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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 andsoitgoes on October 17, 2007, at 16:04:48
Sorry for the double post on this...
I'm a 27, soon to turn 28 year old male. I have what seems like a good life. I have a wife, two kids (twins) and a house. I have a good job, it's stable and to normal people on the outside I seem like I'm in good shape, mentally at least.
Inside, however, I feel anything but the case. I can't even think back on a time that I didn't feel overwhelmed, able to focus or concentrate on much.
Does my schoolwork show it? Yes, and no. In Grade School, I did okay. Nothing great, nothing horrible. Junior High was horrific, the first year at least. I needed glasses, second year of Junior High my grades were good enough to put me into the "Honors" program in my high school.
Come high school, I flunked almost every class in my first semester. I wasn't able to apply myself, "understand" Shakespear, focus to put together the information needed to do papers. I went back to the standard program and did okay in grade 10, much better in grade 11 and then aced damn near everything in grade 12. I used to do great in math, and then I didn't.
Then came life after school. It was far from the norm, I went to a community college as I had no money, scholarships, etc to go to anything but. I failed at that as I had no drive or determination to get things done. After that I moved countries (to Canada) and then tried things here.
Being outside of school I had to start on a path to where I had to "prove myself" more, it seemed. When I started, it all seemed okay and fine. I got interviewed and accepted by the first job that wanted to see me. Shortly after starting that job, my attention was brought to all of my flaws (have someone pay you money, and they don't try to sugar coat things). I actually looked back to see how I had difficulty composing emails, talking with people. I came across like someone who is ESL and who struggled with communication. I've since improved, through focus and a lot of energy - but even writing this I'm going all over the place, and I know in the end I'll look back and realize just how much I've either missed or how disorganized my thoughts are.
I've been very luck at future jobs or "career" moves, all which have been great for a honeymoon, and failed shortly thereafter. Do I get presented with repirmands for poor jobs? No. Do I get fired? No, I actually have gotten promoted, believe it or not.
However, I've never been able to really be a creative thinker, I can't come up with ideas even when I try, and then it seems like I'm expending every single bit of energy I have in me.
I almost always feel like I have a "cloud" in front of my head, and that I'm trying to push through it.
I have no friends, really. Sure I've got a lot of people on my "Facebook" but I talk to barely any. MOST times I can't have a serious conversation with anyone, not something meaningful. I'm always having to fight to try and be sociable. I want to be. A few years ago I decided I needed to try it on my own (as my wife and I got married when I was very young, she was that "one connection" that was there and it seemed right, does even more now - and with her being so supportive) and I used to try and be sociable all the time. However, I'd be so stressed during those times that I wasn't able to be sociable. I used to stress how I'd feel an hour into a social event, or even less - when I lose my 'zing' - usually I have the stamina to be sociable for the first hour, and then I turn into a zombie. Nothing then gets that energy back.
I have huge depressive swings that I feel suicidal (and no matter how bad it's gotten, I've never "planned" suicide, just thought a lot A LOT about just not being around) - my "up" phases are for the most part "normal" - not much more. Although I have gone through periods where I'll skirt duties (like when I had my "own business") and play video games, or go shopping. I also, before that, would go shopping and spend money I didn't have. I got myself into about $12,000 of debt in a period of 2 years.
I've been tentatively diagnosed now with "Bipolar 2 II", which I'm confused about. I know I exhibit symptoms of mixed-depression. I know I have symptoms of ADD. I know I can't function normally to an extent I need to (previous jobs were at an Internet Marketing company that was all of 10 people when I started, and I slowly got "found out", then at an online company which had a lot of people, and my tasks were, well, different) - I most times struggle with simple tasks, but sometimes can complete complex ones. It takes all of my energy to try and put my thoughts in order, and then it ends up disorganized when I actually have the energy to do anything.
I'm almost always fatigued, or lacking in desire to do anything. If I had my way, 24/7 I'd just be laying, watching TV or doing nothing. I was always fatigued, but THIS has come in the last 10 years. I was always a bit lazy, but never this bad.
I'm always overwhelmed. I don't have the typical "Mania" - if anything, I rarely have more than a few hours at a time with any energy. I DO, however, have periods where like I mentioned, skirt anything, job, whatever - especially when it's most inconvenient to do so. When I had my own "business", I remember I'd spend days playing video games instead of getting work done. Other times it would be the shopping. Sometimes I'll have a few hours to where I think I'm a genius and what I type is pure gold, but it never lasts for an extended period.
ANd I'm lost. I have a GP that wants to help, very badly she does. In Canada it's not "easy" to go see a Psychiatrist, and the thought of going to see a "bad" one scares me.
I'm just lost. I need some guidance, I need someone to help me figure out what's going on and how I can fix it so that every day doesn't end with me feeling so drained that I never want to get up again. I don't always need to be "up" - but I can't take anymore of always being down.
Sorry - I didn't define anything as far as meds go.
I've tried, in no specific order:
ADs
- Effexor
- Wellbutrin
- Paxil
- Prozac
- ZoloftMisc
- Ritalin
- Xanax
- AtivanI hate things like Xanax and Ativan because they make me feel WORSE than I do normally. The ADs have done nothing, other than side-effects, no matter how long I've taken them or how I've increased the dosage.
I've also gone to see a psychiatrist who basically did "talk therapy" with me and thought I seemed "normal and put together", but each session only consisted of me talking about my symptoms, always thinking of an end solution.
He gave me a prescription and I never went back. I've since tried most of the ADs after that (having tried Effexor, Ritalin and Xanax) still with the same lack of results. I haven't gone to see a psychiatrist.
I'm CURRENTLY on Zyprexa from my GP, it's been a week.
I think that's all
Nick
Posted by Phillipa on October 17, 2007, at 16:40:55
In reply to Difficulty in Diagnosis? Bipolar II??, posted by andsoitgoes on October 17, 2007, at 16:04:48
What about adding a mood stabalizer like depakote or lamictal or tegetol. Good luck Phillipa
Posted by Racer on October 17, 2007, at 17:15:08
In reply to Difficulty in Diagnosis? Bipolar II??, posted by andsoitgoes on October 17, 2007, at 16:04:48
Hi, Nick,
Well, I'm having concentration troubles today, so I'm not sure I have much useful input, but here's a try:
First of all, I'm not entirely convinced that all of that adds up to bipolar to me. If you're being literal when you say "Sometimes I'll have a few hours to where I think I'm a genius and what I type is pure gold, but it never lasts for an extended period." -- a few hours does not a manic episode make. Also, some of your other descriptions do not sound like bipolar -- the social issues, the work issues, etc.
Yes, you do have symptoms suggestive of ADHD -- the disorganization, etc -- but I'm not sure I'd go for that, either.
Honestly, it sounds like some combination of depression, anxiety, and probably one of the anxiety-related personality disorders -- or more likely Cluster C personality traits, since it doesn't sound like a personality disorder, either, really.
(I'm sorry for being so skimpy on comments -- I'm having an allergy attack today, with burning skin, fever, nausea, and I can only think a little bit... I will try to get back to this when I'm more myself.)
As far as treatment goes, I would very strongly recommend psychotherapy as a main focus -- a lot of what you've described can be approached behaviorally, and it's more likely to be effective than any medication on its own. You won't necessarily need to discuss how you were potty-trained, just learn some more adaptive coping strategies. (Although I'm a big fan of psychodynamic therapy -- I get to talk about myself for fifty minutes? And no one says I'm being selfish? WHOOHOO!)
In terms of medications, I'd think in terms of cocktails -- a lot of the issues you've brought up would likely improve with serotinergic drugs, so maybe include Zoloft into the mix -- or pick your favorite SSRI -- add in some Provigil for focus, and if that doesn't help, try Ritalin again; and add something in to augment the antidepressant effects, while maybe offering a bit of stabilization in case I'm totally off base about your dx -- I'd say Lamictal is pretty helpful for a lot of people, Seroquel is also quite helpful. A lot of people seem to be finding Abilify helpful, too.
Good luck!
Posted by andsoitgoes on October 17, 2007, at 17:54:19
In reply to Re: Difficulty in Diagnosis? Bipolar II?? » andsoitgoes, posted by Racer on October 17, 2007, at 17:15:08
> Hi, Nick,
>
> Well, I'm having concentration troubles today, so I'm not sure I have much useful input, but here's a try:
>
I appreciate any advice :)> First of all, I'm not entirely convinced that all of that adds up to bipolar to me. If you're being literal when you say "Sometimes I'll have a few hours to where I think I'm a genius and what I type is pure gold, but it never lasts for an extended period." -- a few hours does not a manic episode make. Also, some of your other descriptions do not sound like bipolar -- the social issues, the work issues, etc.
>Bipolar, no. Bipolar 2 with heavy depression matches with EVERYTHING but the hypomanic periods, which I do get similar to descriptions from the DSM, *except* for durations.
My mood swings are akin to ultradian cycling, and there ARE mood swings there, which doesn't fit depression, or MDD. It only fits with the rapid constant cycling.
And the irritability comes with no rhyme or reason, as well. So many things really point to Bipolar 2... continued below :)
> Yes, you do have symptoms suggestive of ADHD -- the disorganization, etc -- but I'm not sure I'd go for that, either.
>I have no "H", I'm never hyperactive, sometimes I have a bit of a zing, but it's not hyperactive. However, ADD is a part of my being, however it also fits in Bipolar 2.
> Honestly, it sounds like some combination of depression, anxiety, and probably one of the anxiety-related personality disorders -- or more likely Cluster C personality traits, since it doesn't sound like a personality disorder, either, really.
>Well, see - this is why Bipolar II seemed so right. It has the "add" symptoms, it has the depression, it explains the spurts of "hypomania" along with irritability and... continued below..
> (I'm sorry for being so skimpy on comments -- I'm having an allergy attack today, with burning skin, fever, nausea, and I can only think a little bit... I will try to get back to this when I'm more myself.)
>OUCH... well, that's something to put a person into perspective!
> As far as treatment goes, I would very strongly recommend psychotherapy as a main focus -- a lot of what you've described can be approached behaviorally, and it's more likely to be effective than any medication on its own. You won't necessarily need to discuss how you were potty-trained, just learn some more adaptive coping strategies. (Although I'm a big fan of psychodynamic therapy -- I get to talk about myself for fifty minutes? And no one says I'm being selfish? WHOOHOO!)
>See, I have a very, very difficult time talking about myself. The anxeity, which needs to be talked about, limits my ability to talk about it, which in turns creates more anxiety.
See the problem?
> In terms of medications, I'd think in terms of cocktails -- a lot of the issues you've brought up would likely improve with serotinergic drugs, so maybe include Zoloft into the mix -- or pick your favorite SSRI -- add in some Provigil for focus, and if that doesn't help, try Ritalin again; and add something in to augment the antidepressant effects, while maybe offering a bit of stabilization in case I'm totally off base about your dx -- I'd say Lamictal is pretty helpful for a lot of people, Seroquel is also quite helpful. A lot of people seem to be finding Abilify helpful, too.
>I've never had luck with SSRIs, I've done the gamut. Wellbutrin and Zoloft make the anxiety worse. Effexor I won't try again due to the risk involved, and it was my first and the most HORRIFIC AD in terms of how it messed with my brain. I seriously felt stoned for weeks, and that was at 75mg.
The Zyprexa is similar in acting to the other mood stabilizers, which is why I'm hoping that will help. I do like the thoughts of Lamictal, which I've found on Jim Phelp's site, along with some others - it seems very low as far as side effects as long as you don't get a rash.
However, the Zyprexa is not causing much of an increase in weight gain. It also helps that I'm chunky, and it's been said that the weight gain is mostly when you start off thin.
> Good luck!Thanks, I AM GOING TO NEED IT!
I do plan on doing psychotherapy/CBT - however I need, NEED to get a handle on the overlying issues. I can't be a dad to two girls and deal with the depressive episodes taking me down so much again. I also cannot subject them to being frustrated with rage, it's not fair to them. And I just can't handle it any more. Urgh.
Nick
Posted by andsoitgoes on October 17, 2007, at 17:57:52
In reply to Re: Difficulty in Diagnosis? Bipolar II?? » andsoitgoes, posted by Phillipa on October 17, 2007, at 16:40:55
> What about adding a mood stabalizer like depakote or lamictal or tegetol. Good luck Phillipa
> What about adding a mood stabalizer like depakote or lamictal or tegetol. Good luck Phillipa
That's why she was integrating the Zyprexa, which from what I'm aware is a mood stabilizing drug.
I am going to speak to my GP about Lamictal, I think she may have tried the Zyprexa first due to the quick acting nature of it.
Posted by JayBTV2 on October 17, 2007, at 21:34:39
In reply to Re: Difficulty in Diagnosis? Bipolar II??, posted by andsoitgoes on October 17, 2007, at 17:57:52
I'd recommend trying Lamictal. I had a similar experience with SSRIs as none really helped my depression. Lamictal has done the trick though. However it does take a while to get up to a good dose (100mg+) since you have to titrate slow to avoid the rash. But of all the meds I've been on (SSRIs, MAOIs, Lithium, Depakote, ADHD meds) it's the one that's really helped get rid of the low end of my spectrum. Not euphoric - but not depressed....
http://www.crazymeds.org/lamictal.html
And
http://www.askapatient.com/viewrating.asp?drug=20241&name=LAMICTAL
Have some good info and patient reviews.
Good luck!
-Jay
Posted by andsoitgoes on October 17, 2007, at 22:03:47
In reply to Re: Difficulty in Diagnosis? Bipolar II??, posted by JayBTV2 on October 17, 2007, at 21:34:39
> I'd recommend trying Lamictal. I had a similar experience with SSRIs as none really helped my depression. Lamictal has done the trick though. However it does take a while to get up to a good dose (100mg+) since you have to titrate slow to avoid the rash. But of all the meds I've been on (SSRIs, MAOIs, Lithium, Depakote, ADHD meds) it's the one that's really helped get rid of the low end of my spectrum. Not euphoric - but not depressed....
>How was the process for you? I saw something about a cycle of 25mg and an increase of 25 each week
And I've heard so many good things about the stuff, I really think it's a better option than the Zyprexa, even though I'm not experiencing any problems, and it's been confirmed that the weight gain is not dose-dependant. But still, it's gotten a lot better reviews than the zyprexa!
> http://www.crazymeds.org/lamictal.html
>
> And
>
> http://www.askapatient.com/viewrating.asp?drug=20241&name=LAMICTAL
>
> Have some good info and patient reviews.
I saw those sites, but not for lamictal. Ill check then out
> Good luck!
>
> -Jay
Thanks Jay!!
Posted by Phillipa on October 17, 2007, at 22:10:42
In reply to Re: Difficulty in Diagnosis? Bipolar II??, posted by andsoitgoes on October 17, 2007, at 22:03:47
Lamictal is titrated slowly usually with a starter kit that either is very low starting with l2.5mg and doubling til target dose. Most common in adults is the 25mg each week or two weeks forget. And don't worry about the rash as it's very rare. Good luck Phillipa
Posted by Phillipa on October 17, 2007, at 22:26:01
In reply to Re: Difficulty in Diagnosis? Bipolar II??, posted by JayBTV2 on October 17, 2007, at 21:34:39
Jay really? Worked as ad as I tried it twice excessive salivation spitting constantly at 50mg but no other side effects and no ad's work for me. What can I do any suggestions? Phillipa
Posted by JayBTV2 on October 18, 2007, at 10:41:48
In reply to Re: Difficulty in Diagnosis? Bipolar II?? » JayBTV2, posted by Phillipa on October 17, 2007, at 22:26:01
I guess like everything else everyone reacts differently. I haven't had any side effects w/ it really. Weight neutral, no sexual issues, no dry mouth (or excess salivation)...perhaps the only thing is odd dreams but those have subsided a bit.
I started it once before and jumped up to 100mg really quick (I was stupid) and got really red all over (Not a rash but looked like the blood was rushing to my skin). Luckily after a few months my pdoc let me try it again (following directions this time) and it's been working pretty effectively.
As for titration I also take depakote (250mg) so I had to go even slower than 25mg a week. Depakote can almost double the half life of Lamictal so they give you a different starter kit. 25mg every other day at first, then 25mg a day, then an additional 25mg every week to 10days thereafter. I'm finally up to 200mg (Where I'll stay) and am feeling pretty good. I'm still not as motivated as I'd like to be but I don't get down on myself as I used to....
-Jay
Posted by andsoitgoes on October 18, 2007, at 21:55:08
In reply to Re: Difficulty in Diagnosis? Bipolar II??, posted by JayBTV2 on October 18, 2007, at 10:41:48
Thanks for all the help, it really seems like it is the next thing to try. I don't know if the Zyprexa is doing anything other than reducing my energy. Mind you, 5mg is still pretty low, but I think I'm going to stick with it for a bit at least.
My biggest issue is the "hypomania" and the fact that I really perceive very minor symptoms of the energy that bipolar 2 is surrounded with. But that's also why I'm thinking going to see a pdoc is a good idea, I just don't go back to see my family doctor until next week, so I've got a ways to go.
I'm feeling discouraged again as well, what if this isn't the answer, what if I'm back to the drawing board?
Or, what scares me just as much, is combining drugs and finding a "cocktail" that works. The cost is not an issue, however the difficulty I have telling if something works IS. Hell, I can't tell if Tylenol works a lot of the time, because whatever thought I had before slips from my mind, even if it was a bad headache.
Phelps site has really shown that it very well COULD be BPII, but how do I know? Is a pdoc any better to reat me than a GP who is willing to look at these options?
> I guess like everything else everyone reacts differently. I haven't had any side effects w/ it really. Weight neutral, no sexual issues, no dry mouth (or excess salivation)...perhaps the only thing is odd dreams but those have subsided a bit.
>
> I started it once before and jumped up to 100mg really quick (I was stupid) and got really red all over (Not a rash but looked like the blood was rushing to my skin). Luckily after a few months my pdoc let me try it again (following directions this time) and it's been working pretty effectively.
>
> As for titration I also take depakote (250mg) so I had to go even slower than 25mg a week. Depakote can almost double the half life of Lamictal so they give you a different starter kit. 25mg every other day at first, then 25mg a day, then an additional 25mg every week to 10days thereafter. I'm finally up to 200mg (Where I'll stay) and am feeling pretty good. I'm still not as motivated as I'd like to be but I don't get down on myself as I used to....
>
> -Jay
Posted by Dragon Black on October 21, 2007, at 19:25:56
In reply to Re: Difficulty in Diagnosis? Bipolar II?? » andsoitgoes, posted by Racer on October 17, 2007, at 17:15:08
"First of all, I'm not entirely convinced that all of that adds up to bipolar to me. If you're being literal when you say "Sometimes I'll have a few hours to where I think I'm a genius and what I type is pure gold, but it never lasts for an extended period." -- a few hours does not a manic episode make. Also, some of your other descriptions do not sound like bipolar -- the social issues, the work issues, etc."
I disagree. DSM IV requires a minimum 2-week duration to qualify as a hypomanic episode. IMO the concensus view is that this is bunk - completely leaves out rapid and ultradian cyclers; the whole concept of bipolar spectrum disorder has arisen to deal with these shortcomings, and it's a safe bet that a complete overhaul is coming in DSM V (due out 2010 or 2011). DSM IV has 4 categories for BP, one of which is BP NOS (not otherwise specified) - I can't remember the source, but tons of people end up with this diagnosis basically b/c DSM lacks the complexity to account for the way in which they present. My sense of the the trend toward viewing BP as a spectrum is that the important overriding factor is not the elevation of the highs juxtaposed to depressions, such that we can clearly state, "Aha! That is hypomania!" but rather the FACT that they swing or switch in a way that unipolars just don't.
Posted by Polarbear206 on October 22, 2007, at 10:05:31
In reply to Re: Difficulty in Diagnosis? Bipolar II??, posted by Dragon Black on October 21, 2007, at 19:25:56
Posted by andsoitgoes on October 22, 2007, at 15:15:53
In reply to Re: Difficulty in Diagnosis? Bipolar II??, posted by Dragon Black on October 21, 2007, at 19:25:56
THanks - this is what I had been thinking, because I don't fit any of the common profiles of, well, anything. Even looking at something like Borderline Personality, I don't fit a great amount of the criteria (I don't push people away in such a dramatic way, however I do "take" the personality of the people who are my friends, and have for years - I never understood it... So that adds another confusion portion to the mix.
And my fear about seeing a P-Doc has all regards to these problems, I don't fit into DSM criteria, so what if my p-doc follows those? My family doctor has already expressed a willingness to work with me to find the best treatment possible, I fear I'd be shooting myself in the foot to go to someone else.
however, here I sit - not really any further than I was before. The ZYprexa isn't doing it, the side effects are mostly gone and it's like I never started taking it. All the problems are still there. I don't even know what to suggest when I go back other than something like Lactimcal, or Depakote...
> "First of all, I'm not entirely convinced that all of that adds up to bipolar to me. If you're being literal when you say "Sometimes I'll have a few hours to where I think I'm a genius and what I type is pure gold, but it never lasts for an extended period." -- a few hours does not a manic episode make. Also, some of your other descriptions do not sound like bipolar -- the social issues, the work issues, etc."
>
> I disagree. DSM IV requires a minimum 2-week duration to qualify as a hypomanic episode. IMO the concensus view is that this is bunk - completely leaves out rapid and ultradian cyclers; the whole concept of bipolar spectrum disorder has arisen to deal with these shortcomings, and it's a safe bet that a complete overhaul is coming in DSM V (due out 2010 or 2011). DSM IV has 4 categories for BP, one of which is BP NOS (not otherwise specified) - I can't remember the source, but tons of people end up with this diagnosis basically b/c DSM lacks the complexity to account for the way in which they present. My sense of the the trend toward viewing BP as a spectrum is that the important overriding factor is not the elevation of the highs juxtaposed to depressions, such that we can clearly state, "Aha! That is hypomania!" but rather the FACT that they swing or switch in a way that unipolars just don't.
>
>
This is the end of the thread.
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