Posted by Mark H. on May 1, 2000, at 1:13:29
In reply to Re: Short Trial Success/Bipolar II Qx - Too long., posted by Scott L. Schofield on April 30, 2000, at 12:54:13
Scott L.,
Many, many thanks for your fine response -- I was finally able to open your posting this evening; I couldn't access it earlier. Since I've posted my particulars before, I tend to forget our minions here are so vast that many of us have not read one another's previous personal posts. Also, if I see that you or Cam or John or Noa or several others have already worked on a thread, I tend not to participate unless I have specific questions or advice to offer, since I know the original poster has already received outstanding and helpful advice.
That said, here are my particulars: 50, white male, happily married, no kids, grants administrator for intl non-profit media org, way too much adrenalin (known since teens), dysthymic to bipolar II, borderline hyperactive age 8-9, first depression prob age 10, first hypomania prob age 12, major depression (all this undiagnosed, of course) age 13-14, hypomanic 15, suicidal 16, fluctuations 17-18, hypo 19-20, fairly stable (first marriage) 21-26, moderate to severe depression 26-27, up 28, down 29, up 30-31 followed by big crash 31-32, relatively stable 33-43 (third marriage, continues happily), 43 first diagnosis of major depression, onset at a time when I could not have been happier or less stressed -- great marriage, nice home, happily self-employed, newish cars paid for, no debts, spiritually centered, no exogeneous conflicts, parents alive and healthy, good health, plenty of free time, relaxed lifestyle. What a time to be hit with depression!
Under those circumstances, I didn't even think I was depressed when it hit like a freight train at 43 -- I thought I was getting Alzheimer's disease. I didn't have any sad affect for the first 3 or 4 years of this depression, nor was I suicidal during that time, not until it had completely worn me down after several years. I had all the other classic symptoms, including constipation, inappropriate guilt, early waking, increasing social phobias (unable to return phone calls, procrastination, avoiding friends, etc. -- I assume that's what's meant by social phobias?), greatly slowed mental and verbal abilities, memory loss of recent events with heightened memory of long-forgotten earlier-life events, confusion, lethargy, anhedonism, loss of sexual interest, bizarre uninvited homicidal and suicidal imagery and fantasies that were like bad movies rather than my own ideas.
Anecdotally, here are two examples: waking up at 3:30 a.m. racked with guilt that I hadn't been able to prevent the Polly Klaas kidnapping, even though I knew the thought/feeling was delusional and grandiose. The other, being in Monterey a year later (during a TCA trial) while my wife attended a tax conference, and recalling that on March 17, 1968, I had had a glass of Krug Gamay in a crystal goblet I had purchased at the May Company, but being unable to remember or tell my wife how I had spent that morning or early afternoon (in 1994).
Effexor was the first drug to work, and it worked fairly well for one year, but I had to take ever-increasing dosages to maintain the AD effect, and it had the annoying side effect of causing me to repeat everything I said as though I thought no one would believe me until I had made my point at least three times. By the time I quit taking it, in October 95 on an up-swing, it took me 6 weeks before the severe flu-like symptoms finally ceased. My doc and I thought we'd try other things instead in subsequent cycles.
Over four years, we tried 26 or 28 different ADs and adjunctives and over-the-counter-type remedies based on his experience and my research, including at least 20 different prescription drugs. I am my psychiatrist's poster-middle-age-guy for "don't give up."
Three years ago, I was so near death (during a bout of flu in March 97 I got down to 135 pounds at 6 foot 3), so despondent, so worn down by depression and multiple drug failures, having near-psychotic depressive episodes on stuff like Remeron and Wellbutrin and Buspar and Lithionate and others I don't even remember, that as a last resort we decided to put me back on Effexor, side effects and withdrawal symptoms notwithstanding.
I had been taking Cytomel (thyroid suppl) for 3 years, the only thing that consistently helped with my energy and focus. Because adrenalin overproduction seemed to be one piece of the puzzle in my case, we finally added a beta blocker (Pindolol), which cuts my wind horribly but does blunt the effects of adrenalin successfully and keeps me from long-range exhaustion. We took me off whatever the latest AD was, which was giving me nausea and sweats and necessitating lying on the floor at work with a bottle of Pepto for at least an hour every day, and started me back on Effexor.
My wife and I spent our Sierra vacation discussing the details of my suicide and her future; I was only willing to give this condition one more year if it didn't improve, and I wasn't willing to stick around and destroy her quality of life. An odd side note: when sick, I'm obsessed with cutting off my own head, but I get bogged down in the details of turning off the saw, not disturbing the neighbors, having the blood not make a mess, etc. etc. etc. It's all just too much bother!
A few years before, methylphenidate had helped some in the summer. So on June 20, 1997, my doctor added some Ritalin to the mix and suggested I try a night of sleep deprivation. On June 21, 1997, with the combination of Cytomel (25mcg morning), Pindolol (2.5mg morn/eve), Effexor (150mg morning after breakfast), and methylphenidate (10-20 mg day), my severe depression lifted suddenly and I began putting my life back together with lots of therapy (which had been a waste of time while I was so sick).
This mix has worked effectively for the last 2 years and 10 months, without needing to increase the Effexor. I have had to increase the Ritalin, especially in the last six months of extreme hypersomnia. I would not be able to work or drive without methylphenidate. The most Ritalin I've taken in a day has been 80mg, and that in hot weather while travelling (for reasons unknown, I become overwhelming sleepy in temperatures above about 75 degrees). Happily for us, we live in one of the most moderate climates in the US, where summer temps rarely top 70 degrees and winter temps rarely reach freezing. I currently take 30 to 60 mg of methylphenidate a day, which is more than I would like (but as my doc says, less than many 12 years olds take who have ADD).
About being bipolar: KarenB's referral today to the ADD site was helpful, especially the article about "296 vs. 314," which addresses how to tell the difference between bipolar and ADD. Although I might be 5 percent ADD, I fit 95% of their bipolar descriptions. It's the best fit I've ever read. I'm dxed Bipolar II, although Cam mentioned III, and I don't know what that is.
Another anecdote: My fourth day on Prozac, I did feel like jumping out of bed and dancing in the streets, but I controlled it and it went away and I was able to sleep. It changed my perception of color for the first two days, and otherwise I spent a month or so chasing side effects around my body, while my depression did not improve. Other drugs have caused "zooming," which is where, when driving, other cars seem to come faster or slower than they really are. Not pleasant.
Depakote was no good, as you predicted. Wellbutrin caused alarming memory problems -- scared the hell out of everybody. Lots of things caused "change" that could be interepreted as mild improvement for up to two weeks but then sent me into a tailspin. Remeron was a killer.
Benzodiazepines work differently at different times in my cycle -- Xanax good sometimes, very depressing other times; rarely use it. Clonazepam, which I take for PLMS and a REM disorder, is great: easy to get off of, no side effects or hangover, etc. I take 0.25 mg a night -- taking it or not taking it doesn't affect my depression or hypersomnia one way or the other. Ativan is too good -- I save it for days when I really need it, maybe once a month. Diazepam still the best for muscle spasms. Again, less than once a month. My doc knows I won't abuse these meds, so he lets me keep them on hand and gives me the discretion to use them when I just need to "get through the day," which fortunately isn't too often.
You asked me a surprisingly important question: how am I doing? I don't know -- I think I'm in a mixed state or a controlled hypomanic state. Reading the 296 v 314 article today was helpful, because I realized how little work I'm getting done is probably due to being more sick right now than I realize. At the same time, I've never written more about myself or my illness. It's as though I'm paralyzed with regard to work, and energized with regard to mental health inquiry. I have lots of energy for participating in Psycho-Babble discussions, but no energy or focus for even the most straightforward tasks pressing me at my job. I'm actually quite fearful that they're going to fire me -- I'm just not performing to minimum specs by any standard -- and at the same time, I know it's my illness. I'm scared and "I don't give a f***" at the same time. I should be at work now, since I have a cabinet meeting in the morning with our pres. My wife recently asked, "Are you trying to lose your job?"
It would be nice if I could choose to focus on work. Any suggestions? Sue's gone this weekend, and without her steadiness, I'm sleeping all day and up half the night and all I want to do is have intimate and passionate conversations about mental health with my friends on Psycho-Babble. How AM I doing?
Scott, thank you so much for your help and insight. I'm heartened that you have a friend on the same cycle -- what's going on with us? Sue and I attended a drubchen last October -- a powerful 8-day Buddhist intensive practice -- and since then I've been sleeping 12 hours a day and 14 hours or more a day on weekends. I've just been coming out of that within the last couple of weeks.
Thank you so much for all your help. Any insight or comments are greatly welcome. I expect to be on this drug regimen for the rest of my life (or as long as it works reasonably well). I've given up the idea that I'll just stop taking all this stuff when I feel better some day. Still, although my lama has never said anything other than "keep taking your meds," there's something in his eyes that says, "maybe someday."
I need to sleep some more. Thank you. Thank you.
Mark H.
poster:Mark H.
thread:31659
URL: http://www.dr-bob.org/babble/20000429/msgs/31812.html