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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by cache-monkey on November 30, 2004, at 11:41:45
Folks,
I've had on-going problems with depression and anxiety, and it's gotten worse the past few weeks. I think that part of it is seasonal affective disorder, so I'm getting a light box. But I also think that I need a new med. My p-doc is really not much help in this, so I'm kind of left to my own devices in choosing one.
I'm going to describe my symptoms below, as well as some of the meds that I've tried. Right now I'm deciding between Zoloft (plus BuSpar or possibly Wellbutrin) and low-dose Selegiline. I realize that this is long, but if you at all have the time and inclination to read, any input is greatly appreciated.
Thanks,
cache-monkey==== Symptoms ====
I'm still not sure exactly what my DX is. Motivation, energy, and happiness are big factors. This is true even in my "base state," where I sometimes feel like I live with a brain fog. But, there are days when nothing seems interesting or fun, and everything seems like too much of a hassle, or even energy-draining.I also have problems with my interactions with other people. In my base state, I somehow need to feel like other people are interested in what I'm doing or saying (or thinking or thinking about doing) for me to feel like it's worthwhile. When Im' down, I have trouble with self-confidence, especially when other people are involved. E.g. social situations, academic work. I feel like I'm not acting up to some standard (that's being generated by me) and then I get anxious and withdrawn.
Both the lack of self-confidence and of energy/happiness seem to combine to make me much less verbal and mentally active at times. Getting to an interesting or non-repetitive (bordering on obsessional) thought in those situtations is tough.
There's also a visceral component to my depression. Days where I feel really tense in my body, but weak at the same time. Like moving my limbs is a lot to ask. And I feel like I can't physically experience emotion, even if I know in my mind that I'm happy, amused, frustrated, or sad. Sort of like my face and body are frozen. I feel the tension on my head, kind of like a vice across the sides and top.
But on top of that is this odd feeling like my pulse is racing and the blood is pounding in my skill. The really odd thing is that when I get that feeling, my BP and pulse are actually low; too low: 108/65 for BP and 52 for pulse. (And then when these visceral symptoms subside my BP and pulse got up to like 130/75 and 72, which I find really odd.)
As far as libido: in my base state, it's reasonably high, higher when I'm a little anxious. When I head into depression, the libido has disappeared lately.
The negative symptoms always used to subside, at which point I'd start to feel good, energetic, emotional, all that jazz. Possibly bordering on hypomania. It might also just be not feeling depressed. The past couple of years, however, the negative stuff just hasn't fully remitted for any substantial period of time.
==== Previous Meds ====
Wellbutrin: Plus side: made me more energetic and sexual. Minus side: made me more obsessional, didn't feel very happy most of the time.Wellbutrin plus Celexa: Plus side: felt *great*, experienced full range of emotion and interesting thought. Minus side: I was possibly hypomanic bordering on arrogance; no orgasm, carb cravings, weight gain, often had trouble focussing
Wellbutrin plus Lexapro: Felt a little less good than when on Well+Cel, also had reduction in negative S/Es.
Serzone: Horrible. For the most part it made my negative symptoms worse. On the plus side, I actually lost weight and had a super-strong sex drive. But neither of these felt particularly normal.
BuSpar (which I'm on right now at 10mg/day): I dunno. Maybe it's doing something, providing a small buffer. But I can't increase because I'm already having to split my dose into 4 x 2.5 mg to avoid dizziness and this weird tension right after taking.
==== Other maladaptive remedies ====
Smoking cigarettes has pretty much been a constant for me. Every time I've tried to quit, my depression or whatever it is gets worse, and turns into obsessional brooding.Caffeine used to pick/perk me up. But lately it usually makes me more tense.
Alcohol: I feel like I'll never feel as good as I do with 2-3 drinks in my system. I used to binge drink, which gave me the feeling like I could do anything. I've realized that this doesn't work for me anymore, though. Even one drink can leave me lower the next day.
Love and sex: Used to rely on these to pick me up. Was kind of a serial monogamist for a while, cycling through relationships. Falling in love was what I craved, and then when that giddy feeling went away, I'd go negative and tank the relationship. Now that I've realized what I was doing, this doesn't seem to work for me anymore. Which is probably a good thing, but I'm left feeling often lonely.
==== Dopamine or Serotonin ====
This is the choice for me right now. I think that I have anhedonia, possibly ADD, and sometimes social phobia, wich makes dopamine a potentially useful agent. Dopamine is also a link among {cigarettes, caffeine, binge drinking, love/sex}. If dopamine's the key, then I'd like to maybe try low-dose Selegiline (plus DLPA, possibly). Going the dopamine route also limits anorgasmia and weight gain, which were my big problems with Celexa (even with the Wellbutrin).But then I felt really really good on Celexa+Wellbutrin, although unable to focus very well, which is a problem even in my base state. The combo also killed my ability (but not my desire) to have an orgasm, plus the whole weight gain business. Zoloft might be better for a number of reasons, so it's still an alternative right now, either to my BuSpar, or with Wellbutrin.
I really don't know what to do. Indecisiveness is part of the problem when I get depressed. I guess if anyone sees something in my story that looks familiar, I'd be interested in hearing if either of these routes worked for you.
Thanks for reading this! -cm
Posted by ed_uk on November 30, 2004, at 12:00:46
In reply to Please help; med advice: Zoloft or Selegiline, posted by cache-monkey on November 30, 2004, at 11:41:45
Hi....
Perhaps when you were on the combination of Celexa and Wellbutrin your dose of Celexa was too high... might it be worth trying a lower dose?
Regards,
Ed.
Posted by HappyGirl on November 30, 2004, at 23:41:02
In reply to Please help; med advice: Zoloft or Selegiline, posted by cache-monkey on November 30, 2004, at 11:41:45
Hi:
I can NOT be sure, ... it sounds to me like you've been experiencing VERY 'minor' Bp symptoms after having read all your explantions. The first two/three paragragphs above, you have 'depression,' however, there is also 'hypomania' in the last paragraph. For those two 'comflicted' experiences make you feel 'depression' mixed with anxiety.Concerning your pdoc's hesitation to rx appropriate med./med. combo., ... he/she might need to see more symptoms to surface in order to rx appropriate med./med. combo. Because, as we know, Bp II which has mostly 'depressive' episodes with minor 'manic' symptoms, then your pdoc. might need some more time whether you REALLY have some/little Bp trait.
If you've been developing Bp(very milder form of Bp II), you may need a mood-stabilizer. In my personal experience with Bp II, I did develope Bp symptoms VERY slowly, starting from depression, less manic and 'real' Bp II. Not often, but it takes some time to figure things/problems out accurately. Try to discuss this with your pdoc. at your next appt.
H.G.
Posted by cache-monkey on December 1, 2004, at 10:39:51
In reply to Re: Please help; med advice: Zoloft or Selegiline, posted by HappyGirl on November 30, 2004, at 23:41:02
Hi,
Thanks for the input. You're right, on the face of it, there could be an element of Bipolar II to what's going on with me. I've actually mentioned this to both my psyciatrist and my talk therapist. But, neither seems to think that it's a significant concern. I'm not sure why. There are some pretty legitimate bases for my depression and anxiety otherwise, though, so maybe they want to explore treating those first and then seeing if hypomania really is an issue. I'll bring it up again anyway, since it probably wouldn't hurt to discuss in more detail.
Best,
cache-monkey> Hi:
> I can NOT be sure, ... it sounds to me like you've been experiencing VERY 'minor' Bp symptoms after having read all your explantions. The first two/three paragragphs above, you have 'depression,' however, there is also 'hypomania' in the last paragraph. For those two 'comflicted' experiences make you feel 'depression' mixed with anxiety.
>
> Concerning your pdoc's hesitation to rx appropriate med./med. combo., ... he/she might need to see more symptoms to surface in order to rx appropriate med./med. combo. Because, as we know, Bp II which has mostly 'depressive' episodes with minor 'manic' symptoms, then your pdoc. might need some more time whether you REALLY have some/little Bp trait.
>
> If you've been developing Bp(very milder form of Bp II), you may need a mood-stabilizer. In my personal experience with Bp II, I did develope Bp symptoms VERY slowly, starting from depression, less manic and 'real' Bp II. Not often, but it takes some time to figure things/problems out accurately. Try to discuss this with your pdoc. at your next appt.
> H.G.
Posted by HappyGirl on December 1, 2004, at 18:05:15
In reply to Re: Please help; med advice: Zoloft or Selegiline » HappyGirl, posted by cache-monkey on December 1, 2004, at 10:39:51
Hi:
Probably, .... both your pdoc. and talk-therapist haven't seen Bp symptoms yet. Or, as you're guessing, they might need more time to explore your 'real' DX by keeping you on the same meds. However, some of pdocs. starting to rx 'low dosage' of mood-stabilizer, if there is NO relief with anti-depressants. Beside this, if you have Bp(very milder form of Bp II), you could get 'relief'by taking 'small dosage' of mood-stabilizer, even next morning, ... in my case, 'Depakote.' It was a miracle drug for me at the beginning of Bp med. therapy.I truly understand your struggle and concern over your unstable moods. Hopefully, both you and your pdoc. is able to find a right DX along with appropriate med./med. combo. soon.
H.G.
Posted by cache-monkey on December 5, 2004, at 12:48:11
In reply to Re: Please help; med advice://cache-monkey, posted by HappyGirl on December 1, 2004, at 18:05:15
Hey HappyGirl,
I hadn't really taken the idea of bipolar seriously before reading your post, probably since I've never really had a classical manic episode. But looking back, I definitely think I've been experiencing something in the BP spectrum, BP II or maybe cyclothymia.
When I'm down (which I was was when I wrote the original post), I forget that I can be really up sometimes. Lately it really has been more cyclical: a few bad days and then a few good days. And I guess the down espisodes are often "mixed" where I have racing thoughts and all this energy which I can't quite access, leading to anxiety.
The last down episode (again when I wrote the OP) was so bad and reminiscent of last year when I didn't come back "up" for 5+ months. So I was really thinking depression. But now the past few days I've beeen feeling good again, but still with the racing thoughts, although I can catch/follow them a lot of the time.
Anyway, based on what I've read, this smacks of some sort of BP. I started fish oil a few days ago, which should also be good for the seasonal component of my issues. My p-doc also gave me a starter pack of Lamictal, which I just started today.
I'll see how things go with the meds, but it's nice to have a better understanding of what I've been going through. So, thanks for that!
Best,
cache-monkey
> Hi:
> Probably, .... both your pdoc. and talk-therapist haven't seen Bp symptoms yet. Or, as you're guessing, they might need more time to explore your 'real' DX by keeping you on the same meds. However, some of pdocs. starting to rx 'low dosage' of mood-stabilizer, if there is NO relief with anti-depressants. Beside this, if you have Bp(very milder form of Bp II), you could get 'relief'by taking 'small dosage' of mood-stabilizer, even next morning, ... in my case, 'Depakote.' It was a miracle drug for me at the beginning of Bp med. therapy.
>
> I truly understand your struggle and concern over your unstable moods. Hopefully, both you and your pdoc. is able to find a right DX along with appropriate med./med. combo. soon.
> H.G.
Posted by HappyGirl on December 5, 2004, at 19:25:52
In reply to Re: BPII/cyclothymia » HappyGirl, posted by cache-monkey on December 5, 2004, at 12:48:11
Hi cache-monkey:
I truly understand how you've been going through this, ... 'up and down' moods. I personally did NOT like to mention about Bp issue because of some 'stigma' attached. Depression is a kind acceptable in this society, particularly at work-environment. However, after having read all of the symptoms you described in your very first post, I thought I needed to say the 'truth,' Bp. In my recollecltion, for the first year after dxed with Bp, I was practically depressed for Bp dx on the top of Bp depression, 'double depression.' However, as time went by, the med. combo. started working on me REALLY well. Now after six years on med. therapy, I've been almost as normal as non-Bper's. Then, you can put a good faith in your med. regimen along with rxed pdoc.In regard to 'hypomania,' ... there are two phrases, 'bad and good hypomania.' On 'Bad hypomania,' you want to spend a lot of money, hyper-sexual(sometime, it's GOOD tho', depend on circumstances), dysphoric(rage) and more unpleasant lists go on. In 'Good' hypomania, you're more productive than your ability/level, ... in my case, more alert, quick to move on and of course, much better work done. Those episodes often vary from person to person, ... but generally there are two phrases, bad and good hypomania episodes between depressive episodes if you're Bp.
As for 'Lamical,' ... I've never been on due to my dx with 'ultra rapid cycler,' however in reading/hearing, the Lamical is one of 'BEST' mood-stabilizers. Then, you can faith in this med. by taking it on daily basis.
I'm glad to read your up-date, the mood-stabilizer, 'Lamical.'
H.G.
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