![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by Ines on April 20, 2007, at 11:37:39
I had an appointment with a psychiatrist yesterday, my first one- until now I've been treated by GPs. The pdoc was really nice, but I'm feeling really low after the appointment. Until recently I thought I had atypical depression- I have all the atypical symptoms + some ocd. But psychiatrist seems to think I'm bipolar (actually someone on this site has suggested that before)- he told me they're going to consider putting me on a mood stabiliser. I've reacted badly to all ADs I've tried (not many though), and the latest, reboxetine has made depression and ocd symptoms worse.
I'm a bit freaked as I somehow got the idea that mood stabilisers make you a bit 'dopey' and take the edge off your personality. Is that the case? My job depends totally on brain function so the idea of being slowed down cognitively is freaky. I also binge eat and do not want to put on any more weight. Does anyone have experience of taking mood stabilisers with similar symptoms or know a bit about these types of meds? I know nothing...
Psychiatrist told me there won't be a 'magic pill' for me in the long run and that what they can do is help me cope better with symptoms, so I feel realy low after that. Really cannot imagine the rest of my life being the way my life has been till now- all I can hope for in that case is that it's a short one... He also said I was extraordinarily competent at coping with this and that it could be so much worse if it wasn't for that competence. Soo not reassuring- I'm not sure what could get worse that rating between very depressed and extremely depressed on the depression scale most days, but I guess he meant I have a job and most people don't realise there's anything wrong with me. Anyway, I'm sure he meant well.
When it comes down to it 'll have to take something that has the potential to work, no matter what the side effects are. I've been depressed for years and have hit rock bottom, in mental pain and basically suicidal every day, a lot of the day, so not much choice.... Sorry for such long post, really feel like garbage today which makes me babble. Any ideas would be much appreciated...
Ines
Posted by polarbear206 on April 20, 2007, at 12:55:20
In reply to mood stabilisers for atypical symptoms, posted by Ines on April 20, 2007, at 11:37:39
> I had an appointment with a psychiatrist yesterday, my first one- until now I've been treated by GPs. The pdoc was really nice, but I'm feeling really low after the appointment. Until recently I thought I had atypical depression- I have all the atypical symptoms + some ocd. But psychiatrist seems to think I'm bipolar (actually someone on this site has suggested that before)- he told me they're going to consider putting me on a mood stabiliser. I've reacted badly to all ADs I've tried (not many though), and the latest, reboxetine has made depression and ocd symptoms worse.
> I'm a bit freaked as I somehow got the idea that mood stabilisers make you a bit 'dopey' and take the edge off your personality. Is that the case? My job depends totally on brain function so the idea of being slowed down cognitively is freaky. I also binge eat and do not want to put on any more weight. Does anyone have experience of taking mood stabilisers with similar symptoms or know a bit about these types of meds? I know nothing...
> Psychiatrist told me there won't be a 'magic pill' for me in the long run and that what they can do is help me cope better with symptoms, so I feel realy low after that. Really cannot imagine the rest of my life being the way my life has been till now- all I can hope for in that case is that it's a short one... He also said I was extraordinarily competent at coping with this and that it could be so much worse if it wasn't for that competence. Soo not reassuring- I'm not sure what could get worse that rating between very depressed and extremely depressed on the depression scale most days, but I guess he meant I have a job and most people don't realise there's anything wrong with me. Anyway, I'm sure he meant well.
> When it comes down to it 'll have to take something that has the potential to work, no matter what the side effects are. I've been depressed for years and have hit rock bottom, in mental pain and basically suicidal every day, a lot of the day, so not much choice.... Sorry for such long post, really feel like garbage today which makes me babble. Any ideas would be much appreciated...
> Ines
Ines,Atypical depression with trials of multiple AD's without relief thus causing mood cycling, are hallmark signs for an underlying bipolar spectrum disorder. I have atypical depression with my soft bipolar II symptoms. Lamictal is one of the best mood stabilizers for Bipolar disorders. It does not make me feel dull, in fact I am more mentally sharp on it. It is weight neutral. I haven't gained weight on it. If you are depression dominated as I am, you may be able to tolerate an AD once you are on a mood stablizer. Many bipolars need to be on AD's due to lingering depression. I take effexor and I am highly functional. An AD will work the way it should for you if you are on a mood stabilizer. Life is very good for me and I am very happy. Don't lose hope. It's just around the corner.
Polarbear
Posted by linkadge on April 20, 2007, at 14:27:47
In reply to Re: mood stabilisers for atypical symptoms » Ines, posted by polarbear206 on April 20, 2007, at 12:55:20
I'd like to (for the sake of it) take a different view from above.
Lack of success with antidepressants does not equate to bipolar disorder. That is a logical fallacy that psychiatrists would like you to believe so that they have a better opportunity of keeping patients and making more $. That being said, a trial with a mood stabilizer is worth a shot.
I am in a similar situation. I have depressive symptoms that do not react well to antidepressants. Mood stabilizers make me feel worse still.
I agree with above that lamotrigine might be worth a shot.
I can't recomend any of the other mood stabilizers as they do precious little for low energy, if not making it worse.
Linkadge
Posted by Phillipa on April 20, 2007, at 15:00:12
In reply to Re: mood stabilisers for atypical symptoms, posted by linkadge on April 20, 2007, at 14:27:47
At one time I was taking low doses of trileptal no side effects at all was supposed to raise didn't as the cost was so high now I have Medicaire D and I think it may be covered. Also was on two trial of lamictal no side effects weight neutral supposed to boost my antidepressant. But rare side effect of excess salivation disgusting. but I repeat it's a good med and they have starter packs starting at 25mg for two weeks then 50mg for same time and then l00mg. What is the target dose as many do quite well on lose doses. And Good luck I know this will help you I just have a gut feeling. Love Phillipa ps what ones did the doc suggest????
Posted by polarbear206 on April 20, 2007, at 16:47:51
In reply to Re: mood stabilisers for atypical symptoms, posted by linkadge on April 20, 2007, at 14:27:47
> I'd like to (for the sake of it) take a different view from above.
>
> Lack of success with antidepressants does not equate to bipolar disorder. That is a logical fallacy that psychiatrists would like you to believe so that they have a better opportunity of keeping patients and making more $. That being said, a trial with a mood stabilizer is worth a shot.
>
> I am in a similar situation. I have depressive symptoms that do not react well to antidepressants. Mood stabilizers make me feel worse still.
>
> I agree with above that lamotrigine might be worth a shot.
>
> I can't recomend any of the other mood stabilizers as they do precious little for low energy, if not making it worse.
>
> Linkadge
>
>
>
> I didn't mean to imply that everyone is likely to have bipolar that doesn't respond to AD's. I guess how I worded it was misunderstood. However,there is a high rate of this in undiagnosed bipolar disorders. This is what I have observed often in the clinical setting working in the mental health profession.Polarbear
Posted by Ines on April 20, 2007, at 17:14:35
In reply to Re: mood stabilisers for atypical symptoms » Ines, posted by polarbear206 on April 20, 2007, at 12:55:20
Polarbear thanks so much, your reply gave me much needed hope right now. I've had a look at Lamictal info on the net and it does look promising, and to know it's really helped you does make me feel better (I too am depression dominated). You know Phillipa I was so upset at the end of this appoinment that I didn't ask for more details about what mood stabilisers he was considering- he did mention valproate though, and the info about that has put me off. Linkadge, I take your point about pdocs trying to keep you under meds. But I'm sure this isn't the case here 'cause he said the idea long term is to get me off drugs altogether, just therapy. Also, I'm in the UK and he's an NHS doctor so nothing to gain from me being there... I guess that's one advantage of this system- you know they have no vested interest.
Thanks so much for replies- this forum has great people, I feel a bit better just from support
Ines
Posted by linkadge on April 20, 2007, at 17:39:04
In reply to Re: mood stabilisers for atypical symptoms » linkadge, posted by polarbear206 on April 20, 2007, at 16:47:51
>This is what I have observed often in the >clinical setting working in the mental health >profession.
This may be true, but there is probaably a high rate of misdiagnosis of bipolar disorder where none exists (IMO).
The problem with misdiagnosing bipolar disorder, is that it often corresponds to really heavy medications. Lithium, AC's and AP's are no walk in the park. Bipolar meds can seriously affect ones life.
I was (IMO) misdiagnosed with bipolar, and two years of heavy mood stabilizers really took a toll on my school performance and confidence.
Sometimes too, mood stabilizers "contoll" the patient sufficiantly that the diagnosis of bipolar is believed.
Also, rarely do you find doctors who are willing to fine tweak the subtlties of certain mood disorders. It is either bipolar or unipolar.
I think there are a lot more inbetween mood disorders that don't diserve or do well on either bipolar or unipolar meds.
Linkadge
Posted by linkadge on April 20, 2007, at 17:43:24
In reply to Re: mood stabilisers for atypical symptoms, posted by Ines on April 20, 2007, at 17:14:35
I guess the bottom line is wheather you can find releif or improvement. The only thing I would caution against is the bipolar diagonosis. **It can be a death sentense.**
You can't convince a doctor you're *not* bipolar, cause the harder you try, and the more frustrated you get, the more you look like a bipolar!
Every doctor I go to now reads that chart which says "bipolar", and I can't get a second chance with antidpressants, even though things were a lot better with them than the mood stabilizers.
So I go to a new doctor, and they just want to load me down on lithium or tegretol, and that is not a fun life to live.
I just *cannot* break free of that diagnosis, and it makes my prospects look bleaker.
Linkadge
Posted by Ines on April 20, 2007, at 18:02:56
In reply to Re: mood stabilisers for atypical symptoms, posted by linkadge on April 20, 2007, at 17:43:24
Hey Linkadge,
That sounds really difficult. Have you tried/ thought about tracking down a pdoc that is known for being open minded about looking at things afresh, e.g. one that is against fixed cathegories? If you could find one person that would question that initial diagnosis, gave you a fair shot at non bipolar meds and that worked and went on your chart, maybe things would get easier in the future...One thing I quite liked about this psychiatrist was that he never mentioned the word bipolar. I only got to know that's what he was thinking was because he suggested mood stabilisers. He said he was against attaching labels, he didn't think they were helpful. I kind of liked that, even though I'm one of those people that likes to know the exact diagnosis, so I can do background research on it. Not that there's anything shameful about being bipolar, obviously, but I do agree that putting people in 'boxes' narrows down how you think about treatment options.
Ines
Posted by linkadge on April 21, 2007, at 8:06:15
In reply to Re: mood stabilisers for atypical symptoms » linkadge, posted by Ines on April 20, 2007, at 18:02:56
I would certainly like a fresh start in terms of diagnosis.
In canada, the typical psychiatrist appointment is 10-15 minautes. So they tend to want to cut courners, which often means less interest in getting to the root of the problem.
I also have to get a refferral to a psychaitrist, which comes from my a doctor who passes on all the previous records.
I suppose it is possable, I just don't know how to go about getting there.Linkadge
Posted by Ines on April 21, 2007, at 17:01:32
In reply to Re: mood stabilisers for atypical symptoms, posted by linkadge on April 21, 2007, at 8:06:15
Hmm, that sounds tricky... How about writing a document with your reactions to medications, and do something like a comparison table between how you felt like on AD's vs how you fel like on mood stabilisers. Say you're not questioning the diagnosis (in case that gets their back up), but just that maybe you're somewhere in the grey zone and you feel that overall ADs improved your quality of life more than mood stabilisers did and could you give them a try again, under medical supervision? Impress them with your thoroughness, calmness, and rationality. It's all I can think off... hope it's of some help.
Ines
Posted by linkadge on April 21, 2007, at 18:35:19
In reply to Re: mood stabilisers for atypical symptoms » linkadge, posted by Ines on April 21, 2007, at 17:01:32
These are good ideas. I have tried some of these strategies without sucess.
The doctors I have seen seem to have a BIG problem with asserting their authority. Ie
"I am the doctor, it is not customary for the patient to tell the doctor what is the matter".So if I suggest a particular treatment that may help, they almost surely suggest the opposite to assert their authority.
I am hoping I can find a more reasonable doctor.
Linkadge
Posted by James_glasgow on April 22, 2007, at 8:33:42
In reply to Re: mood stabilisers for atypical symptoms » linkadge, posted by Ines on April 21, 2007, at 17:01:32
Hi Ines,
I am also in the UK and have been tried on a few mood stabilisers.
They generally start with lithium first. I personal found it extremely effective for my mood problem, but I was also taking paroxetine and I developed movement problems so stopped taking it. In my experience I would not say it so much slowed me down as just made me "normal", which I know is not the right word. It was rather like the glue that held my mind together was back and it only took 4 days, not the 2-4 weeks you need to wait for an anti-depressant to work. It also made my beard hair fall out in patches which I suppose I could put up with but still did not like that. I have just come down from a 3 week mania, after treatment with clonazepam at 4mg's per day and I am considering lithium again on its own.
Next was lamotrigine, unfortunately that for me (although I know many people find it works brilliantly) was not so good. After getting up to 100mg I found myself alternating between laughing and crying over the space of an hour or so, and became much more anxious and obsessive than usual.
After, that I tried valproate but I think before I even took it I had told myself I was not going to like it. It upset my stomach and after 3 days went in the bin. I know that is no where near an adequate trial.
I think you really need to just try them and see how you get on, what one person experiences another might not.
Best of luck.
James
Posted by linkadge on April 22, 2007, at 9:36:25
In reply to Re: mood stabilisers for atypical symptoms, posted by James_glasgow on April 22, 2007, at 8:33:42
I agree that it is a good idea to try a mood stabilizer if you have had manic episodes or significant mood cycling.
I suppose, Ines, I should have asked about this. For me it was a little different since I never had mood cycling, it was just that antidepressants did not do anything.
So I felt that calling me bipolar was not really helping, only that it was just an excuse for them to try different meds.
So I guess it depends on your individual case.
Linkadge
Posted by Ines on April 22, 2007, at 11:12:45
In reply to Re: mood stabilisers for atypical symptoms, posted by linkadge on April 22, 2007, at 9:36:25
Thanks James and Linkadge. No, I have never had manic episodes or cycling that I am aware of. A bipolar diagnosis never entered my mind because of that. I just feel depressed. But looking at it carefully now, I suppose I have some characteristics of mixed states depression, i.e. my depression is very agitated and anxious, I can sometimes feel elated just for a minute or so before crashing badly, I alternate between anger/ irritability and sadness. My mood also swings wildly, sometimes from OKness to deep despair for no apparent reason. The only time I felt some sort of mania was when withdrawing (gradually) from an SSRI - it made my mood swing wildly from one moment to the next (literally from crying in despair to feeling euphoric), and I became very sociable and hyper when with friends, but deeply depressed when alone. Most bizarre experience. I most definitely have racing thoughts when depressed, and general mental (but not physical) hyperactivity- only it feels painful, not pleasurable or powerful in any way.
Posted by linkadge on April 22, 2007, at 12:35:52
In reply to Re: mood stabilisers for atypical symptoms, posted by Ines on April 22, 2007, at 11:12:45
>But looking at it carefully now, I suppose I >have some characteristics of mixed states >depression, i.e. my depression is very agitated >and anxious,
Back in the day there was a thing called agitated depression, before all of this bipolar 1000, stuff came into the picture. The TCA's were pretty good for that. Now they like to treat a lot of things with mood stabilizers.
Anger, irritability, and agitation can (IMHO) all be symptoms of just plain depression.
>I can sometimes feel elated just for a minute or >so before crashing badly, I alternate between >anger/ irritability and sadness. My mood also >swings wildly, sometimes from OKness to deep >despair for no apparent reason.
Omega-3 fatty acids might be a usefull adjunct to whatever meds you may end up on.
>The only time I felt some sort of mania was when >withdrawing (gradually) from an SSRI - it made >my mood swing wildly from one moment to the next >(literally from crying in despair to feeling >euphoric), and I became very sociable and hyper >when with friends, but deeply depressed when >alone. Most bizarre experience.
I suppose that this is similar to me too. I got placed on lithium when I came off of celexa, because the withdrawl made me kookey. This is *suprisingly* common. The SSRI's are powerful emotonal anesthetics, and withdrawing from them can let a lot of bottled emotions out.
I think this is why I got called bipolar, but after sufficiant time off the SSRI's I was not cycling.
>definitely have racing thoughts when depressed, >and general mental (but not physical) >hyperactivity- only it feels painful, not >pleasurable or powerful in any way.I know what you are talking about. Some of the earlies accounts of neurotic depression involved descriptions of racing mind, mental and physical agitation.
I can't say I know what the underlying biological underpinnings of what you are going through. Could be hormonal, could be nutritional, biochemical environemntal etc.
The only reason I jumped in on this post was that (in my experience) the mood stabilizers do very little for predominant and persistant depressed mood.
Lamotrigine might be worth a shot. I didn't do well on it as it just made me agitated.
Linkadge
Posted by Ines on April 22, 2007, at 16:10:57
In reply to Re: mood stabilisers for atypical symptoms, posted by linkadge on April 22, 2007, at 12:35:52
Hey Linkadge,
Yes, I'm thinking lamotrigine might be worth a try. And I started omega 3 oil a couple of weeks ago. Fingers crossed that something will work. I'm getting a 2nd opinion from another psychiatrist this week, so we'll see what he says. I really don't want to try everything out there. It is scary what coming off it can do to you! I'll post if anything is successful, as it seems we share many characteristics.
Ines
Posted by Johann on April 24, 2007, at 1:52:26
In reply to mood stabilisers for atypical symptoms, posted by Ines on April 20, 2007, at 11:37:39
Hi Ines,
Don't be discouraged. After decades of atypical depression my new psychi and I realized that I have Bipolar Spectrum Disorder. Lithium and Lamictal have both helped, at the same time, and I don't feel any dullness, etc., just a loss of excrutiating depression. (For my job I must keep my mind and emotions highly tuned as well.) I also have high anxiety, which these two drugs don't help as much, so I am taking Klonopin for this.
PS--I'd say that your drug history does indicate a soft form of bipolar disorder; but even people with BPD1 can have a "normal" life.
Take care,
Johann
> I had an appointment with a psychiatrist yesterday, my first one- until now I've been treated by GPs. The pdoc was really nice, but I'm feeling really low after the appointment. Until recently I thought I had atypical depression- I have all the atypical symptoms + some ocd. But psychiatrist seems to think I'm bipolar (actually someone on this site has suggested that before)- he told me they're going to consider putting me on a mood stabiliser. I've reacted badly to all ADs I've tried (not many though), and the latest, reboxetine has made depression and ocd symptoms worse.
> I'm a bit freaked as I somehow got the idea that mood stabilisers make you a bit 'dopey' and take the edge off your personality. Is that the case? My job depends totally on brain function so the idea of being slowed down cognitively is freaky. I also binge eat and do not want to put on any more weight. Does anyone have experience of taking mood stabilisers with similar symptoms or know a bit about these types of meds? I know nothing...
> Psychiatrist told me there won't be a 'magic pill' for me in the long run and that what they can do is help me cope better with symptoms, so I feel realy low after that. Really cannot imagine the rest of my life being the way my life has been till now- all I can hope for in that case is that it's a short one... He also said I was extraordinarily competent at coping with this and that it could be so much worse if it wasn't for that competence. Soo not reassuring- I'm not sure what could get worse that rating between very depressed and extremely depressed on the depression scale most days, but I guess he meant I have a job and most people don't realise there's anything wrong with me. Anyway, I'm sure he meant well.
> When it comes down to it 'll have to take something that has the potential to work, no matter what the side effects are. I've been depressed for years and have hit rock bottom, in mental pain and basically suicidal every day, a lot of the day, so not much choice.... Sorry for such long post, really feel like garbage today which makes me babble. Any ideas would be much appreciated...
> Ines
Posted by theo on April 24, 2007, at 22:02:53
In reply to Re: mood stabilisers for atypical symptoms » Ines, posted by polarbear206 on April 20, 2007, at 12:55:20
Do you take your Lamictal in a single dose? If so do you take it morning or bedtime? What dose?
Posted by Johann on April 24, 2007, at 23:35:03
In reply to Re: mood stabilisers for atypical symptoms » polarbear206, posted by theo on April 24, 2007, at 22:02:53
Since all of my meds are either sedating or neutral I take them at night, which of course includes Lamictal, which I find to be neutral regarding sedation.
Posted by polarbear206 on April 25, 2007, at 14:58:33
In reply to Re: mood stabilisers for atypical symptoms » polarbear206, posted by theo on April 24, 2007, at 22:02:53
> Do you take your Lamictal in a single dose? If so do you take it morning or bedtime? What dose?
I take 200mg in the morning. It doesn't make me sleepy at all like other mood stabilizers.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.