Posted by Ron Hill on September 19, 2007, at 4:20:52
In reply to Are AD's causing me to rapid cycle? - To Ron Hill, posted by AnneL on September 18, 2007, at 9:56:26
Quick Note to all PB Readers:
This new thread is a continuation of a previous thread located at:
http://www.dr-bob.org/babble/20070831/msgs/780264.htmlAlso, please note that a list of links to research articles addressing the topic of AD-induced rapid cycling and AD-induced mania are located at:
http://www.dr-bob.org/babble/20070911/msgs/782870.html
----------------------------------------------Anne,
Three topics in this post.
Topic #1 – Is Anne Bipolar?
Here are the answer keys to Test #1
http://i.cmpnet.com/CME/pt/PDF/MDQ_Instructs.pdf ,
and Test #2
http://i.cmpnet.com/CME/pt/PDF/HAMD_Instructs.pdfPlease tell me the scores for both tests. One thing I forgot to tell you is that Test #2 is actually a test to determine if the pt is in depression, and if so, what kind of depressive symptoms does the pt have when in a depressive episode. Therefore, I intended to tell you to answer the questions as if you were currently in depression. Does that make sense?
Anne, as you look back over your life prior to 7 years ago, do you see times that you periodically became depressed, and times when you periodically became hypomanic? If so, can you identify any cycling tendencies, albeit much less frequently than now?
How often do you think you are rapid cycling right now? Let’s arbitrarily start the stop-watch at the beginning of a depressive phase. Then one complete cycle would be: Depressive Phase; maybe some dysphoria as the pt comes out of depression; typically followed by a Hypomanic Phase; then Normal Mood Phase; then the next cycle starts at the very beginning of the next depressive phase.
So, Anne, how long do you think it takes you to go through one complete cycle (i.e; the time elapsed from the very beginning of one depressive phase to the very beginning of the next depressive phase)? Do you think that the duration of all consecutive cycles are the same?
Based on all that you know about yourself, and based on the Test #1 results, do you personally think you are bipolar?
Topic #2 -- Daily Mood Tracking
As I’ve said before, in March 2004, I began to daily record the severity levels of my depression, hypomania, and irritability on a scale of 0 to 5. I enter my data into an Excel spreadsheet, and Excel takes the numerical data entries and presents them graphically verse time.
Hypomania has not been problematic for me because I can stop it in its tracks using Trileptal. And, although there have been times when I have experienced severe dysphoric irritability, it’s not my real problem.
My big problem has been depression. So, my depression graph is the one I pay close attention to. My depression graph is absolutely eye opening. Incredible!! My ultra rapid cycling frequency jumps off the page. And I had no idea that this was going on until I started tracking. I wish there were a way for me to send you my graph, so you could see it for yourself.
My mood tracking depression graph is a great diagnostic tool. It clearly shows me which med changes have led to an improvement and which have not. My pdoc loves my graph. The first thing we do at my appointments, is look at my graph.
Anne, you know why I’m saying all this, right? I would love to see you start tracking your moods on a daily basis. It will help you immensely. If you want, just record your mood by hand using four pieces of graph paper. I’d suggest that you track these; Depression, Hypomania, Anxiety, and Dysphoria. But, you know best, so track what you think is important.
Alternatively, you can use a mood tracking program off the net (free). I know of the following ones, and you could probably find others by doing some google searching. Here are the mood tracking programs, and one nice fill in the blank, type of form:
Fill in the blank print off. If you use this one, I encourage you to graph the results by hand onto pieces of graph paper; one piece for each mood state. And, connect the dots on the individual graphs, via free hand drawing.
http://www.psychiatry24x7.com/bgdisplay.jhtml?itemname=mooddiaryDr Phelps Electronic Mood Tracking Software
http://www.psycheducation.org/FAQ/MoodCharts.htmMoodTracker.com
http://www.moodtracker.com/ShrinkTank™ Web Site Files Page
http://www.shrinktank.com/psyfiles.htmBeware. These are programs that you are allowing to be put on your machine. The site looks safe, but make sure you anti-virus software is fully up to date, just incase. And only download them if you decide they look safe.
moodchrt.zip [15 K] W.P.5.1 Chart for moods, depression, man-dep.
[790k] moods.exe - Track/Analyze your moods - Windows
Scroll through the entire site. There are a ton of downloadable programs that may be of interest to you. For example:
panic5.zip [2 K] Commandments to Remember During a Panic Attack
pdq4p&p.zip [23 K] File contains a copy of the Personality Diagnostic Questionnnaire version 4 for the DSM-IV (PDQ-4). Questionnaire can be used for the screening and assessment of personality disorders consistent with the DSM-IV. This "paper & pencil" versi
Topic #3 – Previous (and current?) Self-Medication Using Exercise
Anne, prior to 1996 when my initial pdoc got me all screwed up by misdiagnosing me as ADHD and feeding me Ritalin and Paxil, I did not know that I was bipolar. But, looking back, the BP dx makes a lot of sense and explains a lot. Looking back, I used to cycle about four times per year before getting screwed up. As you know, I know ultra rapid cycle every 15 days, thanks to the idiot pdoc.
Prior to 1996, I used to unknowingly self-medicate with exercise. I was still single at the time, so I had the time and I could do what I wanted. I would hit the health club and get in a lift before work, ride (cycle) 50 or 60 after work, then hit the club again for a swim and sauna. My friends used to criticize me and call me obsessed for working out so much. But, all I knew was that if I did not workout, the stress of my job and life would cause me to unravel.
> History: Rx'd Effexor by my old GP because of some serious depression. I was completely oblivious to problems in my household because I was over-exercising, restricting my food intake, and sleeping maybe 4 hours a night and getting up early to go running. My 13 year old at the time had suicidal ideation and was hospitalized. This caused me great depression at what I had allowed to happen in my own family.
Anne, I talked about my exercise program prior to 1996 solely to ask you if you think you were self-medicating with exercise. Do you?
Do NOT misunderstand me. Exercise is a wonderful natural antidepressant due to the release of phenylethylamine (PEA). Everyone should exercise, and it is absolutely essential for bipolar pts to get into a good workout routine.
As you know, PEA is the neurotransmitter that is released in the brain when people fall in love. It is also in cocoa, an ingredient in chocolate.
As an aside with regard to PEA, when you and I get to the point of listing various possible antidepressant ideas for your long term use, perhaps as one idea, we can talk about taking a dose of PEA in conjunction with a low dose (10 mg) of oral deprenyl (Selegiline).
At 10 mg, deprenyl is a selective MAOI-B. Under normal conditions, PEA in the brain is quickly metabolized by MAO-B enzymes. But, when taking 10 mg of deprenyl, the MAO-B enzymes are inhibited which, thereby, greatly extends the half-life of PEA, and results in an endogenous antidepressant effect.
Topic #3 – Procedures for Opening One of the Documents in a Previous PostAnne, if you had trouble pulling up the full text for the fifth link, http://ajp.psychiatryonline.org/cgi/reprint/152/8/1130?ijkey=c5e3324fd1b2577cc2910022f8a9ce949082da45 , that I listed in this post, http://www.dr-bob.org/babble/20070911/msgs/782870.html , it is because I had to go through a back door to get the full test. Here is the back door procedure:
Click on the fourth link in the list, http://ajp.psychiatryonline.org/cgi/content/full/161/1/163?ijkey=aa1d32dd405ab19eb7bf715a275077615f754f7a, scroll to the bottom of the article and find the list of References. In reference number 6, click on the Free Full Text link. When the page comes up, click on Full Text (PDF) in the boxed in area to the right. When the next page comes up, click on [Begin manual download]. At long last, there is the full text of the article corresponding to the fifth link in the list.
For any of the other APJ links that only pull up only the abstract, merely click on the Full Text link in the boxed in area. If you chose to give your pdoc copies of all of the articles that discuss AD-induced rapid cycling and AD-induced mania, then give her copies of the full text versions. As an aside, I hope you do chose to give copies to her, but you know what is best.
You get off easy today; No homework, and only a couple of questions to answer! Enjoy it while you can because there will be homework (small amount) tomorrow.
Anne, on a very serious note, I hope that your 20 year old son, you daughter, and your entire family are doing well.
I’m on your team, ya know?
-- Ron
Bipolar II with ultra rapid cycling (15 day cycle), and mild Obsessive Compulsive Personality Disorder (OCPD)
600 mg/day Trileptal
200 mg/day Lamictal
875 mg/day Keppra
90 mg/day Nardil
poster:Ron Hill
thread:783710
URL: http://www.dr-bob.org/babble/20070919/msgs/783875.html