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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Simcha on August 10, 2001, at 7:33:10
My pdoc said that I definately have Major Depressive Disorder. I've had several MDEs in my short 31 year long life. Therefore I need ADs to remain in remission. OK, I get that...
He said that when I came in initially he thought that I could be bipolar. He says he has not ruled it out completely but he says he has found no real evidence of bipolar in my case so he can't diagnose it...
He also says that I have mild sexual OCD possibly. I guess the fact that I have made so much progress in my 12-step programs around this issue makes my case mild or barely noticeable. That I find amazing!!!
Well, he is treating me as follows. I'm on 40mg of Celexa and 150mg of Wellbutrin SR. I'm feeling better since he has upped my Celexa from 20mg to 40mg. Perhaps this simple diagnosis of MDD is all I have? It would be nice.
How could he end up diagnosing me as bipolar later? I've read some things about bipolar. I read that at some point in your life you need to have exhibited manic symptoms. I don't ever remember a manic phase. I remember a lot of depression. I remember a lot of obsession and compulsive behavior.
I have been super busy before in my life.... Is this what manic is like? Maybe some of the people who have a diagnosis of bipolar could tell me what the illness is like and what the treatment options are...
Ok now I'm rambling... I posted this in the social board too because I did not think I was going to mention my meds after all..
Posted by sl on August 10, 2001, at 11:08:27
In reply to My Diagnosis is in and It's Still Foggy, posted by Simcha on August 10, 2001, at 7:33:10
Hullo again! ;)
Manic generally includes some self-destructive threads, like sexual compulsion, uncontrollable spending sprees, delusions of ..well, big plans you could never follow thru on in the real world... that kinda thing. From what I understand, the consequences just aren't there. Alcohol seems to do that to me...I talk a mile a minute, do things I'd never do, and have more energy than I know what to do with, literally. *shrug*
Anyway, just having energy isn't mania, but if it includes self-destructive or compulsive behavior it could be.
Just my 2cents...
sl
> My pdoc said that I definately have Major Depressive Disorder. I've had several MDEs in my short 31 year long life. Therefore I need ADs to remain in remission. OK, I get that...
>
> He said that when I came in initially he thought that I could be bipolar. He says he has not ruled it out completely but he says he has found no real evidence of bipolar in my case so he can't diagnose it...
>
> He also says that I have mild sexual OCD possibly. I guess the fact that I have made so much progress in my 12-step programs around this issue makes my case mild or barely noticeable. That I find amazing!!!
>
> Well, he is treating me as follows. I'm on 40mg of Celexa and 150mg of Wellbutrin SR. I'm feeling better since he has upped my Celexa from 20mg to 40mg. Perhaps this simple diagnosis of MDD is all I have? It would be nice.
>
> How could he end up diagnosing me as bipolar later? I've read some things about bipolar. I read that at some point in your life you need to have exhibited manic symptoms. I don't ever remember a manic phase. I remember a lot of depression. I remember a lot of obsession and compulsive behavior.
>
> I have been super busy before in my life.... Is this what manic is like? Maybe some of the people who have a diagnosis of bipolar could tell me what the illness is like and what the treatment options are...
>
> Ok now I'm rambling... I posted this in the social board too because I did not think I was going to mention my meds after all..
Posted by stjames on August 10, 2001, at 11:23:05
In reply to My Diagnosis is in and It's Still Foggy, posted by Simcha on August 10, 2001, at 7:33:10
Given that you are doing better I would not fret
so much about a more specific Diagnosis.James
Posted by Simcha on August 10, 2001, at 13:06:37
In reply to Re: My Diagnosis is in and It's Still Foggy, posted by stjames on August 10, 2001, at 11:23:05
Thanks, stjames.... I want to focus on today and not on what might be... I am feeling well today.. Maybe I've found the right treatment for me today.
;-)
> Given that you are doing better I would not fret
> so much about a more specific Diagnosis.
>
> James
Posted by Simcha on August 10, 2001, at 13:17:05
In reply to Re: My Diagnosis is in and It's Still Foggy, posted by sl on August 10, 2001, at 11:08:27
> Hullo again! ;)
>
> Manic generally includes some self-destructive threads, like sexual compulsion, uncontrollable spending sprees, delusions of ..well, big plans you could never follow thru on in the real world... that kinda thing. From what I understand, the consequences just aren't there. Alcohol seems to do that to me...I talk a mile a minute, do things I'd never do, and have more energy than I know what to do with, literally. *shrug*
>
> Anyway, just having energy isn't mania, but if it includes self-destructive or compulsive behavior it could be.
>
> Just my 2cents...
>
> slHey! ;-)
Thanks for the definition. I'm not sure that I qualify for this one... I do have some of that compulsive behavior. Maybe that tipped my pdoc toward a bipolar diagonsis originally. Well, As Stjames said so beautifully, I feel better so I won't worry about a more specific diagnosis.
One day at a time.
Posted by stjames on August 10, 2001, at 15:20:28
In reply to Re: My Diagnosis is in and It's Still Foggy » stjames, posted by Simcha on August 10, 2001, at 13:06:37
> Thanks, stjames.... I want to focus on today and not on what might be... I am feeling well today.. Maybe I've found the right treatment for me today.
James here....
Often your reactions to the meds will indicate a
diagnosis, but the treatments don't really differ
amoung many different conditions. Often it comes down to what meds you tolerate, too.james
Posted by Zo on August 11, 2001, at 17:28:34
In reply to Re: My Diagnosis is in and It's Still Foggy » sl, posted by Simcha on August 10, 2001, at 13:17:05
You know, it clarifies over time. I've been at it 10 years with one of the best medication pdocs in Northern California, and we have just honed in on the BPII part of my dx. . .the ADD became clearer in '97, the TLE in '98. Course my dx is complicated by CFS/FM. . .but what I mean to say is, there is something about the process, it really needs time. . .Time and different med trials and discussion make things more obvious. . There's no substitute for that process.
Zo
Posted by Elizabeth on August 11, 2001, at 23:32:02
In reply to My Diagnosis is in and It's Still Foggy, posted by Simcha on August 10, 2001, at 7:33:10
> My pdoc said that I definately have Major Depressive Disorder. I've had several MDEs in my short 31 year long life. Therefore I need ADs to remain in remission. OK, I get that...
Major depression is a pretty general diagnosis -- it includes a lot of people with a lot of different types of problems, IMO.
> He said that when I came in initially he thought that I could be bipolar. He says he has not ruled it out completely but he says he has found no real evidence of bipolar in my case so he can't diagnose it...
Well, it's a possibility, and he wants to be on the lookout, since antidepressants can be destabilising for bipolar patients.
> He also says that I have mild sexual OCD possibly. I guess the fact that I have made so much progress in my 12-step programs around this issue makes my case mild or barely noticeable. That I find amazing!!!
This should demonstrate to you (and anyone reading this thread) that these diagnoses aren't as clear-cut as they might appear on the surface. For example, it's possible to have some minor obsessive-compulsive behaviours that don't really constitute OCD.
> Well, he is treating me as follows. I'm on 40mg of Celexa and 150mg of Wellbutrin SR. I'm feeling better since he has upped my Celexa from 20mg to 40mg. Perhaps this simple diagnosis of MDD is all I have? It would be nice.
Like many people with recurrent depression, you have other complications. I think this is common.
> How could he end up diagnosing me as bipolar later?
If you suffer a manic or mixed episode in the future. Perhaps he has a hunch, based on the presentation of your depression, that you might be susceptible to mania or hypomania.
> I've read some things about bipolar. I read that at some point in your life you need to have exhibited manic symptoms. I don't ever remember a manic phase. I remember a lot of depression. I remember a lot of obsession and compulsive behavior.
Some manias and hypomanias are not as obvious as the classic euphoric mania. There may be mixed features -- symptoms of depression and mania occurring simultaneously. Mixed episodes are characterised by anger, agitation, etc. -- unpleasant feelings, rather than a "high" -- combined with behavioural inhibition and impulsivity.
> I have been super busy before in my life.... Is this what manic is like?
That's a common feature -- a period of intense goal-directed activity and feeling like you're accomplishing a lot -- although that by itself doesn't constitute mania or hypomania.
> Maybe some of the people who have a diagnosis of bipolar could tell me what the illness is like and what the treatment options are...
Bipolar disorder is as broad a category as major depression is. You will find that you get a lot of different answers to this question.
> Ok now I'm rambling... I posted this in the social board too because I did not think I was going to mention my meds after all..
Rambling's fine...although it could be a sign of hypomania. :-)
I can give you one bit of advise: if you're not sure if you're unipolar or bipolar, you should take special care to monitor your behaviour and moods when taking antidepressants. If you start seeing signs of impulsivity (spending excessive amounts of money, abusing drugs, hypersexuality, risk taking or self-destructiveness), anger or irritability, racing thoughts, excessive energy (like, you stop feeling a need to eat or sleep), grandiosity (making "big plans" that aren't realistic, for example), etc. If you do feel uncertain about your mood state, ask someone who you spend a lot of time with if you've been acting unusually in any of these ways.
I hope this is helpful to you.
-elizabeth
Posted by sl on August 12, 2001, at 13:35:18
In reply to unipolar vs. bipolar » Simcha, posted by Elizabeth on August 11, 2001, at 23:32:02
Just a note to thank you for agreeing. Sometimes I'm afraid if nobody agrees with me I'm terribly misled/confused. :P
But you just repeated/confirmed/elaborated my definition of mania above. :)Thanks!
sl
Posted by Simcha on August 12, 2001, at 20:28:17
In reply to unipolar vs. bipolar » Simcha, posted by Elizabeth on August 11, 2001, at 23:32:02
Elizabeth,
Thank you soooo much for the very thurough explanation. It really helps me. I might be bipolar as you state it... Well, I guess I'll just wait and see how I do on these meds. I'm not feeling hungry today. That's bizarre for me. It was also a symptom of my depression so that feels weird. It is a side-effect of the Wellbutrin, and actually a welcome one. I gained weight on Effexor. :-)
I haven't had much energy since I titrated up to 40mg of Celexa. I was talking to a friend here who has been on different meds at different times. She is also a nurse. She said I could possibly be adjusting to the new dose for a few weeks.
Fatigue and lack of hunger were depression symptoms for me. It's strange to have these symptoms without the negative thinking that accompanied them before. Maybe these symptoms are just temporary side effects until I get used to these meds? We shall see.
> > My pdoc said that I definately have Major Depressive Disorder. I've had several MDEs in my short 31 year long life. Therefore I need ADs to remain in remission. OK, I get that...
>
> Major depression is a pretty general diagnosis -- it includes a lot of people with a lot of different types of problems, IMO.
>
> > He said that when I came in initially he thought that I could be bipolar. He says he has not ruled it out completely but he says he has found no real evidence of bipolar in my case so he can't diagnose it...
>
> Well, it's a possibility, and he wants to be on the lookout, since antidepressants can be destabilising for bipolar patients.
>
> > He also says that I have mild sexual OCD possibly. I guess the fact that I have made so much progress in my 12-step programs around this issue makes my case mild or barely noticeable. That I find amazing!!!
>
> This should demonstrate to you (and anyone reading this thread) that these diagnoses aren't as clear-cut as they might appear on the surface. For example, it's possible to have some minor obsessive-compulsive behaviours that don't really constitute OCD.
>
> > Well, he is treating me as follows. I'm on 40mg of Celexa and 150mg of Wellbutrin SR. I'm feeling better since he has upped my Celexa from 20mg to 40mg. Perhaps this simple diagnosis of MDD is all I have? It would be nice.
>
> Like many people with recurrent depression, you have other complications. I think this is common.
>
> > How could he end up diagnosing me as bipolar later?
>
> If you suffer a manic or mixed episode in the future. Perhaps he has a hunch, based on the presentation of your depression, that you might be susceptible to mania or hypomania.
>
> > I've read some things about bipolar. I read that at some point in your life you need to have exhibited manic symptoms. I don't ever remember a manic phase. I remember a lot of depression. I remember a lot of obsession and compulsive behavior.
>
> Some manias and hypomanias are not as obvious as the classic euphoric mania. There may be mixed features -- symptoms of depression and mania occurring simultaneously. Mixed episodes are characterised by anger, agitation, etc. -- unpleasant feelings, rather than a "high" -- combined with behavioural inhibition and impulsivity.
>
> > I have been super busy before in my life.... Is this what manic is like?
>
> That's a common feature -- a period of intense goal-directed activity and feeling like you're accomplishing a lot -- although that by itself doesn't constitute mania or hypomania.
>
> > Maybe some of the people who have a diagnosis of bipolar could tell me what the illness is like and what the treatment options are...
>
> Bipolar disorder is as broad a category as major depression is. You will find that you get a lot of different answers to this question.
>
> > Ok now I'm rambling... I posted this in the social board too because I did not think I was going to mention my meds after all..
>
> Rambling's fine...although it could be a sign of hypomania. :-)
>
> I can give you one bit of advise: if you're not sure if you're unipolar or bipolar, you should take special care to monitor your behaviour and moods when taking antidepressants. If you start seeing signs of impulsivity (spending excessive amounts of money, abusing drugs, hypersexuality, risk taking or self-destructiveness), anger or irritability, racing thoughts, excessive energy (like, you stop feeling a need to eat or sleep), grandiosity (making "big plans" that aren't realistic, for example), etc. If you do feel uncertain about your mood state, ask someone who you spend a lot of time with if you've been acting unusually in any of these ways.
>
> I hope this is helpful to you.
>
> -elizabeth
Posted by Elizabeth on August 15, 2001, at 18:32:26
In reply to Re: unipolar vs. bipolar » Elizabeth, posted by Simcha on August 12, 2001, at 20:28:17
Hi. Just a "you're welcome." I'm glad to hear my post was useful.
Simcha:
> I'm not feeling hungry today. That's bizarre for me. It was also a symptom of my depression so that feels weird.I agree; I've had some appetite loss on desipramine. For a while I was eating normally, then the appetite improvement went away again. Very odd. I do think you will probably adjust with time; whoever comes out with an appetite suppressant that works long-term will become extremely wealthy.
BTW, I said "behavioural inhibition" somewhere in my previous post; it should have been "disinhibition."
-elizabeth
This is the end of the thread.
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