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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 12 to 36 of 36. Go back in thread:
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
Posted by jono_in_adelaide on September 17, 2012, at 23:10:23
In reply to Re: Depression, depression, depression, posted by Gia36 on September 17, 2012, at 22:55:18
I've had both endrogenous depression (lethergy, psychomotor retardation) and atypical or neurotic depression (low mood plus anxiety, panic attacks, insomnia)...... I guess there are a lot of shades of grey in there as well, mixed states if I could call them that.
Rather that worrying about what to call it, i have concentrated on finding out what works in my case (and beleive me, that took some time and pushing)
Posted by SLS on September 17, 2012, at 23:43:10
In reply to Re: Depression, depression, depression, posted by alchemy on September 17, 2012, at 19:55:50
> 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.I totally agree.
I doubt that these disorders occur as the result of switching on or off a single circuit. Even if they do, that one circuit does not exist in a vacuum. Its effects would likely radiate downstream and and involve millions of neurons that use many different types of neurotransmitters and second messenger cascades in ways that are unique to each person.
- Scott
Posted by ihatedrugs on September 18, 2012, at 0:26:40
In reply to Re: Depression, depression, depression » Beckett, posted by brynb on September 17, 2012, at 16:01:26
>
> 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.
>b
Did you notice any pmdd exacerbation while taking Lamictal?
ihatedrugs
Posted by brynb on September 18, 2012, at 8:58:10
In reply to Re: Depression, depression, depression, posted by Chris O on September 17, 2012, at 21:20:39
> Brynb:
>
> Glad to share! God knows my wife and her family doesn't get my deal. We'll see how much longer this lasts.
>
> ChrisI know--even those who claim to "get it", well, don't...
Posted by brynb on September 18, 2012, at 9:02:37
In reply to Re: Depression, depression, depression » brynb, posted by ihatedrugs on September 18, 2012, at 0:26:40
>
> >
> > 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.
> >
>
> b
>
> Did you notice any pmdd exacerbation while taking Lamictal?
>
>
> ihatedrugs
>
>
It's hard to say, because it worsened everything, in general. I understand it's often used for its benefit as an AD, but it had the opposite effect with me.
Posted by brynb on September 18, 2012, at 9:03:42
In reply to Re: Depression, depression, depression, posted by alchemy on September 17, 2012, at 19:55:50
Posted by brynb on September 18, 2012, at 9:08:39
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.I agree. Nowadays I go by what works and try to get past which "illness" or label it's meant for.
Thanks.
Posted by brynb on September 18, 2012, at 18:35:49
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
>
>
> - ScottScott-
I had a big "ah-ha" moment today. Tramadol makes me speedy. As in, very talkative, shaking my legs, nervous energy speedy. At first, it lifted my mood (mind you, I was in a BAD depressive episode at the time). It still lifts me, but makes me speedy. I used to take 100 mg, but felt better at 50 mg. Now 50 mg is becoming too much.
I had the exact same thing with Neurontin (though the entire time, Neurontin made me feel high). Lifted mood, speediness, and finally, at the end of taking it, I ended up having full-blown mania.
Other than Lexapro, I can't tolerate most ADs. Perhaps because it's so clean in its serotonin action?
I never equated speediness with high energy. I guess I associated high energy with being euphoric and feeling good. What I'm experiencing is high energy, just not euphoria or light, happy energy. I very often lack insight in the thick of things.
Not sure what to make of all this, but I've made a note to discuss with my pdoc.
-b
Posted by alchemy on September 20, 2012, at 14:41:27
In reply to Re: Depression, depression, depression » alchemy, posted by SLS on September 17, 2012, at 23:43:10
> > 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.
>
> I totally agree.
>
> I doubt that these disorders occur as the result of switching on or off a single circuit. Even if they do, that one circuit does not exist in a vacuum. Its effects would likely radiate downstream and and involve millions of neurons that use many different types of neurotransmitters and second messenger cascades in ways that are unique to each person.
>
> - ScottIt makes you wonder if it is even possible for science to ever come to understand all of the complexities and genetic influences. Not to mention how life's stressors come into play.
The cascading of previous influences and any patterns are something I keep trying to figure out for me (the light cycling). I still have gotten no where. I have so many docs that I have read & collected. Almost 30 years of it...and
it still is pretty random. Maybe I have some sort of random gene - like selecting "shuffle" on your ipod. (jk)
Posted by SLS on September 20, 2012, at 18:21:58
In reply to Re: Depression, depression, depression » SLS, posted by alchemy on September 20, 2012, at 14:41:27
> I have so many docs that I have read & collected. Almost 30 years of it...
<sigh>
That's a long time.
:-(
- Scott
Posted by alchemy on September 20, 2012, at 22:18:46
In reply to Re: Depression, depression, depression » alchemy, posted by SLS on September 20, 2012, at 18:21:58
> > I have so many docs that I have read & collected. Almost 30 years of it...
>
> <sigh>
>
> That's a long time.
>And of course it began with the nutrition/ holistic ways. So when someone assumes that our bodies are built in a way they will function beautifully with the right natural supplements, foods, exercise, ect., I just have to try and smile.
This is the end of the thread.
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