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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by psychpsych on August 1, 2008, at 17:18:41
I'm new to this forum, and need advice from Dr. Bob, or some of the more seasoned people browsing the forums.
I'm a first year resident in an east coast Psychiatry program, and am desperate for advice because Im nervous to get help, and somehow as a result suffer ramifications, professionally.
I'll start by saying that I am beginning to think I may have something seriously wrong with my mood, and maybe have for some time now.
I'm the child of a now sober alcoholic mother, and a father who despite being sort of spacy/brainy/ADHDish was very supportive and present while I was growing up. My parents are both educated, but home life was chaotic.
As a kid, I excelled in school, but was very shy. I don't think I had full blown but I did a lot of throat clearing, eye blinking, and sounds that were quiet enough for people not to hear me. I was also spacey and a day dreamer.
After my parents divorced, I became sort of average in school, and probably depressed as well. I graduated and went on to college, and decided I better start applying myself again and move on with my life/stop being upset with my parents. I had a steady girlfriend, who I still wrongly have now (Ill explain why "wrongly" in a moment.)
In my second year of college, everything started going exceptionally well out of nowhere. I was scoring the highest in my organic chem. and physics classes at a research-I public university. It was this year I also decided to Major in English Literature, Film Studies, and Public Health, all on top of a premed curriculum. I was getting 4.0s, and also drinking, smoking pot daily. I hid this from my girlfriend, bc I knew she wouldnt approve. And somehow I didnt either.
After my sophomore year, I went home to study and take my MCATs early bc I had finished all the requisites. But about a month before I left, I started becoming very depressed and thought it was due to impending time at home with my mom, who I wasnt getting along with optimally at that time. I never took my MCATs that summer and didnt come out of my bedroom much that summer. I was pretty depressed like this even after returning to school in Junior year. Sometime around March in Junior year, my mood became great again. But this time, I was daydreaming about random people and girls on campus, trying to catch their eye, etc. Also, I was looking at porn on the internet enough that it was disturbing even to me. I worked 2-3 part time jobs, studied for the MCATs, spent thousands of dollars on CDs, sneakers, clothing. Unfortunately, I also sparked a relationship up with another girl on the side in the midst of all of it (on the same campus as my girlfriend!) Nevertheless she found out, I broke it off like I had actually wanted to soon after it started, and we mended things.
Senior year I became depressed even though I had gotten accepted to several medical schools, had everything laid out for me. I began having major sleeping troubles, was exhausted, run down, and depressed for most of the year.
Freshman year of med school, my doc gave me amytryptiline for sleep. I felt incredible, and I remember waking up one morning looking at the sun and thinking how good life was (and Im not an optimistic, nature loving type of guy). Also, I began eating out all the time, spending tons of money on clothing, CDs, etc again like I did in college. I also ended up in a relationship with a girl from my class, and broke up with my girlfriend this time, bc I couldnt stand the guilt of putting her through another infidelity. I loved her, remember not wanting to leave her, but everything was too exciting to resist. 6 months later, I was back in the gutter, realized what I did, patched things up with my girlfriend and finances even though I was depressed, not sleeping much, waking up early in the morning.
In Sophomore Year/Junior year of Med school, I finally told my primary about everything, and he placed me on Effexor, which I can say was the best thing to improve my mood, but I still was having problems focusing, paying attention, falling asleep at night (although I had no more early morning awakenings and was in a much better mood.) He sent me to a Psychologist, who told me I was dysthymic, but also was having problems with periods of impulse control, and that Dsythymia/Impulse Control/ADHD could also account for bad attention, poor focus, and difficulty finishing tasks. Combined with my spaciness, he recommended I be treated with an SSRI which helped my mood in the past, and a low dose stimulant. I did this, and things went very well for about a year and a half. I was controlling my money, my relationship with my girlfriend was great, and I was excelling in medical school for the first time since I started, rather than doing nothing and just passing. My friends commented that it was the first time since they met me, that they could actually see the back seat of my car because it wasnt cluttered with books, papers, laundry, old food, and whatever else!
In my senior year, I began pursuing a side interest in theoretical linguistics and syntax. I got the idea to do a research elective to write a paper in the area of linguistics and medicine. By the end of 6 weeks, I had written a comprehensive review of theoretical syntax, all the while drawing connections between neuroscience imaging in aphasia and the current misunderstanding of Brocas aphasia as taught in medical schools. It was 70 pages long, and is being reviewed for publication now. At the same time I did this, I started surfing the internet for dating websites. At the beginning, I told myself I was just browsing for fun, and I wouldnt do anything to hurt my girlfriend. I also began looking at internet porn, spending all my money, and having to borrow money from my parents just to survive. I met several girls on dates, but somehow managed myself to cut myself off before committing an infidelity. I also started believing something was seriously wrong with me at this point as I wasnt able to sleep, and despite being elated to do work, write music which I hadnt done in years, I was very irritable and depressed. I stopped taking my SSRI/Ritalin out of fear that this may have been making things worse. My focus obviously decreased, and so did my productivity. My depression got worse.
Here I am now beginning my psychiatry residency 6 months later. I have started taking my Ritalin again, because my attention, concentration, spaciness, misplacing things never improved in the 6 month interim. Fearing I have something related to Bipolar depression, I have decided not to start an SSRI again. I am depressed as usual, having trouble sleeping (which doesnt improve off of the stimulant by the way), and wondering what the hell I should do. Of course being in the field adds a layer of complexity to the situation, and I dont know what to do. If anyone was patient enough to read this, could someone, possibly Dr. Bob, lend some friendly advice.
Posted by Racer on August 1, 2008, at 21:38:33
In reply to Advice from someone who shouldn't need advice, posted by psychpsych on August 1, 2008, at 17:18:41
Welcome to Babble! There are a lot of great people here, who offer a lot of support, and many of whom know a great deal about psychotropic medications. Dr Bob does not answer medication questions himself, but I'm sure someone else here can offer some information which you might find helpful.
Although I'm not a doctor, nor do I play one on TV, what you've described sure sounds like some flavor of bipolar to me. The cycles of impulsivity and productivity alternating with depression would trump the spaciness in my book, leading me to suspect bipolar rather than comorbid MDD and ADHD. Honestly, though, my opinion -- worth perhaps 2% of a US dollar ;-) -- is that DSM diagnostic criteria is worth a great deal for statistical or research purposes, insurance billing, and a shorthand approach to a new doctor. As far as individuals go, diagnosis is a good starting point for medications. As you said, an SSRI might not be the very best choice for someone with bipolar, although many people with depression-prominent bipolar will benefit from an antidepressant.
Many of the currently used mood stabilizers have antidepressant qualities, so Abilify, Lamictal, or Seroquel might be helpful, with or without an antidepressant.
Those are my thoughts, for whatever they're worth. The best place to ask a question about medications and diagnosis is the main Medications board, located at http://www.dr-bob.org/babble/ There are a lot of people there who have done a great deal of research into the medications they take, and many who have taken a wide variety of drugs who are likely to offer you the benefit of their experience.
Again, welcome to Babble! I hope you like it here and decide to stick around!
Posted by JayMac on August 27, 2008, at 21:55:09
In reply to Advice from someone who shouldn't need advice, posted by psychpsych on August 1, 2008, at 17:18:41
Psych,
Wow and wow! You have gone through a whole lot!! While I congratulate you on getting this far both academically and emotionally, I especially believe that you need to take some time to take good, quality care of yourself. Yes medications are helpful (God knows they have helped me!).In my opinion and experience, psychotherapy in conjunction with medication is often best. Try not to worry about a formal clinical diagnosis (although I know that's what us med/psych types love to do). Sometimes that intellectualizes our thoughts and takes us away from feeling what needs to be felt and really living with the truths of our past and present. I think you would best be served to seek out great therapy with someone who specializes in treating your symptoms. I hope that's helpful.
Hang in there! I understand what you're feeling. I've been through a major depression multiple times. Feel free to babble email me. You are going through a whole lot. You do not have to do this alone. Someone can help you.
Take Good Care,
JayMac
Posted by JayMac on August 27, 2008, at 21:57:52
In reply to Advice from someone who shouldn't need advice, posted by psychpsych on August 1, 2008, at 17:18:41
Hey Psych,
I just realized that I may be too late with my response (since you originally posted 8/1), but I hope it's helpful anyway!!
Thanks,
JayMac
This is the end of the thread.
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