia. I really have to say I'm more of a curmudgeon than someone with this disorder, as it has not exactly gone away ever, so I know no other state. I am not weepy or sobby, unless I don't sleep, and I have my ducks in a row with hobbies, friends, life, etc. It's just a general blahness; it doesn't keep me from leaving my house or enjoying my life. I just don't smile all that much while doing things I find pleasant.
I appreciate your help. And please remember: I'm the one on the med board telling people that we should not be beating ourselves up over having to take meds. Someone told me his goal was to find out what was causing his problem, get therapy for it, and go off meds for good. I told him that my sister found out what caused her allergies, her reflux, and her severe asthma, and that my other friend knew what caused type I diabetes, yet neither of them were able to go off their meds.
I am all for treating known conditions with medicines. I take Ibuprofen when I have a headache. I take Zantac when I have heartburn. I take a Sonata (last night, in fact) when I have trouble sleeping, and I take Serzone every day.
Forgive me if I don't believe in jumping on the med trail for an as-yet-undiagnosed condition I've had all my life and thought was normal. I am not in mental pain or anguish. I am not suffering. I have a terrific life. I'm just not a happy, cheerful, joyous person most of the time.
My best friend has dyslexia and is a healer (Carolyn Myss style, very psychic--even if you don't believe in it, she can prove it). I sent her two poems yesterday, and she wrote me back that they were awesome and that maybe my unhappiness was my gift to the world.
I don't know if I agree, but there are aspects of my personality that I wouldn't change for the world.
Thanks for your concern.
beardy : />
Posted by beardedlady on June 8, 2002, at 6:38:38
In reply to Re: Personality, posted by Tabitha on June 7, 2002, at 22:31:01
Yes, that would hurt. But if he's charging you $40 for an e-mail link, I think I'd take a sledgehammer to him. (Maybe there's something good about being confrontational!)
beardy : )>
Posted by beardedlady on June 8, 2002, at 6:40:44
In reply to Re: Personality- beardy, posted by judy1 on June 8, 2002, at 1:14:33
Yes, I thought perimenopause originally caused my insomnia, but no. Have you had your hormone levels checked? You can know in an instant if that's what your problem is regarding low or high. I am on the low estrogen end, and I think it drops significantly when I have my period. My other levels seem to be fine, and the OB wasn't even concerned about the estrogen.
beardy
Posted by beardedlady on June 8, 2002, at 7:04:33
In reply to Re: Personally - on Personality » beardedlady, posted by wendy b. on June 8, 2002, at 0:17:15
> You think keeping your healthcare providers afraid to say things is GOOD? I say not. Respectfully, of course, don't want my head chewed off.
Do I seem like the type to you that would keep around doctors I could bully? In order to be my doctor--or even my friend--YOU have to be able to tell ME what to do sometimes. And you have to be committed to your educated opinions. Otherwise, how can I respect you?
Your friend,
beardy
Posted by wendy b. on June 8, 2002, at 9:22:47
In reply to p.s. » wendy b., posted by beardedlady on June 8, 2002, at 7:04:33
> > You think keeping your healthcare providers afraid to say things is GOOD? I say not. Respectfully, of course, don't want my head chewed off.
>
> Do I seem like the type to you that would keep around doctors I could bully? In order to be my doctor--or even my friend--YOU have to be able to tell ME what to do sometimes. And you have to be committed to your educated opinions. Otherwise, how can I respect you?
>
> Your friend,
>
> beardy
Dear Beardy,As I said before, I mean this is as helpful a way as I can express, perhaps I'm not doing a great job... I don't know if you would keep drs around who you could bully, but if you did, I think it would be unconscious, and that, I suppose, is what I meant in the other post. People do all sorts of things for less-than-logical or intelligent reasons, most of the time without their knowing it. Of course, the poet in you knows this, I'm not telling you anything new. But anyway, that's what the unconscious is all about -- makes us do things we didn't know we wanted to do... But I'll leave you and your therapist to all that...
As you talk about perimenopause, I wanted to tell you it was my OB/GYN who prescribed me Zoloft, my first anti-depressant, when I was about 35 or so (I'm 42 now). It was for some bad perimenopausal symptoms, like screaming and being angry and irritable for 3 weeks out of 4, every month. My daughter suffered through this, and I felt awful enough about it to try something. And though my levels weren't "off," the doctor still felt these symptoms merited a trial. I knew after about a week on the stuff (not a placebo, IMO) that I had been depressed since childhood. But it was only after feeling better that I could make the distinction, if you know what I mean. The contrast was so marked. It finally stopped feeling like around every corner there was some fresh new disaster just waiting to happen to me. It took me a trial of Zoloft to be able to understand that was how I had felt all my life.
Now I know, you are not me. You are thanking your lucky stars, I know. Since the Zoloft, I've been dx'd with Bipolar I, single incident, and then modified to Bipolar II, and I'm on different meds altogether. It took a near manic episode for the therapist/pdoc to figure it out. I think people like me know we have to be on meds, and there is no luxury of questioning: do I or don't I? We just have to, or we'd be gone to another plane. Personally, I would have gotten hypothermia and then drowned in Lake Michigan last winter...
Happy thoughts!
"And now for my next act..."
Wendy
Posted by beardedlady on June 8, 2002, at 11:29:34
In reply to Re: p.s. » beardedlady, posted by wendy b. on June 8, 2002, at 9:22:47
Wend:
Those who know me would complain that I am too analytical, that I try to get to the underneath of everything, and it's very rare that I do something "unconsciously." Really, I don't bully my docs, knowingly or unknowingly.
It's lucky for you that you found Zoloft. That was what I was initially prescribed, and I cried for four weeks, and I didn't sleep a wink. It was a miserable experience for me, as was the Xanax I was prescribed before it, sometime during it, and after it with another med. It doesn't mean another one wouldn't work, but most of them list insomnia as a side effect. Serzone actually improves sleep, as it is an anti-anxiety med. If I took a higher dose, I'm sure it would work as an AD while still helping me with sleep, but I am doing well at my low dose.
I don't know how one who is depressed "becomes" bipolar, but I know little about mental illness. I have a cousin who has severe bipolar (and at least five suicide attempts under her belt), and she inherited it from her father. Now her teenage daughter has been diagnosed with it. In each of these cases, though, the person had the signs of it since childhood, manic episodes and all. A close friend was so terribly Dr. Jeckyl/Mr. Hyde with me, so I suggested she may have it (several years ago), and she sort of agreed but refused to get help. I couldn't take the abuse, so we are no longer friends, and she is, I hear, still having "accidents"--fires, car wrecks, etc.
Can an AD cause a switch in brain chemicals and make you prone to BP? Does BP run in your family? It's probably normal (pardon my oxymoron) to go from one disorder to another, but I just don't know much about it.
I am, at this point, sorry I brought this up. It's difficult to explain to people who don't know you what kind of person you really are, and I'm finding it odd that I have to defend my choice not to wish to explore medications in search of something that will make me feel chipper, especially if my therapist, who is very good, thinks there are other methods IF--and it's a big IF, since there's been no dx--he finds something unusual.
We'll have to agree to disagree.
beardy
Posted by katekite on June 8, 2002, at 11:33:02
In reply to Re: p.s. » beardedlady, posted by wendy b. on June 8, 2002, at 9:22:47
Hi,
This is turning into a med or no med debate which has been done to death elsewhere. But of course having not done it myself I have to make my one little point.
Drugs have risks. I like drugs, they have occasionally pulled me up out of deep depressions that might have killed me. But they do have side effects, you can be allergic and you can die. A course of ssri statistically reduces the chance that you will get a second episode of major depression (after you stop it). What does that mean? That means, to me, that some very long term changes occur in the brain. That once it wears off its not really gone. I do wish I'd known that before I took them for years. I probably would have taken them anyways but I might not have. I don't like permanent changes.
I don't like allergies or serious adverse effects either. I had a heart attack from trazadone the first time I took it. The majority of drugs I've had no problems with. (how did that with get at the end of that sentence?). Anyhow, my point is that there are risks.
There is also a risk to remaining the way you are. What if you never change or slowly get more bitchy as the years pass? Is that what you want? You might not know just how nice prolonged happiness is until you try some particular drug.
Right now, I'm in a little pit of guarded waiting, my mood is not good, but not terrible. I am jumpy and have insomnia. But I have this wonderful memory of 5 weeks on neurontin last fall during which I felt young and carefree and competent and happy. There were no downsides. (then I got side effects and had to stop). I want that again and I'm willing to work hard for it. I know where I want to end up, which is necessary for creating a plan. Knowing that I should be able to achieve that again gave me the confidence to assail the medical profession with my worries this spring, and that's leading to CT scans and lots of hormone testing etc. I knew instinctively how I felt wasn't quite right, but it made a huge difference to experience how others felt. Both ritalin and neurontin do that for me.
So that's that. If you don't try drugs you won't know what they might do. Most drugs will fail, that's a certainty. A few might not. It takes a long time and is fraught with risk.
There is also a risk that the drug will work! What then... do you take it forever or not? What if it works for a while and poops out? Then what?
The risks may turn into nothing (leading to people who espouse drugs for every minor ailment) or they may be life-threatening (leading to the folks who buy only organic thereafter).
On PB we don't hear from anyone where it worked great the first time and they never saw a psychiatrist again, preferring to see their GP every six months for a prescription. That is one thing to keep in mind -- we may hear more about the risks than the benefits.
However, that all said, its still in individual decision. No amount of babble will make a difference.
Which doesn't seem to stop us from babbling and babbling.
kate
Posted by beardedlady on June 8, 2002, at 12:11:40
In reply to Re: p.s., posted by katekite on June 8, 2002, at 11:33:02
This is the therapy board. It is not the med board. I did not come here to ask advice on medications. I came with a specific question about what a mood disorder is. I have not been diagnosed with anything but insomnia, and I am under the care of doctors that I trust, at long last.
I said that my doctors know better than to give me drugs, as I am sensitive to so many. And I also said I had asked my gynecologist about Prozac before the insomnia hit. I might have done it had I not gotten insomnia. But that was a detail. My post was not about meds.
Neither my pdoc nor my therapist would sacrifice my mental health if meds were indicated. But my therapist has not even given me his test to determine if anything is wrong with me! And once he does, he believes that he may be able to help me with therapy. That's why this is on the PPB board.
I do not recall wanting to get into a med v. no med debate with anyone. I have never judged others by whether they take meds, and I am often the first (as I have said before) to agree that some mental illnesses need to be treated with meds, just as some physical illnesses need to be treated with meds. For me, there is little difference between physical and mental health; they affect each other. But many physical and emotional ailments can be improved by lifestyle and diet changes and therapy. That's the route I will try first.
So please stop it with the pros and cons of drugs. That's not what my post was about, and this is not helping me at all! If you guys would like to debate it, start a new thread on PSB or PB.
If I had a choice between searching for a medication that made me cheerful for the first time in my life and staying exactly the same, this is where I would stay. I like myself. I am assertive, and I am also nice. I have a good life, and I'm not so down I can't enjoy a dozen crabs and the company of friends or a good movie or an adventurous meal or snuggling with my daughter. I am funny, and I laugh. And even though I don't feel so terrific inside, it's more like living with a hairy wart than it is like living with an ulcer. It's not perfect, and it's sometimes annoying, but it doesn't hurt.
I haven't advocated alternative means for you, so please don't advocate drugs--especially pre-diagnosis!--for me.
If anyone has ideas about how therapy has increased happiness, I'd love to hear from you. Otherwise, I'm done with this discussion.
beardy
Posted by bookgurl99 on June 8, 2002, at 16:00:11
In reply to Guys, please stop!, posted by beardedlady on June 8, 2002, at 12:11:40
Hey beardy --
I can say that therapy has helped me a lot, now that I have a therapist who speaks to me and is able to motivate me to change. I find that the best aspect of therapy is that, in addition to any insights gained from working with a 'professional', I learn how to change my own behavior in relationship to certain problems or relationships. Starting therapy (this last round, about two years ago) has really helped me develop a more assertive attitude towards my parents, for example.
It's definitely not a cure-all, but it helps.
bookgurl99
Posted by wendy b. on June 8, 2002, at 20:38:52
In reply to Guys, please stop!, posted by beardedlady on June 8, 2002, at 12:11:40
... just trying to make conversation, I guess. Never intended to upset you, honestly. I have a way of questioning that, when you know me in the flesh, just feels like a little bit of playful prodding, sort of like: "Here - try on this new suit of clothing!" Sometmes people respond well to it, sometimes they don't. Of course, that's hard to convey in writing and on the internet.
I wasn't dx'd by the GYN, he gave me Zoloft for the irritability and anger. I was in therapy at the time, she (a social worker) thought it was plain ol' vanilla depression with the perimenopause, and a little anxiety thrown in. I was dx'd, I hope properly, a little more than a year ago by my therapist (who can also prescribe meds - she's a nurse practitioner who specializes in psychiatry). It was she who dx'd the bipolar. So maybe it's hard for me to keep meds and therapy apart, they are just two sides of the same coin (bad metaphor, couldn't think of a better one right now). In that my therapist is also the person who prescribes my meds. Does this make any sense at all?
Again, will keep meds to the med board, didn't mean to stray so far afield, and never meant harm. I'm so sorry, Beardy...
Wendy
Posted by judy1 on June 8, 2002, at 23:46:54
In reply to Re: p.s. » wendy b., posted by beardedlady on June 8, 2002, at 11:29:34
Just some notes- serzone is similar to remeron, both AD's that at very low levels are sedating. Do you get too tolerant on benzos? (most people do for sedation but not anxiety)
I also had manic and depressive episodes since I was 13, had my first hospitalization at 19 for psychotic mania, had several suicide attempts-2 serious and lost my bipolar father to suicide (and throw in PTSD/DD in this mess). I tend to feel bipolar disorder is extremely over-diagnosed. When there is a manic switch on an AD, that is considered drug induced and not true bipolar disorder (although Akiskal would term it BP3)
I agree that it is sad when people who would clearly benefit from medication (like your friend) refuse help- it's a bipolar thing, we like the manias too much; but I also think it's sad that people who would benefit a great deal from therapy, good friends, even exercise get 5 different meds from a 15 min visit to a shrink.
Last- I also write my best poetry when slightly depressed, most of the famous writers would have said the same.
Hope this doesn't create havoc. Take care, Judy
Posted by Tabitha on June 9, 2002, at 2:59:14
In reply to sledgehammer » Tabitha, posted by beardedlady on June 8, 2002, at 6:38:38
LOL. Oh, but it wasn't just a link, he actually cut and pasted the text. I'm not sure if that makes it better or worse...
Posted by Tabitha on June 9, 2002, at 3:14:12
In reply to Guys, please stop!, posted by beardedlady on June 8, 2002, at 12:11:40
I think so, though often I wonder if there would have been a cheaper way.
I'm a happier person that when I started, though it's difficult to know if that's due to the therapy. Giving up some bad habits helped, and the therapist certainly gave support for those changes. I think my self-esteem went up a few notches. I think I don't waste energy in self-criticism nearly as much, and that probably also reduces anxiety and depression.
My therapist told me that becoming happy wasn't a realistic goal of therapy. She says the reward is self-acceptance.
Posted by beardedlady on June 9, 2002, at 6:45:28
In reply to Re: p.s. » beardedlady, posted by judy1 on June 8, 2002, at 23:46:54
I sent two poems to a friend, and this is what she wrote back. (She was chuckling as she typed it, so she was only slightly serious.) You are so right, Judy. Sometimes we do write our best stuff when we have a little inner turmoil!
beardy : )>
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