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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by bob on January 27, 2002, at 19:43:18
Is the presence of bouts of extreme irritability, comorbid with irrational ruminations indicative of depression, or BPD? These symptoms cycle along with depression and anxiety. I've never been diagnosed as BP, as I've never been manic or hypomanic in the classic sense unless it was med induced. I have experienced bouts of irritability, along with anger. The only problem with me believing I'm bipolar, is that with the mood stabilizers I've taken (Depakote, Lithium, Tegretol), I become a zombie and start sleeping all day. It seems that those meds are much more helpful for people who experience true manic episodes, not irritability and anger. I'm very afraid that what I really have is a personality problem. That seems especially unfortunate to me, since BPDs seem to be so hard to treat, in addition to the fact that I'm extremely med intolerant. Meds are killing me.
Posted by TSA West on January 27, 2002, at 21:36:46
In reply to Persistent, cycling irritability..., posted by bob on January 27, 2002, at 19:43:18
I totally sympathize with your irritability illness...
There is an idea of taking fluoxetine at irregular intervals for irritability because of its long half-life: (http://www.dr-bob.org/tips/split/Fluoxetine-for-irritabilit.html)
Regardless of whether you're bipolar or not, Lamictal or Neurontin could help you, due to their effects on GABA and/or serotonin/NA channels. I've heard many success stories from non-bipolars who have been switched from standard antidepressants to newer mood stabilizers like Neurontin: http://www.psycom.net/depression.central.gabapentin.html
http://www.psycom.net/depression.central.lamotrigine.htmlAnother idea if you really cannot tolerate standard meds for any disorder is to go on something like BuSpar (the tylenol of psychotropics). http://www.dr-bob.org/tips/split/Buspirone-to-augment-antid.html
The best of luck and health to you and your family this season...
TSA West
Posted by Ritch on January 27, 2002, at 22:20:23
In reply to Persistent, cycling irritability..., posted by bob on January 27, 2002, at 19:43:18
> Is the presence of bouts of extreme irritability, comorbid with irrational ruminations indicative of depression, or BPD? These symptoms cycle along with depression and anxiety. I've never been diagnosed as BP, as I've never been manic or hypomanic in the classic sense unless it was med induced. I have experienced bouts of irritability, along with anger. The only problem with me believing I'm bipolar, is that with the mood stabilizers I've taken (Depakote, Lithium, Tegretol), I become a zombie and start sleeping all day. It seems that those meds are much more helpful for people who experience true manic episodes, not irritability and anger. I'm very afraid that what I really have is a personality problem. That seems especially unfortunate to me, since BPDs seem to be so hard to treat, in addition to the fact that I'm extremely med intolerant. Meds are killing me.
Bob, You haven't mentioned a trial with a stimulant... Many folks as adults who have anger-temper probs may benefit from a stimulant to control the impulsiveness-it could be as simple as adult ADHD.
Mitch
Posted by bob on January 27, 2002, at 22:27:26
In reply to Re: Persistent, cycling irritability... » bob, posted by Ritch on January 27, 2002, at 22:20:23
> Bob, You haven't mentioned a trial with a stimulant... Many folks as adults who have anger-temper probs may benefit from a stimulant to control the impulsiveness-it could be as simple as adult ADHD.
>
> MitchMitch:
When I was on Depakote, I had overwhelming fatigue almost all the time. During this period, I tried Ritalin, and Dexedrine. The Ritalin made an enormous difference for a few days (looking back it was a little like a hypomanic episode) but then gradually it had less and less effect. Eventually, I actually experienced a physical lethargy on it, with very little good effects. I then switched to Dexedrine, and had the same response, except without the initial good phase, probably because my body had already adapted to the Ritalin. Of course, the stimulants were being taken to counteract the unrelenting drowsiness of Depakote, and not for any irritability or impulsiveness. That's one thing Depakote was great at, was putting a big damper on everything. I don't know how I'd respond to those stimulants now, but I'd be suprised if any beneficial effect lasted.
Maybe Provigil would be a good thing to try???
Posted by Ritch on January 28, 2002, at 10:52:23
In reply to Re: Persistent, cycling irritability... » Ritch, posted by bob on January 27, 2002, at 22:27:26
>
> > Bob, You haven't mentioned a trial with a stimulant... Many folks as adults who have anger-temper probs may benefit from a stimulant to control the impulsiveness-it could be as simple as adult ADHD.
> >
> > Mitch
>
> Mitch:
>
> When I was on Depakote, I had overwhelming fatigue almost all the time. During this period, I tried Ritalin, and Dexedrine. The Ritalin made an enormous difference for a few days (looking back it was a little like a hypomanic episode) but then gradually it had less and less effect. Eventually, I actually experienced a physical lethargy on it, with very little good effects. I then switched to Dexedrine, and had the same response, except without the initial good phase, probably because my body had already adapted to the Ritalin. Of course, the stimulants were being taken to counteract the unrelenting drowsiness of Depakote, and not for any irritability or impulsiveness. That's one thing Depakote was great at, was putting a big damper on everything. I don't know how I'd respond to those stimulants now, but I'd be suprised if any beneficial effect lasted.
>
> Maybe Provigil would be a good thing to try???
Bob, That is one of the options I mentioned at my last visit. When I was on Adderall I experienced a very mild euphoria and insomnia for about two days. Then I started sleeping *better* and the stuff just kept me awake during the day. Didn't feel a need to increase the dose (I was taking just 5mg Am). I brought up the Provigil because it is supposed to cause less anxiety than the other pstims (that is how my Adderall got ditched). I have got a theory about Provigil based on its clinical pharmacology. I think my increasing anxiety probs on the Adderall had to do with dopamine depletion due to its dopamine *releasing* properties. Provigil doesn't appear to *release* stored up dopamine-it just blocks the reuptake transporter and lets it build up that way. Also, it doesn't affect NE like Ritalin and the amphetamines do. Of course that is all sheer speculation. I might try it for a week and hate the stuff-who knows?Mitch
Posted by bob on January 28, 2002, at 14:22:23
In reply to Re: Persistent, cycling irritability..., posted by Ritch on January 28, 2002, at 10:52:23
How long have you been on the Provigil?
Posted by Ritch on January 28, 2002, at 23:32:41
In reply to Re: Persistent, cycling irritability... » Ritch, posted by bob on January 28, 2002, at 14:22:23
> How long have you been on the Provigil?
OH, I just mentioned it to my pdoc as an *option* to consider (and is being considered). I was just explaining about how I *think* it might work better than conventional pstims. The ONLY medication that I have tried thus far during my seasonal winter major depression that worked (*complete* absence of depression) was Adderall.
Mitch
Posted by IsoM on January 29, 2002, at 0:51:38
In reply to Re: Persistent, cycling irritability..., posted by Ritch on January 28, 2002, at 10:52:23
> > "...I might try it (Provigil) for a week and hate the stuff-who knows?
Mitch"Mitch, if you only give it a week, you'll come to the conclusion it doesn't work at all & give up on something that may very well benefit you.
Provigil (modafinil) & Olmifon (adrafinil) have the same time-frame that ADs have. You don't get immediate benefits from it but it needs to take 2-3 weeks before you notice the benefits. Beneficial effects will continue to increase for another couple of months before evening out at that level.
Posted by Ritch on January 29, 2002, at 9:43:58
In reply to How Soon Provigil Works » Ritch, posted by IsoM on January 29, 2002, at 0:51:38
> > > "...I might try it (Provigil) for a week and hate the stuff-who knows?
> Mitch"
>
> Mitch, if you only give it a week, you'll come to the conclusion it doesn't work at all & give up on something that may very well benefit you.
>
> Provigil (modafinil) & Olmifon (adrafinil) have the same time-frame that ADs have. You don't get immediate benefits from it but it needs to take 2-3 weeks before you notice the benefits. Beneficial effects will continue to increase for another couple of months before evening out at that level.Hi,
Thanks for that. Honestly, I wasn't concerned that much with its *effectiveness*. Being bipolar it has more to do with what *bad* stuff could happen by taking it. If I have a negative response to a medication at the beginning it very rarely ever gets better. My trouble is primarily treatment intolerance rather than treatment resistance. I am just concerned that if I stopped my WB and added a tiny bit of Provigil that I would have GI distress, or bad insomnia, or rages/anxiety, stuff like that.
Mitch
Posted by Krazy Kat on January 29, 2002, at 10:57:13
In reply to Persistent, cycling irritability..., posted by bob on January 27, 2002, at 19:43:18
I'm BP and understand the irritability thing to a tee. It is horrible!!!
I don't know what your diagnosis should be(I've had clear amnia as well), but Depakote helped me some with runinating thtoughts, too.
What about an anti-psychotic?
Good luck!
- KK
Posted by Chris A. on January 29, 2002, at 17:51:05
In reply to Persistent, cycling irritability..., posted by bob on January 27, 2002, at 19:43:18
> Is the presence of bouts of extreme irritability, comorbid with irrational ruminations indicative of depression, or BPD?
Perhaps they should put the word "irritability" first in the diagnostic criteria for bipolar in the DSM. It seems few people read the entire sentence. Five out of the five people I know in real life who are diagnosed with bipolar struggle with the irritability. It's a hard one to admit to. For women it tends to be aggravated hormonally. I feared my nephew was going to kill or seriously injure his family prior to being diagnosed bipolar and put on Depakote. He would be irritable and then go into a rage. BTW, for all of us I've referred to, our chief complaint is depression.
Mixed,
Chris A.
Posted by Ritch on January 30, 2002, at 0:32:15
In reply to Re: Persistent, cycling irritability..., posted by Chris A. on January 29, 2002, at 17:51:05
> > Is the presence of bouts of extreme irritability, comorbid with irrational ruminations indicative of depression, or BPD?
>
> Perhaps they should put the word "irritability" first in the diagnostic criteria for bipolar in the DSM. It seems few people read the entire sentence. Five out of the five people I know in real life who are diagnosed with bipolar struggle with the irritability. It's a hard one to admit to. For women it tends to be aggravated hormonally. I feared my nephew was going to kill or seriously injure his family prior to being diagnosed bipolar and put on Depakote. He would be irritable and then go into a rage. BTW, for all of us I've referred to, our chief complaint is depression.
>
> Mixed,
>
> Chris A.Chris,
You have nailed it quite well! The thing I worry the most about is "Will this new med trial cause me to become so hostile that I will lose my job or worse??" I think my pdoc knows that, and it is making it more difficult to experiment. But.. I have had enough experiences with hostile med reactions to pick up on them real fast and ditch 'em quick.
Mitch
Posted by jimmygold70 on January 30, 2002, at 16:12:23
In reply to Persistent, cycling irritability..., posted by bob on January 27, 2002, at 19:43:18
It can be some sort of personality disorder. I can't rule out BPD, but there are other possibilites (e.g. Narcsistic Personality Disorder or some sort of Bipolar II/Cyclothymia).
Anyway, an SSRI (Prozac and the lice) + Low dose atypical antipsycotic (Risperdal or Zyprexa) will help you with the outbursts and ruminations.
Lithium may be of help as well.
Jimmy
Posted by petters on January 31, 2002, at 1:23:53
In reply to Re: Persistent, cycling irritability... » Chris A., posted by Ritch on January 30, 2002, at 0:32:15
> > > Is the presence of bouts of extreme irritability, comorbid with irrational ruminations indicative of depression, or BPD?
> >
> > Perhaps they should put the word "irritability" first in the diagnostic criteria for bipolar in the DSM. It seems few people read the entire sentence. Five out of the five people I know in real life who are diagnosed with bipolar struggle with the irritability. It's a hard one to admit to. For women it tends to be aggravated hormonally. I feared my nephew was going to kill or seriously injure his family prior to being diagnosed bipolar and put on Depakote. He would be irritable and then go into a rage. BTW, for all of us I've referred to, our chief complaint is depression.
> >
> > Mixed,
> >
> > Chris A.
>
> Chris,
>
> You have nailed it quite well! The thing I worry the most about is "Will this new med trial cause me to become so hostile that I will lose my job or worse??" I think my pdoc knows that, and it is making it more difficult to experiment. But.. I have had enough experiences with hostile med reactions to pick up on them real fast and ditch 'em quick.
>
> MitchHi...
Sounds like signs of bipolar disorder. In your case I would start with treat it with moodstabilizer. Topamax or Lamictal, or both. Then wait to see if you still got sympton that support the diagnosis of BPD. If so, try adding ziprasodone ( Geodon ) or Zyprexa an see whats happened.
Bipolar 2 disorder or refractary depression many times need the same medication treatment that is adequate for BPD. ( if not psychosis sympom exist)
Sorry for my sometimes bad spelling. Not from U.S
Sincerely...//Petters
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