Posted by Fuscia on July 7, 2002, at 11:25:03
In reply to Bipolar or ADD??? » Fuscia, posted by JonW on July 2, 2002, at 12:34:41
> > Hi Jon the poet,
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> Hey, your nickname alone is far more poetic than I'll ever be! :-)
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> > It is good to see you question your diagnosis. It can take years to properly diagnose bi-polar
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> I understand it takes like an average of 8 years from the first report of symptoms and 2 to 3 pdocs to get a correct diagnosis of bipolar disorder. Sometimes I think my symptoms are the result of bipolar disorder and sometimes of ADD. It seems more like ADD, but I don't know a lot about differential diagnosis. I'm not sure how much it matters at this stage of the game.
>
> >have a friend that is a rapid cylcer bi-polar - days start out very depressing, don't want to get out of bed, and then are pretty high by late afternoon. SSRI's worked pretty well the first
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> I'm dead in the morning (slow, depressed, low energy), and I'm a noticeably better by say 10:00am. I have trouble falling asleep (Nardil has made this worse) and trougle waking. I wouldn't describe anything I experience as "high". I feel like I suffer more from mood lability and less from mood cycling. Any so-called cycle certainly wasn't and isn't too profound in terms of "high" and "low" -- but I've definitely always had sleep problems, trouble getting to sleep, trouble waking. By the way, my mood is very sensitive to sunlight. Agitation and irritability have definitely been a *big* problem and are usually aggrevated by anti-depressants. Should I be called bipolar simply because of this reaction to anti-depressants? What do you think? Please ask any questions you want...
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> > Anyway, I was curious, are the above listed symptoms prior to the meds you are currently taking? Do you have any impulses? Shopping? Sex? Aversion to sex? Substance abuse? How does caffeine effect you? How about sugar or bready sugar foods, like doughnuts, waffles, and other simple carbs? How do you do when you're all by yourself? There's lots more questions I could ask, but I don't want to be too nosey ; )
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> Please, be as nosey as you want and ask as many questions as you like! I'm open to anything that could ultimately lead to insight. As for the questions you asked... Yes, the symptoms I described precede being on medication. If anything, I would describe myself as hyper-sexual -- but I have severe social phobia, so you do the math! ;) I *love* carbs! French toast is one of my favorites! When I was a kid I used to eat sugar from the packets at restaurants, my parents would have to stop me. I hate being alone and I hate being bored. If I'm alone or bored I'll often go out in my car for a drive.
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> Thanks for the reply! You've been very helpful.
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> JonHi Jon,
I didn't have time to really think over and answer your post, but now I do (hubby is still in bed - he's an at home engineer (mechanical/design) and usually gives me the elbow to "MOVE OVER" when he needs to use this computer).
Anyway, I was thinking about what you said concerning craving beer, that you love sweets, and how you used to down packets of sugar when you were a child. Well, I started thinking about hypoglycemia. You've probably heard about this low blood sugar problem. It can cause a variety of symptoms that can be mistaken for other health disorders. So, I thought I'd post you the following, just in case you don't need to start taking Adderall or Ritalin. It could just be a diet thing.
I mentioned to my rapid cycling friend that he might try taking a spirulina supplement in the middle of the night in case his morning lows were due to low blood sugar. He never tried it and so I don't know if this was what was causing his morning blues - it was so bad that he didn't even want to get out of bed most mornings.
I have had problems with simple carbohydrate cravings most of my life that started when I was in my early teens. I began to upchuck food after binging in order to stay thin - didn't work. I blimped out anyway, this when I was 16 or 17. I had bulimia. Anyway, throughout my life I've been at a fairly normal weight, though my low-self esteem told me I was fat and ugly. I binged and purged for years until my husband was laid of from the aerospace industry during the early Clinton days. Aerospace was then a dead dog, it still is. We moved out to the country and I think this made me not be self-conscious of myself for what did I care what our hillybilly neighbour thought of me. I began to relax more and care less about my appearance, and stopped the purging, but still had problems with the binging on cookies, cake, white flour stuff like homemade bread, etc. Then, when I was started on Zoloft over two years ago, (25mg) the cravings instantly ceased. I had no appetite, and I began to lose a pound or two. It is still this way for me. SSRI's have completely changed my appetite and I no longer have food cravings - in fact, many times I could easily skip a meal, but I force myself to prepare something for my husband's stomach. This was one appreciated effect from the SSRI's, for it was THAT BAD. Anyway, I used to get very lethargic in the daytime from these food binges, especially mid to late afternoon. Now my energy seems to start at that time of day - quite the opposite. I can't say I was this way on Celexa for it made me lazy - too sedating. It has been shown that bulimia folks have low serotonin levels, so this may be why I no longer see food in the same light. I've been on SSRI's for 2 years and I've not become overweight like so many others complain of. I'm of average weight for my bone size and height, which I am pleased with, especially living in Arkansas where folks tend to be extremely overweight. Anyway, I thought I'd share that with you.
I wouldn't call you bi-polar just from aggravation from SSRI's. That is just an indicator. I must be bi-polar as well for they say a rapid response from SSRI's is a good indicator of bi-polar disorder, and I had one rapid response - two days.
The aggravation could have simply been from too high a start up dose of the SSRI. Like I said, there are some folks that are super sensitive to the effects of drugs. This is very true for high adrenaline Panic Disorder folks. These people are running on fight or flight hormones and this would make any medicine's effects very pronounced.
Here is the information you might find interesting: I'll probably post some more for you on this subject. Maybe you can try reducing the simple carbs from your diet (yes, you'll go through withdrawals for the first few days - I did when I tried it, but I felt so much better by the 5th day of no sugar and no butter sauted flour tortillas that I was truly amazed!) I think you gave me an idea for tomorrows breakfast - French toast. That has eggs in it, so can't be too bad for you ; )
From the book, The Antidepressant Survival Guide by Rober J. Hedaya, M.D.
Hypoglycemia Self-Evaluation
1. If you miss a meal or go more than three or four hours without eating, do you experience any of the following symptoms: irritable, restless, jittery, dizzy, nauseous, lightheaded, sweaty, trouble concentrating, headache?
If so, are these symptoms alleviated by food?
2. Do you frequently crave sugar, cakes, cookies, sweets, or alcohol?
3. Have you gained ten pounds or more since beginning antidepressants?
These are all signs that you may have a condition known as hypoglycemia, or low blood sugar.The control of blood sugar within a normal range is a very complex process, which involves multiple chemicals (epinephrine, insulin, glucagon, cortisol) and minerals (chromium, selenium, manganese, and vanadium). With careful questioning I have found that about 50 % of my patients experience symptoms of hypoglycemia. Hypoglycemia contributes to the weight gain caused by antidepressants.
What exactly is hypoglycemia? It is an intermittent but usually long-term condition that causes blood-sugar levels to fall below the normal range necessary for optimal functioning of the brain and body. Your body can respond to the early stages of hypoglycemia by causing intense cravings for sweets and starches. This is your body signaling your brain that you need more glucose in your bloodstream-NOW! Once your body is in this state, you may either feed these cravings with carbohydrates or drink something with caffeine-which temporarily causes a release of adrenaline, which raises your blood sugar. If you don't respond, you will feel woozy, irritable, and nervous. Most people take a quick sugar fix. This causes temporary relief by increasing blood sugar, but it also increases the output of insulin and cortisol, both of which lead to weight gain and further blood-sugar problems. It's a vicious cycle that quickly spins out of control.
If you're hypoglycemic, your pancreas gradually becomes ill-equipped to handle foods high in sugar or other simple carbohydrates. These are foods that have a high glycemic index, which means your body rapidly breaks them down into glucose and shuttles this glucose into your bloodstream to give you instant energy. Eventually, your pancreas responds too forcefully, by releasing too much insulin to help your cells use the glucose in your blood. So instead of giving you a sustained amount of energy, your blood-sugar levels spike temporarily before plunging again. Any excess sugar not used by your cells gets carted away to be stored as fat-which is why you gain weight. The more you feed your sugar cravings, the less efficient your body becomes at using the sugar. As a result, you feel more intense hunger, which makes you eat more sugar, which causes you to gain weight. Starting to get the picture?
When you bring antidepressants to the mix (with the exception of Serzone and Wellbutrin), you frequently add at least one or two other mechanisms to the weight gain dilemma. All antidepressants that affect serotonin initially cause an increase in serotonin availability. This reduces appetite and contributes to weight loss (which is why the makers of Prozac, Eli Lilly, initially considered marketing it to help with weight reduction). Eventually, however, for most people, the nerve cells adjust to this state, and the net effect can be less (but more efficient) serotonin activity, resulting in increased appetite. In addition to this mechanism, many antidepressants can have an antihistamine effect, which in and of itself may cause weight gain.
The bottom line is that when you add the hypoglycemic drive to eat simply carbohydrates to the serotonin and antihistamine mechanisms, you have a prescription for serious weight gain-and serious loss of self-esteem. Not only have you gained twenty pounds but you can't seem to get a handle on your sugar cravings!
Diagnosis of and Treatment for Hypoglycemia
If you have any of the signs of hypoglycemia, you need to discuss your symptoms with your doctor. Before your appointment, keep a food diary for a week. Write down everything you ate, how you felt right after eating, and whether you experienced any symptoms (fatigue, wooziness, irritability, and so on) one to three hours later. Keep a record of your food cravings and how you dealt with them.
Take this food diary to your doctor. It will be a basis of your diagnosis. Unfortunately, there is no reliable test to confirm whether you have hypoglycemia. (Many doctors perform a glucose tolerance test, in which peaks and valleys of your blood-sugar levels are measured for several hours after drinking a high-sugar beverage. I've found that this test frequently enough misses clinically confirmed cases of hypoglycemia. For this reason, I don't perform it on my patients.)
If you do have signs of hypoglycemia, following the nutrition plan will help get the condition under control. Forgoing sugar, alcohol, caffeine, and refined carbohydrates will help stabilize your blood-sugar levels very rapidly. Eating an increased amount of protein will give you sustained energy. Replenishing your minerals will be critical.
Realize, though, that when you begin the nutrition plan you may not feel well as your body adjusts to less sugar. The first three or four days are the hardest: Many of my patients report feeling weak, dizzy, tired, and moody. After this initial stage, though, your energy will rebound, your depression will lift, and you'll be free from your cravings. By six weeks your taste buds and preferences will have changed so much that you will be surprised you once thought those sweet foods tasted so good. You'll probably also notice that your clothes are looser as you begin to lose weight and retain less fluid. On the flip side, if you cheat a little and sneak some cookies or ice cream, you'll see that your hypoglycemic symptoms will quickly return, and your taste buds and preferences will not change.You also need to make four additional modifications to your eating habits to keep hypoglycemia at bay:
1. Eat five or six small balanced meals a day. More frequent meals will keep your blood-sugar levels stable and should prevent hypoglycemic symptoms.
2. Be sure these meals or snacks contain the right carbohydrate-to-protein ratio. Snacks should have at least 7 grams of protein for every 10 grams of carbohydrates. Read the food labels. Or, if there is no label to read, eyeball the food. The protein (meat, fish, turkey, and so one) portion should be slightly more than one-third the volume of the meal, with the other two-thirds being carbohydrate. Snacks that are balanced will help reduce sugar cravings and keep your appetite under control. Some great balanced snacks include a handful of nuts with some fresh fruit, a cup of plain yogurt sprinkled with wheat germ, cottage cheese on a rye cracker.
3. Avoid artificial sweeteners. No, they aren't sugar, but they can contribute to sugar cravings. If your body is used to getting something sweet, it will continue to crave sugar.
4. Learn to recognize the difference between fatigue and hunger. We often gravitate toward sweet foods thinking they will give us an energy boost when the real problem is fatigue and stress. This depletion usually is associated with cravings toward the end of the day (when you are most tired) or after a night or more of inadequate sleep. Five minutes of simple relaxation will usually alleviate the problem for a while. Catching up on your nighttime sleep will also help a lot.Note To Your Doctor
In my experience, antidepressants can cause or worsen hypoglycemia in many patients. Antidepressants may increase appetite via histamine or serotonergic mechanisms (possibly via the 5-HT2c receptor). Initially, with the serotonergic reuptake inhibition caused by the antidepressant, you will note decreased appetite in your patients. As the postsynaptic serotonergic receptors downregulate in response to the increased serotonin output, the net effect is often a decrease in serotonergic activity, probably in the serotonergic neurons that run from the raphe (mid-brain) to the hypothalamus. Decreased serotonergic activity in this pathway is associated with increased eating. Serzone is unique in that is increases serotonergic output from the presynaptic neuron but blocks the 5-HT2c receptors, so there is no increased serotonergic activity at these receptors and perhaps then no alteration in the raphe-hypothalamic serotonin pathway.
Patients who are clinically hypoglycemic already have a tendency to overeat (independent of the serotonergic and antihistamine drives), particularly carbohydrates. Intervening in this mechanism will help reduce this contribution to weight gain, which occurs at least in part via elevated glucose levels, with gradual insulin resistance, increased insulin output, consequent increased levels of cortisol, and sequestration of glucose in adipose tissue.
I don't put much stock in the glucose tolerance test because of its high rate of false negatives. A far more reliable method is to have your patients keep a written record of what they've eaten and when they experience the onset of symptoms. They should note the effect of a high-carbohydrate snack on their symptoms. I keep a box of fruit cookies in my office and offer a few to fasting patients whom I suspect are experiencing low-blood-sugar levels at the time of their appointments. I then see if they feel any better.
If you suspect hypoglycemia based on history, you can try putting the patient on the Five-Day Jump Start to confirm whether dietary intervention will help improve symptoms. If the patient closely follows the plan and notes significant improvement, you should consider the diagnosis of hypoglycemia reasonably likely. Treating the hypoglycemia with frequent meals balanced with low glycemic index carbohydrates as well as high-quality protein generally has a very beneficial impact on the patient's energy, weight, and mood.
In addition, you should perform a mineral profile, since low chromium, vanadium, and possible manganese and selenium levels are clearly associated with glucose tolerance. If the patient's mineral profile comes back with low or borderline low levels of these minerals, I recommend supplementing fairly aggressively, rechecking the levels in two to three months. Vanadium has been associated with mood-altering properties, but I have not had the occasion to intervene with this mineral in any of my patients. Chromium can be used in doses of 150 to 200 micrograms three times a day. Patients need to be monitored because toxicity can occur, manifested by dermatitis, gastrointestinal ulcers, and kidney and liver disease.
poster:Fuscia
thread:111115
URL: http://www.dr-bob.org/babble/20020628/msgs/111656.html