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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Leighwit on April 25, 2002, at 12:18:02
Is dysphoria a diagnosis separate and distinct from major depression?
In Wednesday's Chicago Tribune there was an article ("Depression Can Leave Blind Spot for Support") which states: "... but when it comes to suffering from depression and dysphoria (a combination of anxiety, depression and irritability), ...."
I searched through past threads, but can find nothing that actually defines dysphoria ~ or addresses it as a particular condition.
Anxiety, depression, and irritability, however, is so much more specific than "major" recurrent clinical depression.
I have a hard time determining whether the anxiety and irritability are part of depression or entirely side effects of Wellbutrin. When I mention those symptoms, I'm always prescribed something to target them as side effects of the WB. Xanax, for example.
It's a vicious cycle. If I mention the primary symptoms of despair and lethargy (as in can't take a shower or get off the couch without planning it for three hours) I get a script for an AD that has energizing characteristics. I can't gain any weight (due to Type 1 Juvenile-onset diabetes) and virtually every SSRI, particularly Celexa caused weight gain in my case, so I've been on Wellbutrin a lot (off and on with and without SSRIs, Serzone, Norpramin/Desiprimine, Effexor and Reboxetine) over the past ten years.
If I mention irritability or anxiety to my current pDoc, she wants to prescribe Xanax on top of the WB.
I think dysphoria sounds much more "specific" to what I've had for ten years than does major depression alone. I feel like saying to the Pdoc: "I have a dysphoria and can't gain any weight. I'd prefer not to loose my memory or my IQ in the treatment process. What do you prescribe for that?"
Can anyone relate?
Posted by Ritch on April 25, 2002, at 12:43:18
In reply to Is Dysphoria an Actual Diagnosis? , posted by Leighwit on April 25, 2002, at 12:18:02
> Is dysphoria a diagnosis separate and distinct from major depression?
>
> In Wednesday's Chicago Tribune there was an article ("Depression Can Leave Blind Spot for Support") which states: "... but when it comes to suffering from depression and dysphoria (a combination of anxiety, depression and irritability), ...."
>
> I searched through past threads, but can find nothing that actually defines dysphoria ~ or addresses it as a particular condition.
>
> Anxiety, depression, and irritability, however, is so much more specific than "major" recurrent clinical depression.
>
> I have a hard time determining whether the anxiety and irritability are part of depression or entirely side effects of Wellbutrin. When I mention those symptoms, I'm always prescribed something to target them as side effects of the WB. Xanax, for example.
>
> It's a vicious cycle. If I mention the primary symptoms of despair and lethargy (as in can't take a shower or get off the couch without planning it for three hours) I get a script for an AD that has energizing characteristics. I can't gain any weight (due to Type 1 Juvenile-onset diabetes) and virtually every SSRI, particularly Celexa caused weight gain in my case, so I've been on Wellbutrin a lot (off and on with and without SSRIs, Serzone, Norpramin/Desiprimine, Effexor and Reboxetine) over the past ten years.
>
> If I mention irritability or anxiety to my current pDoc, she wants to prescribe Xanax on top of the WB.
>
> I think dysphoria sounds much more "specific" to what I've had for ten years than does major depression alone. I feel like saying to the Pdoc: "I have a dysphoria and can't gain any weight. I'd prefer not to loose my memory or my IQ in the treatment process. What do you prescribe for that?"
>
> Can anyone relate?
I have bipolar and sometimes I get "mixed" features which could be described as "dysphoric" whether you could say that I was "hypomanic" or "depressed". It is almost like I have five different states: Euthymic (rare!), Depressed (lethargic-anergic), Hypomanic (bubbly-friendly), Hypomanic-dysphoric (predom. anger-rage), Depressed-dysphoric (predom. agitation/anxiety). There isn't a separate "condition" called dysphoria all its own. If you check out the list of traits or features for major depression or mania you will see them listed in there. So, technically you could be unipolar depressive and have angry, anxious, agitated features that accompany the depression. Different antidepressants tend to have their own "profile" or ability to treat various traits. Some AD's are quite agitating. I found Wellbutrin and desipramine to be the most agitating AD's I have ever taken. Remeron and Effexor, while killing anxiety quite nicely, unfortunatley made me angry and hostile. A lot of your trouble could be too *high* of a dose of WB. Also, sometimes it works better to take lower doses of an energizing AD along with a low dose of a sedative AD (at bedtime, ie.) I found low dose combos of TCA's and SSRI's to work rather well. I would like to try reboxetine (low-dose), but hell will probably freeze over before its available here in the US.Mitch
Posted by Leighwit on April 25, 2002, at 16:36:38
In reply to Re: Is Dysphoria an Actual Diagnosis? » Leighwit, posted by Ritch on April 25, 2002, at 12:43:18
>
> I have bipolar and sometimes I get "mixed" features which could be described as "dysphoric" whether you could say that I was "hypomanic" or "depressed". It is almost like I have five different states: Euthymic (rare!), Depressed (lethargic-anergic), Hypomanic (bubbly-friendly), Hypomanic-dysphoric (predom. anger-rage), Depressed-dysphoric (predom. agitation/anxiety). There isn't a separate "condition" called dysphoria all its own. If you check out the list of traits or features for major depression or mania you will see them listed in there. So, technically you could be unipolar depressive and have angry, anxious, agitated features that accompany the depression. Different antidepressants tend to have their own "profile" or ability to treat various traits. Some AD's are quite agitating. I found Wellbutrin and desipramine to be the most agitating AD's I have ever taken. Remeron and Effexor, while killing anxiety quite nicely, unfortunatley made me angry and hostile. A lot of your trouble could be too *high* of a dose of WB. Also, sometimes it works better to take lower doses of an energizing AD along with a low dose of a sedative AD (at bedtime, ie.) I found low dose combos of TCA's and SSRI's to work rather well. I would like to try reboxetine (low-dose), but hell will probably freeze over before its available here in the US.
>
> MitchThanks for your input, Mitch. I thought the very same: that the Wellbutrin dosage might be too high. I've gone from the max. daily dosage to only 150 mg in the a.m., and unfortunately my agitation hasn't diminished one bit. A low dosage of Celexa did seem to take the edge off the WB, but I gained a lot of weight and my endocrinologist insisted I discontinue it. As soon as I stopped Celexa, the steady weight gain stopped. As for Reboxetine, I took it here in the US (through a teaching hospital in Chicago) but it didn't do a thing for me. In fact, I found it as agitating as Effexor. WB, while I'm having problems with it, has been much easier to tolerate than either Effexor or Reboxetine in my experience. I've had a better response, and less irritability until very recently. I'm hesitant to discontinue or switch from WB ~ yet I feel like I'm settling for miserable results only because I'm not gaining weight or laying on the couch all day.
Thanks again for the feedback.
Posted by Ritch on April 25, 2002, at 21:41:09
In reply to Re: Is Dysphoria an Actual Diagnosis? » Ritch, posted by Leighwit on April 25, 2002, at 16:36:38
> Thanks for your input, Mitch. I thought the very same: that the Wellbutrin dosage might be too high. I've gone from the max. daily dosage to only 150 mg in the a.m., and unfortunately my agitation hasn't diminished one bit. A low dosage of Celexa did seem to take the edge off the WB, but I gained a lot of weight and my endocrinologist insisted I discontinue it. As soon as I stopped Celexa, the steady weight gain stopped. As for Reboxetine, I took it here in the US (through a teaching hospital in Chicago) but it didn't do a thing for me. In fact, I found it as agitating as Effexor. WB, while I'm having problems with it, has been much easier to tolerate than either Effexor or Reboxetine in my experience. I've had a better response, and less irritability until very recently. I'm hesitant to discontinue or switch from WB ~ yet I feel like I'm settling for miserable results only because I'm not gaining weight or laying on the couch all day.
>
> Thanks again for the feedback.What about a more *activating* SSRI to add to the Wellbutrin? Have you considered a low-dose combo of Wellbutrin + Prozac? Here's another idea-Wellbutrin+low-dose nortriptyline (to combat the agitation from the WB). I had a decent response to a low-dose three way combo (last SAD episode) to WB+Celexa+nortriptyline. The NT add-on was done in an attempt to quell the WB agitation.
Mitch
Posted by Chris A. on April 26, 2002, at 0:05:01
In reply to Is Dysphoria an Actual Diagnosis? , posted by Leighwit on April 25, 2002, at 12:18:02
Wellbutrin caused me to be extremely irritable in two different trials. I am diagnosed mixed bipolar now, and Lamictal is my drug of choice. It is an anticonvulsant (neuromodulator) unlike the other ones. It has mood stabilizing and antidepressant effects. I have not experienced weight gain and it doesn't make me foggy like the others. When I hear "irritabilty" I think 1)side effects of Wellbutrin or 2) mixed bipolar, which is by definition dysphoric. Mania is defined as elevated or -irritable- mood. Why is the irritability so often ignored? It's a core part of the diagnosis, which leads to effective treatment. Dr. Susan McElroy, a mood disorders researcher, has found that approximately 50% of men and 75%-%80 of women and adolescents experience mania or hypomania as dysphoric rather than euphoric. It's not a comfortable feeling, so I hope you find some relief soon. Some day soon I hope more docs will get with the program and realize that ADs can make some of these symptoms much worse. The only AD my pDoc is comfortable prescribing for me now (only when I'm steadily on the bottom) are a miniscule amount of selegiline and the use of my light box. We titrate these carefully according to moods. My two cents worth.
Chris A.
Posted by tex1 on April 26, 2002, at 3:40:20
In reply to Is Dysphoria an Actual Diagnosis? , posted by Leighwit on April 25, 2002, at 12:18:02
> Is dysphoria a diagnosis separate and distinct from major depression?
>
> In Wednesday's Chicago Tribune there was an article ("Depression Can Leave Blind Spot for Support") which states: "... but when it comes to suffering from depression and dysphoria (a combination of anxiety, depression and irritability), ...."
>
> I searched through past threads, but can find nothing that actually defines dysphoria ~ or addresses it as a particular condition.
>
> Anxiety, depression, and irritability, however, is so much more specific than "major" recurrent clinical depression.
>
> I have a hard time determining whether the anxiety and irritability are part of depression or entirely side effects of Wellbutrin. When I mention those symptoms, I'm always prescribed something to target them as side effects of the WB. Xanax, for example.
>
> It's a vicious cycle. If I mention the primary symptoms of despair and lethargy (as in can't take a shower or get off the couch without planning it for three hours) I get a script for an AD that has energizing characteristics. I can't gain any weight (due to Type 1 Juvenile-onset diabetes) and virtually every SSRI, particularly Celexa caused weight gain in my case, so I've been on Wellbutrin a lot (off and on with and without SSRIs, Serzone, Norpramin/Desiprimine, Effexor and Reboxetine) over the past ten years.
>
> If I mention irritability or anxiety to my current pDoc, she wants to prescribe Xanax on top of the WB.
>
> I think dysphoria sounds much more "specific" to what I've had for ten years than does major depression alone. I feel like saying to the Pdoc: "I have a dysphoria and can't gain any weight. I'd prefer not to loose my memory or my IQ in the treatment process. What do you prescribe for that?"
>
> Can anyone relate?Dear friend,
it sounds like you've had the same reaction that I've had many, many times. See all AD are *stimulating*. Wellbutrin is much more stimulating than any other AD since it works on both dopamine and noradrenaline. I'm not surprised that your pdoc prescribed to you some benzos. As you've said, sometimes it's a vicious cycle. Pull up or down, this is what psychiatric drugs tend to make. Always. The only exception maybe is lithium that simply flatten the mood.The point is that some people (usually very sensitive to meds) develope a "antidepressant induced dysphoria". The only way to get out of it is to take a benzo, or, better, to reduce the dose of the AD.
I remember when I was taking Efexor XR that I happen to have dramatic mood shifts, was irritable without a reason and even broke up with some friends because of this. This is not good. What I did was simply to reduce the dose to 50 mg/die instead of 75 XR. It worked pretty much. But remember that AD induced dyspohria is bad enough to let you make things you never wanted to.Tex
Posted by Ritch on April 26, 2002, at 8:16:01
In reply to Re: Is Dysphoria an Actual Diagnosis? » Leighwit, posted by Chris A. on April 26, 2002, at 0:05:01
> Wellbutrin caused me to be extremely irritable in two different trials. I am diagnosed mixed bipolar now, and Lamictal is my drug of choice. It is an anticonvulsant (neuromodulator) unlike the other ones. It has mood stabilizing and antidepressant effects. I have not experienced weight gain and it doesn't make me foggy like the others. When I hear "irritabilty" I think 1)side effects of Wellbutrin or 2) mixed bipolar, which is by definition dysphoric. Mania is defined as elevated or -irritable- mood. Why is the irritability so often ignored? It's a core part of the diagnosis, which leads to effective treatment. Dr. Susan McElroy, a mood disorders researcher, has found that approximately 50% of men and 75%-%80 of women and adolescents experience mania or hypomania as dysphoric rather than euphoric. It's not a comfortable feeling, so I hope you find some relief soon. Some day soon I hope more docs will get with the program and realize that ADs can make some of these symptoms much worse. The only AD my pDoc is comfortable prescribing for me now (only when I'm steadily on the bottom) are a miniscule amount of selegiline and the use of my light box. We titrate these carefully according to moods. My two cents worth.
>
> Chris A.Hi Chris,
How much selegiline are you taking-if you don't mind my asking? My pdoc is very scared of MAOI's (even selegeline). It is the only AD class I have never touched. I am going to try Focalin soon, but I have my doubts it will work. As you know I have a lot of prominent ADHD symptoms along with bipolar and my last go round with dexedrine actually didn't help with focus (rats!) that much, but I charted during the time and my mood became more stable on the dexedrine (cycling was flattened+no grouchiness). I want something that will *work* for SAD episodes (which stims do), without the ScheduleII hassles, or the cost of Provigil.
thanks in advance,
Mitch
Posted by Leighwit on April 26, 2002, at 9:15:36
In reply to Re: Is Dysphoria an Actual Diagnosis? » Leighwit, posted by Chris A. on April 26, 2002, at 0:05:01
> Wellbutrin caused me to be extremely irritable in two different trials. I am diagnosed mixed bipolar now, and Lamictal is my drug of choice. It is an anticonvulsant (neuromodulator) unlike the other ones. It has mood stabilizing and antidepressant effects. I have not experienced weight gain and it doesn't make me foggy like the others. When I hear "irritabilty" I think 1)side effects of Wellbutrin or 2) mixed bipolar, which is by definition dysphoric. Mania is defined as elevated or -irritable- mood. Why is the irritability so often ignored? It's a core part of the diagnosis, which leads to effective treatment. Dr. Susan McElroy, a mood disorders researcher, has found that approximately 50% of men and 75%-%80 of women and adolescents experience mania or hypomania as dysphoric rather than euphoric. It's not a comfortable feeling, so I hope you find some relief soon. Some day soon I hope more docs will get with the program and realize that ADs can make some of these symptoms much worse. The only AD my pDoc is comfortable prescribing for me now (only when I'm steadily on the bottom) are a miniscule amount of selegiline and the use of my light box. We titrate these carefully according to moods. My two cents worth.
>
> Chris A.
This is a very helpful post for me, Chris ~ thank you. I've always steered away from MAOIs because I'm insulin-dependent and I haven't seen a pDoc yet that wanted to go that route. I've been tempted of late, however to raise the consideration of selegiline in my next pDoc visit. I don't know anything about Lamictal, so I'll search for more info here and elsewhere on the web.I can't imagine my pDoc will agree to reduce the WB any more (only taking 150 mg/day).
In some ways I'm more confused than ever now that I know from what I've read here, that this irritability/dysphoria could be a part of my condition; could be caused by the WB; or could be excaserbated by the WB. It sounds like the only way to rule any of those three possibilities out, is to stop the drug altogether and see where I land. I've been taking ADs for over ten years now. I'm pretty sure I'll hit the wall (so to speak) if I take nothing ~ but how else can I go about this? Perhaps it's time to sort of "baseline" myself and see where I am without medication?
Posted by Chris A. on April 26, 2002, at 14:08:41
In reply to Chris, selegeline doens't induce dysphoria? » Chris A., posted by Ritch on April 26, 2002, at 8:16:01
> How much selegiline are you taking-if you don't mind my asking? My pdoc is very scared of MAOI's (even selegeline). It is the only AD class I have never touched. I am going to try Focalin soon, but I have my doubts it will work. As you know I have a lot of prominent ADHD symptoms along with bipolar and my last go round with dexedrine actually didn't help with focus (rats!) that much, but I charted during the time and my mood became more stable on the dexedrine (cycling was flattened+no grouchiness). I want something that will *work* for SAD episodes (which stims do), without the ScheduleII hassles, or the cost of Provigil.> Mitch
10 mgs, which is a very low dose is all I took this winter. When I felt my mood starting to lift and anergic state disappating, I immediately discontinued it. Do you have a light box? I use it for the SAD component. My pDoc and my consultant consider it an antidepressant. Even though I have ADD charactristics (and have had problems focusing and paying attention from a very young age), they don't want me on any stimulants because of the potential for serious cycling. I guess everyone is different. BTW, what is Focalin?
Blessings,
Chris A.
Posted by Chris A. on April 26, 2002, at 14:16:28
In reply to Is Dysphoria an Actual Diagnosis? , posted by Leighwit on April 25, 2002, at 12:18:02
If you don't mind my asking, how well controlled is your diabetes? Unstable BGs can contribute to dysphoria and mood symtoms, which I'm sure you already know.
Wishing you the best,
Chris A.
Posted by Leighwit on April 26, 2002, at 16:05:57
In reply to Re: Is Dysphoria an Actual Diagnosis? » Leighwit, posted by Chris A. on April 26, 2002, at 14:16:28
> If you don't mind my asking, how well controlled is your diabetes? Unstable BGs can contribute to dysphoria and mood symtoms, which I'm sure you already know.
>
> Wishing you the best,
>
> Chris A.I don't mind at all ~ it's an intelligent question. My A1c (glycohemoglobin test that is the mainstay for determining average blood sugars over a few months time period) is in the stable zone. I'd like it to be even better, but haven't felt good enough mentally to put the additional time and effort into getting it there.
Having experienced depression for over ten years I know that for me, the two are not related, and my endocrinologist and Pdoc concur. I've been diabetic for most of my life (34 of 44 yrs) though ~ so I follow your chain of thought:
Hypoglycemia often involves irritability as a symptom; and hyperglycemia almost always causes lethargy.Both symptoms, however, go away once the conditions are treated, particularly low blood sugars. There's no lingering around ~ a glass of orange juice and the testy disposition disappears as soon as the blood sugar returns to a normal level ~ gulp and it's gone. While it takes longer to recover from ketosis (linked to hyperglycemia) the extreme lethargy also lifts pretty quickly after blood sugars return to normal ~ usually one feels better in a day or two ~ sort of like recovery from a bad virus.
Not so with the irritability that evidently accompanies some forms of depression and/or is a side effect of Wellbutrin. I can't seem to shake it at all.
The more I think about this, the more I think that irritability and anxiety have always been a part of my condition ~ but more of a backdrop than a "star" symptom. The despair and lethargy were more prominant.
It's hard to admit to being angry without motive, perhaps for years. I'm not sure I'm ready for this. On one hand I want an accurate diagnosis, on the other hand ~ low-boiling anger is a tough thing to look at in the mirror without a person, place, thing, (or medication) to blame it on.
Posted by Chris A. on April 26, 2002, at 16:44:20
In reply to Re: Is Dysphoria an Actual Diagnosis?, posted by Leighwit on April 26, 2002, at 16:05:57
It's too bad we can't all just take a "gulp" of something to cure the depression, irritability, anxiety, etc., etc. It sounds like you have a really good grasp on your diabetes. The reason it came to mind that our daughter has a close friend whose is simply refusing to deal with his diabetes.
Blessings,
Chris A.
Posted by Ritch on April 26, 2002, at 22:39:06
In reply to Re: Chris, selegeline doens't induce dysphoria?, posted by Chris A. on April 26, 2002, at 14:08:41
>
> > How much selegiline are you taking-if you don't mind my asking? My pdoc is very scared of MAOI's (even selegeline). It is the only AD class I have never touched. I am going to try Focalin soon, but I have my doubts it will work. As you know I have a lot of prominent ADHD symptoms along with bipolar and my last go round with dexedrine actually didn't help with focus (rats!) that much, but I charted during the time and my mood became more stable on the dexedrine (cycling was flattened+no grouchiness). I want something that will *work* for SAD episodes (which stims do), without the ScheduleII hassles, or the cost of Provigil.
>
> > Mitch
>
> 10 mgs, which is a very low dose is all I took this winter. When I felt my mood starting to lift and anergic state disappating, I immediately discontinued it. Do you have a light box? I use it for the SAD component. My pDoc and my consultant consider it an antidepressant. Even though I have ADD charactristics (and have had problems focusing and paying attention from a very young age), they don't want me on any stimulants because of the potential for serious cycling. I guess everyone is different. BTW, what is Focalin?
>
> Blessings,
>
> Chris A.Chris,
No, I haven't ever gotten to a light box thing. It is one of those things I think about just right before everything goes (predictably)downhill and I wind up taking meds instead. Focalin is the new Ritalin. Ritalin is two isomers. One is relatively inactive and they have found a way of ditching the inactive isomer. So it is twice as potent. Generically, it is dexmethylphenidate. I am only trying it because I "flopped" Adderall because it caused too much anxiety (but worked great for the SAD episode and for focus without cycling), and I "flopped" dexedrine because it didn't help me focus (but it didn't cause any anxiety or cycling and replaced SSRI which did cause cycling!) It is interesting that you mention your doctor's concern about cycling with psychostimulants. Thus far, ONLY psychotimulants have been able to alleviate depression (more effectively and at lower doses than AD's), and NOT trigger cycling. Also, interestingly, selegeline (Eldeprenyl) metabolizes to methamphetamine (a fraction). So, you were *on* stimulants in a sense when you needed to take them for depression. I know the company that markets Eldeprenyl is targeting ADD bigtime. I just find it fascinating that it didn't trigger any dysphoria when you were taking it. 10mg is a full tab I think.
Mitch
Posted by Chris A. on April 26, 2002, at 23:43:02
In reply to Re: Chris, selegeline doesn't induce dysphoria? » Chris A., posted by Ritch on April 26, 2002, at 22:39:06
Mitch,
My 16 year old daughter takes Concerta for inattentive ADD and it helps her greatly with focus. It's makes the difference between competing to be valedictorian of her class or taking six years to get through high school. She doesn't have any other psych problems (which is wonderful considering the genes she had to choose from)! You're probably aware that it's another form of high-tech timed released Ritalin (never can be sure I am spelling methylphenidate, or whatever, right).
Yes, you are right, selegiline metabolizes to methamphetamine. I forget information on a regular basis. At one time I took 60 mgs of the stuff, so 10 mg seems like a very small dose to me. I do highly recommend light boxes to anyone with a SAD component. It is my breakfast and newspaper reading companion. Mine seems to really help in the winter.
I hope you find the right combo soon.Blessings,
Chris A.
Posted by Ritch on April 27, 2002, at 10:57:31
In reply to Re: Chris, selegeline doesn't induce dysphoria? » Ritch, posted by Chris A. on April 26, 2002, at 23:43:02
This is the end of the thread.
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