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Re: basket-case in a wave-pool fluffy

Posted by Ponder on August 27, 2003, at 14:41:45

In reply to basket-case in a wave-pool, posted by fluffy on August 27, 2003, at 12:26:35

I found your post interesting as you assessed your history and made an effort to identify your current state (cyclothymic). My history is similar, having been treated for depression quite unsuccessfully despite every class of AD meds since my early 20's.
I read a lot of medical literature and regularly review the symtoms of these various states, not just the symtoms listed in the DSMV, but also articles that describe in greater detail how a patient might experience these states. In retrospect I believe I may have been Bipolar all along. Doctors weren't too good at diagnosing BPAD in those days.

Then, a few years ago I had what was clearly a horrendous and protracted mixed states episode that was more suggestive of Bipolar I. It crashed, of course, into incapacitating depression that ultimately resulted in the loss of my career.

I am currently on Lamictal 200 and WB 300-400/day, but also Ativan as needed. Anxiety has always been a strong component of my illness, although I did not realize it when I was working, thinking instead that I was "stressed" about the many tasks that needed doing and that I would be "unstressed" as soon as I got them all done, which was never. Any med to control the anxiety made me too sleepy to work efficiently, so I lived with the anxiety instead.

I did not realize at that time what a strong contributing factor anxiety was to the whole mix of other symptoms.

My bipolar fluctuations continue, but I have not had a bad-as-it's-ever-been depression since that time a 3 years ago. I wonder if the multitude of treatments that I am receiving is actually working, with "bleed-through" mood variations, or if Bipolar II ignited into Bipolar I and later settled down to cyclothymia (well, something a little more intense than cyclothymia, perhaps).

For the life of me, I don't know how a patient is supposed to determine this, and doctors rely on patient reports, so they don't seem to help much in this process if the patient is not pretty good at self-diagnosis and assessment of their own symptoms.

The literature seems to suggest that these different states are distinct pathological entities. In one article, it said that having a mixed-states episode ruled out Bipolar II and indicated Bipolar I. So, I don't know if a person can move from one Dx to another. When I was younger, I had clearer delineation between depression, euthymia, and hypomanic. Now it seems I constantly deal with an amorphous mix of difficulties interspersed with a blessed few days of relative wellness from time to time.

Lamictal/WB may be an overly activating combo. I don't know. I recently had my first full-blown anxiety attack (partly situational, but, you know, I've had plenty of stress in the past and didn't have a panic attack). I backed off the WB a little and added in the Ativan. But I continue to wonder if Lithium would be better, especially since Barbara has had such success with low-dose Li as a part of her combo.

Having been through a million med trials and even neurosurgery (VNS) you'd think I would be over the fear of the med-trial process, but instead I seem to be even more reluctant to change anything. This state of clyclothymic-like symptoms is better than full-blown manic-depressive cycles, so I find myself grateful for the improvement and fearful of spending more time feeling sick from side-effects, lack of efficacy, etc. with new drugs.

I will be very interested in your experience with Lamictal and Lithium. You may even decide to add in WB after that if you find yourself needing more energy/motivation. From what I have read on the board, that may be a good combo. Many people seem to have had good success with Lamictal/Lithium. WB seems to be a pretty versatile add-on with little propensity for destabilization.

I hope you'll keep us all posted on your progress. The sharing of these experiences is so valuable to us all.




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