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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 36. This is the beginning of the thread.
Posted by brynb on September 17, 2012, at 12:57:05
I've been struggling with the "type" of mood disorder I have. I don't mean to get hung up on labels, I just think it would help explain a lot of things, and there's also some comfort in putting a name on something that has consumed my life.
I've seen many pdocs over the past 10 or 12 years, and I was typically diagnosed with MDD or MDD with GAD. A few have suggested Bipolar 2. I don't know that I've ever really worked with someone carefully and long enough to make a definitive diagnosis. That is my intention with my current pdoc.
I'm reading "Why Am I Still Depressed?" by Jim Phelps, MD. He states "one of the most important markers" of bipolar is "depression that keeps coming back." He also claims that people with "true Major Depression" only experience one or two episodes a lifetime. Based on these statements, it seems MANY of us here fall somewhere on the bipolar spectrum. I usually have around three or so depressive episodes a year. And while Lexapro helps with day to day symptoms, it never prevents an episode and always poops out if used alone.
So, how much clout does this theory have? What are your experiences? Feedback?
Thanks, all.
Posted by Chris O on September 17, 2012, at 13:38:47
In reply to Depression, depression, depression, posted by brynb on September 17, 2012, at 12:57:05
I personally have chronic debilitating anxiety and worry that never, ever goes away. Vigorous exercise helps a bit, but not much. For me, it's a lifetime condition, one that I have had since childhood. I don't think I fall on the bipolar spectrum, personally, as I never have energy and never feel good. I feel that I am on the GAD, OCD, PTSD spectrum, with heavy negative brain shaping due to my childhood and brain chemistry.
Chris
Posted by Beckett on September 17, 2012, at 13:56:39
In reply to Re: Depression, depression, depression » brynb, posted by Chris O on September 17, 2012, at 13:38:47
Chris, does the relentless anxiety ever lead you to depression? I have multiple anxiety disorders, too :(
Posted by SLS on September 17, 2012, at 14:27:54
In reply to Re: Depression, depression, depression » brynb, posted by Chris O on September 17, 2012, at 13:38:47
> I personally have chronic debilitating anxiety and worry that never, ever goes away. Vigorous exercise helps a bit, but not much. For me, it's a lifetime condition, one that I have had since childhood. I don't think I fall on the bipolar spectrum, personally, as I never have energy and never feel good. I feel that I am on the GAD, OCD, PTSD spectrum, with heavy negative brain shaping due to my childhood and brain chemistry.
It might be worth trying prazosin if PTSD is a component of your condition.
- Scott
Posted by Chris O on September 17, 2012, at 14:46:10
In reply to Re: Depression, depression, depression » Chris O, posted by Beckett on September 17, 2012, at 13:56:39
Beckett:
Oh, yes, I am depressed. I am just exhausted all the time. If there is any stressor in my life, I will not stop thinking about it. Reflecting on it, my childhood was a place of extreme insecurity and my mom really didn't take care of me emotionally on many levels. I just wish I could resolve my issues better because they are threatening what little stability I have in my marriage. I am going to start Nardil in a few days. I will see if that helps. The SSRIs do nothing for me. But yes, depression, I don't even know if I can separate it from my anxiety.
Chris
Posted by Chris O on September 17, 2012, at 14:47:56
In reply to Re: Depression, depression, depression » Chris O, posted by SLS on September 17, 2012, at 14:27:54
Scott:
Thanks for the suggestion. I've read your posts many times and appreciate your excellent suggestions, even as a bystander. I think I mentioned prazosin once to my psychiatrist based on what you had written months ago. I believe he was open to it. I'm going to start Nardil in the next few days. I'll see how that goes and then figure out what's next from there. Thanks.
Chris
Posted by Phillipa on September 17, 2012, at 15:03:14
In reply to Re: Depression, depression, depression » Beckett, posted by Chris O on September 17, 2012, at 14:46:10
Constant stress for years and years and diagnosis is OCD. Was panic disorder, then Gad no bipolar here. Phillipa
Posted by brynb on September 17, 2012, at 15:03:50
In reply to Re: Depression, depression, depression » Beckett, posted by Chris O on September 17, 2012, at 14:46:10
> Oh, yes, I am depressed. I am just exhausted all the time. If there is any stressor in my life, I will not stop thinking about it.Me too!
>But yes, depression, I don't even know if I can separate it from my anxiety.
I used to not be able to separate the two (they were pretty much intertwined), but nowadays, they seem to exist separately.Thanks for your input.
Posted by Tomatheus on September 17, 2012, at 15:13:56
In reply to Depression, depression, depression, posted by brynb on September 17, 2012, at 12:57:05
> I'm reading "Why Am I Still Depressed?" by Jim Phelps, MD. He states "one of the most important markers" of bipolar is "depression that keeps coming back." He also claims that people with "true Major Depression" only experience one or two episodes a lifetime. Based on these statements, it seems MANY of us here fall somewhere on the bipolar spectrum.
Psychiatrists can spar all they want about whether certain patients have unipolar depression or bipolar depression, but I think that what Phelps says is only so helpful if it doesn't include data showing that those who he deems to be bipolar respond well to mood stabilizers. Personally, my experiences with taking mood stabilizers for what used to be chronic vegetative depression were awful. At best, mood stabilizers have induced a temporary worsening of depressive symptoms. At worst... well, I don't want to go there right now.
Tomatheus
Posted by Beckett on September 17, 2012, at 15:18:47
In reply to Re: Depression, depression, depression » Chris O, posted by brynb on September 17, 2012, at 15:03:50
Hi Bryn,
I read Phelps book and liked his take on things. I try not to get wrapped up in labels either, but did come to the realization that ssri's and snri's made me worse in certain ways, like cycling fast all in one day--my mood would be all over. They were always prescribed to me without a stabilizer. Right now my current doc has me dx'd as cyclothymic with a question mark after it. I am so exhausted I don't think I could be hypomanic, though not that long ago I recall episodes that make me wonder. I dive into depressions now about (crap) about four times a year no matter what meds I seem to take. At least now I am on a mild stabilizer and my current doc recognizes that bipolarity of some sort plays a role in my condition.
Posted by Beckett on September 17, 2012, at 15:27:34
In reply to Re: Depression, depression, depression » Beckett, posted by Chris O on September 17, 2012, at 14:46:10
Chris, I hope Nardil brings you some relief. Will you keep the board posted? I am exhausted, too. Anxiety has the upper hand and depression and anxiety are difficult to discern. They follow each other. Or I guess trigger each other. I cannot tolerate any stress in my life. That makes living pretty difficult. Maybe you know what I mean.
Posted by brynb on September 17, 2012, at 15:36:22
In reply to Re: Depression, depression, depression » brynb, posted by Tomatheus on September 17, 2012, at 15:13:56
> > I'm reading "Why Am I Still Depressed?" by Jim Phelps, MD. He states "one of the most important markers" of bipolar is "depression that keeps coming back." He also claims that people with "true Major Depression" only experience one or two episodes a lifetime. Based on these statements, it seems MANY of us here fall somewhere on the bipolar spectrum.
>
> Psychiatrists can spar all they want about whether certain patients have unipolar depression or bipolar depression, but I think that what Phelps says is only so helpful if it doesn't include data showing that those who he deems to be bipolar respond well to mood stabilizers. Personally, my experiences with taking mood stabilizers for what used to be chronic vegetative depression were awful. At best, mood stabilizers have induced a temporary worsening of depressive symptoms. At worst... well, I don't want to go there right now.
>
> TomatheusThanks for your feedback, Tomatheus. I feel like the responses reinforce the variations in depressive symptoms and our responses to treatment. Certain stabilizers depress me, others don't. Neurontin, with or without Lexapro, used to make me euphoric, then just straight-up manic (textbook). I try to keep my med cocktail simple, but sometimes, it's not that easy.
-b
Posted by SLS on September 17, 2012, at 15:40:12
In reply to Re: Depression, depression, depression » SLS, posted by Chris O on September 17, 2012, at 14:47:56
> Scott:
>
> Thanks for the suggestion. I've read your posts many times and appreciate your excellent suggestions, even as a bystander. I think I mentioned prazosin once to my psychiatrist based on what you had written months ago. I believe he was open to it. I'm going to start Nardil in the next few days. I'll see how that goes and then figure out what's next from there. Thanks.
If Nardil is even partially effective, it might be a reasonable strategy to build a treatment regime around it rather than immediately abandoning it. I would be more optimistic for your chances of responding to prazosin were you to add it to Nardil rather than switching from one drug to the other. Prazosin was first used as a single dose at bedtime to prevent nightmares and disrupted sleep. However, it was learned that it will also help with daytime anxiety and depression if it is taken three times a day. I would consider starting at 1 mg to be given at bedtime for a few days. This will help reduce dizziness and the risk of developing syncope. Thereafter, you can take 3 mg/day taken as 1 mg t.i.d. Startup side effects include dizziness, fatigue, weakness, and even mild depression. However, these things usually disappear within a week. When combining prazosin with Nardil, dizziness might be particularly problematic. It might limit your rate of titration, but not necessarily your final dosage. For me, prazosin was most effective at 10 mg/day. Currently, dosages of 6 - 20 mg/day are being investigated. It is conceivable that you will experience an improvement at 3 mg/day. However, if such an improvement dissipates, I would continue raising the dosage gradually rather than discontinue it.
- Scott
Posted by SLS on September 17, 2012, at 15:44:16
In reply to Re: Depression, depression, depression » brynb, posted by Beckett on September 17, 2012, at 15:18:47
> I am so exhausted I don't think I could be hypomanic,
My dysphoric manias completely exhausted me. However, somehow, I always found the energy to exhaust myself further.
- Scott
Posted by brynb on September 17, 2012, at 16:01:26
In reply to Re: Depression, depression, depression » brynb, posted by Beckett on September 17, 2012, at 15:18:47
> Hi Bryn,
>
> I read Phelps book and liked his take on things. I try not to get wrapped up in labels either, but did come to the realization that ssri's and snri's made me worse in certain ways, like cycling fast all in one day--my mood would be all over. They were always prescribed to me without a stabilizer. Right now my current doc has me dx'd as cyclothymic with a question mark after it. I am so exhausted I don't think I could be hypomanic, though not that long ago I recall episodes that make me wonder. I dive into depressions now about (crap) about four times a year no matter what meds I seem to take. At least now I am on a mild stabilizer and my current doc recognizes that bipolarity of some sort plays a role in my condition.Hi Beckett-
I feel like for those of us with bad enough depression (or beyond garden variety), it's different from those who get a SRI or SRI from their internist and take the same dose for years. Wouldn't it be "normal" or natural for us to cycle or respond wacky? Sometimes I feel like my brain can't interpret it--is it too much serotonin, too much norepinephrine? Like, what's going on?
Lexapro has been the most agreeable AD for me. Others worsen my anxiety or just make me ill.
With stabilizers, I did well on Tegretol and Trileptal, but don't remember why I stopped (naturally, as my memory is shot). Lamictal made my mood worse and Topamax made my anxiety go through the roof. I'm on Lithium now, and even though it's a low dose, I think it's softened the blow this time. I've been down the past three weeks, but I haven't plummeted (yet). We'll see.
Thanks,
b
Posted by Beckett on September 17, 2012, at 16:10:55
In reply to Re: Depression, depression, depression » Beckett, posted by SLS on September 17, 2012, at 15:44:16
Dysphoric mania? I may have found my true calling.
Really, though, Scott. I haven't heard of this. Can you say a bit more?
Posted by SLS on September 17, 2012, at 17:16:10
In reply to Re: Depression, depression, depression » SLS, posted by Beckett on September 17, 2012, at 16:10:55
> Dysphoric mania? I may have found my true calling.
>
> Really, though, Scott. I haven't heard of this. Can you say a bit more?The term "dysphoric mania" is sometimes used interchangeably with "mixed state". However, it is probably a better description of what it is like to experience such a state.
I find it hard to express in words what I experienced.
I had hypomanic energy and reduced need for sleep (3 hours), but no euphoria. I became fixated on certain ideas of reference and making associations between unrelated events. I was always thinking and talking and moving, but I felt like I was never happy with things the way they were. Things were never okay. I was never content. I felt pressured to fix everything. I experienced constant anxiety and even suffered from acid-stomach. It burned me out.
This helps:
"Conditions referred to a mixed mania or dysphoric mania, are characterized by dysphorically excited moods, irritability, anger, panic attacks pressured speech, agitation, suicidal ideation, severe insomnia, grandiosity and hypersexuality, as well as persecutory delusions and confusion."
http://www.dysphoria.info/dysphoric-mania.html
- Scott
Posted by brynb on September 17, 2012, at 17:37:00
In reply to Re: Depression, depression, depression » Beckett, posted by SLS on September 17, 2012, at 17:16:10
> > Dysphoric mania? I may have found my true calling.
> >
> > Really, though, Scott. I haven't heard of this. Can you say a bit more?
>
> The term "dysphoric mania" is sometimes used interchangeably with "mixed state". However, it is probably a better description of what it is like to experience such a state.
>
> I find it hard to express in words what I experienced.
>
> I had hypomanic energy and reduced need for sleep (3 hours), but no euphoria. I became fixated on certain ideas of reference and making associations between unrelated events. I was always thinking and talking and moving, but I felt like I was never happy with things the way they were. Things were never okay. I was never content. I felt pressured to fix everything. I experienced constant anxiety and even suffered from acid-stomach. It burned me out.
>
> This helps:
>
> "Conditions referred to a mixed mania or dysphoric mania, are characterized by dysphorically excited moods, irritability, anger, panic attacks pressured speech, agitation, suicidal ideation, severe insomnia, grandiosity and hypersexuality, as well as persecutory delusions and confusion."
>
> http://www.dysphoria.info/dysphoric-mania.html
>
>
> - ScottA lot of this sounds familiar to me, too.
Posted by Beckett on September 17, 2012, at 17:53:40
In reply to Re: Depression, depression, depression » Beckett, posted by SLS on September 17, 2012, at 17:16:10
Thanks for the elucidation Scott. No, that does not sound like me. I always need sleep except for the times when I have felt hypo or even manic, but even then I would pray for sleep to come. When I finally got medicated and had access to benzos and sleep aids I would just drug myself to sleep. GeneralIy now I feel paralized or leaden. Mixed states sound hellish. I'm sorry you and anyone here has had to endure them.
Posted by alchemy on September 17, 2012, at 19:55:50
In reply to Re: Depression, depression, depression » SLS, posted by Beckett on September 17, 2012, at 17:53:40
I don't think it is always black & white and not even always a spectrum within a disorder.
I agree that it is helpful to have the classical definitions. I also think that they should be expanded, that criteria should be re-evaluated, and it should be acknowledged that everyone may not "fit".
My dr says I most "closely" fit bipolar II. If I go to another dr they may give me another diagnosis.
Every case is so individual, and can be paradoxical. A pure bipolar may actually respond well to antidepressants and negatively to stabilizers. But on the otherhand, it was helpful that it was found that antidepressants often can induce or make cycling worse.
Posted by Chris O on September 17, 2012, at 21:18:20
In reply to Re: Depression, depression, depression » Chris O, posted by SLS on September 17, 2012, at 15:40:12
Appreciate the feedback and advice.
Chris
Posted by Chris O on September 17, 2012, at 21:19:12
In reply to Re: Depression, depression, depression » Chris O, posted by Beckett on September 17, 2012, at 15:27:34
Sorry for interrupting this thread.
Chris
Posted by Chris O on September 17, 2012, at 21:20:39
In reply to Re: Depression, depression, depression » Chris O, posted by brynb on September 17, 2012, at 15:03:50
Brynb:
Glad to share! God knows my wife and her family doesn't get my deal. We'll see how much longer this lasts.
Chris
Posted by Raisinb on September 17, 2012, at 22:29:26
In reply to Depression, depression, depression, posted by brynb on September 17, 2012, at 12:57:05
Like you, I have received all those diagnoses and have been around the block with various pdocs as well as reading everything I can get my hands in.
My conclusion? They don't know. In fifty years maybe they'll know enough about the brain to figure it out and they'll look at our current labels the way we look at the "humors" theory of Shakespeare's time.
Posted by Gia36 on September 17, 2012, at 22:55:18
In reply to Re: Depression, depression, depression » brynb, posted by Raisinb on September 17, 2012, at 22:29:26
> Like you, I have received all those diagnoses and have been around the block with various pdocs as well as reading everything I can get my hands in.
>
> My conclusion? They don't know. In fifty years maybe they'll know enough about the brain to figure it out and they'll look at our current labels the way we look at the "humors" theory of Shakespeare's time.
You are ahead of me. I am just starting to realize this. It's like psychiatry is stuck in the 1980s of medicine.It's bizarre. : x
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