![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 31. This is the beginning of the thread.
Posted by colin wallace on April 30, 2002, at 13:28:30
Need some advice here: although I have (mostly) got may depression/anxiety under control with a low dose sam-e/zoloft regime ,I still suffer from periodic mood crashes;I can be in an upbeat, carefree mood one minute, and utterly crash into an angry, bitter,enraged mood in a few short moments.I have no control over these mood crashes, which vary in length(from minutes to hours) and frequency (occurring maybe once/twice/even three times daily, not at all, or even just once a week.The last few years have taught me that the higher the dose of AD (any AD), the more extreme the mood volatility.As I am highly med sensitive, and am otherwise doing very well (save the mood crashes), I am wondering whether to broach the possibility, with my GP, of trying out lithium for size.
I am now beginning to suspect I may be bipolar 11, as I believe that may account for the downward swings, without the corresponding highs.
Having said that, every account of a bipolar 11 diagnosis I have dug up seems to be a little vague.Do my symptoms ring true with anyone with a bipolar 11 diagnosis? Any drawbacks to a lithium trial I should really know about? 'Grateful for any insights.Col.
Posted by katekite on April 30, 2002, at 15:07:03
In reply to A budding bipolar ??, posted by colin wallace on April 30, 2002, at 13:28:30
Which of the following would be likely to make you down? You can choose more than one, choose all that could be responsible for sending you into a slump:
a. Theatre or concert hall or sporting event office is out of tickets, all sold out, to something you wanted to go to two weeks from now?
b. You are trying to study in a library but don't seem to be able to get anywhere, but you really need to learn this material now?
c. You say something important to your sweetheart but they are absorbed in something and ignore you, or maybe they just don't care?
d. A meeting you didn't particularly want to go to is cancelled and you have nothing to do?
e. none of the above
I'm just curious if you respond to things the way I do. Seems like it's really hard to figure out whether someone is bipolar or not... having been misdiagnosed not too long ago I know it has to be really hard in some cases.
kate
Posted by johnj on April 30, 2002, at 15:20:06
In reply to A budding bipolar ??, posted by colin wallace on April 30, 2002, at 13:28:30
to "boost" my AD and felt an improvement the first day, many years ago, when I started it. I take lithobid (slow release) as I can't handle the lithium carbonate because I am med sensistive too. I take 300 mg in the morning and evening. I believe now that lithobid was in essence a mood stabilizer and it cleared up the late afternoon foggy feeling I had on the AD by itself. I tried to cut down my lithium to one a day and felt foggy after a few weeks. I don't see what harm it would do to give it a try. The dose I am on is borderline theraputic. Colin, could the zoloft cause the mood swings?
FWIW: I also found an article where excercise and a zoloft combination study didn't yield any adverse effects on mood. take care.
John
Posted by JonW on April 30, 2002, at 15:38:39
In reply to A budding bipolar ??, posted by colin wallace on April 30, 2002, at 13:28:30
Your mood swings could well be the result of bipolar disorder. There's a huge spectrum when it comes to the wonderful world of bipolar! A good site to check out is:
http://www.bipolarworld.net/Phelps/topicarchive.htm
See if you identify with any of the people on this site. Also, you should really consider working with a psychiatrist who understands mood disorders and in particular bipolar disorder. I'm not trying to tell you what to do, but working with an expert can save *lots* of time. I sure wish I changed doctors a lot sooner than I did. Anyway, another couple of links you might want to check out are:
http://www.psycheducation.org
http://www.manicdepressive.org/referraldatabase.htmlThe first one is a site all about bipolar II and related stuff, and the second link is a referral database that might be useful in finding a doctor.
Good luck with everything,
Jon> Need some advice here: although I have (mostly) got may depression/anxiety under control with a low dose sam-e/zoloft regime ,I still suffer from periodic mood crashes;I can be in an upbeat, carefree mood one minute, and utterly crash into an angry, bitter,enraged mood in a few short moments.I have no control over these mood crashes, which vary in length(from minutes to hours) and frequency (occurring maybe once/twice/even three times daily, not at all, or even just once a week.The last few years have taught me that the higher the dose of AD (any AD), the more extreme the mood volatility.As I am highly med sensitive, and am otherwise doing very well (save the mood crashes), I am wondering whether to broach the possibility, with my GP, of trying out lithium for size.
> I am now beginning to suspect I may be bipolar 11, as I believe that may account for the downward swings, without the corresponding highs.
> Having said that, every account of a bipolar 11 diagnosis I have dug up seems to be a little vague.Do my symptoms ring true with anyone with a bipolar 11 diagnosis? Any drawbacks to a lithium trial I should really know about? 'Grateful for any insights.
>
> Col.
Posted by Ron Hill on April 30, 2002, at 16:37:50
In reply to A budding bipolar ??, posted by colin wallace on April 30, 2002, at 13:28:30
Colin,Wow. I never said anything before because I do not know for sure, but I've always thought that you may be bipolar II. Maybe you are, maybe you aren't. But it sounds like you and your pdoc need to compare notes. Did I previously send you the link to an on-line diagnosis site? I'll provide it here (again?) in case you are interested. As a screening tool, it is pretty good and I think it is worth spending the ten bucks to gain access. If you decide to take the test, I recommend that you ask someone who knows you well to sit beside you as you take the test and provide objective feedback to your answers.
http://www.mentalhealth.com/fr71.html
You and I talked previously about my short-lived bout with "flash rage". What you describe in your post sounds similar. I still don't know the root cause(s) of my short-term problem, however as I told you previously, when I skipped a day of vitamins it went away. But I still wonder if a lower dose of SAM-e might minimize the chances of the return of an irritable mood. Currently my med cocktail (600 mg/day Lithobid and 200 mg/day SAM-e) is working extremely well and, therefore, I'm not going to monkey with it straight away (that's my feeble attempt at speaking in the UK vernacular).
Colin, I consider you to be a good friend. If I can help, please let me know.
-- Ron
-------------------------------------------
> Need some advice here: although I have (mostly) got may depression/anxiety under control with a low dose sam-e/zoloft regime ,I still suffer from periodic mood crashes;I can be in an upbeat, carefree mood one minute, and utterly crash into an angry, bitter,enraged mood in a few short moments.I have no control over these mood crashes, which vary in length(from minutes to hours) and frequency (occurring maybe once/twice/even three times daily, not at all, or even just once a week.The last few years have taught me that the higher the dose of AD (any AD), the more extreme the mood volatility.As I am highly med sensitive, and am otherwise doing very well (save the mood crashes), I am wondering whether to broach the possibility, with my GP, of trying out lithium for size.
> I am now beginning to suspect I may be bipolar 11, as I believe that may account for the downward swings, without the corresponding highs.
> Having said that, every account of a bipolar 11 diagnosis I have dug up seems to be a little vague.Do my symptoms ring true with anyone with a bipolar 11 diagnosis? Any drawbacks to a lithium trial I should really know about? 'Grateful for any insights.
>
> Col.
Posted by johnj on April 30, 2002, at 16:50:03
In reply to Re: A budding bipolar ?? » colin wallace, posted by Ron Hill on April 30, 2002, at 16:37:50
Ron,
Did you ever track down which vitamins might be the culprit? I was just curious since I take a multiple plus some more B vitamins in the evening and have been having some big ups and downs. I think it is related to working out, but am not quite sure yet. take care
John
Posted by Ron Hill on April 30, 2002, at 17:17:05
In reply to Re: A budding bipolar (Ron), posted by johnj on April 30, 2002, at 16:50:03
Hi John,> Did you ever track down which vitamins might be the culprit? I was just curious since I take a multiple plus some more B vitamins in the evening and have been having some big ups and downs. I think it is related to working out, but am not quite sure yet.
No, I don't know yet. As I indicated in my post to Colin, I'm currently functioning extremely well on my med cocktail and, therefore, since I've got a lot going on, finding the answer to this question has been put on the back burner. As a preventive measure, I skip my vitamins about once a week. However, skipping vitamin doses is probably just voodoo pharmacology.
-- Ron
Posted by Cindylou on April 30, 2002, at 21:27:09
In reply to A budding bipolar ??, posted by colin wallace on April 30, 2002, at 13:28:30
Hi Collin,
We talked before about responding to subtherapeutic doses of meds ... It seems we respond similarly to meds, and from your post here, it sounds as if you might be bipolar II.I was recently diagnosed as BPII, and I kept fighting it, denying it, because I never have any kind of "manic" episodes -- just highly agitated, then extremely fatigued, then back again -- never normal. I took the screening that Ron mentioned to you, and it did NOT seem to think I was bipolar because of the fact I don't have those manic episodes.
But my pdoc convinced me the other day. She said my reactions to meds are a strong sign of bipolar (reacting differently to ADs than most people.) Also, she said that people with the low energy, low motivation, sleep-alot depression are often bipolar II.
The thing that convinced me most (and that does not apply to you) is that I had serious postpartum depression/anxiety, and she has heard that in 90% or so of postpartum cases, the people are bipolar. She said I may have been bipolar all my life, but it didn't manifest itself until after I had my baby, which makes complete sense to me.
Sorry to ramble on here, but I really feel for you and with you -- this whole bipolar thing threw me for a loop! But I am accepting it now, and I believe just accepting the diagnosis is going to help me. I have just started a trial of Neurontin. I also take Klonapin for the agitation, and a tiny bit of Serzone (25 mg for now!)
I tried Lithium at one point and it made me extremely fatigued. With you being med sensitive, you may want to try Lamictal first -- it has very low side effects, and I was actually able to tolerate it, but it didn't help me much. I think I need something more calming (Lamictal tends to be activating), since this agitation is so out of control at times. But Lithium was TOO calming! All I wanted to do was sleep.
So far, I am doing well on the Neurontin, but I only started yesterday.
Take care -- I look forward to hearing more about your situation ...
cindy> Need some advice here: although I have (mostly) got may depression/anxiety under control with a low dose sam-e/zoloft regime ,I still suffer from periodic mood crashes;I can be in an upbeat, carefree mood one minute, and utterly crash into an angry, bitter,enraged mood in a few short moments.I have no control over these mood crashes, which vary in length(from minutes to hours) and frequency (occurring maybe once/twice/even three times daily, not at all, or even just once a week.The last few years have taught me that the higher the dose of AD (any AD), the more extreme the mood volatility.As I am highly med sensitive, and am otherwise doing very well (save the mood crashes), I am wondering whether to broach the possibility, with my GP, of trying out lithium for size.
> I am now beginning to suspect I may be bipolar 11, as I believe that may account for the downward swings, without the corresponding highs.
> Having said that, every account of a bipolar 11 diagnosis I have dug up seems to be a little vague.Do my symptoms ring true with anyone with a bipolar 11 diagnosis? Any drawbacks to a lithium trial I should really know about? 'Grateful for any insights.
>
> Col.
Posted by Ron Hill on April 30, 2002, at 22:36:48
In reply to Re: A budding bipolar ?? (long) » colin wallace, posted by Cindylou on April 30, 2002, at 21:27:09
Posted by oona on April 30, 2002, at 22:38:39
In reply to A budding bipolar ??, posted by colin wallace on April 30, 2002, at 13:28:30
> Need some advice here: although I have (mostly) got may depression/anxiety under control with a low dose sam-e/zoloft regime ,I still suffer from periodic mood crashes;I can be in an upbeat, carefree mood one minute, and utterly crash into an angry, bitter,enraged mood in a few short moments.I have no control over these mood crashes, which vary in length(from minutes to hours) and frequency (occurring maybe once/twice/even three times daily, not at all, or even just once a week.The last few years have taught me that the higher the dose of AD (any AD), the more extreme the mood volatility.As I am highly med sensitive, and am otherwise doing very well (save the mood crashes), I am wondering whether to broach the possibility, with my GP, of trying out lithium for size.
> I am now beginning to suspect I may be bipolar 11, as I believe that may account for the downward swings, without the corresponding highs.
> Having said that, every account of a bipolar 11 diagnosis I have dug up seems to be a little vague.Do my symptoms ring true with anyone with a bipolar 11 diagnosis? Any drawbacks to a lithium trial I should really know about? 'Grateful for any insights.
>
> Col.Hey col, just read your post after i had posted mine on questions on celexa and risperadol. Whn I read yours, I remembered what my pdoc said today about bipolar and moods, up and down, anger... Mine used to be like that BZ BEFORE ZOLOFT, and now that I am off Zoloft and looking for another helper. I just started celexa today with respiradol. The respiradol is supposed to stabilize the moods as bipolar or manic can become angry or irritable by taking ADs but the mood stabilizer are supposed to help. Will let you know how they help with me.. I am older though and do not have all the raging hormones that may affect a lot of moods. I think I had a harder time of it when I was younger.
Still learning..
oona
Posted by alex01 on May 1, 2002, at 6:05:08
In reply to Re: A budding bipolar ?? (long) » colin wallace, posted by Cindylou on April 30, 2002, at 21:27:09
Cindylou
I was very interested to hear you mention that you had had unusual reactions to anti-depressant meds, and also that your doc had said that low energy, low motivation, sleep-alot depression are often bipolar II. I qualify with the depression stuff (plus have been manic of occasion) and have tried about 15 different AD meds without success and generally wierd responses:
eg ssri's and serzone/effexor made me feel very blank which blocked out everything but I couldnt think, had sort of muscle cramp/seizures with big dizzy spells on bupropian, and a host of other entertaining reactions to lots of differnt ADs, including my now 9 month reaction to a small amounnt of amphetamine.
Anyway, all of this to say I am interested in what sort of unsual reactions you have had on ADs. I am going to try lithium soon so interested in all background I can get
Regards
Alex
Posted by katekite on May 1, 2002, at 13:20:31
In reply to does something cause the swing?, posted by katekite on April 30, 2002, at 15:07:03
Hi,
Apologies for my odd quiz format post -- must have been in a ritalin rebound moment. So nice to have a drug to blame, LOL.
What I meant to say was that with ADD vs bipolar downswings are usually triggered by overstimulation, being overwhelmed vs. nothing at all or mild minor disappointment. Then there's rejection/abandonment, where someone who's moody in an emotionally dramatic way (borderline tendencies) would experience a downswing, and that is possibly different from either ADD or bipolar.
Point is if you can find even minor causes for a bad mood you could be just over-reacting to the causes for some reason, not having the independent cycling of bipolarism. If you can find no cause (rational or irrational) then bipolarism is more likely. At least this is what I've come up with to see in retrospect how I managed to be diagnosed as bipolar.Of course in a way it may be a mute (moot? sp?) point, because for many people bipolar meds help serious moodiness from any cause, and if it helps it helps and one doesn't need to get in a tizzy (like I do) about why.
kate
Posted by colin wallace on May 1, 2002, at 13:30:24
In reply to A budding bipolar ??, posted by colin wallace on April 30, 2002, at 13:28:30
Thanks so much to all of you for those responses.
Kate: As regards what actually triggers my mood crashes, I thinks I’m pretty philosophical as far as everyday upsets are concerned. Tickets sold out, cancelled meetings etc. generally won’t send me into a spin. In fact, after a short string of expletives, I think I deal with these types of mishap better than most.(Maybe I just laugh and consider them trivial compared to the depression I’ve been through!)
That said, from that list, studying and not being able to absorb stands out as a likely candidate for a mood nosedive.Foul (UK) overcast weather will , without fail, cause me to crash badly (seems to be air pressure related , rather than light- I can wake up feeling like crap on an overcast day, without even looking out of the window).My fibromyalgia angers me greatly, and that causes swings too. But , I have to admit, often there need be no cause or trigger.John J.
John, I was meaning to ask how you’re faring with the exercise/med program right now.
I have just emerged from a pretty awful (scary, in truth) mood crash, which lasted two days. It has sapped all my mental energy in fighting against it (like somebody suddenly plunging my head underwater!), and has lifted as suddenly as it came on.I did a furious hour on a climber in the gym today, and that helped snap me out of it I think .Does lithobid adversely affect exercise? I don’t think Zoloft is the culprit as far as I am concerned- I’ve always suffered mood crashes.I get on well with Zoloft as a rule.I’m far better since taking sam-e/Zoloft than I ever was without.John W.
John, those links are invaluable.I’m almost certain now that I’m BP11- The criteria listed fit me perfectly. I’m waiting to get a consultation with a psych., but as this takes time here in the UK, I’ll discuss my belief with my GP. and angle for a lithium trial.
Ron!
Speaking of voodoo , I’m beginning to wonder whether you’ve placed some sort of hex on your ol’ limey pal !! Our symptoms seem to be almost merging into one!Serves me right for calling you madder than a pumpkin eh??? I took the test, and one other, and both came back with major depressive disorder/dysthymia. As you say though, some face to face discussions with my doc are in order, and I hope to follow suit with a lithobid trial, if I have my way. Do you get any prominent side effects with it? I read that it can greatly increase suicidiality if discontinued after some timeBut the.Hair loss concerns me more !?
Cindy.
Thanks for the time you took with that response.I’m now beginning to see that, especially in retrospect, my depressive course has been as ‘undulating’ as yours. Never normal, often anxious, agitated, anergic. Even though my mood swings are less frequent , I’d really like to eliminate them completely.Like you, I never considered the possibility of being in any way bipolar, due to never being ‘manic’.Our symptoms again are very, very similar it seems.I will also discuss neurontin with my doc, and let you know how it goes.
If I am bipolar 11, I’ll have no difficulty accepting it- I may have difficulty convincing my doc though!Oona.
I’d like to hear how you fare with Respiradol-seems like Zoloft didn’t agree with you particularly.I wonder, did you try lithium first ? I’m still on that learning curve too-didn’t realize there were so many mood stabilizers around. Hope it goes well.
Cheers all,Col. (back in the land of the living!!)
Posted by Cindylou on May 1, 2002, at 13:51:20
In reply to Re: Question for Cindylou, posted by alex01 on May 1, 2002, at 6:05:08
Hi Alex,
Well, first of all I am VERY med-sensitive, and can only tolerate small doses of most drugs out there.Specifically, I would get extremely fatigued and foggy-headed on SSRIs, to the point of "zombie-ness," and this feeling would not subside even after several months (e.g., Zoloft, Effexor, Paxil, etc.) The only exception is Prozac. If I started out low enough on Prozac (e.g., 2.5 mg.) I would do very well on it, but then crash after 2 months. I tried this three different times over the course of 10 years, and every time I would experience this crash after 2 months -- I would be left exhausted, couldn't concentrate or focus, feel "depleted" -- worse off than I was before I started the med. Increasing the dose did not help. (Basically, it broke my heart.)
With stimulants, again I can only tolerate extremely small doses (e.g., 2.5. mg of Adderall). I've tried most of them. They usually work wonderfully for a few days, and then WHAM!!!! I crash -- hard. Similar crash to the Prozac, but I feel even worse -- like i have the flu, or the worst hangover of my life. I try taking more, and it only makes it worse.
I tried Nortriptyline (the tricyclic), and at only 10 mg., I was so agitated I wanted to jump out of my skin! I could barely function due to the agitation.
Buspar made me feel very clouded-headed, heavy-headed, extremely tired, could not snap out of the fog no matter how much coffee I drank!
The antipsychotics made me extremely spacey and disoriented and exhausted.
The meds I've done okay with are:
- Klonapin, at small doses
- Lamictal, up to 75 mg.
- Serzone, but only up to 75 mg (too small a dose to help with depression, but it does help with anxiety)
- So far, Neurontin -- but it's only my 3rd day. I am actually very fatigued today, and it could be due to the Neurontin, I'm not sure.)
- Wellbutrin, kind of. I could tolerate it while on Effexor and Zoloft, probably because those meds made me so exhausted that nothing could cause me agitation! But when trying it without those meds, or with Lamictal, the Wellbutrin did make me quite agitated. This is a fairly normal reaction though.Hope this is of some help to you! I didn't include EVERY med I've tried, because some of them I could only handle for a day and then I'd quit -- if there is a specific med you're wondering about that I didn't mention, let me know (I may well have tried it!)
I look forward to hearing how things go for you...
take care,
cindy
> Cindylou
>
> I was very interested to hear you mention that you had had unusual reactions to anti-depressant meds, and also that your doc had said that low energy, low motivation, sleep-alot depression are often bipolar II. I qualify with the depression stuff (plus have been manic of occasion) and have tried about 15 different AD meds without success and generally wierd responses:
>
> eg ssri's and serzone/effexor made me feel very blank which blocked out everything but I couldnt think, had sort of muscle cramp/seizures with big dizzy spells on bupropian, and a host of other entertaining reactions to lots of differnt ADs, including my now 9 month reaction to a small amounnt of amphetamine.
>
> Anyway, all of this to say I am interested in what sort of unsual reactions you have had on ADs. I am going to try lithium soon so interested in all background I can get
> Regards
> Alex
Posted by johnj on May 1, 2002, at 15:38:20
In reply to Re: A budding bipolar ??, posted by colin wallace on May 1, 2002, at 13:30:24
Colin,
Glad to hear you have emerged from the crash. I myself have been in a slump for about 3 days. I tried remeron at 7.5, but was more drugged so I went back to 15 and had one decent day. Remeron is just too sedating for me. I like the sleep, but I don't ever emerge from it feeling rested, and I almost feel is actually depresses me at low doses. Does that sound funny? I felt better at 30 mg, but WAY too spacey.
I am pretty muched resigned to the fact I may have to give up excercise until I switch and become stable. And then have at it and see if my mood goes downhill. I have read that with a minority of people, the SSRI's have caused insomnia and I cannot afford that. I have resisted SSRI's since I hear they poop out when compared to other drugs. I have put out some feelers and it seems that Celexa has been a decent med, and it is also coming out with metabolite? that doesn't have all of the sexual side effects. I don't think I am ready for effexor yet. Basically, I need something that will help with energy, and not keep me up all night. If an SSRI makes me feel good I could look at trazodone or sonata to help sleep.
Another option is too get something to help me sleep and get off of everything and just excercise a ton and try supplements(probably a dumb idea!)
LITHOBID, did not make me more tired, but then again I couldn't go any lower when I started it. I have alwys been told and have followed the advice to keep very hydrated. I think I did mention that I had a harder time on lithium carbonate than lithoibid so that is the route I would recommend since your are med sensitive too. I don't think it would cause a negative effect on excercise. You may be a little more tired, but if it stablizes you it might be a small price to pay. I hope it works for you.
A question for you I have is that you said impraimine didn't cause the negative excercise response as the sedating drugs? Did it help the depression? Did zoloft harm your sleep? I just need to get to a notch on the ladder so I can climb out by myself and that is by excercise. Keep your head up and I will try to do the same. take care
JohnjJohn J.
John, I was meaning to ask how you’re faring with the exercise/med program right now.
I have just emerged from a pretty awful (scary, in truth) mood crash, which lasted two days. It has sapped all my mental energy in fighting against it (like somebody suddenly plunging my head underwater!), and has lifted as suddenly as it came on.I did a furious hour on a climber in the gym today, and that helped snap me out of it I think .Does lithobid adversely affect exercise? I don’t think Zoloft is the culprit as far as I am concerned- I’ve always suffered mood crashes.I get on well with Zoloft as a rule.I’m far better since taking sam-e/Zoloft than I ever was without.
Posted by Cindylou on May 1, 2002, at 19:04:05
In reply to Well said Cindy. Best wishes to both you and Colin (nm) » Cindylou, posted by Ron Hill on April 30, 2002, at 22:36:48
... I met with those alternative medicine M.D.'s yesterday. Unfortunately, he didn't advocate much for SAM-e -- I guess what they do there is determine each patient's individual needs, then put them on a vitamin/herb/diet program. They actually have someone in their office who makes up vitamin/herb combos specifically for each individual. They also will distribute vitamins through an IV ... quite interesting.
He wasn't negative about SAM-e, but just didn't seem especially interested in it -- perhaps he doesn't know enough about it.
The whole appointment was kind of a bummer, because I shelled out a lot of dough only for him to tell me that he couldn't do anything for me until he had all my blood tests, urine tests, etc. I won't see him again for 3 weeks. He didn't even suggest a multi-vitamin.
I will ask more about the SAM-e issue next time I'm there -- I was very overwhelmed yesterday, and didn't push the issue much.
Thought I'd give you the update! I am definitely interested in trying SAM-e in the future, once I get myself leveled out a bit after my 2-week "no-med stint." Not a good idea, I've learned (one too many times.)
Take care!
cindy
Posted by colin wallace on May 2, 2002, at 5:50:14
In reply to Re: A budding bipolar ??(Colin), posted by johnj on May 1, 2002, at 15:38:20
Johnny boy,
I know precisely what your going through with the Remeron experience- I tinkered around with the dosage, from 15mg to 90mg at one point, and found that the 'sponge-brain' feeling and post-exercise crash were just too much for me in the end.
There are two similar tricylic AD's that you may want to investigate, if that's the way you want to go.One is Lofepramine (gamanil), and the other is desipramine.Both work similarly on the noradrenegic systems primarily, and aren't particularly sedating as far as tricyclics go.(However, you cant get gamanil in the States I believe, or Desipramine here in the UK.)
I felt quite good on Gamanil, but tricyclics cause me tachycardia at anywhere near therapeutic doses.Didn't interfere with exercise at all though, and the side-effects with Gamanil are slight , as it's a 'modified' tricyclic.
Many people on this site have done well with desipramine too.
Amitriptyline is the the most potent and sedating tricyclic, and when used in very small doses (10mg etc) is a great sleep aid.
I wouldn't be in too much of a hurry to dismiss SSRI's either to be honest. 'Poop out' need not be inevitable- these meds are very effective for some people, who can go for years without a poop-out; even then a dose increase can solve the problem.
Basically, any med can cease to work after a certain length of time anyway, as the brain somehow adjusts to its effects.Also, I personally had more sexual side-effects with the tricyclics than with the ssri's.
Hope you stumble upon something that works for you soon- I'm going to discuss a Lithobid trial with my doc. tomorrow. Hopefully that'll keep my head above water permanently, when it joins forces with my sam-e/ zoloft arsenal- we'll see.Col.
Posted by colin wallace on May 2, 2002, at 7:17:07
In reply to does something cause the swing?, posted by katekite on April 30, 2002, at 15:07:03
Hey Kate, nothing wrong with a quiz to get the ol' grey matter ticking!Eliminating certain scenarios as precursors to a mood-crash can only help get closer to the true cause.
Actually, I especially agree with what you say about definitive causes being something of a moot (mute?!*_- ) point - so many people get misdiagnosed anyway, I'm less concerned with pinning labels on an illness than with whether a med. works or not; that's good enough for me right now...Take care,
Col.
ps. (you recommend Ritalin??!)
Posted by lizzyg on May 2, 2002, at 9:03:00
In reply to Re: A budding bipolar ?? » colin wallace, posted by Ron Hill on April 30, 2002, at 16:37:50
Cor blimey and stone the crows, Ron, you sound like a proper Cockney! (Actually we'd say 'I'm not going to muck around with it straight away', but your attempt at Britishness is much appreciated).
Talking of which, I had a lovely walk today from one of our offices near the Tower of London to the other one next to St Paul's Cathedral. The sun was shining and my spirits were soaring. The anxiety seems to have gone away, and I was pleased to hear that your irritability has, too.
Chalk up another SAM-e success!
Best wishes and thanks for your help and support.
Lizzy
Currently my med cocktail (600 mg/day Lithobid and 200 mg/day SAM-e) is working extremely well and, therefore, I'm not going to monkey with it straight away (that's my feeble attempt at speaking in the UK vernacular).
Posted by Ron Hill on May 2, 2002, at 12:58:03
In reply to Thanks, Ron. By the way... » Ron Hill, posted by Cindylou on May 1, 2002, at 19:04:05
Posted by Ron Hill on May 2, 2002, at 13:02:17
In reply to Strike a light, Ron! » Ron Hill, posted by lizzyg on May 2, 2002, at 9:03:00
Posted by Ron Hill on May 2, 2002, at 15:25:57
In reply to Re: A budding bipolar ??, posted by colin wallace on May 1, 2002, at 13:30:24
Colin,
> Speaking of voodoo , I’m beginning to wonder whether you’ve placed some sort of hex on your ol’ limey pal !!
I wouldn't do that to my buddy, Colin.
>I took the test, and one other, and both came back with major depressive disorder/dysthymia.
I'm beginning to wonder if that on-line diagnosis test does not adequately account for dysphoric hypomania and, therefore, it may under diagnoses this subtype of BP II.
>As you say though, some face to face discussions with my doc are in order, and I hope to follow suit with a lithobid trial, if I have my way. Do you get any prominent side effects with it?
Initially, I experienced an increase in the frequency of urination and some rashes on my face. Both of these side effects subsided with time.
>I read that it can greatly increase suicidiality if discontinued after some timeBut the.Hair loss concerns me more !?
One problem with going off lithium is that some patients find it to be ineffective when (if) they try to go back to it later. I lost a lot of hair on Depakote, but I have not noticed any hair loss on Lithobid.
Colin, here are five self-help methodologies that I find useful in keeping any irritable (flash rage) tendencies under control. Some, none, or all may be of use to you.
1. Rigorous, strenuous, and regular exercise melts away stress like a hot knife melts butter. With stress levels lowered, my irritable mood is much less likely to rear its ugly head. You already know this, Colin, but I list it here because it is so very important.
2. Some call it meditation, I call it pray. Don't ask me how it works because I don't know. All I know is that pray (and/or meditation) lowers stress levels and, thereby, lowers the flash rage threshold in my emotional personality.
3. Regular sleep is extremely important. I can't overstate the importance of good quality sleep, of sufficient duration, on a day in and day out basis. It's critical for bipolars.
4. I need structure and order in my living and working environments. If I get disorganized, I have a very hard time. I feel overwhelmed in a disorganized environment and this triggers irritability and flash rage.
5. It is very useful for me to understand that, due to my bipolar disorder, I have a predisposition toward an irritable mood and flash rage (as well as other characteristics). This DOES NOT serve as license for me to act out inappropriately. But it does provide an internal explanation to myself of why it can seem so much more difficult for me to control my irritability than it is for the population at large. Understanding this helps my self-talk which, for example, can go like this:
"Okay Ron, I know you feel very irritable right now, but it's not really Candace's (my wife) fault. What she did was very minor. You are feeling this inordinately intense irritability because you are bipolar. These feeling will subside soon, so wait for a little while before expressing yourself because your feelings regarding the situation will very likely change."
I'm not suggesting that we stuff our feelings. Instead, I'm suggesting that merely understanding the characteristics of my bipolar disorder allows me the opportunity to implement coping strategies. In the example above, implementing some wait time can be part of the coping mechanism.
Further, understanding myself and understanding the disorder helps me to bring sense to my world. No longer am I stuck with the self assessment that I just must be a "bad person" since "good people" do not allow their temper to flash. Instead, there is a reason. I'm bipolar and, therefore, I need to implement coping strategies.
Lastly, in general, people that repeatedly display irritability and flash rage do not lead highly successful lives (e.g. relationships, career, etc). For example, the Stanford Research Institute conducted a study a few years ago that showed 87% of the probability of success in the workplace depends on our people skills and only 13% depend on our technical abilities. If these data are even close to being accurate, and my life experiences lead me to believe that they are, then it is absolutely essential that I develop excellent people skills. Therefore, I use this information in my self-talk by reminding myself that successful people do not explode and that the damage caused by such an outburst may have long term repercussions. I must be intelligent enough to keep my emotions under control.
-- Ron
Posted by colin wallace on May 2, 2002, at 15:26:47
In reply to Lizzy, I'm very happy for you! Hope it continues. (nm) » lizzyg, posted by Ron Hill on May 2, 2002, at 13:02:17
Posted by colin wallace on May 2, 2002, at 16:01:19
In reply to Re: A budding bipolar ?? » colin wallace, posted by Ron Hill on May 2, 2002, at 15:25:57
Ron, your a great guy.
What you advocate here makes a lot of sense too.The screening test is actually very good I feel-the fact that bipolar type 11 (and even bipolar disorder itself!) is often missed by primary care physicians, and even psychiatrists allows me to forgive the authors of an online screening test!
As for my mood crashes/bouts of rage, they seem to be very 'introspective'- I have never in my (adult) life lapsed into an open display of aggression/anger-I seldom even raise my voice.
(I did brawl occasionally in my youth though!?)
When these creashes happen, my mood becomes erratic, and I simply have to 'withdraw' and deal with it.Those around me would simply attribute this to 'depression', but have no comprehension of the sense of 'rage'or even suicidiality I would be grappling with.I have, ordinarily, near consummate self-control.(maybe that's bad too!?)
The fact that I am, for the most part, well-adjusted and well on the road to recovery has set me on the BP11 trail.I'll chat to my doc. about this tomorrow, but as he's an aussie, he'll most likely tell me to crack open a beer and go grab meself a Sheila!! And maybe I'll succumb...oh, and as far as meditation/prayer are concerned, neither would I dismiss.Seen too much positive evidence for both.
Ps.... Ican feel a PBC (or worse!)looming- ah well, too late now......
Posted by Ron Hill on May 2, 2002, at 16:17:34
In reply to Re: A budding bipolar ??Ron Hill, posted by colin wallace on May 2, 2002, at 16:01:19
Colin,
Are you verbally abusive toward yourself (self-critical) in your self-talk when your mood is outta wack?
-- Ron
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