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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Rob Hallett on May 19, 2002, at 2:21:34
I wonder if anyone could offer information around what medications may have helped them get out of a short-cycling and apparently unipolar depression phase?
I'm currently on a combined therapy of 375mg venlafaxine and 45mg mirtazapine (Zispin in the UK). The cycle I'm talking about is one where I'm pretty low & withdrawn & with little energy & poor cognitive ability for about 2.5 days. I then fairly quickly come up to ok functioning, with reasonable energy etc for another 2 to 2.5 days before then dropping back to the first state. I do not have a bi-polar diagnosis and have not experienced abnormal highs or "manic" episodes.
Can anyone relate to this from their own experience and say how theirs was resolved, and through what medication?
I have had a co-morbid chronic migraine syndrome
which only became managed in August last year through taking pizotifen(Sanomigran in UK)nightly. That has proved to be really effective .My history prior to the onset of the major depression (much of which has remitted) was of experiencing what probably amounted to traumatic stress levels over prolonged periods through gross work overload.
I need someone (or two!) who has been through this sort of short cycle to tell me there's a way out...........and how long it may take?Thanks,
Rob
Posted by JonW on May 19, 2002, at 12:27:42
In reply to 2-3 day cycling, posted by Rob Hallett on May 19, 2002, at 2:21:34
Hi Rob,
You may fall somewhere in the bipolar spectrum but closer to unipolar. Get your psydoc to recommend someone who specializes in bipolar disorder and go to them for a consultation. Have you ever been on any mood stabilizers? Have you ever been on Lamictal alone? You don't have to have wild "highs" to have bipolar disorder. Some sort of a cycle is a good indication. Anyway, don't be afraid to move on to a more experienced psydoc. People with your symptoms can require a "best of the best" doctor.
Good luck,
Jon
Posted by Vanessa on May 19, 2002, at 16:44:57
In reply to 2-3 day cycling, posted by Rob Hallett on May 19, 2002, at 2:21:34
I have about the same cycles as you do -- 3-4 days up, then 3-4 days down. In the "up" cycles
I am more energetic than usual, but not really manic. In the down cycles, I have a pretty pronounced depression, with extreme lethargy. My diagnosis is bipolar 2; I was given that diagnosis about 6 years ago, after having a unipolar diagnosis for 10 years. I think I was bipolar all along and it took several psychiatrists before I got the right diagnosis. I am telling you this because it sounds as if you might have a bipolar situation; if you do, a whole new world of medications would open up to you (lithium, anti-seizure meds, the new antipsychotics, etc.)I wish I could tell you that I have overcome my cycling situation; unfortunately, so far, I have found meds that stop the cycling but they "flatten" me out so much I almost feel like I do when I am depressed.
So I struggle along, hoping that I will find something that will help..
Posted by Rob Hallett on May 20, 2002, at 7:31:09
In reply to Re: 2-3 day cycling, posted by Vanessa on May 19, 2002, at 16:44:57
The next proposition by way of medication that my psychiatrist has suggested is the addition of valproate, though lithium,too,has also been mentioned,as have the anti-psychotics,though all in a context of "boosting" the effect of the antidepressants. Currently my docs view is that I do not have evidence for a bi-polar diagnosis. I did , however, have a mother who was very clearly bi-polar,so my candidacy for the unholy estate of
bipolarism already has some blue blood flowing through its veins!!
This last week or so I have had 2.5 good days, the last of which I was foolish or opportunistic
enough to use to try to complete so decorating at my home. I did about 8 hrs of this in the one day , and as is the way of these things, felt ok
(not particularly tired etc) in the evening.The day after I was pretty wiped-out/lethargic/unfocussed etc.,and have remained that way up to the present.Today is day 4 of being generally u/s. Probably if I had not done 8 hrs of decorating I would have resurfaced after 3 days. Physical work activity extends the period of my being wiped-out ,but my ok periods are in no way "highs" or remotely "manic", just ok and, I think, "normal" !
I have wondered if a part of my problem is a thyroid issue, and was concerned at the proposition of lithium cos it is known to be instrumental, ironically, in causing hypothyroidism.Here's hoping that tomorrow brings some energy!
I'd still like to hear from anyone else with similar "cycling " to my own.
Rob
Posted by Emme on May 20, 2002, at 10:07:32
In reply to 2-3 day cycling, posted by Rob Hallett on May 19, 2002, at 2:21:34
Hi. You really sound like you're in the bipolar spectrum to me. I have cycled up and down similar to yours but on a scale of a week or two - extreme exhaustion/misery and then an unexplainable lift to something closer to normal energy. I don't seem to really go "high", though I can be terribly anxious and my therapist's observation is that she's seen me rather agitated. This up and down pattern, plus other subtle clues such as poop-outs on several antidepressants led to my bipolar II diagnosis. I don't think you have to go hypomanic in the traditional sense in order to have some component of bipolarity (is that a word?) to your illness. You might benefit from a mood stabilizer. I'm on Lamictal, Neurontin, Klonopin, and atenolol (beta blocker short circuits some of the anxiety).
Emme
Posted by manowar on May 21, 2002, at 17:29:19
In reply to 2-3 day cycling, posted by Rob Hallett on May 19, 2002, at 2:21:34
> I wonder if anyone could offer information around what medications may have helped them get out of a short-cycling and apparently unipolar depression phase?
> I'm currently on a combined therapy of 375mg venlafaxine and 45mg mirtazapine (Zispin in the UK). The cycle I'm talking about is one where I'm pretty low & withdrawn & with little energy & poor cognitive ability for about 2.5 days. I then fairly quickly come up to ok functioning, with reasonable energy etc for another 2 to 2.5 days before then dropping back to the first state. I do not have a bi-polar diagnosis and have not experienced abnormal highs or "manic" episodes.
> Can anyone relate to this from their own experience and say how theirs was resolved, and through what medication?
> I have had a co-morbid chronic migraine syndrome
> which only became managed in August last year through taking pizotifen(Sanomigran in UK)nightly. That has proved to be really effective .
>
> My history prior to the onset of the major depression (much of which has remitted) was of experiencing what probably amounted to traumatic stress levels over prolonged periods through gross work overload.
> I need someone (or two!) who has been through this sort of short cycle to tell me there's a way out...........and how long it may take?
>
> Thanks,
>
> Rob
Hi Rob,I have a similar case, I think. I have been diagnosed with Cyclothymia which I’m guessing would be equivalent to Bipolar 2 1/2 or 3.) My swings are fairly unpredictable but range anywhere from feeling normal from 1 to 7 days, then feeling very depressed for at least 3 days to a week or two. I’ve never been manic, and I don’t think I’ve even been hypomanic.
To answer your first question: “ I wonder if anyone could offer information around what medications may have helped them get out of a short-cycling and apparently unipolar depression phase?” If your asking if I’ve found something to kill the down cycle and get me back to normal-not really. Psychostimulants like Ritalin make some folks like me feel better for a day or two, but unfortunately pstims like Ritalin are not anti-depressants by themselves, and the euphoric effect is very short lived. Personally, I have not found any drug that could kill a down cycle.
For me, there is no “magic pill”. But I am starting to overcome my Cyclothymia, with a great doctor, a combination of several meds, and a good attitude. Finding the great doctor, and the good attitude towards wellness was the easy part. Finding the right combination of meds has taken a lot of patients, and diligence.
Jon was absolutely correct when he said, “People with your symptoms can require a ‘best of the best’ doctor.”
Like yourself, not only do I suffer depression when I’m on my down swing, but my cognitive or thinking abilities grind to a halt.
After suffering for many years and not getting any relief from my pdocs, I started doing a lot of research on depression. In summary, I found a great ‘brain doctor’ and had scans done. I was diagnosed not only with Cyclothymia, but also with the inattentive subtype of ADD. Since I’ve started the stimulants and Klonipin, along with the antidepressants, I’ve made a ton of improvement. But for my condition I have to take several different meds.
I’m not saying that you may have ADD. I am saying do your homework, and find the best doctor you can, because like Jon, I don’t think you have a simple case.
Hang in there, and be diligent towards getting better. If you’ve not already got one, find a doctor you can trust, and that trusts you (i.e. doesn’t treat you like a druggy and can fit you in his schedule at a moments notice, if need be).
Like most of the people on this site, I’ve learned a lot about my condition, because I think my health is my responsibility, not my doctor’s. In other words, if I don’t like my doctor, and I don’t agree with his treatment regimen, it’s my responsibility to hit the bricks and find another one.
Cheerio and good luck,
Tim
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