Posted by Dr. D on May 25, 2006, at 9:53:38
good morning all. I'm writing this because I have a number of questions about depression, mania, and especially medications. I'll provide a brief overview of my history and current situation, and hope you can advise me in the best course of action.
I was diagnosed as being depressed early in my life - already at age 5-6 it started its onset. I walked alone on the playground, didn't play football, had few friends etcetera. My father, who had depressions all his life and was one of the first to have taken MAOIs, recognised this and had to start a war against the then-ruling concept that children could not be depressed (that was the early Eighties; I was born in '76.) Finally however, we found a psychiatrist at least willing to have a look, and not long after they started me out with Tricyclics (Norpramin). This didn't appear to help much, so they switched me over to an MAOI (Humoryl, a french drug) which had markedly better results. However, my youthful recalcitrance and depression itself along with my lack of insight into the importance of taking it prevented my taking it regularly over long periods of time, so I remained the oddball. My lack of social experience was becoming an increasing problem - kids are merciless to each other - and it wasn't until I was 12-13 that I started to actually have good friends and develop something resembling a life. This was after I had moved from the States to my country of birth, the Netherlands, after a sojourn of 10 years due to dad's business.
Then puberty hit with all its annoying complications, so life continued: I was good at school (when I could be bothered to take the effort... I'll spare you my history of "homework helpers" :P) and although most of the kids thought I was a moron, the few people who bothered to take an interest became and have hitherto remained good friends. (I also have to add that I got on increasingly well with them as I got older, so a lot of this is probably typical child and adolescent crap.)
Then at age 15, I discovered weed, and started smoking up. First weekly, then daily, then I was hooked. It became a destructive addiction which affected everything in my life. School went down the drain, I started stealing to finance my addiction (which was later compounded by a gambling machine addiction), I was chronically depressed and stoned and thus too lazy to do pretty much anything with my life except sit behind my computer (which saved my bacon later on.) Nevertheless, with the help of a boarding school, homework helpers and the fact that despite everything I still have a damn good brain, I managed to pass through school and get my diploma.
After this not much changed. I decided to work for a year and give school a break (but was in truth too lazy and down to want to do much of anything). I had a few odd jobs, but none lasted - weed conquered all. I sat at home and played computer games, went out, and increasingly drank more. All this went on until the start of 2002, when I was so thoroughly sick of myself that when I was having one of my better spells, I grabbed the chance with a "now or never" mindset, and quit everything - smoking, weed, and alcohol. Needless to say, the changes were astonishing. I had energy, surprised myself by turning out to be creative and intelligent, and set up a small IT company a few months later with two friends.
The first year or so was excellent. My mind was sharp and I was able to work out and execute one idea after another; in retrospect I think this was a state of controlled hypomania. Unfortunately, this took its toll, and I slowly sunk back down. At the same time something else was happening: my mind was getting "stuck" as a result of constant stress from work. This ultimately ended in a burn-out which I stayed in for two years - from approx. end 2003 to end 2005.
During 2005 somewhere I also slipped back into depression, but my mind was so dulled that I was in no condition to think about it properly, much less get help. I was smoking and drinking again (though thankfully the desire for weed never returned) and I also drank gallons of coffee. I later discovered that both the smoking and the coffee (and, interestingly, doing sports) were keeping me "burned out"; after I stopped those and had two weeks of rest, I was gradually able to think more clearly and the effects of the depression also started to lift away. From research I understand that the burn-out is due to oversensitization of my brain to Cortisol, a steroid produced and used by the body to manage sugar levels and thus energy levels. Coffee, fitness and smoking are known cortisol antagonists, and I noticed I became extremely frustrated about ten seconds after a drag from a cigarette where I was previously feeling decent. Similarly, drinking a cup of coffee resulted in my brain "freezing up" where all I felt was a sort of dizziness and a pressure on the top of my skull. During my burnout/depressed time, I was hardly able to respond to anything at work, could only execute routine chores and reacted overemotionally to everything; every comment from friends or colleagues felt like an accusation instead of a suggestion or an idea, which resulted in my griping them more and more often.
The last two months are decidedly better. I have energy again and can think fairly clearly. I immediately got myself a psychiatrist to help find a way to manage things for the future, because I don't EVER want to fall back into that hellhole of self-hate and pain again. I still drink myself to anywhere between tipsiness and drunkenness in the evenings, although the "need" seems to be becoming weaker. I have visited my psych twice now, but I don't get the impression he's the sharpest tool in the shed. Of course, I could be wrong. But my previous shrinks were generally better and more active. And here's where the questions begin:
- He suggests I start taking a mood stabilizer, as there is a good chance I could slip into (hypo)mania now. He advises Depakine, maybe for a period of two years or so. What do you think of this? Have you had experience with Depakine? Does it work well, and how are the side affects? How about Tegretol, Lithium or Gabapentin? Note: I have never had a true manic episode, only the aforementioned period of hypomania.
- Is there a way to work out what my "baseline" is, that's to say: my average emotional state? If at all possible, I would like to stay in the hypomanic state indefinitely. Is it possible that this is my basic state and that I suffer from depressions, or would you rather say I'm bipolar? Is it possible to medicate yourself safely into controlled hypomania and stay there? Would it, for example, be possible to take e.g. Depakine to control the swings and combine it with an SSRI to "push up" the average level into controlled hypomania? Or is it an "either-or" story: either depressions and hypomania, or neither?
- Does taking medication for longer periods of time "imprint" on the body and brain, meaning that medications will be necessary less often later in life since the body accepts a certain state of mood as the norm?
Any comments would be most welcome. I am perfectly willing to experiment, but am trying to get help from as many corners as possible so I can make a well-balanced decision. Thanks in advance!
regards and best wishes,
Dr. D (I'm not a doctor though.. well, maybe my computer thinks I am, to it :)
poster:Dr. D
thread:648326
URL: http://www.dr-bob.org/babble/psycho/20060517/msgs/648326.html