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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by socialdeviantjeff on December 28, 2003, at 2:31:44
I'm probably beating a dead horse here, but some opinions would be helpful.
My cocktail and durations on meds:
150 mg Effexor, 75 mg at night, 75 mg in the morning. 2 months.
300 mg Tegretol, at night. 4 months.
2 mg Perphenezine, at night. 3 weeks.
Nicotine, smoked as required depending on stress level. :/My Dx:
Atypical refractory depression with psychotic symptoms, Generalized Anxiety Disorder.I've been reading into the bipolar and borderline spectrums and I'm beginning to wonder if my dx is off.
I've tried a long grocery list of ADs and mood stabilizers. All have had to stop because of allergic reactions or side effects. SSRI's and neuroleptics mess me up or do nothing. TCA's trigger a psychotic state. Any meds that have any benefit have even worse side effects than ones with no effect.
Right now I have constant fatigue, sleep disturbances, short term memory and cognitive trouble, muscle pain (spasms, shooting pain and cramps), bad coordination, lack of emotion (except the bad ones), sexual dysfunction, "brain shocks", lightheadedness, dizziness, transient twitches, nausea and more I don't remember right now. I'm pretty numbed up emotionally, unfortuantely I've felt like I've had the flu for three months. I've endured this in hopes that the benefits may outweigh the drawbacks on these meds. They are literally the last of less than a handfull left to try. I have had a good drop in my anxiety,
I'm beginning to wonder if I have a problem along the bipolar axis. The better I am emotionally, the worse physically. The more energy, the worse the irritability, restlessness, anxiety. The depression can come in anytime, lasting from 1 day to 3 weeks. When I'm not in a depressive episode, I'm dysthemic. This creates a complex web of states, depressed, dysphoric, and mixed. This would seem to be consistent with Bipolar II except that the states are unpredictable, inconsistent and change without warning.
Sorry, I know this is complicated and it's difficult for me to explain. I will try to clarify anything in this post. Any insight is appreciated.
Posted by mtdew on December 28, 2003, at 3:50:34
In reply to ---- I think I might have the wrong diagnosis-----, posted by socialdeviantjeff on December 28, 2003, at 2:31:44
I have no idea what all those meds would do to someone. However, constant fatigue, sleep disturbances, memory/cognitive difficulty, muscle pain, poor coordination, lightheadedness, dizziness, nausea, food/drug allergies, and feeling like you have a never-ending flu are all associated with Chronic Fatigue Syndrome (CFS). There is also a number of ways that CFS can cause anxiety or symptoms resembling anxiety. I recommend taking a look at http://www.cfids.org/ and seeing if this sounds like you.
Posted by linkadge on December 28, 2003, at 6:17:46
In reply to ---- I think I might have the wrong diagnosis-----, posted by socialdeviantjeff on December 28, 2003, at 2:31:44
You could be right. Bipolar mania is often misconceived as having to be a euphoric spending spree, but infact the anger mixed with the psychosis could easily be dysphoric mania.
You say you have tried the mood stabalizers. Have you ever tried them alone, or always with an antipressant? Mood stabalizers alone, without an antidepressant are a whole diferent experience. Many people, not just myself notice a strong disinhibiting effect from the combination of mood stabalizers and antidepressants.
Linkadge
Posted by dragonfly25 on December 28, 2003, at 9:41:49
In reply to ---- I think I might have the wrong diagnosis-----, posted by socialdeviantjeff on December 28, 2003, at 2:31:44
i don't know if this helps....but...it took me 6mths to figure out that "brain shocks" come from effexor- it was really hard to explain to my doctor, but i played around with my meds and i figured it out and i am off it now. the effexor also causes a loss of interest in sex, and i think that Perphenezine is a neuroleptic? if so i would mention to your doctor about twitches (but i think effexor can do that as well. i don't think it necessarily matters what your diagnosis is, it matters more that you are being treated for your symptoms. the treatments for all mental illnesses are really just a guessing game for doctors, our brain and its chemical actions are not understood enough, so it is just trial and error- taking a very active role in your medication is very important, b/c whether the doctor likes it or not, the patient is the only one who can really tell them if it is working (depending on illness of course). if you don't feel like you are getting any positive results from your drugs, see if you can go off of them one at a time and start over. this is of course if you can be off of meds for a time safely.
sometimes undoing the brain fog from the drugs can help to see things clearer, and in the end you may not need all the drugs you were taking. less is sometimes better :)
good luck> I'm probably beating a dead horse here, but some opinions would be helpful.
>
> My cocktail and durations on meds:
> 150 mg Effexor, 75 mg at night, 75 mg in the morning. 2 months.
> 300 mg Tegretol, at night. 4 months.
> 2 mg Perphenezine, at night. 3 weeks.
> Nicotine, smoked as required depending on stress level. :/
>
> My Dx:
> Atypical refractory depression with psychotic symptoms, Generalized Anxiety Disorder.
>
> I've been reading into the bipolar and borderline spectrums and I'm beginning to wonder if my dx is off.
>
> I've tried a long grocery list of ADs and mood stabilizers. All have had to stop because of allergic reactions or side effects. SSRI's and neuroleptics mess me up or do nothing. TCA's trigger a psychotic state. Any meds that have any benefit have even worse side effects than ones with no effect.
>
> Right now I have constant fatigue, sleep disturbances, short term memory and cognitive trouble, muscle pain (spasms, shooting pain and cramps), bad coordination, lack of emotion (except the bad ones), sexual dysfunction, "brain shocks", lightheadedness, dizziness, transient twitches, nausea and more I don't remember right now. I'm pretty numbed up emotionally, unfortuantely I've felt like I've had the flu for three months. I've endured this in hopes that the benefits may outweigh the drawbacks on these meds. They are literally the last of less than a handfull left to try. I have had a good drop in my anxiety,
>
> I'm beginning to wonder if I have a problem along the bipolar axis. The better I am emotionally, the worse physically. The more energy, the worse the irritability, restlessness, anxiety. The depression can come in anytime, lasting from 1 day to 3 weeks. When I'm not in a depressive episode, I'm dysthemic. This creates a complex web of states, depressed, dysphoric, and mixed. This would seem to be consistent with Bipolar II except that the states are unpredictable, inconsistent and change without warning.
>
> Sorry, I know this is complicated and it's difficult for me to explain. I will try to clarify anything in this post. Any insight is appreciated.
Posted by sailor on December 28, 2003, at 10:08:19
In reply to Re: ---- I think I might have the wrong diagnosis-----, posted by dragonfly25 on December 28, 2003, at 9:41:49
Jeff--I,m inclined to agree with dragonfly--don't focus so much on the "correct diagnosis". It's easy to think that just because we give a name to something that we've done something useful. Sometimes yes, sometimes no. Psych. diagnosis and treatment is far more art than science, and as dragonfly pointed out, trial-and-error ia all too often our best, if not only strategy. Using 3+ meds (I'm glad you included nicotine on your list, a powerful drug), it's almost impossible to know which med is doing what and how they are combining synergistically. Your diagnostic markers can be changing continuously with the fluctuating effects of your drug combo. Like tring to drive a nail into a chunk of jello. Only you can decide but I would consider backing up, reducing if not eliminating your current pharmacy, and perhaps even seeking a new evaluation after a washout period. That's hard to do (I've suffered through it many times in the past 30 years), but I always feel more hopeful starting from a baseline, than trying to make sense of a swirling stew of med. interactions. If you try "backing up" have an active support system on hand. Let some trusted friends know what you're doing so they can give support and feedback. Whatever you choose, keep us informed on PB. Best of Luck, Sailor
Posted by SLS on December 28, 2003, at 10:34:47
In reply to ---- I think I might have the wrong diagnosis-----, posted by socialdeviantjeff on December 28, 2003, at 2:31:44
> My Dx:
> Atypical refractory depression with psychotic symptoms, Generalized Anxiety Disorder.What exactly are your psychotic symptoms?
- Scott
Posted by leopard on December 28, 2003, at 18:44:47
In reply to ---- I think I might have the wrong diagnosis-----, posted by socialdeviantjeff on December 28, 2003, at 2:31:44
I would get a second opinion...or maybe even a third. Get the name of a pdoc who specializes in BP. (Get a referral from the BP web sites). They are better prepared to sift through your symptoms than a general pdoc...at least this was my experience. I had a diagnosis quite similar to yours...I was not diagnosed with BPII until recently...the SSRI's had a similar effect on me too...they are horrible for people with BP. Have you tried any of the atypicals? Currently I am taking Geodon and so far it has been a life saver. Truly, best of luck.
~Shannon
Posted by Utopia on December 28, 2003, at 19:26:28
In reply to Re: ---- I think I might have the wrong diagnosis-----, posted by sailor on December 28, 2003, at 10:08:19
Hi Jeff
I don't want to sound pseudo-intellectual purely because I've been through the same frustrations. My condition is almost identical to yours and mimicks the symptoms almost identically.
I venture to say that it is refractory Bipolar II, however your frustration is that the mood shifts are unpredicatable. Although one could say that it is the nature of beast, it does not solve the problem.
Being more helpful however, there is a further complication to Bipolar II and that is measuring how many times the mood shifts, including the irritability. This obviously helps treatment. Generally what you have is termed as "Rapid Cycling" meaning the amount of shifts of a mood. Usually it can change once a week, once every three weeks and is part of Bipolar II Disorder. Should these cycles be long as in months then it wouldn't fall under rapid cycling and the condition is generally Bipolar I. However, it can go to "Ultra-Rapid" or "Ultra Ultra-Rapid Cycling". This means the mood can even change 3-4 times in a day. The more rapid, the more difficult to treat and stabilize. An Ultra Rapid Cycler can have a cup of coffee and it will destabilize his mood and make his condition closer to remaining refractory.
Obviously the treatment revolves around mood stabilizers and appropriate anti-depressants which won't make you 'switch' to another mood state or make you more irritable.
It's a fine path to walk.
I hope I was some help. Good luck.
P.S. A good indication if you are a Rapid Cycler is to notice just how sensitive and responsive you are to excitory chemicals like caffeine and nicotine. If after a cup of coffee the response is almost immediate and perks you up a ton, it means you are "exquisitively sensitive" to stimulants (and probably depressants like alcohol as well). People who respond this way and have Bipolar II are usually rapid cyclers because their mood destabilizes so easily. This is however just a rule of thumb.
Posted by HappyGirl on December 29, 2003, at 1:32:30
In reply to ---- I think I might have the wrong diagnosis-----, posted by socialdeviantjeff on December 28, 2003, at 2:31:44
Hi:
It sounds to me like you have Bipolar II with rapid cycler. On this condition, you DEFINITELY need atypical med. such as Zyprexa, Geodon, and more to say. Also, AD such as Effexor is a good med., however, as for 'Rapid Cycler,' other form of AD is more practical and ideal tx, like Wellbutrin SR is pretty common usage among Rapid Cycler. Frankly and truthfully, it's VERY hard to get appropriate med. comb. in the first place, because most of pdoc. is a hard time to rx to those who has this symptoms. Rather, just Bipolar is easier for them.
In my suggestion, try to find more knowledgeable pdoc., if your current pdoc. would fail to listen to your problem, even get a second opinion if your insurace allows you to do. For me, it took a long time, almost two years to find a right combo. that still does not give me total happiness, but manageable enough to live 'normalcy.'
In my case, Zoloft triggered this rapid cycler, ... but I can not be sure. Either way, it's hard work to find the right med. combo.
Good Luck!
H.G.
Posted by socialdeviantjeff on December 29, 2003, at 1:34:12
In reply to Re: ---- I think I might have the wrong diagnosis-----, posted by Utopia on December 28, 2003, at 19:26:28
Thanks all for the replies :)
My psychotic symptoms are moderate auditory hallucenations (voices, constant music),minor visual hallucenations, tactile hallucenations coincidental to my phobia of any flying bug, racing thoughts, persecutory and other delusions, racing thoughts.
It seems I have some more homework to do. I have wanted to try a drug washout. The problem is that I don't honestly know how stable I would be. The meds I'm on have done a little to curb suicidal ideation, guilt and anxiety. I really could end up trying to kill myself. I really don't know. Factor in Effexor withdrawals.
How long does Tegretol take to have a effect? It is the one mood stabilizer I have been on solo. After one month, titirating from 100-400 mg there were no effects but side effects. In fact, I haven't felt much relief until I started the Perphenazine 3 weeks ago.
A lot of what you all told me makes sense. I have an appointment with my pdoc in a couple of weeks. I think I'm ready to talk to him about it. Thanks again.
Posted by leopard on December 29, 2003, at 1:48:43
In reply to Re: ---- I think I might have the wrong diagnosis-----, posted by HappyGirl on December 29, 2003, at 1:32:30
Your story and your advice are similar to mine. I feel like I cannot say it enough...it takes a great pdoc who specializes in BP, lots of trial and error with the meds, and a great shrink to get this under control. I also highly suggest EMDR. Good for you for hanging in there and dealing with this disease. What meds finally worked for you?
Posted by SLS on December 29, 2003, at 8:20:54
In reply to Re: ---- I think I might have the wrong diagnosis-----, posted by socialdeviantjeff on December 29, 2003, at 1:34:12
> The meds I'm on have done a little to curb suicidal ideation, guilt and anxiety. I really could end up trying to kill myself. I really don't know.
It might make sense to take Zyprexa 10-20mg temporarily.- Scott
Posted by leopard on December 29, 2003, at 17:39:11
In reply to Re: ---- I think I might have the wrong diagnosis----- » socialdeviantjeff, posted by SLS on December 29, 2003, at 8:20:54
You don't want to kill yourself...it's the chemicals in your brain that need to be fixed...call a pdoc immediately and get a fast acting sedative....seriously....feeling the way you do must feel like hell...don't bail out now...hang in there!!!!!!
Posted by socialdeviantjeff on December 30, 2003, at 1:20:07
In reply to Re: ---- I think I might have the wrong diagnosis----- » SLS, posted by leopard on December 29, 2003, at 17:39:11
Sorry, Maybe the language was a little too strong. I have had suicidal ideation and attempts in the past. I am going through a lot of crap right now, but I have some good reasons to stay here. I'm just concerned, given my past, what could happen off meds.
I really do appreciate your concern. Don't worry. The med washout is only an idea. I talked to my pdoc on the phone today and he said he wants to try Lamictil, but without a face to face he doesn't want to make changes.
This is the end of the thread.
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