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Dr. Bob is Robert Hsiung, MD,
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Posted by jealibeanz on September 1, 2006, at 15:49:15
In reply to Re: Tomorrow Part 1 » jealibeanz, posted by gardenergirl on September 1, 2006, at 15:31:46
Do you have any advice as to "key words" I should use? I know that I full description of my symptoms should lead to a proper diagnosis, but if I forget things, don't place enough emphasis, or aren't prompted at all by my doctor he may not come to the conclusion that it's "atypical depression". (I know Nardil is probably the most well-know MAOI... and that I probably don't want that one, for reasons which I don't need to dwell on it yet another post!)
Whyyy is this called "atypical"? In my mind depression can be characterized many things... the main idea is that it's a deviation from the person's natural state and there's unhappiness and lowered funtioning. This can be over/undereating, hyper/hyposomnia, anxiety, apathy, or all! My main concern is that it's not normal or healthy in the longterm.
Any further suggestions as to how to present my case tomorrow in effort to get the best treatment for myself?
Posted by jealibeanz on September 1, 2006, at 17:01:55
In reply to Re: Tomorrow Part 1, posted by jealibeanz on September 1, 2006, at 15:49:15
Funny... I forgot about one of my disorders we're still trying to treat. Which one? ADHD! Haha... a little ironic. I always feel a little strange talking about or trying to treat it, like I'm just being a hypochondriac making up a new issue for myself.
I think it's because for years people always assumed that those with ADHD were low achievers or unintelligent, or little boys bouncing off the walls in elementary school. This is obviously untrue as there are many high achieving doctors, lawyers, professionals, ect. with the disorder. They probably struggled with the same biased thinking that I do and only sought treatment when things got way out of hand.
I don't actually doubt that I have major attention problems. I nevvver read or studied anything throughout middle school, high school, or most of undergrad. Yeah, sometimes I'd glance at material before a test, just to make myself feel better. Otherwise, I'd have to live with the guilt that I wasn't trying (still, in my mind, I wasn't because I didn't properly study for any length of time or with structure, like everyone else receiving the same grades as me, but that slight effort was better than nothing at all).
I avoided reading novels or reviewing my texts for exams. I honestly felt like it "hurts" my brain to try to sutain high levels of attention, or I turn off my brain, become sleepy, or daydream. As soon as I shut the book, that feeling subsided. So, it does make sense that I was avoiding such "pain". Maybe that's a good thing... I'm not a hedonist trying to punish myself, just trying to go with my natural flow.
Amazingly, I'd squeak out A's on each report card... haha... and I never felt like I earned them because I didn't study or put in the same kind of work that my friends did.
However, in retrospect, it was hard work. It was hard for me to realize that I was staring at my book for hours without actually reading. It was hard that I was always so confused and forgetful, constantly asking friends to remind me of what I needed to do, when I should have been able to remember for myself.
I remember feeling huge guilt for not being able to force myself to read all the classic novels that everyone reads in high school. Sure, I guess I'd skim, or even "pseudo-read", but never absorbed the material well. I just blamed it on laziness, lack of interest, or being too tired from my busy day (all of which are factors, but not the major culprit).
This isn't due to another type of reading or learning disorder. I always read above grade level. I actually have very high language and reading skills. All of my standardized reading/language comprehension test scores have been near the 99th percentile my whole life. I'm not trying to be immodest here, just trying to present the extreme gap between optimal ability and every-day performance. I'd actually prefer that I truely wasn't capable of performing at a higher level that I do most of the time. I wouldn't have to justify any underachievement.
I guess when I'm absolutely forced to sit at a desk with only one thing, I can manage to do it. Otherwise, well... my friends affectionately like to tell me I "wander":) (physically and mentally)
Somehow I just got by on good intuition, an almost sublimination absorption of material, and great testing ability (plus, multiple choice exams are just not an appropriate indicator of knowledge in my opinion. Some students can "beat the system" and appear to know more than they actually do, while others with great knowledge struggle with the format).
In college... most of the time I wouldn't "hear" a thing that was said in lecture... ever! I think the format was especially difficult for me to focus on. The lower grades are more interactive, allowing me to shift gears enough to pay attention to some extent, although not a whole lot.
When I'd casually tell my friends in college after a class that had noo idea what the prof just talked about or would not pick up on major points or announcements, they'd just stare at me in awe... as if to say "Are you kidding me? Even I know what just went on, and you're smarter than me!"
I did struggle through undergrad. My grades dropped well below previous years. While this isn't uncommon for people to have a hard time adjusting to the format of higher education, I took this to extremes. I failed classes I should have aced, that anyone should have aced.
I actually did some biofeedback therapy for a while when it got really bad. That's how I've managed to get where I am today. It helped "raise my baseline" of concentration, but I seemed to have maxed out on its benefits and need further help.
Soo... treatment... Do I even wanna go there? I don't know. He may ask about it. Do I care if I'm not in school? Well, not entirely, although it's a disorder that does carry over into every day life, not just college! (that's why it's soo horrible for severe cases when parents stop kid's meds on summer break, but that's another discussion!) However, it's not going to be a huge issue if I'm not in college. (ohhh... decisions, decisions).
In terms of recent concentration/organization:
Well, after one week of classes I have yet to actually study or do any work... oops! I'm not terribly organized, sharp, and I'm forgetful. My brain feels a little foggy at times.
I don't do well with listening to lectures, but I never really have. I end up reteaching myself at home, when I come upon a rare moment of extreme concentration. This is obviously very ineffective. I realize this is partly due to my learning style, but I'm going to need to be able to concentrate with more focus to oral instructions when I'm in the real world, where I can't do everything in accordance to my fluctuations.
Sorry!!! Sometimes we "hyperfocus", huh? Ohhh well, if you got to the bottom of this and you can relate, I hope it can do others some good to know you're not alone.
Posted by Phillipa on September 1, 2006, at 19:45:57
In reply to Re: Tomorrow Part 1 » jealibeanz, posted by llrrrpp on September 1, 2006, at 10:23:00
Ummm seroquel is an atypical antipsychotic used off label for anxiety, sleep. But I've never heard of it being a mood stabalizer. The best known stabalizers are lamictal, tegretol, depakote, trileptal,lithium,. Maybe I should google seroquel I may have missed something who knows? Love Phillipa
Posted by Phillipa on September 1, 2006, at 19:56:40
In reply to Remember the day I accidentally wrote a novel!? :), posted by jealibeanz on September 1, 2006, at 17:01:55
Jelly do you have a copy machine. I think you've done a wonderful job of describing what is wrong so it you did a printout of the posts the writing is over and just give it to the doctor. I think he'd understand very well what's going on. Give it a try. Love Phllipa
Posted by jealibeanz on September 1, 2006, at 20:42:56
In reply to Re: Tomorrow Part 1 » llrrrpp, posted by Phillipa on September 1, 2006, at 19:45:57
Well I'm not sure a mood stabilizer is what I need.
Posted by Phillipa on September 1, 2006, at 20:47:04
In reply to Re: Last Ditch Effort to Save My Life » nickguy, posted by llrrrpp on September 1, 2006, at 7:35:27
Lurpsie where have you found a pdoc that does any talk theraphy? Now a days they want a therapist to handle that aspect. My old one used to do it but gave it up. And the recent ones except the older lady I'm seeing don't talk either. This one I'm traveling 5 hours to see is unique. Love Phillipa
Posted by exquilter on September 1, 2006, at 21:12:15
In reply to Remember the day I accidentally wrote a novel!? :), posted by jealibeanz on September 1, 2006, at 17:01:55
All these problems sound like a visit to your school's disabled student services could be helpful. They teach study skills and may be able to test to see what your best learning style is.
With ADA, these services are required to be available to students with diagnosed disorders including ADHD, depression and anxiety. The accomodations can be as simple as allowing more time for tests to one on one tutoring. Why not see what help they can offer before giving school up completely? Even if you found the perfect med combo tomorrow your grades could have tanked before they kicked in. Better study habits might take a bit of pressure off- God knows I wish these services had been available when I was in school.
Don't try to be the Dr. tommorrow. Help the man do his job by telling him ALL your symptoms and let him decide what to treat first and how. Your posts here are articulate and should help you make a list of what is bothering you so you don't forget anything. Good luck tomorrow.
Exquilter
Posted by gardenergirl on September 1, 2006, at 21:32:46
In reply to Re: Tomorrow Part 1, posted by jealibeanz on September 1, 2006, at 15:49:15
I think the key words you need to use are the ones that best describe your experience of your depression. There's no point in trying to make your description match some pre-determined criteria when you are trying to find the best treatment for YOU.
Atypical depression presents and feels different than major depression as defined by the DSM criteria. Many with major depression experience insomnia, while those with atypical may experience hypersomnia, sleeping way more than necessary for physiological needs. Similary, those with major depression are more likely to have a decrease in appetite, while those with atypical might be more likely to eat more when more depressed.
The other hallmarks of aytpical depression are rejection sensitivity, emotional reactivity, and a feeling of "leaden paralysis" in the body. With emotional reactivity, the person can experience happiness or joy or some other positive emotion when the circumstances warrant, whereas the person with major depression might remain feeling dysphoric, negative, or flat.
I believe whoever coined the term "atypical" did so because they found this subtype to be different from the "usual" or "typical" major depression presentation. Whether "aytypical" holds up over time remains to be seen, because some studies are finding it occurs more frequently than they first thought.
I agree with Racer, who (I think) suggested writing down and prioritizing your symptoms/complaints from most severe or bothersome to least. Be as honest and descriptive as you can.
good luck
gg
Posted by jealibeanz on September 1, 2006, at 22:58:40
In reply to Re: Tomorrow Part 1 » jealibeanz, posted by gardenergirl on September 1, 2006, at 21:32:46
I think one of my hardest problems is decided what is the main complaint. Right now I'm going to say that I neeeed to treat insomnia. If I only end up sleeping a couple hours at night, then must be awake the entire day, it's soo hard and painful.
Yet, at the same time, I've been having periods of hypersomnia during the day. I don't blame this mainly from nights of insomnia. When I have flexibility in my day, I feel the need to sleep constantly, allllll the time! It's not that type of sleep where people "make up" for lost rest, like on weekends. Completely different.
I'm not sure this even makes sense to anyone but myself, so I don't know if I want to tell him. However, I feel that I should because this fatigue doesn't actually go away on the days when I out and busy, I'm just forcing myself to be awake. I'd rather have more energy on those days without class so I can have a life! Being conscious only for class isn't a life. I've done that before.
Does this make sense to anyone? If not, I might just have to pick a complaint: either sleeping too much, or not at all, even though it's not really the whole story.
It seems contradictory when I'm explaining. It seems contradictory when it's happening!
Posted by Racer on September 2, 2006, at 1:53:27
In reply to Re: Tomorrow Part 1 » jealibeanz, posted by gardenergirl on September 1, 2006, at 21:32:46
>
> I believe whoever coined the term "atypical" did so because they found this subtype to be different from the "usual" or "typical" major depression presentation. Whether "aytypical" holds up over time remains to be seen, because some studies are finding it occurs more frequently than they first thought.Actually, I think it's been known for a very long time that atypical depression is actually more common than the alternative. Or, at least about as common.
It's called "Atypical," because once upon a time, it was thought that the early TCAs would treat ALL depression, so the cases of depression which didn't respond to -- I think it was amitriptyline? Or imipramine? One of the early TCAs, at any rate -- any depression which didn't respond to that drug was considered "atypical." And the atypical depression cases tended to respond to the MAOIs, despite the fact that the received wisdom of the day said that they just weren't all that great for depression. It's a little recursive, huh? MAOIs are good for atypical depression, which is called atypical depression because it responds to MAOIs? Hunh?
At least, that's my fuzzy memory. I know that the bare bones of that explanation are correct, though. And that it's about half of all cases of depression, so not all that atypical.
>
> I agree with Racer, who (I think) suggested writing down and prioritizing your symptoms/complaints from most severe or bothersome to least. Be as honest and descriptive as you can.
>Thank you, GG. It means a lot to me to read that.
Posted by jealibeanz on September 2, 2006, at 2:23:07
In reply to Re: Tomorrow Part 1 » gardenergirl, posted by Racer on September 2, 2006, at 1:53:27
OK here's my order then:
1. depression
2. fatigue
3. insomnia
The 2nd two exacerbate the first, so really they've all gotta be looked at!
Posted by jealibeanz on September 2, 2006, at 11:27:10
In reply to Re: Tomorrow Part 1, posted by jealibeanz on September 2, 2006, at 2:23:07
Just got back...
So, he asked about the Lunesta. I said it wasn't helping much, but added an hour or two to my nighttime sleep. However, in the 3 weeks I've had off, I've been able to sleep a little more continuously throughtout the night, 4 hours, haha, an improvement. Yet, I'm soo tired I've slept about 18 hours constantly napping the entire day.
Ohh offf course I baffle him, haha. So he was a little confused but definitely acknowledged that this was not good. The fact that I haven't been able to catch up on rest wasn't normal.
I mentioned that I did this for a whole year before, only waking briefly throughout the day to go to class. He asked what I did, if I'd tried something like Concerta. I said no, Provigil, which helped, but had to stop when I moved.
He grasped that idea. Asked how much... 100mg? No, I said I thought it was more... 200mg? Haha ummm noo I was reaally tired, I had a lot! So, then he said, oh some people are even doing 2x200mg. I said that seemed right.
So that's what I got... no change in the Lunesta. I actually said that maybe if I could force myself to take a break from it, it could work again. He also noted that if I were able to be more active during the day I'd sleep better.
OK, no talk of depression. I'm OK with this. 400 mg of Provigil works as an antidepressant for me! If it's not enough, I'll work up the courage to address depression again. I made sure I have a recheck in about 5 weeks.
So, for now, I'm happy with this. Yeaa, Provigil. It's good stuff for me. This is a good start. If he ever does try to take me off, assuming the fatigue has resumed, I'll definitely make sure he knows it majorly lifts my mood. I don't want to go off unless we can find a suitable AD for me.
I'm pleased with today. No in depth discussion. Saturdays are sooo rushed. If I neeeeeeded to make him listen, I could have. But the second he listened to the Provigil idea I knew this was going to help me for now.
Posted by llrrrpp on September 2, 2006, at 12:20:11
In reply to Re: Tomorrow Part 1, posted by jealibeanz on September 2, 2006, at 11:27:10
Hi Jeali,
you sound pleased with your visit. That's wonderful. I'm glad that you had a good appointment. Provigil is supposed to be less disruptive to nighttime sleep than other types of stimulants. My mom is narcoleptic AND has sleep apnea, so she has been prescribed it. She says it's actually has a great anti-depressant effect too.Keep us posted!
-ll
oh, I wanted to suggest maybe working in "sprints"
Write out a list of stuff that needs to be done. Some reasonable list, start really small, until you practice making lists enough to know what's reasonable.Now prioritize your list. If you have a test tomorrow: "study neurobiology" is kind of vague. If you write:
learn major divisions of CNS
learn cranial nerves
memorize three important experiments that proved [...]And then do a sprint: full gas on item number one on your list. set the timer for 30 seconds, or 5 minutes. Whatever is reasonable. Work hard. Then space out. Then work hard... etc. Perhaps the best time to study like this is about 30-90 minutes after you take your provigil?
Posted by llrrrpp on September 2, 2006, at 12:25:56
In reply to Re: Last Ditch Effort to Save My Life » llrrrpp, posted by Phillipa on September 1, 2006, at 20:47:04
> Lurpsie where have you found a pdoc that does any talk theraphy? Now a days they want a therapist to handle that aspect. My old one used to do it but gave it up. And the recent ones except the older lady I'm seeing don't talk either. This one I'm traveling 5 hours to see is unique. Love Phillipa
Hi Phillipa,
My T and pdoc work together as a team. They both know what's going on with me, so I can discuss both med issues and life issues with both of them. Of course my pdoc doesn't really have time for a full session of talk therapy every week, but just having the opportunity to talk about one's problems in confidentiality with a caring adult is very therapeutic. I go to a group practice.A couple people (maddie?) have mentioned that their psychiatrist does both talk therapy and psychopharm therapy. Probably becoming rarer and rarer these days. Ask Tony Soprano- his pdoc is also his T.
Posted by llrrrpp on September 2, 2006, at 12:26:51
In reply to Re: Tomorrow Part 1 » llrrrpp, posted by Phillipa on September 1, 2006, at 19:45:57
seroquel is also FDA approved for treating bipolar disorder.
-ll
Posted by jealibeanz on September 2, 2006, at 12:59:05
In reply to Re: Tomorrow Part 1 » jealibeanz, posted by llrrrpp on September 2, 2006, at 12:20:11
Yeah, I think it went OK, since I thought Provigil would be the last thing I'd get, let alone 400 mg daily. I'm actually verry surprised he didn't ask about the depression. I didn't present myself as distrssed though, never mentioned leaving school. We didn't really get that far. As soon as I began talking about the fatigue he mentioned stimulants. Hmm... so, we shall see how this works out. I'd like to keep it. As I become better educated I may think of a new idea. I don't ever think my tendencies to depression will go away, but I suppose that's where the hope of new drug releases comes into play.
Posted by Phillipa on September 2, 2006, at 19:39:12
In reply to Re: Tomorrow Part 1 » Phillipa, posted by llrrrpp on September 2, 2006, at 12:26:51
Where did that come from? But a bad memory doesn't help. It would for any psychotic symptoms. Love Phillipa
Posted by llrrrpp on September 2, 2006, at 21:06:08
In reply to Re: Tomorrow Part 1, posted by jealibeanz on September 2, 2006, at 12:59:05
Jealibeanz,
Have you ever looked into therapy to find out what's at the root of your depression? I bet that you can spare an hour a week. Many therapists have a sliding scale, if your school doesn't have an option that's appropriate for you. When's your next appt. with the doctor? Hopefully your fatigue will be under control by then, and you can get a little more focus with the provigil. You ever try benedryl for short term use for insomnia?best,
-ll
Posted by jealibeanz on September 2, 2006, at 21:14:25
In reply to Re: Tomorrow Part 1 » jealibeanz, posted by llrrrpp on September 2, 2006, at 21:06:08
I don't want to sound stereotypical, but I believe I have a "chemical imbalance" as so many people like to call it. Right now, after having taken Provigil, I feel normal and happy for the first time in quite a while. The lack of restorative sleep doesn't help matters either. However, I believe that once my days get better, my nights will as well. My doctor believe this too. He actually hopes that if I'm able to be a little more active and productive, I'll eventually get my body to the point where it needs to sleep at night and nothing else.
Posted by llrrrpp on September 2, 2006, at 21:29:27
In reply to Re: Tomorrow Part 1, posted by jealibeanz on September 2, 2006, at 21:14:25
Yep, I understand completely. Insomnia for any length of time will get almost anyone down. And when you have the energy to tackle your day, you'll probably feel better about yourself and your future too. Keep your eye on the big D, though, and if you're not feeling better, don't be afraid to try something new. Remember- therapy can change your brain chemistry too!
In the meanwhile, I'm SOOOO happy that you're feeling great. That's awesome that you got what you need. I remember the first time I took provigil. It was ... like the sun came out, and I woke up, and ... my day was like the yellow brick road. Easy to follow, met some interesting folks along the way, and I don't remember what happens at the end, because I fell asleep!
-ll
Posted by jealibeanz on September 2, 2006, at 21:52:49
In reply to Re: Tomorrow Part 1 » jealibeanz, posted by llrrrpp on September 2, 2006, at 21:29:27
This isn't my first time with Provigil, as I mentioned before. I remember it too, a great feeling. It's come back again. My doc was actually very happy to prescribe it, and seemed pleaseed that I mentioned it because he wouldn't have come up with the idea himself.
It makes complete sense for me though... it's not too stimulating, to the point where it increases anxiety or insomnia. It help's me concentrate and focus better. And of course, it allows me to function like a normal person and be conscious during the day.
I actually think it helps to lessen anxiety in some respect, but it's difficult to put the feeling in writing. Maybe it's just that the increase in energy and mood results in higher confidence, this less worrying.
Posted by jedi on September 2, 2006, at 22:02:22
In reply to Re: Tomorrow Part 1, posted by jealibeanz on September 2, 2006, at 12:59:05
> Yeah, I think it went OK, since I thought Provigil would be the last thing I'd get, let alone 400 mg daily. I'm actually verry surprised he didn't ask about the depression. I didn't present myself as distrssed though, never mentioned leaving school. We didn't really get that far. As soon as I began talking about the fatigue he mentioned stimulants. Hmm... so, we shall see how this works out. I'd like to keep it. As I become better educated I may think of a new idea. I don't ever think my tendencies to depression will go away, but I suppose that's where the hope of new drug releases comes into play.
Hi,
You have written that your #1 priority is the depression. Provigil is not really an antidepressant. It seems to be used more and more as an augmentor for depressed people that also have an element of fatigue in their depression. Are you taking any antidepressants at the present time? Your depression sure sounds atypical from your description.I have treatment resistant atypical depression with social and generalized anxiety. The MAOI Nardil is the only med that has worked for me through 35+ different combination of meds. What's a little wierd about Nardil is some of the side effects, such as daytime somnolence and weight gain, are the same as some of the symptoms of atypical depression. I am trying to convince my MD to prescribe modafinil for the related daytime fatigue. So far I haven't had much luck. GG has had good luck with this combination, and she has the ADHD like you, with the associated atypical depression. I believe she also takes Lamictal.
I have not tried EMSAM yet, but Parnate didn't work for me. I tend to doubt if selegiline is going to have the horsepower for treatment resistant atypical depression.
You say you are waiting for new meds to be invented. What have you tried that is out there now? I apologize if you've mentioned this already. I rarely get to read all of the threads.
Wishing you well,
Jedi
Posted by jealibeanz on September 2, 2006, at 22:16:02
In reply to Provigil for depression? » jealibeanz, posted by jedi on September 2, 2006, at 22:02:22
Nope, no antidepressant at this time... However, "antidepressant" is such a narrow term in the pharmaceutical world. There are many neurotransmitters and hormones that may contribute to depression, yet only a few select classes of drugs have been FDA approved to treat the disorder. We shouldn't get sucked into the trap of such tunnel vision, especially when considering medications and physiology that isn't thoroughly understood. Provigil does have antidepressant properties that have been observed, just like many other medications not approved for depression.
BTW, I've taken at various points in my life: Paxil, Wellbutrin, Buspar, Effexor, Klonopin, Adderall, Straterra, Xanax, Lunesta, Ambien
Posted by jedi on September 3, 2006, at 1:05:39
In reply to Re: Provigil for depression?, posted by jealibeanz on September 2, 2006, at 22:16:02
...
> BTW, I've taken at various points in my life: Paxil, Wellbutrin, Buspar, Effexor, Klonopin, Adderall, Straterra, Xanax, Lunesta, AmbienHi again,
Please don't take this wrong. Only one SSRI, no TCA, no MAOI; how can you say this is a last ditch effort?
Be well,
Jedi
Posted by Declan on September 3, 2006, at 1:31:19
In reply to Last Ditch Effort to Save My Life? » jealibeanz, posted by jedi on September 3, 2006, at 1:05:39
Also no tianeptine.
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