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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Erik on November 3, 1998, at 22:08:29
Hello! My name is Erik, and I'm having quite a bit of trouble recently. I am definitely suffering from some kind of depression, as I have no appetite, feel down all the time, and so on. This waxes and wanes in intensity. Also I have these periods of intense anxiety, like a low-grade panic attack, but it lasts for hours every night, for about a week, and I can't sleep very well! One doctor told me I was bi-polar and another thought depression (with anxiety). Since totally differnet medicines are used for mania versus depression with anxiety, I need to be sure which I have! How would I know? I have some suspicions about the bi-polar diagnosis, since I'm never happy. But during the high-anxiety times I can't rest at all. Also, well, I react horribly to most medicines. A .5 dose of Klonopin left me in the emergency room (150bpm heart rate for TWO days! I was MISERABLE -- my normal heart rate is 60). Other benzodiazapams left me not much better. (at least the effects went away quicker!) Well, I recovered, but still haven't found the medicine for me. I'm either highly depressed or VERY VERY anxious, or both, at any given time. Is there a medicine that might help me even before the doctors are 100% sure about what I have? I'm miserable all the time and need help, quickly! What would I look for if I wanted to be sure about what I have? I checked all the classic symptoms of mania, but I don't have any of them, except for sleeplessness. The doctor who thought I was bi-polar said it was some weird rapid-cycling anxiety-based bi-polar, but I have found NO information on this particular disorder, despite thoughrally searching the web and libraries. Although they say in the description that "irratability" can be there instead of a "euphoric or expansive mood" simple "irratability" just doesn't seem to describe what I'm going through!!! And classic anxiety disorder doesn't quite fit either since I only rarely have panic attacks, instead I'm highly anxious for hours and hours, having some of the symptoms of panic attacks, but not all. Help! Also, there are no phobias, social or otherwise, and no OCD.
Erik
Posted by Lisa on November 4, 1998, at 3:41:46
In reply to mania or anxiety? Or what???, posted by Erik on November 3, 1998, at 22:08:29
Let me see if I can help here since I've gone through a very similar ordeal for most of my life. I too was diagnosed for years with depression and anxiety until the hypomanic episodes began, got worse, and then came the bipolar diagnosis.
You seem very concerned with fitting the "classic" symptoms of some form of mental illness. I don't think you should waste time dwelling on that since so many of us are not classic anything but yet a mix of two and even three disorders. All on top of each other can make for one confusing diagnosis! Let me try to address this one problem at a time :)
There are so many ways of looking at this can I have no concrete answers for you, only suggestions. Sometimes the manic part of bipolar disorder can manifest itself as extreme anxiety, especially since bipolar is a progressive illness where a manic or hypomanic episode may not show up for years. There are also many instances where bipolar can be coupled with an anxiety disorder, as in my case. How do you know the difference? Well, is the anxiety always there or does it come and go between the depressions (it can also mix)? Are you on an anti-anxiety medication? If not, try one out for now. If you can decrease or eliminate the anxiety, you can then possibly notice any "high" periods. If there are none, then you may only have depression and anxiety, and I stress the "may." Manias can also be much more that irritability. They can be dysphoric episodes where you despise the whole world, throw things in agitation, or do things harmful to yourself or others. You don't necessarily have to be happy, manias are destructive.
Regarding a "classic anxiety disorder," you don't have to have a panic attack to fit the profile. There is also Generalized Anxiety Disorder (GAD) where a person can have a constant level of anxiety but no panic. I am also med intolerant, but have had good luck with benzos, particularly Klonopin, though there are still other very good anti-anxiety drugs that could help you. Maybe Toby or Dr. Bob can help in that department. Another question to consider is the lack of sleep. Is it caused mainly by the anxiety? Do you wake up because you have to and are tired throughout the day, or do you finally fall asleep and stay that way for a good amount of time? IOW, is there a *decreased* need for sleep -- 4 hours and you're still energetic, or is it insomnia caused by anxiety and an alarm clock that wakes you up before you're fully rested? Do you have racing thoughts at the time, or is your mind clear?
One other way of knowing whether or not you are bipolar is by inducing a mania with one of the antidepressants known to cause manias in bipolars. Unfortunately, they've also been known to cause manias in some people who are not bipolar, but I think that is much less infrequent. I don't condone this and would rather see an approach based on a patient's history with good, targeted questions, still it *can* answer the question. I have bipolar and panic and generalized anxiety disorder, am currently taking Neurontin and Klonopin, and am doing well. I sure hope this helps.
Lisa
Posted by Erik on November 5, 1998, at 0:33:33
In reply to Re: mania or anxiety? Or what???, posted by Lisa on November 4, 1998, at 3:41:46
> Let me see if I can help here since I've gone through a very similar ordeal for most of my life.
Thank you, Lisa, for your answer. If you only knew how much it means to me that other people are going through similiar things! Even though I already knew of course that many people have mental illnesses, I was really bothered by being med-intolerant. (really more like hyper-sensitive). Doctors only rarely are willing to try doses smaller than what is typically prescribed. They must assume that all anxiety concerning medication is simply a symptom of the disease and will go away when the medicine takes effect. I bought into this, tolerating horrible side effects from what are typically fairly benign medicines (SSRI's and benzodiazapams) until I could take them no more. Klonopin landed me in the hospital with a racing heart (150BPM) for TWO days! I felt terrible. It was off of a single 0.5 dose. I described my symptoms in the hospital to the doctor. He told me, "oh, that symptom is not caused by the drug, and neither is such and such a symptom" -- I researched the drug databases on the web and found that yes, every problem symptom (that had suddenly erupted within hours taking the drug) was in fact on the side effect list, and they slowly went away (more or less together) over about a week. So if anyone is reading this and is having trouble with your medicines, know that it does in fact happen. I don't know if the best route is to lessen the dose, or stop the medicine. But don't be afraid to tell your doctor that something is amiss and be willing to research for yourself. If I hadn't, who knows what kind of trouble I'd be in now.
Erik
Posted by Matt on January 14, 1999, at 7:23:09
In reply to med intolerance and hypersensitivity, posted by Erik on November 5, 1998, at 0:33:33
> > Let me see if I can help here since I've gone through a very similar ordeal for most of my life.
> Thank you, Lisa, for your answer. If you only knew how much it means to me that other people are going through similiar things! Even though I already knew of course that many people have mental illnesses, I was really bothered by being med-intolerant. (really more like hyper-sensitive). Doctors only rarely are willing to try doses smaller than what is typically prescribed. They must assume that all anxiety concerning medication is simply a symptom of the disease and will go away when the medicine takes effect. I bought into this, tolerating horrible side effects from what are typically fairly benign medicines (SSRI's and benzodiazapams) until I could take them no more. Klonopin landed me in the hospital with a racing heart (150BPM) for TWO days! I felt terrible. It was off of a single 0.5 dose. I described my symptoms in the hospital to the doctor. He told me, "oh, that symptom is not caused by the drug, and neither is such and such a symptom" -- I researched the drug databases on the web and found that yes, every problem symptom (that had suddenly erupted within hours taking the drug) was in fact on the side effect list, and they slowly went away (more or less together) over about a week. So if anyone is reading this and is having trouble with your medicines, know that it does in fact happen. I don't know if the best route is to lessen the dose, or stop the medicine. But don't be afraid to tell your doctor that something is amiss and be willing to research for yourself. If I hadn't, who knows what kind of trouble I'd be in now.
> ErikI have been searching for information on medical intolerance/hypersensitivity with no luck (this is first glimmer of hope.
My wife is EXTREMELY sensitive to all medications, including her anti-depressants. So much so, that she has to stay with
one particular manufacturer - the pharmacy changed mfr's at one point and the change in formulation (no idea what specifically was different) threw her
for a loop that took weeks to recover from. Doc's do not understand this sensitivity.Does anyone know where more information can be found about the causes of the sensitivity?
Thanks!!
Posted by CindyM on May 24, 1999, at 23:34:07
In reply to mania or anxiety? Or what???, posted by Erik on November 3, 1998, at 22:08:29
> Hello! My name is Erik, and I'm having quite a bit of trouble recently. I am definitely suffering from some kind of depression, as I have no appetite, feel down all the time, and so on. This waxes and wanes in intensity. Also I have these periods of intense anxiety, like a low-grade panic attack, but it lasts for hours every night, for about a week, and I can't sleep very well! One doctor told me I was bi-polar and another thought depression (with anxiety). Since totally differnet medicines are used for mania versus depression with anxiety, I need to be sure which I have! How would I know? I have some suspicions about the bi-polar diagnosis, since I'm never happy. But during the high-anxiety times I can't rest at all. Also, well, I react horribly to most medicines. A .5 dose of Klonopin left me in the emergency room (150bpm heart rate for TWO days! I was MISERABLE -- my normal heart rate is 60). Other benzodiazapams left me not much better. (at least the effects went away quicker!) Well, I recovered, but still haven't found the medicine for me. I'm either highly depressed or VERY VERY anxious, or both, at any given time. Is there a medicine that might help me even before the doctors are 100% sure about what I have? I'm miserable all the time and need help, quickly! What would I look for if I wanted to be sure about what I have? I checked all the classic symptoms of mania, but I don't have any of them, except for sleeplessness. The doctor who thought I was bi-polar said it was some weird rapid-cycling anxiety-based bi-polar, but I have found NO information on this particular disorder, despite thoughrally searching the web and libraries. Although they say in the description that "irratability" can be there instead of a "euphoric or expansive mood" simple "irratability" just doesn't seem to describe what I'm going through!!! And classic anxiety disorder doesn't quite fit either since I only rarely have panic attacks, instead I'm highly anxious for hours and hours, having some of the symptoms of panic attacks, but not all. Help! Also, there are no phobias, social or otherwise, and no OCD.
> ErikHi, this sounds really familiar! I was having panic attacks every now and then and my regular practitioner gave me paxil, which WIRED me like i was drinking pot after pot of coffee! it GAVE me attacks cause it freaked me out so much! since it's an anti depressant my regular doc sent me to a nurse practitioner who diagnosed me as bi polar...she said that one of the main reasons that she gave that diagnosis was my reaction to my antidipressant. i've been on depakote since, and it's getting much better. i used to have a lot of trouble getting to sleep, and now i can get to sleep alot easier. and stay asleep, where before i woke up three to four times a night. now, i don't get the "i'm going to kill myself" depressions (which i am thankful i don't) but i am generally a very up and exciteable person. i'm extremely sensitive to ANY meds and my nurse tried to get me on a "regular" dose of depakote, which is actually too much for me to handle. right now, i've been on 875 mgs a day for a month, and just moved it to 1000 mg a day, so far so good. sometimes, i think, you DO have to tell the docs what reactions you're getting. also, have a physical to actually RULE OUT other stuff, for example, because i easily panic about physical stuff, i made sure my blood sugar was good, and cholesterol, and all that. so, it's all a luck of the draw, sometimes. try to find a doc who'll listen to you. Good luck!!
Posted by Phoebe on May 25, 1999, at 5:29:55
In reply to Re: med intolerance and hypersensitivity, posted by Matt on January 14, 1999, at 7:23:09
> > > Let me see if I can help here since I've gone through a very similar ordeal for most of my life.
> > Thank you, Lisa, for your answer. If you only knew how much it means to me that other people are going through similiar things! Even though I already knew of course that many people have mental illnesses, I was really bothered by being med-intolerant. (really more like hyper-sensitive). Doctors only rarely are willing to try doses smaller than what is typically prescribed. They must assume that all anxiety concerning medication is simply a symptom of the disease and will go away when the medicine takes effect. I bought into this, tolerating horrible side effects from what are typically fairly benign medicines (SSRI's and benzodiazapams) until I could take them no more. Klonopin landed me in the hospital with a racing heart (150BPM) for TWO days! I felt terrible. It was off of a single 0.5 dose. I described my symptoms in the hospital to the doctor. He told me, "oh, that symptom is not caused by the drug, and neither is such and such a symptom" -- I researched the drug databases on the web and found that yes, every problem symptom (that had suddenly erupted within hours taking the drug) was in fact on the side effect list, and they slowly went away (more or less together) over about a week. So if anyone is reading this and is having trouble with your medicines, know that it does in fact happen. I don't know if the best route is to lessen the dose, or stop the medicine. But don't be afraid to tell your doctor that something is amiss and be willing to research for yourself. If I hadn't, who knows what kind of trouble I'd be in now.
> > Erik
> I have been searching for information on medical intolerance/hypersensitivity with no luck (this is first glimmer of hope.
> My wife is EXTREMELY sensitive to all medications, including her anti-depressants. So much so, that she has to stay with
> one particular manufacturer - the pharmacy changed mfr's at one point and the change in formulation (no idea what specifically was different) threw her
> for a loop that took weeks to recover from. Doc's do not understand this sensitivity.
> Does anyone know where more information can be found about the causes of the sensitivity?
> Thanks!!
Many doctors have, over the years, prescribed virtually every anti-depressant to augment the Xanax and Klonopin I take for severe panic disorder with agoraphobia, depression, suicidal ideation, racing thoughts, terrible tremor and multiple severe somatizations.
I have been unable to tolerate any. One doctor tried lithium; I couldn't handle that either. I've tried depakote with the same results. With the exception of lithium, which caused nausea and vomiting, I invariably suffer greatly increased anxiety and panic.
Is this heightened sensitivity a tip-off that I may be bi-polar? And, if so, in light of my inability to take either lithium or depakote, is there anything else left? Oh, yes zyprexa had the same effect as did thorazine, risperdal, and mellaril.
Wish I could be of more help, but I'm in the same boat. Doctor has virtually written me off; one told me I am "neurologically shot"; that really made my day. I'm postmenopausal but HRT didn't seem to help. Nor has cognitive therapy; my one glimmer was hypnosis. That wore off.
Thank you for any thoughts you can offer. I'd be willing to do ECT or even psychosurgery IF my insurance would pay; I can't work and money is tight!
This is the end of the thread.
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