![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by loosmrbls on May 21, 2001, at 9:33:33
I have made references to my diagnsosis and some of my care before, but I want to give the full story and find out what people think.
Until about three years ago, I was a "Type A" person, did very well in college and was in excelling in a professional school.
All of a sudden, I began feeling very disconnected witht the world, could not experience pleasure, felt "flat" lost motivation, and had no energy. Went to my doc, was started on Prozac for depression. Felt no better, so saw a pdoc. Diagnosed me with "double depression" Went through several typical AD's, had one or two "possible" hypomanic episodes (increased energy, felt great, not sure about sleep) within days of meds, then pooped out within a couple of weeks.
Went to new doc, told may also have an "anxiety disorder" (did have lots of anxiety) -- started on celexa and buspar. Terrible, so changed buspar to Klonopin. Slid into suicidal depression.
While in hospital, told I may have "bipolar II" due to (in my opinion) equivocal hypomanic episodes (while on AD) so started on lithium, stayed on celexa. After 8 days, came out of hospital and had TRUE hypomanic episode -- WAY high energy, euphoric, energy like crazy (again on AD). So they increased the lithium until I felt sick. Lowered the dose, and I felt OK. For a short time.
I then, over a week or two, began to feel very agitated, irritible, had lots of violent/hostile ruminating thoughts (fantasies, no one I knew and no impulses to do them), sleep was crazy (usually could not sleep but sometimes slept alot), could not sit still. VERY uncomfortable. To the point where I wanted to O.D. on lithium to end it all. Told a social worker, back in hospital.
Over three weeks, taken off all meds and switched to Depakote, dose titrated to 1250mg. Than Zoloft added at 50mg. Initially OK, but then depression began kicking in hard again. Atypical type (eating too much, sleeping too much, NO energy. Completely withdrew from wife and child, they were thinking of leaving to stay with in-laws and me go to hospital (except I wasn't suicidal).
On my pdoc's advice, I had stopped the zoloft a few weeks ago. With my depression moderately severe, I deicided to stop the Depakote too. And to numb the pain, I did a few shots of alcohol (not an alcoholic).
I immediately began to feel better. I mean, within 24 hours. I am now 3 days off all meds, and I can think better, am more interactive, and besides some mild ruminating thoughts (usually bad memories or guilt thoughts) am much improved.
PLEASE tell me what you think!
Posted by Mitch on May 21, 2001, at 10:45:28
In reply to Help, what does this sound like?, posted by loosmrbls on May 21, 2001, at 9:33:33
Just my two cents worth:
1) Celexa can be very destabilizing (setting off cycling) and anxiety-provoking for some people-myself included. You said Prozac didn't help any.
If you take another antidepressant, SSRI's probably shouldn't be considered.2) Depakote can aggravate depression in *some* people. Some people it helps. I didn't have a nice experience with Depakote either. It can make you very tired and hungry. I got bad tremor from it and had to stop it.
3) Just because you stopped taking everything doesn't mean everything is going to be ok. When you first come off of some meds you will feel temporarily quite better.
Your doc said you had double-depression. So obviously you are mildly bummed out chronically, and then have periodic major depressions, then if you are given AD's you get hypomanic, right?
Are these major depressive episodes frequent or fairly predictable?My suggestion would be to find a different mood stabilizer (no AD's) that seems to work for you-maybe some Neurontin or Lamictal?, then see how your major depressive episodes are affected. I have rapid-cycling bipolar II (but only get hypomanic when I am taking an AD), then recurrent major depressions (two a year). I don't know-I am considering maybe getting *shocked* (ECT) twice a year right before they usually strike and forgo the antidpressants.
Posted by loosmrbls on May 21, 2001, at 11:41:13
In reply to Re: Help, what does this sound like?, posted by Mitch on May 21, 2001, at 10:45:28
> Just my two cents worth:
> 1) Celexa can be very destabilizing (setting off cycling) and anxiety-provoking for some people-myself included. You said Prozac didn't help any.
> If you take another antidepressant, SSRI's probably shouldn't be considered.I agree, and the only one I would consider would be Remeron if AD's are needed in future.
> 2) Depakote can aggravate depression in *some* people. Some people it helps. I didn't have a nice experience with Depakote either. It can make you very tired and hungry. I got bad tremor from it and had to stop it.No tremor, but otherwise exact same response -- with depression.
> 3) Just because you stopped taking everything doesn't mean everything is going to be ok. When you first come off of some meds you will feel temporarily quite better.
Yes, I've thought about this and am scared. Don't know what to do. Hard to convince yourself to be on a drug when you feel better without them. But when you get sick enough to want to kill yourself, it's too late.
> Your doc said you had double-depression. So obviously you are mildly bummed out chronically, and then have periodic major depressions, then if you are given AD's you get hypomanic, right?Exactly. I couldn't describe it better myself.
> Are these major depressive episodes frequent or fairly predictable?
Have been getting worse and more frequent. Never was suicidal until two close episodes this year. Never noticed a predictability to them. But I am so "in tune" with them now I can feel even the most subtle changes, and I know a slide is coming.
> My suggestion would be to find a different mood stabilizer (no AD's) that seems to work for you-maybe some Neurontin or Lamictal?, then see how your major depressive episodes are affected. I have rapid-cycling bipolar II (but only get hypomanic when I am taking an AD), then recurrent major depressions (two a year). I don't know-I am considering maybe getting *shocked* (ECT) twice a year right before they usually strike and forgo the antidpressants.
My last diagnosis was "bipolar II, rapid cycling, current episode mixed." A different stabilizer sounds appropriate. I often think about ECT, especially when I am severely depressed and sick of meds. I think it is torture to make someone wait AT LEAST two weeks for a drug to work when they are depressed. If someone had an open fracture of the arm, would you wait two weeks to give pain relief?
Thank you for the info. I would love to talk more, as your case sounds similar to mine. Do you get hostile or violent thoughts as well during "mixed" episodes? These are very bothersome to me.
Posted by niss on May 21, 2001, at 14:22:30
In reply to Re: Help, what does this sound like?, posted by loosmrbls on May 21, 2001, at 11:41:13
Severe anxiety just compounds itself..I know that the terrible bad thoughts,guilt, etc...can be severe anxiety. And it can be made worse by the medication. I took zoloft once and it made me..I guess they call it "hypermania"..awful. It actually made me feel even more crazy. Then took xanax and over some time, felt much better. Along with Paxil to work on the depression and compusive thoughts...I also listened to a meditation tape with headphones every time I started to feel like that (at night in bed). There is a program that is really great. I think it is called "overcoming anxiety and depression". It is a tape series from a place in Chicago...I think the person's name is Leticia something...maybe that is enough info for you to find it on the internet. It is really good and made me feel normal. To give you an example..my anxiety was so bad that I was afraid to go to bed because I was afraid I was going to hurt my husband in my sleep...and the terrible thoughts were actually much worse..which produce guilt and compound the anxiety...some doctors are stupid. It may not be as bad as you think..The xanax is terribly addicting, but it works...it is a trade off.
Good luck,
anissa> >
Just my two cents worth:
> > 1) Celexa can be very destabilizing (setting off cycling) and anxiety-provoking for some people-myself included. You said Prozac didn't help any.
> > If you take another antidepressant, SSRI's probably shouldn't be considered.
>
> I agree, and the only one I would consider would be Remeron if AD's are needed in future.
>
> > 2) Depakote can aggravate depression in *some* people. Some people it helps. I didn't have a nice experience with Depakote either. It can make you very tired and hungry. I got bad tremor from it and had to stop it.
>
> No tremor, but otherwise exact same response -- with depression.
>
> > 3) Just because you stopped taking everything doesn't mean everything is going to be ok. When you first come off of some meds you will feel temporarily quite better.
>
> Yes, I've thought about this and am scared. Don't know what to do. Hard to convince yourself to be on a drug when you feel better without them. But when you get sick enough to want to kill yourself, it's too late.
>
> > Your doc said you had double-depression. So obviously you are mildly bummed out chronically, and then have periodic major depressions, then if you are given AD's you get hypomanic, right?
>
> Exactly. I couldn't describe it better myself.
>
> > Are these major depressive episodes frequent or fairly predictable?
>
> Have been getting worse and more frequent. Never was suicidal until two close episodes this year. Never noticed a predictability to them. But I am so "in tune" with them now I can feel even the most subtle changes, and I know a slide is coming.
>
> > My suggestion would be to find a different mood stabilizer (no AD's) that seems to work for you-maybe some Neurontin or Lamictal?, then see how your major depressive episodes are affected. I have rapid-cycling bipolar II (but only get hypomanic when I am taking an AD), then recurrent major depressions (two a year). I don't know-I am considering maybe getting *shocked* (ECT) twice a year right before they usually strike and forgo the antidpressants.
>
> My last diagnosis was "bipolar II, rapid cycling, current episode mixed." A different stabilizer sounds appropriate. I often think about ECT, especially when I am severely depressed and sick of meds. I think it is torture to make someone wait AT LEAST two weeks for a drug to work when they are depressed. If someone had an open fracture of the arm, would you wait two weeks to give pain relief?
>
> Thank you for the info. I would love to talk more, as your case sounds similar to mine. Do you get hostile or violent thoughts as well during "mixed" episodes? These are very bothersome to me.
Posted by froggy on May 21, 2001, at 14:44:30
In reply to Help, what does this sound like?, posted by loosmrbls on May 21, 2001, at 9:33:33
You sound like Bipolar I and not Bipolar II. You have full blown manic episodes and not just irratable and have some out of cntrl behavior. However I was reading earlier on the Mental Health Net that the two some times combine and that differnt meds at certain times can help this. Good luck finding a doctor who will take the time though. By the way apathy can be caused by some AD's.
Posted by niss on May 21, 2001, at 14:45:56
In reply to Help, what does this sound like?, posted by loosmrbls on May 21, 2001, at 9:33:33
>the webiste is:
www.stresscenter.com
it is the midwest center for anxiety..the name is lucinda rather than leticia...
I have made references to my diagnsosis and some of my care before, but I want to give the full story and find out what people think.
>
> Until about three years ago, I was a "Type A" person, did very well in college and was in excelling in a professional school.
>
> All of a sudden, I began feeling very disconnected witht the world, could not experience pleasure, felt "flat" lost motivation, and had no energy. Went to my doc, was started on Prozac for depression. Felt no better, so saw a pdoc. Diagnosed me with "double depression" Went through several typical AD's, had one or two "possible" hypomanic episodes (increased energy, felt great, not sure about sleep) within days of meds, then pooped out within a couple of weeks.
>
> Went to new doc, told may also have an "anxiety disorder" (did have lots of anxiety) -- started on celexa and buspar. Terrible, so changed buspar to Klonopin. Slid into suicidal depression.
>
> While in hospital, told I may have "bipolar II" due to (in my opinion) equivocal hypomanic episodes (while on AD) so started on lithium, stayed on celexa. After 8 days, came out of hospital and had TRUE hypomanic episode -- WAY high energy, euphoric, energy like crazy (again on AD). So they increased the lithium until I felt sick. Lowered the dose, and I felt OK. For a short time.
>
> I then, over a week or two, began to feel very agitated, irritible, had lots of violent/hostile ruminating thoughts (fantasies, no one I knew and no impulses to do them), sleep was crazy (usually could not sleep but sometimes slept alot), could not sit still. VERY uncomfortable. To the point where I wanted to O.D. on lithium to end it all. Told a social worker, back in hospital.
>
> Over three weeks, taken off all meds and switched to Depakote, dose titrated to 1250mg. Than Zoloft added at 50mg. Initially OK, but then depression began kicking in hard again. Atypical type (eating too much, sleeping too much, NO energy. Completely withdrew from wife and child, they were thinking of leaving to stay with in-laws and me go to hospital (except I wasn't suicidal).
>
> On my pdoc's advice, I had stopped the zoloft a few weeks ago. With my depression moderately severe, I deicided to stop the Depakote too. And to numb the pain, I did a few shots of alcohol (not an alcoholic).
>
> I immediately began to feel better. I mean, within 24 hours. I am now 3 days off all meds, and I can think better, am more interactive, and besides some mild ruminating thoughts (usually bad memories or guilt thoughts) am much improved.
>
> PLEASE tell me what you think!
Posted by Mitch on May 21, 2001, at 23:33:23
In reply to Re: Help, what does this sound like?, posted by loosmrbls on May 21, 2001, at 11:41:13
1) Start taking an antidpressant that will be least likely to induce cycling or mixed-states ASAP. Remeron (15-30mg) I think would be a great start(@bedtime)-you might also consider adding low-doses of Wellbutrin in the morning/midday as well-that is if panic is not a trouble for you and the Remeron is too sedating.
2) As far as "mood-stabilizers" go-I would try out some Neurontin (with the Remeron and perhaps Wellbutrin)and take it from there.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.