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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 5 to 29 of 63. Go back in thread:
Posted by Mr.Scott on December 31, 2004, at 1:24:49
In reply to Re: Dysthymia versus Bipolar type 2 » Mr.Scott, posted by barbaracat on December 30, 2004, at 14:05:14
WOW! I really want to thank you for sharing that with me. I know it probably took more than a minute to write.
In general I have the first type of depression and I have it almost always. Then If I add an antidepressant I get brief hypomanias 'or' more likely the second kind of depression you noted except that I've never in my life gone without sleep or have had any tinge of psychoses. My natural sleep cycle has me going to bed at 3am and waking at noon. Obviously that doesn't work well so I wake every day feeling like death until coffee number four. I definately have an increasing sense of urgency as the antidepressant goes up.
Thanks,
Scott
Posted by Mr.Scott on December 31, 2004, at 1:34:51
In reply to Re: Dysthymia versus Bipolar type 2, posted by King Vultan on December 30, 2004, at 8:33:21
Hi Todd,
Thanks for your response. I meet the criteria for hypomanic once in a blue moon, but ALWAYS induced temporarily by antidepressants or stimulants. NEVER have I experienced it in the absence of a chemical with the potential to cause it. Other side effects I get from SSRI's include muscle stiffness and aches, constipation, mild facial swelling, weight gain (I weighed 190 on 100mg of Zoloft, and now weigh 155 on 25mg), Severe cholesterol increase (more than doubling from Zoloft!), agitation & general tension, increased sense of restlessness. I attribute these to ExtraPyramidal Symptoms on top of a depression which essentially makes the condition worse. My doc disagrees and says it's activation of bipolar disorder. The fact that the symptoms include muscle aches & stiffness have always led me to believe it was dopamine related and EPS and not manic activation. Also mood stabilizers alone have only allowed me to sink into hellish depressions!
Scott
Posted by ed_uk on December 31, 2004, at 7:23:41
In reply to Re: Dysthymia versus Bipolar type 2 » King Vultan, posted by Mr.Scott on December 31, 2004, at 1:34:51
Hi Scott,
Have you ever tried any anti-depressants which don't cause EPS eg. desipramine or nortriptyline. How do you do on these drugs?
Regards,
Ed.
Posted by Mr.Scott on December 31, 2004, at 14:11:33
In reply to Re: Extrapyramidal Symptoms » Mr.Scott, posted by ed_uk on December 31, 2004, at 7:23:41
Good point!I immediately experienced anxiety, agitation, and the last time I took 25mg of imipramine (last year). I'm not sure if it goes away or if the initial hell burns out into a rapid cycling. However this last time I took 25mg of Imipramine my depression worsened into such an agitated hell I decided to drink again to get some relief and that inevitably led to a major cocaine relapse and a host of other'inappropriate and dangerous behaviors' I couldn't even think of doing right now. After that binge weekend I took large doses of Lithium, depakote, and trileptal just to get over the coke effects, withdrawal and general agitation. When I returned to work on Monday, everyone said I seemed to be in a much better mood. Was it the coke or the mood stabilizers? I don't know, but I guess it sounds bipolarish... It's just not entirely clearcut like most bipolars I know or read about.
Scott
Posted by Mr.Scott on December 31, 2004, at 14:19:11
In reply to Re: Dysthymia versus Bipolar type 2 » Mr.Scott, posted by SLS on December 30, 2004, at 4:31:06
Hi SLS,
I missed your post until just now. Thank you for stopping to post. I think you are right about something being superimposed on dysthymia. My antidepressant response makes it unclear to me however whether it's depression or bpII. Hopefully, I can be helped. This has been killing me now for 15 years. And in the last 5 it has become less and less clear that it's just depression on top of depression. I'll mention these atypicals to my doc.
Scott
Posted by ed_uk on December 31, 2004, at 14:42:02
In reply to Re: Extrapyramidal Symptoms » ed_uk, posted by Mr.Scott on December 31, 2004, at 14:11:33
Hello,
Have you ever tried Remeron or Trazodone?
Ed.
Posted by barbaracat on December 31, 2004, at 18:07:52
In reply to Re: Dysthymia versus Bipolar type 2 » barbaracat, posted by Mr.Scott on December 31, 2004, at 1:24:49
Have you considered that you're Bipolar IV? Hypomanic symptoms brought on by ADs? Sounds like you might be to me and the treatment is a bit different. Here's a thorough website about the different subtypes of BP. It really doesn't sound to me like you're in the BP-II pocket at all.
http://www.psycom.net/depression.central.lieber.html
Also, Wellbutrin has been used successfully in alot of cases of BPIV or in med resistant BP in general. It was too stimulating for me, a classic BP-II, however. I'm doing really well on lithium, SJT and fish oil.
If only I could stay away from alcohol. I'm drawn like a moth to a flame in that regard, especially with it being everywhere over the holidays. I overindulged last night and feel like ka-ka this morning. A good lesson.
Oh yes, I can't speak for your experience, but Remeron was awful stuff for me. It worked fine for a few months, pooped, and I had to keep ratcheting it up. In the meantime, it's a notorious porky med. I found myself getting up 3am and haunting the freezer for Dove bars, anything sweet. I never do that. Put on 30 pounds. I do not recommend Remeron. It doesn't sound to be like you need Serotonin and excess Serotonin may be one of your problems. It would be interesting giving Wellbutrin with it's Dopamine kick a try.
Posted by Ritch on December 31, 2004, at 18:24:45
In reply to Re: Extrapyramidal Symptoms » ed_uk, posted by Mr.Scott on December 31, 2004, at 14:11:33
>
> Good point!
>
> I immediately experienced anxiety, agitation, and the last time I took 25mg of imipramine (last year). I'm not sure if it goes away or if the initial hell burns out into a rapid cycling. However this last time I took 25mg of Imipramine my depression worsened into such an agitated hell I decided to drink again to get some relief and that inevitably led to a major cocaine relapse and a host of other'inappropriate and dangerous behaviors' I couldn't even think of doing right now. After that binge weekend I took large doses of Lithium, depakote, and trileptal just to get over the coke effects, withdrawal and general agitation. When I returned to work on Monday, everyone said I seemed to be in a much better mood. Was it the coke or the mood stabilizers? I don't know, but I guess it sounds bipolarish... It's just not entirely clearcut like most bipolars I know or read about.
>
> Scott
Scott, those symptoms are very much like mine. I think there is a big difference between BPI episodes and this chronic BP-IIish stuff.. I know the "spectrum" thing is big deal now, but they just seem like two very different illnesses altogether. I've known some BP-I's and they just don't have the same symptoms I have. I've seen them really high and I can relate to that racing consciousness, but it just comes out of the blue and goes ON and ON, then they seem OK for months at a time. Definitely a different expression.
Posted by barbaracat on December 31, 2004, at 20:45:14
In reply to Re: Extrapyramidal Symptoms » Mr.Scott, posted by Ritch on December 31, 2004, at 18:24:45
HI Rich,
You brought up a point I've been wondering about for awhile. I've got a dx of BP-II but suspect I may be BP-I. I do horribly on SSRIs like a good little BP-II, but don't BP-I's as well? Some of my manic episodes have been corkers, complete with the singing of angelic hosts, and other not so nice hallucinations. My depressions, the mixed-state kind, are horrendous, simply ghastly, and I've heard somewhere that these mixed states are the province mainly of BP-I. Yes, I do have nice little hypomanias which are tons of fun, and these are the majority - but oh boy, those other ones. There's nothing 'hypo' about those others and no doubt something quite spectacular is occurring.I also used to have longish periods of normalcy in between when I was younger, but once I hit menopause, everything intensified and mixed states depression became my constant companion. I was on SSRI's of all various forms and potencies cause nothing was helping and no one knew that I was bipolar. I can't imagine we missed it since I'd had so many episodes that now are pretty unmistakable, however, mixed states depression was not yet in the common lexicon, so it was treated as major depressive disorder with SSRIs - bad bad idea.
I'd like your thoughts on the differences you've noticed with your BP-I acquaintences vs. BP-II (that's you, right?). I don't know anyone personally in my boat at all and it would help. The main reason this interests me is the fact that I've had a miraculous response to lithium and it seems like this is typical of BP-I's. Other supposed BP-II's I know are still struggling with finding a good mood stabilizer and lithium has not helped very many BP-II's, or those with cyclothymia. So maybe there's something else going on with BP-I, not just a matter of degree of symptoms, but a matter of different chemistry and response to treatment. - Barbara
> Scott, those symptoms are very much like mine. I think there is a big difference between BPI episodes and this chronic BP-IIish stuff.. I know the "spectrum" thing is big deal now, but they just seem like two very different illnesses altogether. I've known some BP-I's and they just don't have the same symptoms I have. I've seen them really high and I can relate to that racing consciousness, but it just comes out of the blue and goes ON and ON, then they seem OK for months at a time. Definitely a different expression.
>
Posted by barbaracat on December 31, 2004, at 20:53:36
In reply to Dysthymia versus Bipolar type 2, posted by Mr.Scott on December 30, 2004, at 3:16:02
Have you looked into pyroluria? There's a lot of stuff on it in the Alternative board and it may be worth looking into. It's a metabolic disorder that essentially strips off the nutritional cofactors that make neurotransmitters. Some of your symptoms sound like it.
The Pfeiffer Institute has done alot of work with different metabolic factors into mood disorders. They've found that around 30%of bipolars, ADD and Schizophrenics have this condition and it's one that confounds most diagnosis or treatment. You might just go over to Altnative or do a Google search, or if you want you can get back to me, we can move over to Alternative and I can point you to some resources. One question: how to you tan? Do you burn? in red and white blotches? Have white spots on your fingernails?
Feel internal pressure?
Posted by Mr.Scott on January 1, 2005, at 4:45:30
In reply to Re: Extrapyramidal Symptoms » Mr.Scott, posted by ed_uk on December 31, 2004, at 14:42:02
Hi,
I remember trying Remeron and feeling sedated and ravenous yet also possibly anxious. It's been a while so I forget. Trazodone is a fairly unexplored med for me. I only remember it being sedating at around 50mg for insomnia.
Scott
Posted by Mr.Scott on January 1, 2005, at 4:59:15
In reply to Re: Extrapyramidal Symptoms » Ritch, posted by barbaracat on December 31, 2004, at 20:45:14
Thinking about what you said to Ritch...and how there was a change in your experience of the illness. Just kind of thinking out loud here in this post.
I may be wrong, but I suspect that overusing antidepressants might have changed something in me. My inability to tolerate meds that I once could and that once helped, and an increased sensation of being 'out of it' and agitated all at once only happened in the last few years. I never actually did okay on antidepressants except until SSRI's when they first came out, nardil later. But now I am so cynical about them I don't know if I could 'let them' work. My experience of SSRI's 'working' also sent me boldy into major substance abuse. So maybe I was hypomanic. So confusing...to not really know what normal really is. Since the age of 17 it's never been very consistent and it's always been painful.
One thing I am sure of is that I was depressed and unable to stop using cocaine on Prozac at one point, and that the addition of Wellbutrin to help with cravings caused my to rapid cycle into a dysphoric hypomania in which I attempted suicide (circa 1996). That was the one time I was truly OUT OF CONTROL!
Scott
Posted by Mr.Scott on January 1, 2005, at 5:02:13
In reply to Re: Dysthymia versus Bipolar type 2 » Mr.Scott, posted by barbaracat on December 31, 2004, at 20:53:36
Hi Barbaracat,I'll do a search right now! I have had the white spots all my life, although they seem less now then when I was younger. Tell me where to go and I'll follow! What sort of internal pressure?
Scott
Posted by Ritch on January 1, 2005, at 10:13:42
In reply to Re: Extrapyramidal Symptoms » Ritch, posted by barbaracat on December 31, 2004, at 20:45:14
>...I'd like your thoughts on the differences you've noticed with your BP-I acquaintences vs. BP-II (that's you, right?). I don't know anyone personally in my boat at all and it would help. The main reason this interests me is the fact that I've had a miraculous response to lithium and it seems like this is typical of BP-I's. Other supposed BP-II's I know are still struggling with finding a good mood stabilizer and lithium has not helped very many BP-II's, or those with cyclothymia. So maybe there's something else going on with BP-I, not just a matter of degree of symptoms, but a matter of different chemistry and response to treatment. - Barbara
I think the main difference that I've personally seen is the striking difference in *chronicity* of symptoms. "BP-II" people seem to have more chronic dysthymic symptoms and seem to rapid-cycle and also have a lot more comorbid anxiety problems that are sometimes tough to weed out from the bipolar symptoms. In my case, I wouldn't be surprised if the correct dx term would be something like "Multimodal Affective Disorder" or "Bipolaroid Anxiety Disorder" :) The folks that I've known that are BP-I's can have so many months of "euthymic" clear-headed functioning it just boggles my mind. I don't think I go more than a few days in a row at most where I feel "normal". .... As far as treatment goes I found lithium useful in the past for the years that I took it, it just seems that anticonvulsants work *better* for me. They say that Li doesn't help rapid-cyclers as much, and I would have to agree with that somewhat. .. As far as BPII going to BPI with time.. there have been hypomanic episodes in the past where it seemed that all I would have to do is stop meds and it turn into something fullblown, but it seems that anxiety is a limiting factor to that.. My symptoms tend to flux or morph from hypomania into hostility then into PANIC, and when things start getting mixed and agitated I can't stand it and I treat it aggressively to get a lid on it. The BPI people I've known just get this pure EUPHORIC nonstop racing derailment that just goes and goes and they feel great. Not so with me.
Posted by King Vultan on January 1, 2005, at 11:57:51
In reply to Re: Dysthymia versus Bipolar type 2 » King Vultan, posted by Mr.Scott on December 31, 2004, at 1:34:51
I guess my suggestion would be to consider an atypical antipsychotic, if you haven't tried one already. Agitation and restlessness on SSRIs and other drugs that increase serotonin transmission may be caused by stimulation of the 5-HT2A receptor, which all of the atypicals blockade. Judging how well even a tiny dose (0.25 mg/day) of Risperdal is working for me in reducing my own agitation, I'm rapidly coming to the conclusion that one of my major issues is that I simply have too many 5-HT2A receptors. All of the atypical antipsychotics also blockade dopamine D2 receptors at higher dosages, which I believe can help prevent mania or hypomania; although, I am not an expert on bipolar disorder.
I must admit to not understanding the pharmacology of mood stabilizers and tending to look askance at them, and I used to feel the same way about atypical antipsychotics, but I've become convinced that this is a very useful class of meds, even in some instances for people who are neither bipolar nor schizophrenic. I have long term unipolar depression, with associated social phobia and ADD symptoms, and while Parnate works relatively well for these things, I still find myself suffering from a chronically low libido and an agitation/anxiety/getting ahead of myself that is fairly distracting and impairs my ability to enjoy activities. I'm looking forward to my next visit with my psychiatrist to discuss going up in dosage on the Risperdal, perhaps to 0.5 mg/day, given how noticeable the positive effects have been at this dosage, with no detectable side effects.
Todd
Posted by Mr.Scott on January 1, 2005, at 15:16:03
In reply to Re: BP I vs BPII » barbaracat, posted by Ritch on January 1, 2005, at 10:13:42
I've said it before and I'll say it again..."You and me both!"
The only thing that would not be 100% identical to your descriptions, would be the substance abuse that I sought relief in for many years. It just felt so good to relieve all that anxiety and angry despair. Then that became a dead end prospect...One thing I should note...is that I can force myself into distraction sometimes through work and social activities so that all this crap stays in the backround. That seems to be my greatest source of relief today aside from paltry doses of this that and the other which inevitably cause side effects as I approach therapuetic doses.
Scott
------------------------------------------
I think the main difference that I've personally seen is the striking difference in *chronicity* of symptoms. "BP-II" people seem to have more chronic dysthymic symptoms and seem to rapid-cycle and also have a lot more comorbid anxiety problems that are sometimes tough to weed out from the bipolar symptoms. In my case, I wouldn't be surprised if the correct dx term would be something like "Multimodal Affective Disorder" or "Bipolaroid Anxiety Disorder" :) The folks that I've known that are BP-I's can have so many months of "euthymic" clear-headed functioning it just boggles my mind. I don't think I go more than a few days in a row at most where I feel "normal". .... As far as treatment goes I found lithium useful in the past for the years that I took it, it just seems that anticonvulsants work *better* for me. They say that Li doesn't help rapid-cyclers as much, and I would have to agree with that somewhat. .. As far as BPII going to BPI with time.. there have been hypomanic episodes in the past where it seemed that all I would have to do is stop meds and it turn into something fullblown, but it seems that anxiety is a limiting factor to that.. My symptoms tend to flux or morph from hypomania into hostility then into PANIC, and when things start getting mixed and agitated I can't stand it and I treat it aggressively to get a lid on it. The BPI people I've known just get this pure EUPHORIC nonstop racing derailment that just goes and goes and they feel great. Not so with me.
Posted by barbaracat on January 1, 2005, at 16:23:21
In reply to Re: Dysthymia versus Bipolar type 2 » Mr.Scott, posted by King Vultan on January 1, 2005, at 11:57:51
Have you noticed any weight gain? Do you have early morning grogginess? I tried Seroquel (which I understand is a powerful histimine antagonist) and it was tough to wake up. I imagine all ATs are different from each other and I certainly don't understand their action. Have you tried others?
> I guess my suggestion would be to consider an atypical antipsychotic, if you haven't tried one already. Agitation and restlessness on SSRIs and other drugs that increase serotonin transmission may be caused by stimulation of the 5-HT2A receptor, which all of the atypicals blockade. Judging how well even a tiny dose (0.25 mg/day) of Risperdal is working for me in reducing my own agitation, I'm rapidly coming to the conclusion that one of my major issues is that I simply have too many 5-HT2A receptors. All of the atypical antipsychotics also blockade dopamine D2 receptors at higher dosages, which I believe can help prevent mania or hypomania; although, I am not an expert on bipolar disorder.
>
> I must admit to not understanding the pharmacology of mood stabilizers and tending to look askance at them, and I used to feel the same way about atypical antipsychotics, but I've become convinced that this is a very useful class of meds, even in some instances for people who are neither bipolar nor schizophrenic. I have long term unipolar depression, with associated social phobia and ADD symptoms, and while Parnate works relatively well for these things, I still find myself suffering from a chronically low libido and an agitation/anxiety/getting ahead of myself that is fairly distracting and impairs my ability to enjoy activities. I'm looking forward to my next visit with my psychiatrist to discuss going up in dosage on the Risperdal, perhaps to 0.5 mg/day, given how noticeable the positive effects have been at this dosage, with no detectable side effects.
>
> Todd
>
Posted by barbaracat on January 1, 2005, at 16:32:48
In reply to Re: Dysthymia versus Bipolar type 2 » Mr.Scott, posted by King Vultan on January 1, 2005, at 11:57:51
Have you noticed any weight gain? Do you have early morning grogginess? I tried Seroquel (which I understand is a powerful histimine antagonist) and it was tough to wake up. I imagine all ATs are different from each other and I certainly don't understand their action. Have you tried others?
> I guess my suggestion would be to consider an atypical antipsychotic, if you haven't tried one already. Agitation and restlessness on SSRIs and other drugs that increase serotonin transmission may be caused by stimulation of the 5-HT2A receptor, which all of the atypicals blockade. Judging how well even a tiny dose (0.25 mg/day) of Risperdal is working for me in reducing my own agitation, I'm rapidly coming to the conclusion that one of my major issues is that I simply have too many 5-HT2A receptors. All of the atypical antipsychotics also blockade dopamine D2 receptors at higher dosages, which I believe can help prevent mania or hypomania; although, I am not an expert on bipolar disorder.
>
> I must admit to not understanding the pharmacology of mood stabilizers and tending to look askance at them, and I used to feel the same way about atypical antipsychotics, but I've become convinced that this is a very useful class of meds, even in some instances for people who are neither bipolar nor schizophrenic. I have long term unipolar depression, with associated social phobia and ADD symptoms, and while Parnate works relatively well for these things, I still find myself suffering from a chronically low libido and an agitation/anxiety/getting ahead of myself that is fairly distracting and impairs my ability to enjoy activities. I'm looking forward to my next visit with my psychiatrist to discuss going up in dosage on the Risperdal, perhaps to 0.5 mg/day, given how noticeable the positive effects have been at this dosage, with no detectable side effects.
>
> Todd
>
Posted by Ritch on January 1, 2005, at 16:33:55
In reply to Bipolaroid Anxiety Disorder » Ritch, posted by Mr.Scott on January 1, 2005, at 15:16:03
> The only thing that would not be 100% identical to your descriptions, would be the substance abuse that I sought relief in for many years.
You're not the lone ranger with regards to tinkering with non-prescription substances! When I went off lithium in my late '20's for a few years, alcohol crept in to medicate the agitative depressions (or mixed episodes). If I'm not on an antimanic medication I start craving alcohol(esp. in a mixed or primarily depressive episode). Also, oddly enough, ADHD meds reduce cravings (desipramine, stimulants).
> One thing I should note...is that I can force myself into distraction sometimes through work and social activities so that all this crap stays in the backround. That seems to be my greatest source of relief today aside from paltry doses of this that and the other which inevitably cause side effects as I approach therapuetic doses.
>
> ScottI also feel compelled to stay busy and use the energy productively and not get idle. I've had people ask me things like: "Don't you ever just do ... NOTHING?". I think some of this is panic disorder in some indirect way coming through. My Mom is just like that and she had epilepsy and panic attacks. When she gets idle she starts getting uptight and agitated. I'm the same way, if there isn't a chore or a project or SOMETHING, I just start pacing all around, and start focusing on somatic symptoms and feeling panicky.
Posted by D minor on January 1, 2005, at 16:52:16
In reply to Re: Dysthymia versus Bipolar type 2 » Mr.Scott, posted by SLS on December 30, 2004, at 4:31:06
> Hi Scott.
>
> It sounds to me as if you might have "double-depression", wherin major depressive episodes are superimposed upon a chronic dysthymia. Both aspects of this mixed condition are capable of producing irritability as a symptom. Dysthymia tends to be stubborn to treatment. You might want to look into trying amisulpride or perhaps even Abilify. If you use Abilify, be prepared to experience some anxiety or irritability initially.
>
> I don't think you have bipolar disorder. You really have to express a hypomanic episode to be eligible for this diagnosis. Episodes can last for as few as 5 days, though. Doctors seem to be quite fond of this diagnosis lately.
>
>
> - Scott
>
Hi to both Scotts!Mr. Scott, I know how you feel about being confussed about diagnosis. I was initially diagnosed with unipolar psychotic depression. But a new doc recently diagnosed me with BP. I don't know if I believe him.
The main reason for my doubt is this: I have never been "hypomanic" for more than a day at a time. I felt really "high" for a day, then really depressed for a few days with a few normal days in between for about two weeks. When I started Depakote that all stoped. So my question to SLS is, can you be hypomanic for just one day? I know the DSM says 5 days. Or does duration not matter when you're rapid cycling?
Thanks,
dm
Posted by barbaracat on January 1, 2005, at 17:33:21
In reply to Re: Dysthymia versus Bipolar type 2 » barbaracat, posted by Mr.Scott on January 1, 2005, at 5:02:13
OK, hoist yer petard over to my post in Alternative for info on pyroluria:
http://www.dr-bob.org/babble/alter/20050101/msgs/436445.html
> Hi Barbaracat,
>
> I'll do a search right now! I have had the white spots all my life, although they seem less now then when I was younger. Tell me where to go and I'll follow! What sort of internal pressure?
>
> Scott
Posted by SLS on January 2, 2005, at 10:06:21
In reply to Re: Dysthymia versus Bipolar type 2 SLS, posted by D minor on January 1, 2005, at 16:52:16
> > Hi Scott.
> >
> > It sounds to me as if you might have "double-depression", wherin major depressive episodes are superimposed upon a chronic dysthymia. Both aspects of this mixed condition are capable of producing irritability as a symptom. Dysthymia tends to be stubborn to treatment. You might want to look into trying amisulpride or perhaps even Abilify. If you use Abilify, be prepared to experience some anxiety or irritability initially.
> >
> > I don't think you have bipolar disorder. You really have to express a hypomanic episode to be eligible for this diagnosis. Episodes can last for as few as 5 days, though. Doctors seem to be quite fond of this diagnosis lately.
> >
> >
> > - Scott
> >
>
>
> Hi to both Scotts!
>
> Mr. Scott, I know how you feel about being confussed about diagnosis. I was initially diagnosed with unipolar psychotic depression. But a new doc recently diagnosed me with BP. I don't know if I believe him.
>
> The main reason for my doubt is this: I have never been "hypomanic" for more than a day at a time. I felt really "high" for a day, then really depressed for a few days with a few normal days in between for about two weeks. When I started Depakote that all stoped. So my question to SLS is, can you be hypomanic for just one day? I know the DSM says 5 days. Or does duration not matter when you're rapid cycling?
>
> Thanks,
> dm
>Some of the quantitative diagnostic criteria of the DSM are arbitrary, but are usually based on statistics. For instance, if one were to have three dramatic bipolar mood episodes per year every year, does this make him any less a rapid cycler than someone who has four? I don't know. Perhaps six is a better number. For some people with bipolar disorder, rapid cycling might only be a temporary change in the course of the illness that is perhaps limited to a phase lasting a few years.
There is an inherent contradiction between the observed and accepted existence of "ultra-rapid cyclicity" and "ultradian cyclicity" in which one can alternate between mood states every few days or even every few hours and the DMS requirement that a manic or hypomanic episode last a minimum of 4-7 days. How, then, could your mood state lasting only 24 hours disqualify you from one of these rapid cycling presentations? It can't. Be cognicant, however, that an episode is defined by some investigators as being a period of cyclicity that lasts for at least two weeks. It is this single period a rapid-cycle persists and not the cycles themselves. In other words, if you have been ultra rapid cycling for a period of time lasting more than two weeks, than you will qualify for rapid cycling if you experience more than four of these episodes per year. You can see how there is yet some confusion in the psychiatric field as to what constitutes rapid cycling.
Can you be more detailed and specific in the description of your "manic" days?
Do your manic episodes during these days reach the threshold of mania and not hypomania? Do you become psychotic or lose your ability to function at work or at home or around friends?
- Scott
Posted by King Vultan on January 2, 2005, at 12:44:05
In reply to Re: Dysthymia versus Bipolar type 2 » King Vultan, posted by barbaracat on January 1, 2005, at 16:23:21
> Have you noticed any weight gain? Do you have early morning grogginess? I tried Seroquel (which I understand is a powerful histimine antagonist) and it was tough to wake up. I imagine all ATs are different from each other and I certainly don't understand their action. Have you tried others?
>
>
I've only been on Risperdal for a couple of weeks, and with such a tiny dosage (0.25 mg/day), I personally haven't noticed any adverse effects at all. This is the first AP I've, tried, but the atypical with the lowest side effects appears to be Geodon; in "Psychotropic Drugs", it is listed as having both low weight gain and low sedation, while Risperdal is listed as having moderate weight gain and high sedation. They show Seroquel, by comparison, as having moderate weight gain and moderate sedation, while Zyprexa is listed as having moderate weight gain and high sedation.I guess I have to question how much faith you can have in those descriptions, as which side effects are most prominent and to what degree they are going to affect a person are heavily dependent on dosage. From the data I have, Zyprexa looks like it should be much more sedating than Risperdal at low dosages because Zyprexa has an extremely powerful histamine blockade. Risperdal also blockades histamine H1 receptors, but the effect is comparatively weak at the very low dosages of 0.5 to 1.0 mg/day that I am interested in. It does appear that Geodon has a rather favorable side effect profile compared to most of these other agents, however. It also happens to be a $50 copay on my insurance, while Risperdal is only $25 and can also be easily cut into halves for intermediate dosages and to save money.
Todd
Posted by D minor on January 2, 2005, at 16:29:17
In reply to Re: Rapid cycling definitions: varying concepts » D minor, posted by SLS on January 2, 2005, at 10:06:21
> Can you be more detailed and specific in the description of your "manic" days?
>
> Do your manic episodes during these days reach the threshold of mania and not hypomania? Do you become psychotic or lose your ability to function at work or at home or around friends?On my hyper days I felt really sped up. I could do anything faster. I felt like I could fly. I was exuberant. My brain was so busy it felt like there was a radio in my head. I also felt really sexy. I thought I was doing a better job at work, and I was more creative. As far as psychosis, I've had hallucinations off and on for the past two years, so I really don't know what to make of that. But they're never severe enough to keep me from working. My husband was really conserned. He said it was as if I was high. I'm not sure if all of this qualifies as hypomania. But I reallyl miss those days.
gotta go
dm
Posted by Mr.Scott on January 2, 2005, at 17:13:34
In reply to Re: Rapid cycling definitions: varying concepts » D minor, posted by SLS on January 2, 2005, at 10:06:21
Hi,
Here's my experiences of what I'll call hypomania. Keep in mind no physician has ever claimed to have seen me in a hypomanic state and I've seen the doc for 4 years. He once said I was in a mixed state from what I described.
Here goes....
-Antidepressant induced or stimulant induced-
-Lexapro 2002-Feeling of a rush of energy inside that feels wonderful! Lot's of mental energy. Music playing in the mind all the time. Creative wheels moving. Listening to super loud music in the car and really 'feeling' it diferently than usual. Giddy...Making tons of jokes and being slap happy. A little relentless, but others find amusing not annoying. Internal desire to make plans for the future and a feeling that I need to get moving and quit being so depressed. A feeling that things are going to be different this time (although due to repeated experience this has gone away and is now replaced with fear). Desire for lots of sex! Feel more charismatic and charming. A feeling that it's absolutely okay to be me, and that anything is possible! Rekindle old flames disregarding previous experiences. Maybe buy too many presents or a couple of unneeded items for myself. Nothing Too extravagant though. Sleep is not affected except maybe at the very beginning of an Antidepressant trial. Inevitably this feeling starts to go away. Maybe after 2 days or 1 week. I notice side effects from the antidepressant. Could be facial swelling, muscle aches, constipation, fatigue, or whatever! Agitation albeit mild replaces initial excitement and euphoria. Now I begin to feel more angry, anxious, agitated. I'll fantasize about morbid things. At this point the Antidepressant gets lowered or canned entirely.
-Prozac & Wellbutrin Combo 1996-
Was on Prozac alone which gave my the positive feeling above, except it actually lasted 6-9 months! Then it pooped out and I started using more and more alcohol, amphetamines, cocaine, etc to keep it alive. I developed a constant dysphoria and a bad drug habbit. Went to rehab and detoxed. Came home and relapsed and Wellbutrin + Clonazepam was added to Prozac. My mood literally shifted every few hours one night from 'driven happiness' to 'driven dysphoria' I smoked tons of cigarettes this night and talked as is everything was going to be okay. Later that night I became agitated and could not sleep. I began to feel that there was no point and I proceeded to attempt suicide by using alcohol, pills, razor blades, and Carbon Monoxide. Apparently I wasn't all that serious because while bleeding in the garage I phoned an old girlfriend and gave away where I was inadvertantly. The garage door was completed broken through 15 minutes later and I was in a coma for 2 or 3 days.
-Imipramine 2003-
Already seriously depressed and newly participating in 12 step group (6mos). My doc tells me I'm in a mixed state and recommends ECT. Feels like an agitated depression and that SSRI's can't help due to side effects. I see another doc who poo poos ECT and says everyone is bipolar. He gives me Impramine. This agitates me further and I say F*** It! I go out drinking and coking for an entire weekend keeping company with unsavory fellows in a motel I had just met on the street in a bad part of Chicago. I come back to work on Monday and employees and partner note that I seem to be doing better! (to come down I used 3 different mood stabilizers and slept all day and night Sunday). Eventually I decide 'to try' ECT. Results are questionable. "I guess maybe it helped a little."-Initial and seperate Nardil, Ritalin, and Prozac trials-
Similar experience as Lexapro, except these last longer. Prozac 6-9months. Nardil 3 months. Ritalin 2 months. All end with tremendous dissapointment and more depression. Some with drug relapses.Keep in mind there have been hundreds more smaller scale events like these that lasted only a day or two where I was activated, hostile, highly productive, anxious or even obsessed with intense violent thoughts.
Mostly I feel depressed and anxious and obsessed with one thing or another though. Winters are awful it seems literally must sleep all the time and have NO energy. I have a history of ADD/conduct disorder and had a penchant for antisocial activities in my youth. I was always angry/fearful/ and threatening as a youth. Early involvement with sex & drugs. Currently I am in recovery from all street drugs and alcohol, but I crave often and it takes a lot of energy I really don't have right now to fight them off! Today I'm just unhappy...tired...scared...and still unf***ing clear as to what my diagnosis is!
Scott
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