Posted by Mark H. on April 30, 2000, at 15:26:41
In reply to Re: Short Trial Success/Bipolar II Qx - To Mark, posted by Cam W. on April 30, 2000, at 11:05:43
Cam and all,
I'm posting from home at the moment, and my "antique" Pentium 133 and related software frustratingly cannot open everyone's messages in this thread. I'll catch up later this afternoon when I get into the office, but I apologize in advance if there are holes already answered in this follow-up.
First, Cam, THANK YOU for your detailed responses. I really appreciate your depth of understanding and willingness to share your knowledge. I hope you can help further.
I don't think my questions/statements were clear enough in a couple of cases, so I hope you don't mind my asking for clarification on these.
You wrote: > • I fully agree that if "depression" seems to be getting worse within the first week, another "cause" of the depression should be looked for.
Mark here: In my case (and others with whom I've corresponded), I had classic, moderate depression that rapidly deteriorated to severe on a TCA. Why would that be? Switching to Prozac after a few horrible weeks (stopping the TCA more likely) seemed to bring me back to the level of depression for which I sought help originally. However, it too did not improve the depression. Prozac followed by Zoloft followed by Paxil did not help, and there seemed to be no cumulative benefit. Eventually, I just cycled into my OK phase on my own, and stopped taking meds until the next phase started.
You wrote: > • ... many people do not give the ADs that one or two weeks. In my experience people are ready to give up after a couple of days.Mark here: Right. Since I'm conscientiously compliant, I forget that others sometimes blow off their doctor's instructions. When sulfa for an infection years ago made me so sick I was sweating, shaking, vomiting and literally fell down in the bathroom at one point, I still called my doctor before stopping treatment. Unrelated but interestingly, two local pharmacies have sent me home with other people's prescriptions, so it also pays to read labels carefully and not just start popping pills because your doctor said to take three of each a day. (These were clerk errors, not pharmacist errors, but I'm sure such things still keep you awake at night.)
I wrote: ... stopping my AD for EVEN ONE OR TWO DAYS a year or two later causes the curtain to fall..
>
You wrote: > • At one or two days into a therapy, you are still depressed.Mark here: What I meant to say was, after taking my drugs religiously every day for now almost three years, I still become very depressed for a couple of days if through a scheduling error or other mistake I don't take my primary AD for even one or two days. I rebound on the days I accidentally missed -- it's similar to hypomania, but a trough follows a day or two later as my system waits to regain the right med level. Does that make sense??
You wrote: > • I know you probably have, but there must be some "trigger" setting off your episodes at these predictable times (eg pre & post-Xmas blues, SAD, beginning & end of summer) I realize that these explanations are too simple, but are just meant for illustrative purposes. You may have to journal your moods and experiences around them to pinpoint what is going on.
Mark here: The journal is an excellent idea. There doesn't seem to be a trigger per se (but I'll still look deeper). The transition isn't sudden; it's like a slow slide up and down -- it's continuous, cyclic. Not related to light or holidays as far as I can tell, and not the times that other allergic people normally are affected by pollens and spores.
>
You wrote: > • In some people with bipolar disorder, I belive that the antidepressant just "unmasks" the mania and this could be the reason for manic switch. The depression, in these people is just an adaptation by the body to control the mania (maybe?).Mark here: That's an extremely interesting idea, Cam, even though I am not BP one. The reason is, in junior high when I was very hyper, the only way I learned to control myself at all was through intense self-hatred. At 50, I still forget occasionally that I have other skills with which to control inappropriate impulses, and that I don't have to kill my spirit (figuratively) to keep myself in line. Hmmm. I wonder if I'm creating depression out of unconscious guilt about my impulses when I feel OK? More work needed.
Thank you, Cam. If you have any insight on any of the above, I'd love to hear from you.
Very best wishes,
Mark H.
poster:Mark H.
thread:31659
URL: http://www.dr-bob.org/babble/20000429/msgs/31766.html