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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by psychpsych on August 1, 2008, at 21:52:42
I'm new to this forum, and need advice from Dr. Bob, or some of the more seasoned people browsing the forums.
I'm a first year resident in an east coast Psychiatry program, and am desperate for advice because Im nervous to get help, and somehow as a result suffer ramifications, professionally.
I'll start by saying that I am beginning to think I may have something seriously wrong with my mood, and maybe have for some time now.
I'm the child of a now sober alcoholic mother, and a father who despite being sort of spacy/brainy/ADHDish was very supportive and present while I was growing up. My parents are both educated, but home life was chaotic.
As a kid, I excelled in school, but was very shy. I don't think I had full blown Tourette's but I did a lot of throat clearing, eye blinking, and sounds that were quiet enough for people not to hear me. I was also spacey and a day dreamer.
After my parents divorced, I became sort of average in school, and probably depressed as well. I graduated and went on to college, and decided I better start applying myself again and move on with my life/stop being upset with my parents. I had a steady girlfriend, who I still wrongly have now (Ill explain why "wrongly" in a moment.)
In my second year of college, everything started going exceptionally well out of nowhere. I was scoring the highest in my organic chem. and physics classes at a research-I public university. It was this year I also decided to Major in English Literature, Film Studies, and Public Health, all on top of a premed curriculum. I was getting 4.0s, and also drinking, smoking pot daily. I hid this from my girlfriend, bc I knew she wouldnt approve. And somehow I didnt either.
After my sophomore year, I went home to study and take my MCATs early bc I had finished all the requisites. But about a month before I left, I started becoming very depressed and thought it was due to impending time at home with my mom, who I wasnt getting along with optimally at that time. I never took my MCATs that summer and didnt come out of my bedroom much that summer. I was pretty depressed like this even after returning to school in Junior year. Sometime around March in Junior year, my mood became great again. But this time, I was daydreaming about random people and girls on campus, trying to catch their eye, etc. Also, I was looking at porn on the internet enough that it was disturbing even to me. I worked 2-3 part time jobs, studied for the MCATs, spent thousands of dollars on CDs, sneakers, clothing. Unfortunately, I also sparked a relationship up with another girl on the side in the midst of all of it (on the same campus as my girlfriend!) Nevertheless she found out, I broke it off like I had actually wanted to soon after it started, and we mended things.
Senior year I became depressed even though I had gotten accepted to several medical schools, had everything laid out for me. I began having major sleeping troubles, was exhausted, run down, and depressed for most of the year.
Freshman year of med school, my doc gave me amytryptiline for sleep. I felt incredible, and I remember waking up one morning looking at the sun and thinking how good life was (and Im not an optimistic, nature loving type of guy). Also, I began eating out all the time, spending tons of money on clothing, CDs, etc again like I did in college. I also ended up in a relationship with a girl from my class, and broke up with my girlfriend this time, bc I couldnt stand the guilt of putting her through another infidelity. I loved her, remember not wanting to leave her, but everything was too exciting to resist. 6 months later, I was back in the gutter, realized what I did, patched things up with my girlfriend and finances even though I was depressed, not sleeping much, waking up early in the morning.
In Sophomore Year/Junior year of Med school, I finally told my primary about everything, and he placed me on Effexor, which I can say was the best thing to improve my mood, but I still was having problems focusing, paying attention, falling asleep at night (although I had no more early morning awakenings and was in a much better mood.) He sent me to a Psychologist, who told me I was dysthymic, but also was having problems with periods of impulse control, and that Dsythymia/Impulse Control/ADHD could also account for bad attention, poor focus, and difficulty finishing tasks. Combined with my spaciness, he recommended I be treated with an SSRI which helped my mood in the past, and a low dose stimulant. I did this, and things went very well for about a year and a half. I was controlling my money, my relationship with my girlfriend was great, and I was excelling in medical school for the first time since I started, rather than doing nothing and just passing. My friends commented that it was the first time since they met me, that they could actually see the back seat of my car because it wasnt cluttered with books, papers, laundry, old food, and whatever else!
In my senior year, I began pursuing a side interest in theoretical linguistics and syntax. I got the idea to do a research elective to write a paper in the area of linguistics and medicine. By the end of 6 weeks, I had written a comprehensive review of theoretical syntax, all the while drawing connections between neuroscience imaging in aphasia and the current misunderstanding of Brocas aphasia as taught in medical schools. It was 70 pages long, and is being reviewed for publication now. At the same time I did this, I started surfing the internet for dating websites. At the beginning, I told myself I was just browsing for fun, and I wouldnt do anything to hurt my girlfriend. I also began looking at internet porn, spending all my money, and having to borrow money from my parents just to survive. I met several girls on dates, but somehow managed myself to cut myself off before committing an infidelity. I also started believing something was seriously wrong with me at this point as I wasnt able to sleep, and despite being elated to do work, write music which I hadnt done in years, I was very irritable and depressed. I stopped taking my SSRI/Ritalin out of fear that this may have been making things worse. My focus obviously decreased, and so did my productivity. My depression got worse.
Here I am now beginning my psychiatry residency 6 months later. I have started taking my Ritalin again, because my attention, concentration, spaciness, misplacing things never improved in the 6 month interim. Fearing I have something related to Bipolar depression, I have decided not to start an SSRI again. I am depressed as usual, having trouble sleeping (which doesnt improve off of the stimulant by the way), and wondering what the hell I should do. Of course being in the field adds a layer of complexity to the situation, and I dont know what to do. If anyone was patient enough to read this, could someone, possibly Dr. Bob, lend some friendly advice.
Posted by no_rose_garden on August 1, 2008, at 22:13:38
In reply to Advice for a Psychiatrist in Training, posted by psychpsych on August 1, 2008, at 21:52:42
I'm sorry you left chat so abruptly...And that I'm not Dr. Bob.
As i read your story, bipolar kept coming to my head...I feel like you're in a place where you can get a lot of advice and help, though.
Also, I would strongly suggest you read the book "An Unquiet Mind" by Kay Redfield Jamison...I feel like it may be very helpful for you as the situations seem semi-parallel.
Posted by Phillipa on August 2, 2008, at 0:38:23
In reply to Re: Advice for a Psychiatrist in Training » psychpsych, posted by no_rose_garden on August 1, 2008, at 22:13:38
Spending money, depression, then all that energy, girlfriends does sound like it might be bipolar. Suggest getting a few opinions from other docs and can or do you keep a record of your moods. That could help you sort it out. Phillipa
Posted by Justherself54 on August 2, 2008, at 5:55:38
In reply to Re: Advice for a Psychiatrist in Training » no_rose_garden, posted by Phillipa on August 2, 2008, at 0:38:23
I'm bipolar and a lot of the behaviour you decribe fits...huge amounts of energy, spending, increased interest in sexual activities, then the crash into depression. When you were talking to the psychiatrist, did you tell him exactly what you've described here? You need to be brutally honest with your doctor and leave nothing out. If you are bipolar I hope you get on the right meds to help you continue your studies. I was misdiagnosed for over 20 years and am now dealing with the aftermath of a very prolonged mania four years ago and the depressive phase is still ongoing. I have been unable to work. If you are bipolar, catch and treat it now...you're young and can have a full, rich life ahead of you.
Posted by obsidian on August 2, 2008, at 8:46:43
In reply to Advice for a Psychiatrist in Training, posted by psychpsych on August 1, 2008, at 21:52:42
lay it all out on the table with a good psychiatrist
are you worried about ramifications because of how symptoms might make your life unmanageable, or because it might mean that some psychiatrist will know your difficulties, you'll be "branded" seriously mentally ill, and this will somehow mean that you are unfit to pursue your professional goals?-sid
Posted by psychpsych on August 2, 2008, at 13:58:40
In reply to Re: Advice for a Psychiatrist in Training » psychpsych, posted by obsidian on August 2, 2008, at 8:46:43
Sid,
I am definitely afraid of being branded. Psychiatrists all know when someone suffers from something, and it does get around. I know it seems vain fo rme to worry. I dont think Im better than anyone else, I just love this career and want to be able to help others without being doubted by patients and co-workers. I am capable of doin gmy job, and want desperately to keep my life together.
Posted by Nadezda on August 2, 2008, at 14:21:15
In reply to Advice for a Psychiatrist in Training, posted by psychpsych on August 1, 2008, at 21:52:42
Can't you consult someone either in another city, or with a non-medical school practice, in a community near yours but not in your city?
I know things can get around, but since it is unethical to violate confidentiality, it probably happens in conversations with people who have some connection to people, so the likelihood is less the further you go from any direct connection to any of the people involved.
Also in another community, you can say you don't want to identify your hospital, for reasons of privacy-- I think some pdocs would understand that. Or don't say you're a doctor, even though you need to be clear about your symptoms and to some degree the type of life you lead. There are other professions in which people need a lot of energy and have to stay up late many nights-- associates in law firms, for example.
You do really need to consult someone and get some help. It's not necessarily the case by the way that it would impede your career. There are a couple of psychiatrists who've been on the board who are being treated and whose careers seem to be progressing. I think it's not entirely out of the question to continue despite medication and treatment. Maybe one of them will see your post, and be able to speak more directly to the issue.
Unfortunately, Bob isn't around much and doesn't respond substantively to posts on the board. Unless you can contact him more directly, he may not see or answer your post.
best, Nadezda
Posted by obsidian on August 2, 2008, at 21:18:21
In reply to Re: Advice for a Psychiatrist in Training, posted by psychpsych on August 2, 2008, at 13:58:40
> Sid,
> I am definitely afraid of being branded. Psychiatrists all know when someone suffers from something, and it does get around. I know it seems vain fo rme to worry. I dont think Im better than anyone else, I just love this career and want to be able to help others without being doubted by patients and co-workers. I am capable of doin gmy job, and want desperately to keep my life together.I had a job in mental health in a place my psychiatrist was affiliated with.(I'm not a dr though). I found myself attending a couple of presentations he was also at. THAT was a bit uncomfortable.
It doesn't sound vain to me.
In fact I relate to it in some ways.
I hope you figure it out and find a way to get help that doesn't add to your stress.
be well,
sid
Posted by Nuala on August 3, 2008, at 13:18:03
In reply to Advice for a Psychiatrist in Training, posted by psychpsych on August 1, 2008, at 21:52:42
Before you go on any sort of psych meds, I would first have a thorough examination of your endocrine function, especially, thyroid and adrenal function. There is a clear connection between endocrine dysfuntion and "mental illnees", really the psychiatric manifestations of endocrine illness/dysfunction.
I regret that I did not have this opportunity.
there is a ton of medical literautre on the subject,and I have read as much as I could on pubmed. the fields of nueroendocrinology and psychopharmachology are populated with lots of these studies. Very interesting stuff.
Some background
I have been treated for a variety of conditions for a number of years - including major depression with psychotic features, depersonalization, extreme anxiety and some unspecified personality disorders (which I really see now are adaptive behaviors and a consequence of my mood shifts)
In the midst of treatment, after being put on Seroquel and Lexapro, with ativan as needed, I was diagnosed with hypothyroidism.
I subsequently discovered that I was already hypo ten years prior, after ordering all my old medical records, but it had been overlooked.
I was then treated with thyroxine and felt IMMENSELY better. I tapered down on my meds and was totally stable. I also felt like I was "waking" up as I reduced the psych meds.
I have spent the past year and a half researching the connection between endocrine dysfuntion and psychiatric manifestations thereof.
My psych "disorders" are really expressions of my endocrine problems. I also have seconday adrenal insufficiency.
Currently, I am not able to tolerate my thyorid meds becasue of the untreated adrenal situation (but, that is a long and complicated story).
What i know now, from being on and off thyroid meds, and on and off hyodrocritsone, is that I exerienced a preety good remission of my psych problems when on thyroid meds, and re-experienced them as well when I was off my thyroid/adrneal medications,
Now, I while my research was always focused on my own situation, I did see quite frequently, studies concerned with endocrine dysfunction and bipolar, as well as schizophenia.
Believe me, even though I hve suffered while "re-experiencing" my "illness" during the course of trying to remedy my endocrine problems, I know with such certainty that it is not "me" or some impersonal biochemical mystery which makes me feel the way I do, it is simply a hormonally-based phenomenon, which in many instances is treatable without having to resort to psych meds.
At least give yourself this option before you go on bipolar meds, or lose faith in your own abilities.
I still have a way to go, but I am much further along than I was when I was "zombied out" on 300mg Seroquel, and slept so much of the day away and lived so much of the day in a stupor.
Finally, the reason I started on this research journey is that someone on a thyroid board pointed out that psych meds themselves have a great effect on the endocrine system. For example, SSRIs are now understood to reduce circulating thyroid hormones, esp. T4, while Seroquel significantly reduces ACTH and cortisol (downregulating the HPA axis).
I thought it was counterintutitve for me to be taking thyroxine and at the same time taking the psych meds which worked against it.
Good luck :)
Posted by Phillipa on August 3, 2008, at 19:53:42
In reply to Re: Advice for a Psychiatrist in Training, posted by Nuala on August 3, 2008, at 13:18:03
Well since I have hasimotos thyroiditis I will definitely stay at the low dose of luvox and valium on now. Could you babblemail me any research you found my Mother had Addison's disease. Thanks. Phillipa
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