Posted by Scott L. Schofield on January 9, 2000, at 20:08:55
In reply to Re: Parnate "properties" :), posted by Scott L. Schofield on January 9, 2000, at 10:54:46
> > > The verapamil sounds pretty good, especially since it may offer some mood-stabilizing properties.
>
> > (Note: I'm not bipolar.)
>
> > Actually I feel smarter since decreasing the lithium to 300mg! (I'm not taking any hard classes this semester, FWIW.)
>
> I guess my next question is obvious. If you are so convinced that you are not bipolar, why have you been taking lithium at all. I am *sure* that using lithium to augment antidepressants in unipolar depression is often a successful strategy. If this has been the rationale for using it, would not this rationale also apply to other “mood-stabilizers”?
>
> Sorry, gotta go…
>
>
> - Scott
To continue…I imagine if you were bipolar, mania would probably have made an appearance by now. You seem to have challenged the system with enough antidepressants and med-changes to trigger it were you to have that potential. Also, your presentation of depressive vegetative symptoms doesn’t seem to fit very well into the typical bipolar profile.
Severe depression began with me when I was 17. My initial diagnosis at age 22 was determined to be atypical unipolar. I tried an awful lot of drugs between then and age 27. As I guess you know by now, my depressed state has been quite severe and unrelenting. During this time, I can count on two hands the number of days in which I experienced a transient improvement. Never did I experience mania. However, I experienced a robust and steady remission of depression brought about by a combination of Parnate with Norpramin. I spent about six months in a state of euthymia, or something close to it, after which things began to change. Hypomania appeared and later blossomed into a psychotic manic dysphoria. I don’t want to discuss what happened with subsequent therapy, but I think it is important to note that the doctor I was seeing did not perceive this episode as being a diagnostic criterion for bipolar disorder. He continued to treat me as if I were unipolar, and thus I never received any “mood-stabilizers” that now seem necessary if I am to have a chance to get well.
I think I mentioned in an earlier post that I came across something on one of the newsgroups that purported to list bipolar subtypes being considered for adding to a future DSM. I think there were five total. One of them described a presentation in which any manias that occur are due to some drug intervention. I think I qualify for that one. The last on the list really surprised me. It described a bipolar subtype in which mania *never* occurs. This actually makes sense to me. Additionally, I think it makes sense to consider some cases as being “soft-bipolar”, a term that I came across recently. Without going back to find the literature, I think I remember cyclothymia as being an example of this. Treating these presentations as if they were bipolar was advocated, as well as the notion that these may represent precursor conditions to “hard” bipolar illness.
I have no reason to believe, and certainly don’t suggest that you are in any way bipolar. I know very little about your treatment history, but I get the impression that your depression is quite episodic. Have you ever been successfully treated? I think that if I were in your position, should I find a treatment that works, I would stick with it indefinitely. Also, I agree with Dr. Kupfer at Western Psychiatric that there is no such thing as a maintenance dose of an antidepressant. A patient is best maintained at the dosages that got them well in the first place. Dr. Kupfer is one of the few investigators who have studied the course of treatment of his patients longitudinally.
- Scott
poster:Scott L. Schofield
thread:17762
URL: http://www.dr-bob.org/babble/20000101/msgs/18494.html