Posted by SLS on March 10, 2012, at 7:39:51
In reply to Re: To SLS: update » SLS, posted by Roslynn on March 9, 2012, at 15:42:50
Hi Roslynn.
What's happening?
Have you had any dissociative or panic episodes?
Why were you prescribed lithium?
Why was the dosage of 600 mg/day chosen?
How do you experience anxiety? What are the symptoms?
Does anxiety disappear when the depression goes into remission?
Does your anxiety get worse when your depression gets worse?
What situations make your anxiety worse?
How is your mental energy level?
Do you ever experience racing thoughts?> I am so glad you are doing better! How far do you think you have to go before you achieve remission?
I am perhaps 30% improved as compared to my untreated baseline. I have very clear recollections of what remission feels like, as I was 100% improved for 6 months in 1987. I remain optimistic that I will reach remission within a year. Progress is slow. However, progress is wonderful and exciting. I have no complaints (today).
> To answer your question, my diagnosis is recurring major depressive disorder.
How often does it recur?
> I think it is the "atypical" type. Probably also anxiety disorder, though that has not been formally diagnosed.
Bipolar depression looks very much like atypical unipolar depression.
> I am not bipolar and I'm not sure why I get the depersonalization/derealization sometimes.
When you combine anhedonia with anxiety, this is what can happen.
> I don't know, maybe it was from dropping the 600mg lithium down to 300mg. The drop is also making me really nauseated and dizzy.
Well, I think you need to look at the possibility that you might be bipolar, and that these symptoms are early signs of relapse.
- Scott------------------------------------------------
I don't consider this an exhaustive list, and not all items listed are found in any one individual.
http://www.psycheducation.org/depression/02_diagnosis.html#soft
"Unofficial but evidence-based markers of Bipolar DisorderYou have probably figured it out by now: making a diagnosis of bipolar disorder can be pretty tricky sometimes! You're about to read a list of eleven more factors that have been associated with bipolar disorder. None of these factors "clinches" the diagnosis. They are suggestive of bipolarity, but not sufficient to establish it. They are best regarded as markers which suggest considering bipolar disorder as a possible explanation for symptoms. They are not a scoring system, where you might think "the more I have of these, the more likely it is that I have bipolar disorder." That way of thinking about these factors has not been tested.
Here's the list of items which are found with bipolar disorder more often than you would expect by chance alone. This list is adapted from a landmark article by Drs. Ghaemi and Goodwin and Ko. (Drs. Goodwin and Ghaemi are among the most respected authorities on bipolar diagnosis in the world. This important article is online).
The patient has had repeated episodes of major depression (four or more; seasonal shifts in mood are also common).
The first episode of major depression occurred before age 25 (some experts say before age 20, a few before age 18; most likely, the younger you were at the first episode, the more it is that bipolar disorder, not "unipolar", was the basis for that episode).
A first-degree relative (mother/father, brother/sister, daughter/son) has a diagnosis of bipolar disorder.
When not depressed, mood and energy are a bit higher than average, all the time ("hyperthymic personality").
When depressed, symptoms are "atypical": extremely low energy and activity; excessive sleep (e.g. more than 10 hours a day); mood is highly reactive to the actions and reactions of others; and (the weakest such sign) appetite is more likely to be increased than decreased. Some experts think that carbohydrate craving and night eating are variants of this appetite effect.
Episodes of major depression are brief, e.g. less than 3 months.
The patient has had psychosis (loss of contact with reality) during an episode of depression.
The patient has had severe depression after giving birth to a child ("postpartum depression").
The patient has had hypomania or mania while taking an antidepressant (remember, severe irritability, difficulty sleeping, and agitation may -- but do not always -- qualify for "hypomania").
The patient has had loss of response to an antidepressant (sometimes called "Prozac Poop-out"): it worked well for a while then the depression symptoms came back, usually within a few months.
Three or more antidepressants have been tried, and none worked.There is a very radical idea buried in these 11 items, which we should look at before going on, but you should be aware that this idea is likely be dismissed with a "hmmmph" by many practicing psychiatrists. The idea is this: Dr. Ghaemi and colleagues propose that there might be a version of "bipolar disorder" that does not have any mania at all, not even hypomania. They call it "bipolar spectrum disorder"."
This form of bipolar disorder is also to be called Bipolar V in the new DSM V."Bipolar V involves patients who only experience depressive symptoms as a diagnosis of major depressive disorder, but have a family history of bipolar disorder. The knowledge of bipolar disorder existing in family history would suggest starting depression treatment with a mood-stabilizer or an antipsychotic that treats depression. Because of the family history, if a patient was started on an antidepressant it could easily act as the trigger for developing bipolar because it produced manic symptoms (type IV). In family studies, the link between genetics and mental disorder has been proven to be strong. Patients should remember that genetics doesn't doom them to developing a disorder, there must be a trigger."
BIPOLAR I: Both mania and major depressionBIPOLAR II: Major depression and hypomania
BIPOLAR III: Cyclothymia. Mild depression and hypomania
BIPOLAR IV: Depression and usually no mania. Mania may be triggered by some
antidepressants.BIPOLAR V: Depression and no mania. Some blood relatives have had mania
BIPOLAR VI: Mania and no depression
Some see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1012587
URL: http://www.dr-bob.org/babble/20120302/msgs/1012710.html