![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by spike4848 on January 23, 2002, at 0:00:05
Hey There Everybody,
This post struck me as very insightful .... and very helpful. I have read alot about bipolar spectrum disorders and bipolar II/III in the literature. Elizabeth's view finally uses some common sense to describe the correct way at viewing "soft bipolar" disorders. I thought it was worth posting again if anyone missed it. Thanks Elizabeth.
"Here's my take on the issue of "soft" bipolar disorders (a seemingly ever-expanding category)....
In addition to classic depression and manic-depression, there seems to be another category of mood disorder, the core symptom of which is what I will call "mood dysregulation" (a term sometimes used in the literature). This symptom is often attributed to anxiety and/or personality disorders. It may be identified as extreme interpersonal sensitivity (social phobia, atypical depression) or excessive mood reactivity (usually diagnosed as emotionally unstable [cluster B] personality disorder). The mood dysregulation syndrome also resemble posttraumatic stress, except that the reactions occur frequently and are far out of proportion to the "traumatic" events. Sometimes there is a personal history of severe childhood trauma, which probably contributes to the syndrome in many people, perhaps sensitising them to emotional pain later in life, contributing to the development of dissociative symptoms, etc. There also may be temperamental (congenital) aspects: some people seem to be sensitive, easily hurt, "thin-skinned," by nature.The group of people who I'm attempting to identify are very susceptible to emotional pain and tend to have extreme reactions even to relatively minor hurts or losses. The mood dysregulation results in behavioural manifestations that can resemble symptoms of depression, mania, and/or anxiety disorders.
The course appears to be episodic; mood dysregulation episodes are much briefer than major depressive, manic, or hypomanic episodes, lasting hours or at most days rather than weeks, months, or years. Some examples of mood dysregulation episodes:
-extreme, but short-lived, depression following interpersonal rejection or loss (e.g., feeling suicidal after the breakup of a romantic relationship)
-anxiety attacks in response to fear or threat of loss, rejection, or abandonment
-emotional "crises" or "breakdowns," often involving self-injury or impulsive suicide attempts
-impulsive aggression and intense anger, often directed at selfMood dysregulation and emotional hypersensitivity also have profound effects on a person's outlook:
- a sense of desperation and chronic suicidality
- feelings of bleakness, emptiness or boredom when not in a state of "crisis"
- thrill seeking, risk taking, and/or self-destructive behaviour (perhaps in an effort to recreate emotional crises)
- extreme concern about how the person is viewed or judged by others, resulting in body dysmorphia, eating disorders, various types of social anxiety, etc.
- drug abuse (especially, alcoholism) in attempts to self-medicate; addiction may occur very rapidly perhaps due to impulsivity and frequent excess in the use of drugsMedications that seem to be helpful for people with this type of mood disorder include:
- Anticonvulsants: valproate (Depakote) and carbamazepine (Tegretol) are the best-studied ones, but lamotrigine (Lamictal), topiramate (Topamax), and gabapentin (Neurontin) may also be effective in smoothing out the mood swings.
- Antipsychotics: can be helpful, as you've discovered, in relieving rage, obsessive suicidal ideation, and other intense and dysphoric feelings. Because of their better safety profile, the newer "atypical" antipsychotics are the ones usually used; these include risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), and ziprasidone (Geodon). They are usually used in smaller doses than would be prescribed for psychotic disorders. They can be used acutely/"as-needed," to help the person out of episodic emotional "crises," or on a fixed schedule, to prevent such episodes from occurring. Because these drugs can take a couple of hours to work, the latter may be more practical unless the episodes are infrequent or are mostly controlled by other medication.
- Psychostimulants: in some cases, mood dysregulation may arise from what is currently called "attention deficit disorder;" stimulant drugs can help them to focus and slow down (or perhaps, allow them to keep up with their racing thoughts and feelings) so that they can experience moderate emotions and not only extreme ones, and so that they are able to think fully before acting, rather than acting on impulse.
- Serotonin reuptake inhibitors: the selective SRIs (Prozac, etc.) and the nonselective ones (e.g., Effexor) can be helpful in smoothing out moods and alleviating hypersensitivity and decreasing mood-reactivity.
- Monoamine oxidase inhibitors: may combine the benefits of SSRIs and stimulants.
- Opioid antagonists (naltrexone (ReVia)): seems to be particularly helpful for people who experience dissociation. I'm not too clear about this, but my guess is that naltrexone eliminates the "rush" that some people experience from "dangerous" behaviours such as self-injury. It also decreases opioid and alcohol cravings.Because of the wide range of medications that can be helpful to people with this problem, I think that it would be interesting to study the relationship between clinical features and drug response (antidepressant, stimulant, mood stabiliser, antipsychotic) in individuals with this type of syndrome (which I think should be classified as a mood or anxiety disorder).
OK, so now that I've written a dissertation < g >, back to your question! I think you're on the right track toward achieving long-term stability. I'm pretty sure you will find that at least some of the stuff I've written about applies to you. If the Risperdal is working and you're tolerating it okay, stay with it -- "antipsychotic" drugs (dopamine antagonists) can be effective in nonpsychotic disorders and may even have antidepressant effects in some people (just as "antidepressants" can be used for panic disorder, social anxiety, and even nonpsychiatric disorders such as neuropathic pain and allergies). Has Risperdal helped with any other symptoms besides rages?
Some of the other medications I mentioned might be worth looking into as well. It might be a good idea to take a look at the anticonvulsants, since your response to antidepressants has been lukewarm; on the other hand, you might want to try some other antidepressants since Effexor did help for a while. See what your doctor says. Stimulants and naltrexone are more experimental, so those should probably be low on your list of things to try.
One thing worth noting is that tricyclic antidepressants rarely work for emotion dysregulation; MAOIs, SSRIs, and Effexor have good track records, and Remeron, BuSpar (in high doses and/or in combination with SSRIs or other ADs), and Wellbutrin might be worth looking at too.
I know a few people who would fit into the category I've described. One is a young woman diagnosed with bipolar II disorder, borderline personality disorder, and temporal lobe epilepsy who has an extensive history of self-injury and multiple suicide attempts (she has several large, prominent scars as well as many smaller ones). She now takes Tegretol, Zyprexa, and Zoloft. Another woman, who has been diagnosed with unipolar depression and borderline personality, was abused as a child, used to dissociate and cut herself, and has an extensive drug abuse history (mainly alcohol and methamphetamine), takes Wellbutrin, naltrexone, and lithium (lithium can also be used as a mood stabiliser, although I think the anticonvulsants have a better record for this type of mood swings). She was the person who first brought naltrexone to my attention as a potential treatment for this condition, actually. A third woman, diagnosed bipolar I and borderline personality, has a history of self-injury (cutting and burning) and has had a hard time achieving stability despite being very intelligent (IMO). She is now getting herself together. She takes Moban (an older antipsychotic), Topamax, Zyprexa (as-needed), Wellbutrin, and Prozac. These are just some examples -- there are a lot of people who are overcoming this very painful condition.
I think that psychosocial therapy is warranted, if you can afford it. Are you seeing a psychotherapist of some sort, and if so, what is his or her school of thought (psychoanalytic, cognitive-behavioural, etc.)? This isn't really the primary topic of this board, but I thought I should mention it because I think it's important for people who've been mentally ill for most of their lives. (I have too, BTW, although the emotion dysregulation syndrome I described is not among my problems.)
Be well. I hope this lengthy discourse has helped answer some of your questions.
-elizabeth"
Spike
Posted by Elizabeth on January 23, 2002, at 15:26:31
In reply to Soft Bipolar Disorders-Repost from Elizabeth(long), posted by spike4848 on January 23, 2002, at 0:00:05
< blush >
I'm very happy to read that you liked it. Looking back over it, I think it would be nice if people started looking at this syndrome as a separate mood disorder. The current fad is, of course, to diagnose it as bipolar II or borderline personality. I think that bipolar II is inaccurate -- this is very different from bipolar disorder -- and borderline personality disorder is perhaps more accurate, but very stigmatizing (how would you like to be told that you have a "personality disorder?"). I think that if this condition were recognized as a mood disorder, it would help sufferers to get adequate treatment (which those diagnosed as "borderline" are often denied, based on the assumption that medications don't help with "personality disorders").
-elizabeth
Posted by spike4848 on January 23, 2002, at 17:07:08
In reply to Re: Soft Bipolar Disorders » spike4848, posted by Elizabeth on January 23, 2002, at 15:26:31
Hey Elizabeth,
It probable should be published in a psychiatric journal .... you have taken ALOT of information and synthesized it into a logical perspective on mood dysregulation syndromes. I think with the proliferation of new mood stablizers .... it is tempting to relabel certain disorders soft bipolar. (Dr. Cole alluded to this-shaping disease around pharmacology, i.e. new drugs ... new disorders.) I think it would be ashame to load these individuals up (including me .. I think I have mood dysregulation to a degree) on multiple anticonvulants.
I going to show it to my pdoc ....
Spike
Posted by Mr. Scott on January 23, 2002, at 22:18:39
In reply to Re: Soft Bipolar Disorders » Elizabeth, posted by spike4848 on January 23, 2002, at 17:07:08
I'm glad to see a little healthy skepticism and original thought.
New products, new indications, and large direct to professional marketing budgets give birth to new disorders, and or more inclusive diagnostic categories. Lithium has fallen out of favor for one reason more than any other, Abbott Labs...The Makers of Depakote.
See Dr. Leland Heller's Biological Unhappiness for more theory along this line.
Posted by petters on January 24, 2002, at 1:24:18
In reply to Re: Soft Bipolar Disorders » spike4848, posted by Mr. Scott on January 23, 2002, at 22:18:39
> I'm glad to see a little healthy skepticism and original thought.
>
> New products, new indications, and large direct to professional marketing budgets give birth to new disorders, and or more inclusive diagnostic categories. Lithium has fallen out of favor for one reason more than any other, Abbott Labs...The Makers of Depakote.
>
> See Dr. Leland Heller's Biological Unhappiness for more theory along this line.Hi...
Borderline personality disorder is very possible to treat with meds. Altough you need higher dosages than pure depression.
Some experts in these area means that only 5-10 % get sufficient level of the meds they take.
For exampel:
T. Effexor 300 -600 mg, will often stop the moodswing. Or: T. Zoloft 300 - 500 mg.....Often one need an moodstabilzer as well. Like Hermolepsin and Lamictal...
Sincerely...//Petters
Posted by Elizabeth on January 25, 2002, at 1:30:53
In reply to Re: Soft Bipolar Disorders, posted by petters on January 24, 2002, at 1:24:18
> Borderline personality disorder is very possible to treat with meds. Altough you need higher dosages than pure depression.
>
> Some experts in these area means that only 5-10 % get sufficient level of the meds they take.
> For exampel:
> T. Effexor 300 -600 mg, will often stop the moodswing. Or: T. Zoloft 300 - 500 mg.....
>
> Often one need an moodstabilzer as well. Like Hermolepsin and Lamictal...I don't think that borderline personality disorder is a single entity. Some people will do well on ADs, anticonvulsants, antipsychotics, or other types of medications. Many require combinations. I definitely don't believe that BPD can be reduced to a subtype of depression or bipolar disorder.
High doses of antidepressants are warranted if the usual dose is only partially effective, although I think it's rare that raising the dose of an SSRI very high will help (for any indication). In general, treatment of this disorder is best approached by looking at individual symptoms separately -- there isn't any single "anti-borderline" drug.
-elizabeth
Posted by Blue Cheer 1 on January 25, 2002, at 6:20:49
In reply to Re: Soft Bipolar Disorders » petters, posted by Elizabeth on January 25, 2002, at 1:30:53
> > Borderline personality disorder is very possible to treat with meds. Altough you need higher dosages than pure depression.
> >
> > Some experts in these area means that only 5-10 % get sufficient level of the meds they take.
> > For exampel:
> > T. Effexor 300 -600 mg, will often stop the moodswing. Or: T. Zoloft 300 - 500 mg.....
> >
> > Often one need an moodstabilzer as well. Like Hermolepsin and Lamictal...
>
> I don't think that borderline personality disorder is a single entity. Some people will do well on ADs, anticonvulsants, antipsychotics, or other types of medications. Many require combinations. I definitely don't believe that BPD can be reduced to a subtype of depression or bipolar disorder.
>
> High doses of antidepressants are warranted if the usual dose is only partially effective, although I think it's rare that raising the dose of an SSRI very high will help (for any indication). In general, treatment of this disorder is best approached by looking at individual symptoms separately -- there isn't any single "anti-borderline" drug.
>
> -elizabeth
I'm not so sure. I've seen Prozac used successfuly at 120 mg/day (TRD) for those who didn't respond at lower doses -- the same goes for OCD.Blue
Posted by petters on January 25, 2002, at 7:12:27
In reply to Re: Soft Bipolar Disorders, posted by Blue Cheer 1 on January 25, 2002, at 6:20:49
> > > Borderline personality disorder is very possible to treat with meds. Altough you need higher dosages than pure depression.
> > >
> > > Some experts in these area means that only 5-10 % get sufficient level of the meds they take.
> > > For exampel:
> > > T. Effexor 300 -600 mg, will often stop the moodswing. Or: T. Zoloft 300 - 500 mg.....
> > >
> > > Often one need an moodstabilzer as well. Like Hermolepsin and Lamictal...
> >
> > I don't think that borderline personality disorder is a single entity. Some people will do well on ADs, anticonvulsants, antipsychotics, or other types of medications. Many require combinations. I definitely don't believe that BPD can be reduced to a subtype of depression or bipolar disorder.
> >
> > High doses of antidepressants are warranted if the usual dose is only partially effective, although I think it's rare that raising the dose of an SSRI very high will help (for any indication). In general, treatment of this disorder is best approached by looking at individual symptoms separately -- there isn't any single "anti-borderline" drug.
> >
> > -elizabeth
>
>
> I'm not so sure. I've seen Prozac used successfuly at 120 mg/day (TRD) for those who didn't respond at lower doses -- the same goes for OCD.
>
> BlueHi Blue...
You are correct. Like OCD, one often need high dosages for BPD. The affective instability that is characteristic for this people often improve very well on high dosages ssri or venlafaxine.
Sincerely...//Petters
Posted by Dinah on January 25, 2002, at 9:15:27
In reply to Re: Soft Bipolar Disorders, posted by petters on January 25, 2002, at 7:12:27
>
> Hi Blue...
>
> You are correct. Like OCD, one often need high dosages for BPD. The affective instability that is characteristic for this people often improve very well on high dosages ssri or venlafaxine.
>
> Sincerely...//PettersI have mixed feelings about this topic. People with OCD and BPD are in a lot of pain and do need help. High does of SSRI's flatten moods, increase apathy, and reduce cognitive function (especially memory). So of course high doses of SSRI's work for BPD. By making you numb emotionally and apathetic, many of the behaviors will disappear. Those around you are happier because you are behaving better. The same holds true for OCD. SSRI's cause apathy and reduce your ability to remember what you might have done to cause disaster. So naturally the symptoms are less too and you aren't so much trouble to those around you.
But what is the cost? Extremely high doses of SSRI's rob you of your motivation and to a certain extent your humanity. (I'm talking about extremely high doses here, so don't flame me over this.) I was on Luvox at up to 300mg for four years, and I'm not sure I've fully recovered yet my ability to love and laugh and feel fully engaged in life.
Wouldn't it be worth the additional time and expense to combine lower doses of SSRI's with really good therapy programs like Linehan's DBT or CBT and then follow-up long term supportive therapy? I know health care dollars are short, but for those who have the money and the motivation to change, I would think that this would be first line treatment for both OCD and BPD. Both disorders have shown themselves extremely well suited to these therapies.
Of course, not everyone has the motivation to change, and everyone is different and have different degrees of these disorders, but I have to agree with Elizabeth here. Treatment should be more personalized to the individual. And I also agree with her that BPD is an umbrella diagnosis that probably covers a lot of different underlying problems. Just because high dose SSRI's routinely work with BPD doesn't change that fact.
Just my opinion based on my personal experience, put out mainly for the purpose of discussion.
Dinah
Posted by BarbaraCat on January 31, 2002, at 2:10:13
In reply to Re: SSRI's, BPD, OCD, posted by Dinah on January 25, 2002, at 9:15:27
Dinah,
Have to agree with you on all fronts. I can say from personal experience how flattening high doses of SSRI's are. But even on 300 mg of zoloft the depression still broke through plus I was having very unapathetic panic attacks. All SSRI's had the same effect - massive doses that did zip for the depression and left me feeling like a sexless brain fried malingerer. I have a huge beef with the current state of affairs in psychiatric medicine. I have one of the large HMO's as my insurance carrier and get to see my pdoc every 6-8 weeks if I'm lucky. I have been in his office and on the phone to him in states of utter desperation. I have let him know in every way possible that the meds were not working, I was one hurting unit and please help. "Well let's just increase the amount or try another SSRI', suggests he. It has only been through this board that I've gained the info that I have been misdiagnosed and am now assuming complete responsibility for my own treatment. I use him mainly as a drug procurer, someone who wields the prescription pad, nothing more. I don't really blame him. It's not possible for any human with a massive patient case load to have any extra bandwidth to 'care' about me and my suffering, but how unfortunate we have to not only put up with this treatment but PAY for it as well. -- Barbara Cat>
> I have mixed feelings about this topic. People with OCD and BPD are in a lot of pain and do need help. High does of SSRI's flatten moods, increase apathy, and reduce cognitive function (especially memory). So of course high doses of SSRI's work for BPD. By making you numb emotionally and apathetic, many of the behaviors will disappear. Those around you are happier because you are behaving better. The same holds true for OCD. SSRI's cause apathy and reduce your ability to remember what you might have done to cause disaster. So naturally the symptoms are less too and you aren't so much trouble to those around you.
> But what is the cost? Extremely high doses of SSRI's rob you of your motivation and to a certain extent your humanity. (I'm talking about extremely high doses here, so don't flame me over this.) I was on Luvox at up to 300mg for four years, and I'm not sure I've fully recovered yet my ability to love and laugh and feel fully engaged in life.
> Wouldn't it be worth the additional time and expense to combine lower doses of SSRI's with really good therapy programs like Linehan's DBT or CBT and then follow-up long term supportive therapy? I know health care dollars are short, but for those who have the money and the motivation to change, I would think that this would be first line treatment for both OCD and BPD. Both disorders have shown themselves extremely well suited to these therapies.
> Of course, not everyone has the motivation to change, and everyone is different and have different degrees of these disorders, but I have to agree with Elizabeth here. Treatment should be more personalized to the individual. And I also agree with her that BPD is an umbrella diagnosis that probably covers a lot of different underlying problems. Just because high dose SSRI's routinely work with BPD doesn't change that fact.
> Just my opinion based on my personal experience, put out mainly for the purpose of discussion.
> Dinah
Posted by Dinah on January 31, 2002, at 9:03:51
In reply to Re: SSRI's, BPD, OCD » Dinah, posted by BarbaraCat on January 31, 2002, at 2:10:13
Hi Barbara Cat,
I'm glad someone took me up on my invitation to discuss this. I suspect that, contrary to Kramer's Listening to Prozac, that you can't always diagnose based on SSRI response because SSRI's have properties that just about anyone would respond to. So I'm not actually convinced that high dose SSRI's get to the root of the problem, just change the superficial presentation. This is particularly true in "disorders" that have a large behavioral component, such as BPD and OCD. The assumption is that if the behavior is changing, the SSRI must be a "cure".
If you don't mind my asking, what were you diagnosed with and what do you actually think your diagnosis is?
Dinah
Posted by BarbaraCat on January 31, 2002, at 14:09:30
In reply to Re: SSRI's, BPD, OCD » BarbaraCat, posted by Dinah on January 31, 2002, at 9:03:51
Dinah,
I've been diagnosed as unipolar with mixed states. Severe depression off and on throughout my life, contributed to by a very violent and abusive childhood. I also have recently been diagnosed with fibromyalgia which causes it's own brand of depression. When I have a fibro flare, I know I am sick throughout every cell of my body. I sleep, am in pain and cry alot because I feel so hopeless as to my future. It's a slowing down, vegetative type of depression. The other kind is much worse. It's frenzied despair, panic attacks, seeing only the horror and terror in the world, feeling constant doom and anguish. This has been diagnosed as PTSD from my past, but also could be other things. It goes way beyond general anxiety disorder. I can get into some very dark places that scare the heck out of my husband, family and friends (when I've let myself be seen like this). It's a very bleak and terrifying place and usually NOTHING but time will bring me out of it.What's in a label? There is plenty in this world to be scared of and I can go down that track all too easily. Does this mean I have OCD, PTSD, BPII, GAD? Spirit Possession? I have no idea and neither have any of my many docs. I know that SSRI's seemed to feed that inner disquiet and the despair always breaks through, so for me they have not worked, even at very high dosages. This has left my shrinks scratching their heads since one expects at least some benefit from SSRI's. On a purely structural note, I think my amygdala has been damaged from the chronic stress. I do know that my soul needs deep healing and the way to do this is to allow Nature to do it's work by allowing comfort to my body and mind. I'm helping this process along by taking klonopin and lithium which seems to be helping to smooth and soothe.
So 'nuff about me. What form does your dis-ease take?
> Hi Barbara Cat,
> I'm glad someone took me up on my invitation to discuss this. I suspect that, contrary to Kramer's Listening to Prozac, that you can't always diagnose based on SSRI response because SSRI's have properties that just about anyone would respond to. So I'm not actually convinced that high dose SSRI's get to the root of the problem, just change the superficial presentation. This is particularly true in "disorders" that have a large behavioral component, such as BPD and OCD. The assumption is that if the behavior is changing, the SSRI must be a "cure".
> If you don't mind my asking, what were you diagnosed with and what do you actually think your diagnosis is?
> Dinah
Posted by Mr. Scott on January 31, 2002, at 21:04:25
In reply to Re: Soft Bipolar Disorders, posted by petters on January 25, 2002, at 7:12:27
> > > > Borderline personality disorder is very possible to treat with meds. Altough you need higher dosages than pure depression.
> > > >
> > > > Some experts in these area means that only 5-10 % get sufficient level of the meds they take.
> > > > For exampel:
> > > > T. Effexor 300 -600 mg, will often stop the moodswing. Or: T. Zoloft 300 - 500 mg.....
> > > >
> > > > Often one need an moodstabilzer as well. Like Hermolepsin and Lamictal...
> > >
> > > I don't think that borderline personality disorder is a single entity. Some people will do well on ADs, anticonvulsants, antipsychotics, or other types of medications. Many require combinations. I definitely don't believe that BPD can be reduced to a subtype of depression or bipolar disorder.
> > >
> > > High doses of antidepressants are warranted if the usual dose is only partially effective, although I think it's rare that raising the dose of an SSRI very high will help (for any indication). In general, treatment of this disorder is best approached by looking at individual symptoms separately -- there isn't any single "anti-borderline" drug.
> > >
> > > -elizabeth
> >
> >
> > I'm not so sure. I've seen Prozac used successfuly at 120 mg/day (TRD) for those who didn't respond at lower doses -- the same goes for OCD.
> >
> > Blue
>
> Hi Blue...
>
> You are correct. Like OCD, one often need high dosages for BPD. The affective instability that is characteristic for this people often improve very well on high dosages ssri or venlafaxine.
>
> Sincerely...//PettersUnfortunately for me if I took more than 10mg of Prozac or it's equivalent in virtually any of these pills I'd have to quit my job and go on public aid just because of the side effets.
Scott
Posted by Dinah on February 1, 2002, at 0:44:52
In reply to Re: SSRI's, BPD, OCD » Dinah, posted by BarbaraCat on January 31, 2002, at 14:09:30
OCD, cyclothymia. I'm on Depakote and Klonopin and much prefer them to the SSRI's. I still have OCD thoughts and I still have mood cycling, but I'm willing to put up with it to not have my thinking dulled with SSRI's. My self image is way too tied in to being smart and bright. SSRI's robbed me of that feeling.
Besides I like being the quirky odd person that I am. I wouldn't want to be medicated out of that. Of course, my OCD and mood cycling are relatively mild compared to some. If they caused me enough discomfort, I might well make a different choice.
Your fibromyalgia sounds like a terrible thing to have to deal with. Chronic pain must really wear you out. Is it an immune related illness like lupus? I'm afraid that although I've heard the term, I just don't know all that much about it.
Dinah
Posted by BarbaraCat on February 1, 2002, at 2:48:33
In reply to Re: SSRI's, BPD, OCD » BarbaraCat, posted by Dinah on February 1, 2002, at 0:44:52
Dinah, that's great that you've found a way to celebrate who you are, quirkiness and all. You sound like someone involved in the arts. I remember when I was on 300 mg of zolof I just couldn't feel a thing - and I was still miserable! But it was like watching someone else being miserable and not caring.
Fibromyalgia is kind of like chronic fatigue syndrome. No one really knows exacly what it is since there's no blood marker for it yet (sorta like depression). It goes in cycles causing a deep aching in all the muscles, fatigue like you can't believe, insomnia, cognitive impairment. I'll be flat on my back in bed for 2-3 weeks at a time and then I'll get better for 1-2 months or so. Never can tell when it will pull the rug out. Some theories say it's an impairment in the enzyme that breaks down substance P, but most agree that it's a metabolic dysfunction. It's becoming extremely common, mainly in women, and I suspect it has alot to do with a cellular toxic overload caused by pollution, stress, genetics, virus - who knows? It's my little buddy, however, in that it keeps me real conscious of my limits. I can't get away with anything anymore and am in danger of becoming terminally pure!
> OCD, cyclothymia. I'm on Depakote and Klonopin and much prefer them to the SSRI's. I still have OCD thoughts and I still have mood cycling, but I'm willing to put up with it to not have my thinking dulled with SSRI's. My self image is way too tied in to being smart and bright. SSRI's robbed me of that feeling.
> Besides I like being the quirky odd person that I am. I wouldn't want to be medicated out of that. Of course, my OCD and mood cycling are relatively mild compared to some. If they caused me enough discomfort, I might well make a different choice.
> Your fibromyalgia sounds like a terrible thing to have to deal with. Chronic pain must really wear you out. Is it an immune related illness like lupus? I'm afraid that although I've heard the term, I just don't know all that much about it.
> Dinah
Posted by Dinah on February 1, 2002, at 17:32:21
In reply to Re: SSRI's, BPD, OCD » Dinah, posted by BarbaraCat on February 1, 2002, at 2:48:33
Thanks for the compliment, but I'm a left brained thinker with almost no artistic leanings. And I'm in a field that doesn't particularly value quirkiness, too. It's a really good thing that I'm really good at what I do. (No one has ever accused me of having low self esteem.) :)
The fibromyalgia sounds like a miserable thing to have to deal with, especially since they aren't clear about the cause or the remedy. That would drive me crazy. I always want concrete answers, with no ambiguity whatsoever.
I agree with you on the SSRI's. The apathy was overpowering. (Can apathy be overpowering?)
Dinah
Posted by Krazy Kat on February 1, 2002, at 18:42:00
In reply to Re: SSRI's, BPD, OCD, posted by Dinah on January 25, 2002, at 9:15:27
Dinah:
"Those around you are happier because you are behaving better."
My experience has been with stabilizers, but you expressed my feelings perfectly! Thanks.
- KK
Posted by Ponder on March 21, 2002, at 21:25:18
In reply to Re: SSRI's, BPD, OCD » Dinah, posted by BarbaraCat on January 31, 2002, at 2:10:13
Perhaps this should be a new thread, but I like the insights of the people who have posted on this one and hope some of you may have some wisdom to share.
I recently met someone who is bright, beautiful, affectionate, etc. and became somewhat involved rather quickly. When it became apparent that we were developing something more than a casual friendship, he said he had something he needed to discuss with me. It seems he has a history of exhibitionism and is currently in treatment pursuant to the probationary provisions of a misdemeanor conviction. He seems to have a great deal of insight and is pursuing treatment responsibly and sincerely. He is extremely affectionate with me and tends to my sexual needs, but does not achieve satisfaction for himself, nor does he even seem to try, really.
I already have compelling feelings for this man. Since he told me his situation, I have been reading all I can about this disorder, it's treatment and prognosis. So far, the literature has not yielded much optimism. Apparently SSRIs are sometimes used to lessen the OCD aspects of the disorder, the sexual side-effects being seen as beneficial. The psychiatric literature seems wholly directed at extinguishing the offender's sexual feelings altogether, with little being written about redirecting those feelings to more acceptable outlets.
The prognosis appears dim from what I have read. Do any of you have any knowledge of this subject?
Posted by davew on March 22, 2002, at 19:49:50
In reply to SSRIs and Paraphilias, posted by Ponder on March 21, 2002, at 21:25:18
Could be ual addiction--see literature by Patrick Carnes for more info.
Posted by Ponder on March 25, 2002, at 19:21:21
In reply to Re: SSRIs and Paraphilias, posted by davew on March 22, 2002, at 19:49:50
> Could be ual addiction--see literature by Patrick Carnes for more info.
Thank you, DaveW, for the very useful reference. I found Dr. Carnes' website at www.sexhelp.com. Why do you suggest a dual addiction?
Posted by Zo on March 26, 2002, at 4:20:05
In reply to SSRIs and Paraphilias, posted by Ponder on March 21, 2002, at 21:25:18
Yeah. When a guy exposed himself to me. It sure felt like a highly aggressive, assaultive act. . .I wasn't too interested in the name of his disorder at the time. I was too busy being scared shitless, infuriated, and feeling sorry for him, all at the same time.
Sorry, but let's do call a spade a spade, first of all. It matters, anyway, to me.
Thanks,
Zo
Posted by Ponder on March 26, 2002, at 12:01:49
In reply to Re: SSRIs and Paraphilias » Ponder, posted by Zo on March 26, 2002, at 4:20:05
Zo, Thanks for your response. I'm sorry that happened to you and agree that the behavior is assaultive, predatory, completely unacceptable, and certainly not at all a victimless crime. Sometimes I think there is some karma going on here because I used to work in the judicial system and believed without hesitation that sex offenders were the scum of the earth. Seems my karmic journey has been bent on humbling me and showing me that things are never that simple.
Still, your comments are part of what I need to hear to help keep this in perspective. Reading through the research literature on sex crimes is really messing with my head. Many of the same debates go on there as in schools of thought regarding depression and bipolar--is it a medical condition? Is it purely behavioral? Is it conditioning from trauma in childhood? An addictive process via faulty feedback systems in the brain? A simple failure of the will or deficit of character? Geesh! Just when I was beginning to feel comfortable about the nature of my own problem (Bipolar II) I am now all confused again. Anyway, thanks for the input. Other thoughts?
> Yeah. When a guy exposed himself to me. It sure felt like a highly aggressive, assaultive act. . .I wasn't too interested in the name of his disorder at the time. I was too busy being scared shitless, infuriated, and feeling sorry for him, all at the same time.
>
> Sorry, but let's do call a spade a spade, first of all. It matters, anyway, to me.
>
> Thanks,
> Zo
Posted by BarbaraCat on March 26, 2002, at 12:47:54
In reply to Re: SSRIs and Paraphilias, posted by Ponder on March 26, 2002, at 12:01:49
I had more than my share (at least I hope so) of experiences with exposers. At least 5 when I was a child and more as the years went by. Men in cars, men waiting at soda machine at the kid's matinee, men in libraries in the stacks, etc. I always got the feeling that the perps were in the grip of a horrible addiction. They seemed ashamed, furtive and beyond control.
This had a big impact on me as a child, causing me to think that there was something about ME that was causing it (maybe karma, like you said?). After the 10th or so incident it was like 'oh yeah, another one, yawn'. In fact the last time it happened (in the back annex of a large bookstore) I actually snapped - I had HAD IT! - and ran after the perp screaming with teeth bared and claws raised. He tried to run away with his pants down around his ankles yelling 'Help me! She's crazy!' I was pummeling and kicking him as he ran out the door still 'un-cocked'. It was pretty funny and healed alot of old wounds.
From the look on every one of these guys faces, it was clear that it was beyond their power to stop. I have compassion for these people but I would not want to subject myself to being in relationship with one. You can't hide the world from them and it would only be a matter of time. - BCat
Posted by Zo on March 26, 2002, at 16:30:22
In reply to Re: SSRIs and Paraphilias, posted by Ponder on March 26, 2002, at 12:01:49
Thanks for your thoughtful reply. My sense was that this is not just a nice guy with a problem. . .but you already knew the other side of it! Actually, the real red flag for me is that he doesn't feel sexual, or even want anything in return. I would really be sure that was just SSRI side effects; if it's an issue of longstanding, then, intuitively, it seems tied in with the essential passive/aggressive nature of the act--which bodes nothing but trouble for you, in the long run. It takes two to make a relationship, and to make love. Know what I mean?
If he's in recovery, it's your call, and I would let your gut sense be more of a guide than perhaps a guy is used to, for it's trying to tell you something. Hey, I've been attracted like crazy to people who couldn't help but break my heart.
Is he really truly in therapy? Did he have a rotten childhood--or is he hard-wired this way? Seems to me he'd have to be willing to dig back thru some very early experiences, and that's a big commitment. If he can commit to himself and his recovery--that's how much he can commit to you.
Maybe not fool around anymore until issues are clearer? Sure befuddled my head.
Lemme know,
Zo
Posted by dove on March 26, 2002, at 17:30:20
In reply to Re: SSRIs and Paraphilias » Ponder, posted by Zo on March 26, 2002, at 16:30:22
I would like to add my two cents regarding pursuing a relationship with a recovering exhibitionist/misdemeanor sex offender.
I've also been exposed to a number of "flashers" and other oddities during my lifetime, and have found that many have an extreme view of their own sexuality. Either it's high-throttle or no throttle, and they seem unable to marry the two into a healthier balance.
My advice, which easier 'said' from way over here than 'done' way over there, is to be cautious and vigilant for warning signs that this relationship is not going to work out. It will break your heart if you go too deep and can't let go, I know, I've been there, and in many ways, am still there!
Some red lights would include his own unfulfillment while being very attentive to you. Even though SSRI's lower sexual desire and/or ability, there should still be an element of desire and intimacy that expresses his desire for you. Not for you to be physically fulfilled, but his desire to be *with* you, to be part of you. Any feelings that he is detached, or more of an onlooker than an active participant is very big warning sign, at least in my experience.
Hope it works out better than the statistics, truly!
dove
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