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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Dr. D on May 25, 2006, at 9:53:38
good morning all. I'm writing this because I have a number of questions about depression, mania, and especially medications. I'll provide a brief overview of my history and current situation, and hope you can advise me in the best course of action.
I was diagnosed as being depressed early in my life - already at age 5-6 it started its onset. I walked alone on the playground, didn't play football, had few friends etcetera. My father, who had depressions all his life and was one of the first to have taken MAOIs, recognised this and had to start a war against the then-ruling concept that children could not be depressed (that was the early Eighties; I was born in '76.) Finally however, we found a psychiatrist at least willing to have a look, and not long after they started me out with Tricyclics (Norpramin). This didn't appear to help much, so they switched me over to an MAOI (Humoryl, a french drug) which had markedly better results. However, my youthful recalcitrance and depression itself along with my lack of insight into the importance of taking it prevented my taking it regularly over long periods of time, so I remained the oddball. My lack of social experience was becoming an increasing problem - kids are merciless to each other - and it wasn't until I was 12-13 that I started to actually have good friends and develop something resembling a life. This was after I had moved from the States to my country of birth, the Netherlands, after a sojourn of 10 years due to dad's business.
Then puberty hit with all its annoying complications, so life continued: I was good at school (when I could be bothered to take the effort... I'll spare you my history of "homework helpers" :P) and although most of the kids thought I was a moron, the few people who bothered to take an interest became and have hitherto remained good friends. (I also have to add that I got on increasingly well with them as I got older, so a lot of this is probably typical child and adolescent crap.)
Then at age 15, I discovered weed, and started smoking up. First weekly, then daily, then I was hooked. It became a destructive addiction which affected everything in my life. School went down the drain, I started stealing to finance my addiction (which was later compounded by a gambling machine addiction), I was chronically depressed and stoned and thus too lazy to do pretty much anything with my life except sit behind my computer (which saved my bacon later on.) Nevertheless, with the help of a boarding school, homework helpers and the fact that despite everything I still have a damn good brain, I managed to pass through school and get my diploma.
After this not much changed. I decided to work for a year and give school a break (but was in truth too lazy and down to want to do much of anything). I had a few odd jobs, but none lasted - weed conquered all. I sat at home and played computer games, went out, and increasingly drank more. All this went on until the start of 2002, when I was so thoroughly sick of myself that when I was having one of my better spells, I grabbed the chance with a "now or never" mindset, and quit everything - smoking, weed, and alcohol. Needless to say, the changes were astonishing. I had energy, surprised myself by turning out to be creative and intelligent, and set up a small IT company a few months later with two friends.
The first year or so was excellent. My mind was sharp and I was able to work out and execute one idea after another; in retrospect I think this was a state of controlled hypomania. Unfortunately, this took its toll, and I slowly sunk back down. At the same time something else was happening: my mind was getting "stuck" as a result of constant stress from work. This ultimately ended in a burn-out which I stayed in for two years - from approx. end 2003 to end 2005.
During 2005 somewhere I also slipped back into depression, but my mind was so dulled that I was in no condition to think about it properly, much less get help. I was smoking and drinking again (though thankfully the desire for weed never returned) and I also drank gallons of coffee. I later discovered that both the smoking and the coffee (and, interestingly, doing sports) were keeping me "burned out"; after I stopped those and had two weeks of rest, I was gradually able to think more clearly and the effects of the depression also started to lift away. From research I understand that the burn-out is due to oversensitization of my brain to Cortisol, a steroid produced and used by the body to manage sugar levels and thus energy levels. Coffee, fitness and smoking are known cortisol antagonists, and I noticed I became extremely frustrated about ten seconds after a drag from a cigarette where I was previously feeling decent. Similarly, drinking a cup of coffee resulted in my brain "freezing up" where all I felt was a sort of dizziness and a pressure on the top of my skull. During my burnout/depressed time, I was hardly able to respond to anything at work, could only execute routine chores and reacted overemotionally to everything; every comment from friends or colleagues felt like an accusation instead of a suggestion or an idea, which resulted in my griping them more and more often.
The last two months are decidedly better. I have energy again and can think fairly clearly. I immediately got myself a psychiatrist to help find a way to manage things for the future, because I don't EVER want to fall back into that hellhole of self-hate and pain again. I still drink myself to anywhere between tipsiness and drunkenness in the evenings, although the "need" seems to be becoming weaker. I have visited my psych twice now, but I don't get the impression he's the sharpest tool in the shed. Of course, I could be wrong. But my previous shrinks were generally better and more active. And here's where the questions begin:
- He suggests I start taking a mood stabilizer, as there is a good chance I could slip into (hypo)mania now. He advises Depakine, maybe for a period of two years or so. What do you think of this? Have you had experience with Depakine? Does it work well, and how are the side affects? How about Tegretol, Lithium or Gabapentin? Note: I have never had a true manic episode, only the aforementioned period of hypomania.
- Is there a way to work out what my "baseline" is, that's to say: my average emotional state? If at all possible, I would like to stay in the hypomanic state indefinitely. Is it possible that this is my basic state and that I suffer from depressions, or would you rather say I'm bipolar? Is it possible to medicate yourself safely into controlled hypomania and stay there? Would it, for example, be possible to take e.g. Depakine to control the swings and combine it with an SSRI to "push up" the average level into controlled hypomania? Or is it an "either-or" story: either depressions and hypomania, or neither?
- Does taking medication for longer periods of time "imprint" on the body and brain, meaning that medications will be necessary less often later in life since the body accepts a certain state of mood as the norm?
Any comments would be most welcome. I am perfectly willing to experiment, but am trying to get help from as many corners as possible so I can make a well-balanced decision. Thanks in advance!
regards and best wishes,
Dr. D (I'm not a doctor though.. well, maybe my computer thinks I am, to it :)
Posted by B2chica on May 25, 2006, at 11:08:05
In reply to questions about bipolar, hypomania, and meds, posted by Dr. D on May 25, 2006, at 9:53:38
Hi Dr.D.
first i want to say hello and welcome to babble.
they will most likely redirect this thread over to the meds board (the main psycho-babble board). you questions will best be answered over there. this board is more for talk about therapy and such.but
i'm not sure about the hypomania, because it did happen right after you stopped smoking/drinking etc. this was enough to clean you out and let you realize what you could do after years of depressing your system. keep in mind you mentioned these behaviors had been going on since early adolescents.
however, it does seem like you are suffering from depression (no sh@t right).well, first, is there a reason you don't think your pdoc is bright? and are you able to find a different one? it is crucial that you find a pdoc that you can trust and be very open and honest with.
a mood stabilizer is pretty common for those folks diagnosed with BP, but there is more risk for shooting into mania from AD then from mood stabilizers (not to say it doens't happen...it does). i haven't heard of depakine so i can't comment on that. others may be able to. and the other meds you mentioned are pretty well established meds. again on the meds board you will get comments from those that have taken these.IMHO i do infact think that what you mentioned earlier was not necessarily a hypomanic state but may infact be a natural state for you (not knowing exactly what your emotions were like during that time-just taking into consideration your surrounding environment). so it's possible that you were experiencing life for the first time without drugs or depression and with a life goal.
to be honest, i can't say i know anyone that 'wants' to stay in hypomania due to its effects so i'm not sure how meds could control that nor would i advise it. No offense but to be blunt it sounds like you are looking for a similar 'rush' to what you experienced before. though hypomania i've heard can be 'addicting'. Either way what you've expressed is an addictive behavior and you may want to consider this Carefully before you rush into testing meds. this could also lead you to more damaging narcotics. Have you happened to mention any of this to your pdoc? i'm just wondering, maybe that's why he's suggested a moodstabilizer??as for med 'imprint', this varies from person to person. i've known some that need to be medicated for the rest of their life. they go off it for a week and they are in crisis. i have also heard of others taking it for a few years and tapering slowly off and only taking meds for maintenance once in a while. sometimes taking meds in combination with thearpy is the best answer. i strongly suggest this for you.
again, you will get much better replies on the meds board. there are some really intelligent folks over there.
good luck and please becareful
b2c
Posted by B2chica on May 25, 2006, at 11:09:11
In reply to questions about bipolar, hypomania, and meds, posted by Dr. D on May 25, 2006, at 9:53:38
i don't know how to redirect but i think this thread will get a much better response from the meds board. if anyone can help that would be great.
Thanks!
Posted by Dr. D on May 25, 2006, at 11:56:42
In reply to Re: questions about bipolar, hypomania, and meds, posted by B2chica on May 25, 2006, at 11:08:05
> Hi Dr.D.
> first i want to say hello and welcome to babble.
> they will most likely redirect this thread over to the meds board (the main psycho-babble board). you questions will best be answered over there. this board is more for talk about therapy and such.- Okidoki... I'll see what happens... hope someone will transfer us :)
>
> but
> i'm not sure about the hypomania, because it did happen right after you stopped smoking/drinking etc. this was enough to clean you out and let you realize what you could do after years of depressing your system. keep in mind you mentioned these behaviors had been going on since early adolescents.
> however, it does seem like you are suffering from depression (no sh@t right).- The depression is quite real, although it could be due to work as much as hereditary. I've been wondering whether with me, it's not also environmental. I HAVE been under a LOT of stress the last few years. But my father is bipolar, my mom is often depressed and bipolar is strong in my father's side (one of his sisters committed suicide). But I'm hoping that what you say is indeed true - that my "hypomania" is simply my natural state. It is with my father, at any rate.
>
> well, first, is there a reason you don't think your pdoc is bright? and are you able to find a different one? it is crucial that you find a pdoc that you can trust and be very open and honest with.- He admitted himself that he doesn't know much about certain meds; he only does 'shrinking' part-time (his fulltime job is helping people who are in the slammer). He also seems rather insecure for a psychiatrist. Now maybe I've been spoiled in the past, but previous shrinks were able to keep up with me mentally and I had some quite stimulating discussions with them. I'm lacking that here. But I'll try him a bit longer and see what happens, I can always switch and my insurance pays all...
> a mood stabilizer is pretty common for those folks diagnosed with BP, but there is more risk for shooting into mania from AD then from mood stabilizers (not to say it doens't happen...it does). i haven't heard of depakine so i can't comment on that. others may be able to. and the other meds you mentioned are pretty well established meds. again on the meds board you will get comments from those that have taken these.
>
> IMHO i do infact think that what you mentioned earlier was not necessarily a hypomanic state but may infact be a natural state for you (not knowing exactly what your emotions were like during that time-just taking into consideration your surrounding environment). so it's possible that you were experiencing life for the first time without drugs or depression and with a life goal.> to be honest, i can't say i know anyone that 'wants' to stay in hypomania due to its effects so i'm not sure how meds could control that nor would i advise it. No offense but to be blunt it sounds like you are looking for a similar 'rush' to what you experienced before. though hypomania i've heard can be 'addicting'. Either way what you've expressed is an addictive behavior and you may want to consider this Carefully before you rush into testing meds. this could also lead you to more damaging narcotics. Have you happened to mention any of this to your pdoc? i'm just wondering, maybe that's why he's suggested a moodstabilizer??
- You're quite right. I really enjoyed that time and would dearly like to be 'back' there again. I was productive, thoughts were fast but not impossible, I had a lot of ideas and impulses but they were manageable. Memory was nearly flawless, libido was good, I didn't gripe myself for past mistakes (as happens obsessively during depression), I could go up to and talk to any girl and actually have something to say, I was amusing to myself and my friends. Who wouldn't want to be like that for life? I also remember thinking back then that if I stayed that way for life, life would not only be bearable but actually quite fun.
I haven't mentioned that to my shrink yet for exactly that reason - I wanted to see what he suggested on basis of his perceptions of me and my general history alone. I described it, of course, but didn't tell him I would like to be that way for life if possible. I'll probably do that a few sessions from now. For now I want to gather as much intel as possible about meds and ramifications of both depression and bipolar disorder; I prefer to look before I leap, and this is probably the most important decision I'll be making any time soon since it directly influences all other choices I may make. I basically want an overview of all the current meds on the market, their pros/cons, their side effects and people's experiences. Since it's hard for me to tell whether I'm bipolar or 'just' depressed, I may have to gamble on one or the other, but I'm not doing that without a LOT of research.
I slightly shrink away from mood stabilizers though, because I've heard firsthand from my cousin (father's side) how utterly zombifying that can be, and my Uebergoal, if you will, is to live life fully, be helpful, and advance myself socially and spiritually. I want to continue to grow, and in my honest opinion, depression is shrinking (you 'fall back', especially if you have a history of bad habits which you can and will fall back into); and 'normalcy' is stagnation. I was able to tweak and fix more of my bad habits and problems during that short happy period than I had in my whole life beforehand. I was sublimely aware of myself, my actions and their effects upon others, and was effortlessly happy. I wouldn't be surprised if that state isn't what all those eastern mystics are on about - spiritual being, and all that. And that may suggest that there are more factors to the equation than genetics; it might well just be a question of proper balance, food, exercise etcetera.
>
> as for med 'imprint', this varies from person to person. i've known some that need to be medicated for the rest of their life. they go off it for a week and they are in crisis. i have also heard of others taking it for a few years and tapering slowly off and only taking meds for maintenance once in a while. sometimes taking meds in combination with thearpy is the best answer. i strongly suggest this for you.
>Well, the ball is rolling, so I'm certainly going to try :)
> again, you will get much better replies on the meds board. there are some really intelligent folks over there.
>
> good luck and please becareful
> b2cthanks for your time!
Posted by B2chica on May 25, 2006, at 12:46:34
In reply to Re: questions about bipolar... B2Chica, posted by Dr. D on May 25, 2006, at 11:56:42
whether the depression be from heredity or from external stressors either way it can be a terrible way to live. and i'm hoping you find a reprieve.
if doctors know that BP is in your family they are much more likely looking for cues that what you have is BP this can be good and bad. on the good side, they could much more quickly catch it if you are showing symptoms and get meds to help ASAP, on the down side, they could very easily misinterpret normal energy for hypomania. i think this is where it's REALLY important for you to have a pdoc that really knows his stuff.
i think what yo'uve mentioned about him would certainly make me wonder if he's infact the best for the job. go with your instincts, trust that.>>You're quite right. I really enjoyed that time and would dearly like to be 'back' there again. I was productive, thoughts were fast but not impossible, I had a lot of ideas and impulses but they were manageable. Memory was nearly flawless, libido was good, I didn't gripe myself for past mistakes (as happens obsessively during depression), I could go up to and talk to any girl and actually have something to say, I was amusing to myself and my friends. Who wouldn't want to be like that for life? I also remember thinking back then that if I stayed that way for life, life would not only be bearable but actually quite fun.
this sounds wonderful. i've had similar hypomania but if i have it like that it lasts about 2 days before it turns horrible. i think i'd want to go back to that too!
but again...i wasn't in your shoes so this could have been just a really good break from substance and depression.
did you say you have been on several types of AD? can't remember.anyway, good call on waiting to tell pdoc. if you do want to tell him, tell him the way you described it to me the second time. don't say 'i want to stay hypomanic' this will send him into the (oh no he's just looking for drugs) routine. tell him that when you felt this way, you were energetic, had focus, determination, self-esteem and enjoyed life, that you want to be able to do that again....this was much better and he won't peg you as drug seeking.
i think we all here like to look before we leap...i strongly suggest maybe reposting on the meds boards...they are great for assistance of this kind.
and don't let a bad experience steer you away from meds. some drugs will infact make you feel zombie like, others will let you feel normal again. funny thing is we all react differently. most recently one of the drugs i was on was zyprexa. now i've heard many people saying they couldn't stand being on it because it was so sedating. but for me it was the only AP that didn't fog my thinking and stopped my ruminations, helped with depression, helped with anxiety, helped me sleep And helped with my sometimes somewhat psychotic depression.
keep in mind when you go to the meds boards, most of the people there are there because they are having difficulty finding a drug that works. you will get 10 responses on how one drug works. some hate it, some love it... but i guess i like that. i like to see all the possibilities then choose from that. and you have a great uebergoal.
also, i think there is CERTAINLY something to be said about proper balance, food exercise and such. i know exercise has helped both my depression and my sleep patterns.>>thanks for your time!
you bet....HTH
b2c
Posted by B2chica on May 25, 2006, at 13:00:01
In reply to questions about bipolar, hypomania, and meds, posted by Dr. D on May 25, 2006, at 9:53:38
i may have successfully redirected your post to the meds board. if you scroll to the top of the page it is the 'plain' psycho-babble link. it will show up at the bottom of the page, except that it looks like i wrote it (my name after the title).
keep checking to see replies.good luck Dr.D!
b2c.
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