Posted by jrbecker on August 4, 2003, at 11:31:14
In reply to Re: just more evidence...ADs protect the brain » jrbecker, posted by zinya on August 2, 2003, at 13:16:26
> JRB,
>
> greetings ... I've just stumbled on this thread and went to the link you gave here to the prior thread as well - I'm double-posting this in both threads to hope to catch you.
>
> I'm wondering if the experience I've been recounting to doctors who give me only glazed looks for the past 15 years could begin to be explained if I understand correctly the line of interconnection you seem to be outlining here between neural and (adrenal? and) depression-triggering 'damages'.
>
> A brief history, as I know no other way to present my 'case study'. I lived 34 years with energy for anything I wanted, never knew what pain was really, not chronic pain. In 1981, after a serious roller skating accident which left me with a compression fracture between my 4th and 5th lumbars, i discovered a congenital anomaly (quite a unique one according to my chiropracter) involving an extra half a lumbar fused to my sacrum which has from birth presumably meant a pull on my right hip that creates something of an angle. Perhaps some childhood accidents like crashing on my coccix had some impact, but never chronic pain until that 1981 accident. It started first to manifest in sciatic pain for some years. Then a chronic viral infection beginning in 1985 entered the picture. By 1987, i crashed (compounded by the stress and grief of my father's death) into a 'black curtain' of zero energy and only at that point did the doctors look back and realize i'd been running with the chronic viral infection for 2 years, having gone in for sheer exhaustion, had blood tests but no one told me of the infection, figuring it would pass.
>
> For two years from 87 to 89, recovery was elusive. Every time i would try to resume normal activity, which had included swimming between one and two miles a day prior to '87, i recrashed into zero energy even though i resumed with very gradual steps (like 1/4 mile only). Walking became a re-injuring activity. I was referred to various specialists who diagnosed Epstein-Barr, then Chronic Fatigue, also fibromyalgia, miofascial pain syndrome... I tried all kinds of traditional and nontraditional (eg acupuncture) methods.
>
> I was given Prozac first in 89, later lithium (because of merely a one-day-ever manic episode and because i tend to do "fast talk" when i'm with a doctor trying to cram a lot into a visit and some then think i'm hyper but i'm not. What i've eventually come to realize is that my adrenal system, shown in blood work in 2000 to be depleted, is erratic but almost entirely on the no-adrenalin, no-energy side of the pendulum.
>
> Okay, with that as some peripheral but converging background:
>
> I've been telling my doctors for all these years that, in my lay terms, "My back goes out on me and then i just cascade downwards into no energy and feeling depressed." By which i mean that the nerve damage (pinched nerve) in my sacroiliac area -- or then also after getting hit in 1990 by a red-light-runner and suffering additional neck nerve damage from a concussion into my driver's window -- also enough nerve damage that i can no longer applaud as that hand clapping triggers nerve damage that also cycles into body-wide energy flagging and other downturns.
>
> Doctors have been hard pressed to see how or why a reinjury to lower back nerve pain should be related to body-wide energy levels and depressive states. They seem to distrust me that i'm accurately assessing that i'm fine until a reinjury of my back and that that then alone launches a downcycle impacting depression.
>
> Would an upshot of this research you have presented suggest that in fact there would be a plausible cause-effect linkage?
>
> And, to get to remedies, as I'm now on Effexor (month 2 at 150 mg) after having tried without success Prozac, lithium, depakote, zoloft, paxil and celexa at various crisis moments over the past 15 years, usually having to quit due to side effects but sometimes because of no positive effect.
>
> I have begun to wonder (since the Effexor I'd been led to hope would start to work on my adrenal system and show energy benefits by 150 mg levels but so far after 2 weeks at this level has shown none -- and i have had two back reinjuries -- rotated lumbar -- during this time period):
>
> Would I perhaps be better off treating back injuries with stronger painkillers (I tend to try to get by with just 1/2 a vicodin which often is enough to be satisfactory but i've also learned that a full vicodin not only masks the pain but gives me actual energy restoration -- yet i am reluctant to take a full vicodin on a regular basis for fear of addiction), that perhaps if i did let myself take a full vicodin more immediately more regularly at the first sign of back pain, would i perhaps "envelop" the pain that perhaps then would not deplete (?) the adrenal system which then might not -- along the lines of what i gather from the research you cite -- trigger the depressive cycles??
>
> I realize this can at best be answered on a theroretical level here based on a streamlined (!! believe me, you got the short version!) case study and no physical examination plus you are a researcher not a doctor. However, if you have any thoughts on the "logic" of the kind of connection I have long sensed intuitively lies at the root of this past 15 years of debilitation which has impacted my career and my ability to travel as i used to, etc. It's this lay sense that "my back (nerve damage in lumbar/sacrum) that goes out and then i cascade into depression that takes longer to recover from than the back pain itself."
>
> Any thoughts? And apologies if this feels like an imposition in terms of being something out of your bailiwick.
>
> thanks,
> zinya
Zinya,
That's quite a history.Do you mind if I ask some questions...
What is your diagnosis, currently? Talk more to the bipolar piece that your docs have suspected.
What is the current cocktail? You mentioned Effexor @ 150mg, but are you still on the Lithium?
Rate your symptoms on a 1-10 scale.
How do you like your current pdoc? How open is he/she to your input? Do you feel he is doing a fair job?
To answer your more general question, there's no doubt a connection between your physical ailment (back issues) and your depression -- I'm assuming your question was somewhat rhetorical though. The anguish you're going through everytime you re-injure your back is probably putting your mood into a tailspin. That's our kryptonite -- a vulnerability to stressors, as minor as they come. The biological science behind why this occurs has been the details of this thread. For a more simplified summary of this topic, go to:
http://www.mcmanweb.com/article-44.htm
The reaction to chronic stress is quite different across individuals. Some react by sleeping very little, poor appetite, fearing overly anxious all the time. While others exhibit the opposite symptoms of poor energy, sleeping all the time, ravenous appetite, and no motivation. Most are a mix of these symptoms. Atypical depression, has a lot in common with both CFS, FMS, and other physiological ailments in terms of poor energy. But for more on the diff's b/t the two types of depression, as well as atypical depression's overlap with CFS, see:
http://www.mcmanweb.com/article-200.htm
http://www.dr-bob.org/babble/20030407/msgs/217313.html
http://www.cfids-cab.org/cfs-inform/Cfsdepression/vanhoof.etal03.pdf
Despite being very similar CFS/FMS and atypical depression are still viewed as different diagnostically. One, because the pain element seems to be only apparent in FMS and sometimes CFS. But more importantly, in terms of looking at it causationally in terms of the mood aspect, all physical ailments can bring on depression only as a direct result of dealing with the stress of a dabilitating condition. However, with atypical depression, low mood seems to be the core of the illness to begin with, and is intimately linked with the physical symptoms of low energy and sluggishness. In general of course, all illnesses, to varying degrees are brought on by interaction with the environment. And perhaps, your depression would have never come out (at least to this severity) if you hadn't injured your back. But that can be said about pretty every one of us, to varying degrees, since depression is thought to be only a biological ~predisposition~ to illness -- but actual day-to-day life is the acid test to see if we can the withstand stress. No one can live in a bubble though.
PS -- Apologies if this is repetitive to some of the info you already know, but I'm ignorant to what knowledge you retain already on the subject.
poster:jrbecker
thread:247363
URL: http://www.dr-bob.org/babble/20030802/msgs/248033.html