Posted by SLS on January 5, 2001, at 21:08:44
In reply to Re: Bipolar type that cycles betw norm. and depressed? » SLS, posted by S.D. on January 5, 2001, at 17:30:24
Dear S.D.,
> > No need to respond - just a few things to think about.
>
> *Now* you tell me.I always read the punchline first so that I can better understand the rest of the joke when I read it for the first time. :-)
Frustrating, isn't it. I wish I could help you pinpoint the right treatment for you to be "cured". Me too, while I'm at it.
> And it may not even be all that treatment-resistant if I can find an AD I can tolerate.
With which ADs have you experienced a significant antidepressant effect? What side effects of these drugs did you find intolerable? Very often, the side effects themselves need to be treated. If there is one drug that is a standout as far as improvement of your depression is concerned, perhaps you could get some feedback here as to how to remedy the side effects. For instance, I could not tolerate a combination of Nardil + imipramine. My blood pressure was so low, that I had to crawl around the house to avoid passing-out. I would just about bust a gut every time I tried to urinate. Florinef fixes #1 and bethanecol fixes #2. Over time, after the body makes some adjustments, one can often tolerate such a combination and discontinue the remedial drugs.
> Definitely no true rapid cyclicity. It can certainly be seen as simple recurrent unipolar depression, comorbid with an anxiety disorder ( I have other anxiety too, but 'subsyndromal' I guess since it doesn't seem to qualify as GAD ).
Rapid cyclicity is defined by the DSM IV as being the occurrence of four or more mood episodes (not cycles) over a one year period. I guess you gotta start somewhere. It seems a bit arbitrary to me, but I think it has value. There is no mention of a regularity of cycles.
If you are looking for accurate diagnoses for the purpose of choosing those treatments most likely to fix the problem, I should think that it was worth the effort to have made your inquiry. It is relevant. However, sometimes it comes down to a best guess. Sometimes not even that. Things can get pretty fuzzy. That's why the idea of a spectrum is useful.
Perhaps you suffer from an agitated major depression superimposed upon dysthymia - a double depression. The "agitated" would help explain the anxiety and even the racing thoughts. You haven't mentioned sex. That's O.K. I'm not in the mood anyway. However, the presence of hypersexuality would help differentiate an agitated depression from a bipolar mixed-state. Either way, perhaps Depakote or lithium would help. For agitated depressions, I think tricyclics are worth pursuing. Right now, I wouldn't know which of them to recommend - maybe nortriptyline or Sinequan.
Do you eat too much or too little when you are in the middle of a serious depression?
Do you experience insomnia, particularly in the early morning (3:00am-5:00am) when seriously depressed?
- Scott
poster:SLS
thread:50592
URL: http://www.dr-bob.org/babble/20001231/msgs/51005.html