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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by Jjoe on May 30, 2001, at 8:54:50
I have been suffering from major depression for the past 9 months following my first and only 'manic' episode, which led to me being diagnosed as Bipolar 1.
I was started on lithium and then added Zoloft to try to combat the depression. I ceased the lithium after about 2 months due to 'D.T.'s side effects and weight gain. Also it had had no effect on me. I continued the Zoloft 100mg per day for another 3 weeks, to total 8 weeks. Depression was not relieved at all so I stopped the Zoloft as well.
Other A.D.'s I've tried include Effexor, Moclobemide and recently Luvox, all which did nothing to reduce the depression, however they did not induce mania even though I wasn't taking a mood stabiliser.The only temporary relief I have had from this depression has been from Valium at doses 20mg and higher and from illegaly obtained dex-amphetamines 20mg and higher, up to 50 mg over 24 hours, the latter which pretty much relieved most depressive symptoms but had an unwelcome come down, with higher than normal anxiety.
My depressive symptoms include lack of energy & motivation, fatigue, chronic insomnia and early morning and night wakening, loss of interest in preciously enjoyable activities. The worst 'symptom' is a disabilty to engage and/or maintain a normal conversation, long periods of uncomfortable silence, especially among strangers but even with people I work with, inluding my boss. This inability to communicate effectively is very frustrating, I simply find it hard to talk to people. I also have a constantly running internal dialouge which I can't shut off which the main topic is 'Whats wrong with me, what do I need to feel better, will I ever feel better, I haven't always been this way so what happened to make it like this. This dominated 90% of my thoughts, and therefore I suffer poor concentration, in-attentiveness and apathy.
What I am hoping is that some of you very knowledgeable people can offer some advice or can relate to what I am going through. Also I wonder if
a) Will continued use off A.D.'s increase the chance of rapid cycling/mixed states (do I already suffer from this??
b) What other A.D.'s besides S.S.R.I's might be helpfull, Wellbutrin? Remeron?
c) What is the best mood stabiliser besides Lithium, that doesn't promote weight gain.
d) Does the absence of mania with S.S.R.I. and dex-amphetamine use, without a mood stabiliser indicate I may not be Bipolar?Plese note that I live in rural Australia and I don't know which drugs are available here. I only have access to a G.P. at the moment, no Pdoc.
Also in the past I have suffered chronic marijuana addiction and this may be a factor as to the cause of the depression. I haven't smoked dope chronically for about 10 months and now only rarely as it has lost its 'theraputic' effects for me. One Psychiatrist diagnosed me with cannabis induced mood disorder, whatever that is, before I was Bipolarised...
Any response would be greatly appreciated...
Joe
Posted by super on May 30, 2001, at 9:01:39
In reply to Bipolar depression??? - 'Lost for words...', posted by Jjoe on May 30, 2001, at 8:54:50
Joe,
Sounds awful. I would try a different antidepressent like Wellbutrin with a different mood stabilizer (I don't know which one--I've only taken lithium and depakote, but I want to try something different). Also try to exercise if you can--it will help you sleep better and lift your mood.Hope you feel better soon!
Posted by loosmrbls on May 31, 2001, at 10:43:14
In reply to Bipolar depression??? - 'Lost for words...', posted by Jjoe on May 30, 2001, at 8:54:50
The mania episode is interesting, because it sounds like you were taking cannabis at the time. Although cannabis doesn't normally cause "manic" symptoms, it can on occasion. It can also cause depression and lack of motivation, and for chronic users who even STOP COMPLETELY, it can take months or years to recover. So, this is a wild card -- how much it is playing a role I don't know. You certainly sound significantly depressed by your symptoms. The lack of response is sad, but not uncommon (just read this forum!!!). The lack of going into mania does NOT rule out any bipolar disorder. Depression is much more common in bipolar disorder than mania for many people, and AD's only sometimes cause a switch in manic people.
My guess is, the valium probably releived a lot of agitation/anxiety often related with depression, and the amphetamines probably relieved some vegetative symptoms of depression. If you are bipolar, and I think it is at least probable, I would start with a mood stabilizer other than lithium (never worked for me either, in fact i think it was de-stabilizing) such as depakote, or some newer ones like topamax and lamictal. Neurontin seems to work only when combined with other mood stabilizers..To answer your questions:
a) If you have bipolar disorder, being off meds will likely result in a relapse sooner later -- either mixed, depressed, or manic.
b) Many AD's can be effective. Serzone, Wellbutrin, Effexor, and especiaally Remeron work by novel mechanisms and many have low risk to induce mania.
c) Depakote seems to be the first try, but if it doesn't work or has bad side effects Topamax, Lamictal, and Neurontin also can be used alone or in combinations.
d) No.
This is the end of the thread.
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