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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by JeffH on December 13, 2001, at 15:21:32
After a month, I finally found a pdoc at the U. of Arizona in Tucson who was willing to try opiates. Just for fun, I had been mood charting myself and discovered my depression was cycling daily from severe depression to a non-depressed state (although still had anhedonia).
Well, opiates went to the wayside temporarily when I was diagnosed Bipolar II and given a script for lithium. That night, I took the minimum dose (one capsule) and a half-hour later, I literally felt a jolt and my depression went away and has been gone now for two weeks!
I have been depressed for 33 years and have tried many medications (including lithium). Nothing else has ever worked. Why did it work now and so fast? Could the turmoil of my recent divorce turned unipolar depression into bipolar?
Anyway, tomorrow I go back to Tucson to get started on a TCA and possibly Mirapex. I still need to take care of that life-draining anhedonia.
Is there anyone else out there that is Bipolar who has been effectively treated with a mood stabilizer for depression but still has anhedonia? Is treatment different than people with unipolar depression and anhedonia?
Posted by Mitch on December 14, 2001, at 0:31:23
In reply to Can lithium work in 30 mins? Am I Bipolar?, posted by JeffH on December 13, 2001, at 15:21:32
> After a month, I finally found a pdoc at the U. of Arizona in Tucson who was willing to try opiates. Just for fun, I had been mood charting myself and discovered my depression was cycling daily from severe depression to a non-depressed state (although still had anhedonia).
>
> Well, opiates went to the wayside temporarily when I was diagnosed Bipolar II and given a script for lithium. That night, I took the minimum dose (one capsule) and a half-hour later, I literally felt a jolt and my depression went away and has been gone now for two weeks!
>
> I have been depressed for 33 years and have tried many medications (including lithium). Nothing else has ever worked. Why did it work now and so fast? Could the turmoil of my recent divorce turned unipolar depression into bipolar?
>
> Anyway, tomorrow I go back to Tucson to get started on a TCA and possibly Mirapex. I still need to take care of that life-draining anhedonia.
>
> Is there anyone else out there that is Bipolar who has been effectively treated with a mood stabilizer for depression but still has anhedonia? Is treatment different than people with unipolar depression and anhedonia?Hi Jeff,
Many people might think this is some sort of placebo effect related to a positive session with a decent pdoc. My next to last last pdoc thought it was a "placebo" effect when I switched from lithium to Depakote and complained about worsened depression. But, if lithium can *stop* working when you stop and start it again later-then who's to say it couldn't *start* working when it never worked before??
Anhedonia and dysthymia are still major troubles with BP-II's who are taking only mood stabilizers. Lithium is the only mood stabilizer that I have ever taken as monotherapy that could keep hypomanias in check and at the same time treat major depressions (also by itself). BUT, I have the same trouble with the dysthymia/anhedonia that you refer to. IMHO, I would try adding low-dose Wellbutrin (or bupropion-generic) before I would add a TCA. It is pretty cheap and you will get less side effects.
People with treatment-resistant unipolar depressions tend to tolerate antidepressants better with much higher doses. The trick to see if your bipolar hypothesis is correct is to add an antidepressant and see what happens and see if you get hypomanic. Some unipolar depressives can respond to lithium by itself. But, if you find yourself easily becoming hypomanic from antidepressants that is fairly tell-tale for bipolar.
Mitch
Posted by ben on December 14, 2001, at 13:54:20
In reply to Re: Can lithium work in 30 mins? Am I Bipolar? » JeffH, posted by Mitch on December 14, 2001, at 0:31:23
I dondt guess that it works in 30 minutes ! 24 hours is the fastest response time I read of. It seems that you are a rapid cycler. Lamotrigine (Lamictal) is possibly a good addition to severe mood swings (as lithium as well) and high dose T4 is a trial worth.
Good luck and dont give up
ben
> > After a month, I finally found a pdoc at the U. of Arizona in Tucson who was willing to try opiates. Just for fun, I had been mood charting myself and discovered my depression was cycling daily from severe depression to a non-depressed state (although still had anhedonia).
> >
> > Well, opiates went to the wayside temporarily when I was diagnosed Bipolar II and given a script for lithium. That night, I took the minimum dose (one capsule) and a half-hour later, I literally felt a jolt and my depression went away and has been gone now for two weeks!
> >
> > I have been depressed for 33 years and have tried many medications (including lithium). Nothing else has ever worked. Why did it work now and so fast? Could the turmoil of my recent divorce turned unipolar depression into bipolar?
> >
> > Anyway, tomorrow I go back to Tucson to get started on a TCA and possibly Mirapex. I still need to take care of that life-draining anhedonia.
> >
> > Is there anyone else out there that is Bipolar who has been effectively treated with a mood stabilizer for depression but still has anhedonia? Is treatment different than people with unipolar depression and anhedonia?
>
> Hi Jeff,
>
> Many people might think this is some sort of placebo effect related to a positive session with a decent pdoc. My next to last last pdoc thought it was a "placebo" effect when I switched from lithium to Depakote and complained about worsened depression. But, if lithium can *stop* working when you stop and start it again later-then who's to say it couldn't *start* working when it never worked before??
>
> Anhedonia and dysthymia are still major troubles with BP-II's who are taking only mood stabilizers. Lithium is the only mood stabilizer that I have ever taken as monotherapy that could keep hypomanias in check and at the same time treat major depressions (also by itself). BUT, I have the same trouble with the dysthymia/anhedonia that you refer to. IMHO, I would try adding low-dose Wellbutrin (or bupropion-generic) before I would add a TCA. It is pretty cheap and you will get less side effects.
>
> People with treatment-resistant unipolar depressions tend to tolerate antidepressants better with much higher doses. The trick to see if your bipolar hypothesis is correct is to add an antidepressant and see what happens and see if you get hypomanic. Some unipolar depressives can respond to lithium by itself. But, if you find yourself easily becoming hypomanic from antidepressants that is fairly tell-tale for bipolar.
>
> Mitch
Posted by spike4848 on December 15, 2001, at 14:56:24
In reply to Re: Can lithium work in 30 mins? Am I Bipolar?, posted by ben on December 14, 2001, at 13:54:20
No, response to lithium does not label you as bipolar. Lithium, possibly lamictal and depakote, works on serotonin which may allievate feelings of depression. Lithium is unique in that it may work at the post synaptic level, maybe making the receptors more efficient. This occurs very quickly. I suspect you had this response. The literature is filled with studies of lithium augmentation and people responding less than 48 hours.
Personally though, most neuroscience is hypothetical assumptions ... I would just look to the sky and say "thank you .. keep it coming."
Spike
Posted by JeffH on December 19, 2001, at 9:31:43
In reply to Re: Can lithium work in 30 mins? Am I Bipolar?, posted by spike4848 on December 15, 2001, at 14:56:24
Thanks for your responses. My school's internet service has been down until today, so I couldn't respond.
I rushed out and bought a couple of books: one on Bipolar and Listening to Prozac. Both authors wrote that when depression moves to rapid-cycling bipolar, it's not a good thing in terms of management. Indeed, I will see what happens with the nortripyline as I will be moving to a pretty high dose in three weeks.
Mitch, my pdoc said the same thing as you, that anhedonia and dysthymia are major problems with BP-IIs, as well as atypical symptoms such as weight gain, rejection sensitivity, and the ability to respond in mood to stimuli.
Jef
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