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Dr. Bob is Robert Hsiung, MD,
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Posted by B2chica on January 23, 2012, at 11:37:56
In reply to Re: agitated depression, posted by polarbear206 on January 22, 2012, at 21:56:32
psychotic features normally include hallucinations, auditory and/or visual, delusions or the like.
you had derealization.i would think your issue is either med induced or from the anxiety.
especially if anx been bad lately.
i use low dose perphenazine, gabapentin and xanax for anxiety.
Best wishes to you.
Posted by Roslynn on January 23, 2012, at 11:50:52
In reply to agitated depression, posted by markwell on January 22, 2012, at 10:17:22
Hi,
I think (as a layman) this could be more due to anxiety or a combo of anxiety/depression. I've had those feelings before and I think it's referred to as derealization/depersonalization. I don't think it's psychosis. But it can be terrifying. Just my two cents. I hope it goes away soon. I know it's hard.
Roslynn
> I am having such a difficult time with anxiety and depression. I feel like I have somewhat lost touch with reality. Could I possibly have psychotic depression? I don't know what the signs are. I'm not hearing voices or seeing things but when I have a conversation it's almost like someone else having the conversation...so strange. I don't know how this is diagnosed.
> Mark
Posted by SLS on January 23, 2012, at 12:51:38
In reply to Re: agitated depression, posted by Roslynn on January 23, 2012, at 11:50:52
> I think it's referred to as derealization/depersonalization.
This is very possible. These things happen most often when depression and anxiety are both present, especially when the depression includes anhedonia.Mark, if you are psychotic, it is not obvious in your writing. DP/DR feels like losing touch with reality in that there is a remoteness from the things around you. You become a spectator of your own conversations as if you were looking down on yourself as you interact with your environment. It is not that easy to describe.
- Scott
Posted by phidippus on January 23, 2012, at 13:02:32
In reply to agitated depression, posted by markwell on January 22, 2012, at 10:17:22
Have you switched from Tegretol to Lithium? This will help a lot.
Depression and anxiety is a mixed presentation of bipolar disorder. The feeling you are having that you are losing touch with reality is called 'derealization' and is a common symptom of anxiety.
Also, the feeling you are detached from yourself in conversation, as if someone else is speaking is called 'depersonalization' and also comes as a consequence of high anxiety states. Depression can also cause this feeling.
Don't worry about being psychotically depressed-you'd be deluded or hallucinating.
You need a better mood stabilizer and something to help with your anxiety.
Eric
Posted by david blistein on January 23, 2012, at 17:22:18
In reply to Re: agitated depression, posted by Roslynn on January 23, 2012, at 11:50:52
I "lived" with this condition for almost two years, in the course of which it was given the following names: "agitated depression," "cyclothemia," "double depression," "borderline bipolar" "dysphoric mania" "bipolar with dysphoria instead of euphoria." With the word "psychosis" used occasionally. You get the idea.
I have my psychiatrist(s)' notes from the time and, on DSM Axis 5 (easy to find on the web), I hovered around 30+; i.e. about as crazed as it can get without hallucinations.
I often had that experience you talk aboutalthough I'd experience it as trying to "push out" or "juggle" a functioning personality while I cowered behind it.
Currently, I'm very successfully medicated with an anti-psychotic, anti-depressive, and occasional benzodiazepam. (I'm new to the board and am not sure whether we're supposed to list actual drugsbesides, it's different for everyone.)
I've also written fairly extensive about this, but am not sure re rules for posting links so let me know if you want to read more.
BUT what seems really important to me is that you insist to your psychiatrist (I assume you have one!) that you are not "just" depressed or not "just" anxious. If he/she hasn't dealt with this combination, I'd strongly urge finding someone who has. I'd been treated for depression before this episode and know that this is different. Good luck, Mark...it CAN be treated.
> Hi,
>
> I think (as a layman) this could be more due to anxiety or a combo of anxiety/depression. I've had those feelings before and I think it's referred to as derealization/depersonalization. I don't think it's psychosis. But it can be terrifying. Just my two cents. I hope it goes away soon. I know it's hard.
>
> Roslynn
>
>
>
> > I am having such a difficult time with anxiety and depression. I feel like I have somewhat lost touch with reality. Could I possibly have psychotic depression? I don't know what the signs are. I'm not hearing voices or seeing things but when I have a conversation it's almost like someone else having the conversation...so strange. I don't know how this is diagnosed.
> > Mark
>
>
Posted by Phillipa on January 23, 2012, at 18:15:58
In reply to Re: agitated depression, posted by david blistein on January 23, 2012, at 17:22:18
David welcome to babble!!!. As for posting actual meds that's okay you can. And links are allowed as long as civil and don't contain anything that could hurt someone. You sound like you have a lot to offer. Phillipa
Posted by morgan miller on January 23, 2012, at 19:04:51
In reply to Re: agitated depression, posted by david blistein on January 23, 2012, at 17:22:18
Sorry you are going through this Mark. I would stay away from antipsychotics and benzodiazepines for now and try a much better mood stablizer than Tegretol. I think a month or so of lithium or depakote would be worth a try. If you take depakote, supplement with l carnitine and l methylfolate. I personally think you should try Depakote first, and if you feel stabilized after a while but need an antidepressant, try an SSRI like Zoloft or Lexapro. I have been feeling more stable since starting LDN, just something to think about for the future.
Posted by morgan miller on January 23, 2012, at 19:04:56
In reply to Re: agitated depression, posted by david blistein on January 23, 2012, at 17:22:18
Sorry you are going through this Mark. I would stay away from antipsychotics and benzodiazepines for now and try a much better mood stablizer than Tegretol. I think a month or so of lithium or depakote would be worth a try. If you take depakote, supplement with l carnitine and l methylfolate. I personally think you should try Depakote first, and if you feel stabilized after a while but need an antidepressant, try an SSRI like Zoloft or Lexapro. I have been feeling more stable since starting LDN, just something to think about for the future.
Posted by david blistein on January 23, 2012, at 19:30:14
In reply to Re: agitated depression » david blistein, posted by Phillipa on January 23, 2012, at 18:15:58
> David welcome to babble!!!. As for posting actual meds that's okay you can. And links are allowed as long as civil and don't contain anything that could hurt someone. You sound like you have a lot to offer. Phillipa
Thanks for the welcome! The post after mine proves how different everyone is, but with that caveat...I sequed from Depakote and Valium to Lamictal and Clonazepam, slowly adding Cymbalta underneath. Even though it was 6 months before I could confidently say: "I'm back," I felt a little better fairly quickly and that gave me courage to carry on. Obviously, for others, Depakote is great.
Re link: I'm turning my experience into a book (may even have a publisher) but you can see a little at our local newspaper's site, if interested. http://www.commonsnews.org/site/site04/story.php?articleno=4371&page=1
Posted by morgan miller on January 23, 2012, at 20:30:47
In reply to Re: agitated depression, posted by david blistein on January 23, 2012, at 19:30:14
> > David welcome to babble!!!. As for posting actual meds that's okay you can. And links are allowed as long as civil and don't contain anything that could hurt someone. You sound like you have a lot to offer. Phillipa
>
> Thanks for the welcome! The post after mine proves how different everyone is, but with that caveat...I sequed from Depakote and Valium to Lamictal and Clonazepam, slowly adding Cymbalta underneath. Even though it was 6 months before I could confidently say: "I'm back," I felt a little better fairly quickly and that gave me courage to carry on. Obviously, for others, Depakote is great.
>
> Re link: I'm turning my experience into a book (may even have a publisher) but you can see a little at our local newspaper's site, if interested. http://www.commonsnews.org/site/site04/story.php?articleno=4371&page=1Hey David...Everyone is different, but if you are looking for the best chance of taking something long term with the least potential for harm, Depakote(with l carnitine and l methylfolate supplementation) and an SSRI would be safer long term-easier on the brain and body.
Morgan
Posted by morgan miller on January 23, 2012, at 20:37:05
In reply to Re: agitated depression, posted by david blistein on January 23, 2012, at 19:30:14
I just believe that AP's and benzos should be last resort, and we should try to tough it out for a while and see if we can stabilize on better medications before rushing into and getting hooked on medications that have the potential to do more harm down the road. Plus, benzos have a short half live, I just don't see how they ever will fit in to anybody's long term regimen if they are bipolar, with the exception being klonpopin.
Posted by Phillipa on January 23, 2012, at 21:11:41
In reply to Re: agitated depression, posted by morgan miller on January 23, 2012, at 20:37:05
Maybe not bipolar I don't know. I only know that when age 24 had two small children and panic attacks hit and nothing I could do stopped the catastrophic thoughts. Til I was then given valium 5mg three times a day and mepbrobamate. Mep is and was only taken til didn't need it anymore. But this combo saved my life at the time. Yes we are all so different. Phillipa
Posted by david blistein on January 24, 2012, at 7:48:12
In reply to Re: agitated depression, posted by morgan miller on January 23, 2012, at 20:37:05
> I just believe that AP's and benzos should be last resort, and we should try to tough it out for a while and see if we can stabilize on better medications before rushing into and getting hooked on medications that have the potential to do more harm down the road. Plus, benzos have a short half live, I just don't see how they ever will fit in to anybody's long term regimen if they are bipolar, with the exception being klonpopin.
Hey Morganagreed on the benzosClonazepam is a trade name of Klonopin. I now nibble a little piece once in a while (probably equivalent of less than .25), and can go a week without even thinking about it. Whereas the Valium was definitely addictive and Lorazepam I just didn't like (and is also more addictive) As far as the more harm with the anti psychoticsI thought Depakote was of more concern there 'cause of the liver thing? Is that why you suggest the supplements?
As far as Lamictal/Lamotrigine I thought the biggest concern was that odd potentially-fatal rash that occurs rarely, and hasn't with me. I didn't know of long-term concerns. So curious.
Thanks
Posted by SLS on January 24, 2012, at 8:21:40
In reply to Re: agitated depression, posted by david blistein on January 24, 2012, at 7:48:12
I never became addicted to any of the benzodiazepines I used. However, I did become physiologically dependent on them. For this reason, they were difficult to discontinue.
I would be wary of Xanax producing true addiction.
Addiction is not the same as physiological dependence. Addiction includes psychological dependence and cravings.
- Scott
Posted by morgan miller on January 24, 2012, at 12:48:37
In reply to Re: agitated depression, posted by SLS on January 24, 2012, at 8:21:40
> I never became addicted to any of the benzodiazepines I used. However, I did become physiologically dependent on them. For this reason, they were difficult to discontinue.
>
> I would be wary of Xanax producing true addiction.
>
> Addiction is not the same as physiological dependence. Addiction includes psychological dependence and cravings.
>
>
> - ScottPsychological dependence and cravings along with physiological dependence. This is what you are saying right Scott?
Posted by morgan miller on January 24, 2012, at 12:58:23
In reply to Re: agitated depression, posted by david blistein on January 24, 2012, at 7:48:12
Hey david, yeah I thought you said clonazepam, my bad. Did you specify that you just nibble on a little sometimes and go without it for a whole week? If not, that might be very valuable information for someone seeking help to know. Then at least they know that klonopin is not really what is helping to hold you together, and it may be something you want to do without completely at some point.
I do think L-Carnitine can help prevent liver issues. L-Carnitine plays a pretty major role in liver function and is depleted by Depakote. Folate is also depleted by Depakote. I believe we can eat right, supplement right, avoid toxins, and find a fairly low but still effective dose of Depakote and thrive for the rest of our lives-that is most of us at least. There are some that for whatever reason may be very sensitive to liver issues with Depakote. I just think mood stabilizers for the most part have less potential to do harm than antipsychotics.
Lamictal is a very powerful drug, more so than lithium and depakote I believe. It works great for many, and many do not notice much of anything as far as side effects go, but that sh*t is strong, I know it is. I just believe, after doing a little research, that it can have more potential to mess with one's mind over the long run, or the short run, than the other mood stabilizers. It appears that anectodal reports seem to show this-if you check out reviews on drug review websites I think you will find this to be the case.
Morgan
Posted by SLS on January 24, 2012, at 13:42:09
In reply to Re: agitated depression, posted by morgan miller on January 24, 2012, at 12:48:37
> > I never became addicted to any of the benzodiazepines I used. However, I did become physiologically dependent on them. For this reason, they were difficult to discontinue.
> >
> > I would be wary of Xanax producing true addiction.
> >
> > Addiction is not the same as physiological dependence. Addiction includes psychological dependence and cravings.
> >
> >
> > - Scott
>
> Psychological dependence and cravings along with physiological dependence. This is what you are saying right Scott?Yes. This is true of exogenous chemical substances. However, there can also be addiction without physiological dependence. Lots of behaviors are addicting. I guess one can make the argument that in these cases, there develops a dependence upon endogenous substances like endorphins and dopamine. I would have to wrestle with that idea for awhile, though.
- Scott
Posted by markwell on January 24, 2012, at 18:29:37
In reply to Re: agitated depression » morgan miller, posted by SLS on January 24, 2012, at 13:42:09
Thanks everyone for your input. I'm seeing a new doctor next week (second opinion). I'm hoping she suggests lithium. I think I have too much depression for depakote.
Mark
Posted by JohnLA on January 24, 2012, at 20:52:20
In reply to Re: agitated depression, posted by morgan miller on January 23, 2012, at 20:30:47
morgan;
what is your opinion of low dose abilify as a add-on to a ad? like 1, 2 or 5mg?
thanks.
john
Posted by JohnLA on January 24, 2012, at 20:54:37
In reply to Re: agitated depression, posted by markwell on January 24, 2012, at 18:29:37
mark-
left you a msg up in your ect thread.
i am glad that you are patient enough to see a 2nd doc.
good job. keep-up the fight.
john
Posted by morgan miller on January 25, 2012, at 0:29:50
In reply to morgan a ?, posted by JohnLA on January 24, 2012, at 20:52:20
> morgan;
>
> what is your opinion of low dose abilify as a add-on to a ad? like 1, 2 or 5mg?
>
> thanks.
>
> johnIt might be worth a shot. I think others here should chime in on their thoughts on Abilify. I personally believe that time and taking an integrative approach will often be enough to get someone over the hump. Are we talking about 75 percent recovery and looking for the remaining 25 percent to be taking care of by Abilify? In this case I say hell no man. This is the very reason why I hate the Abilify commercials. A customer came into the store I work at looking for supplements to treat type II diabetes that she developed due to low dose Abilify adjunctive antidepressant treatment. Abilify for this use is the biggest b*llsh*t scam in the history of psychiatric drugs.
Posted by Christ_empowered on January 25, 2012, at 7:47:51
In reply to Re: morgan a ?, posted by morgan miller on January 25, 2012, at 0:29:50
I read somewhere that you're more likely to experience akathisia off the abilify than you are to experience remission. could be wrong though.
Posted by SLS on January 25, 2012, at 7:51:49
In reply to Re: morgan a ?, posted by morgan miller on January 25, 2012, at 0:29:50
Hi Morgan.
> > what is your opinion of low dose abilify as a add-on to a ad? like 1, 2 or 5mg?
> It might be worth a shot. I think others here should chime in on their thoughts on Abilify. I personally believe that time and taking an integrative approach will often be enough to get someone over the hump. Are we talking about 75 percent recovery and looking for the remaining 25 percent to be taking care of by Abilify? In this case I say hell no man. This is the very reason why I hate the Abilify commercials. A customer came into the store I work at looking for supplements to treat type II diabetes that she developed due to low dose Abilify adjunctive antidepressant treatment. Abilify for this use is the biggest b*llsh*t scam in the history of psychiatric drugs.I appreciate your passions. I am not so sure that it is such a scam, though. Abilify does work well as an adjunct for some people to reduce the severity of their depression when combined with more traditional antidepressants. I doubt we will come to an agreement on the appropriateness of the advertizement campain, but what do these advertizements say that is not factually true?
I know people for whom Abilify made it possible for them to remain employed by treating their residual depression. I do gravitate towards the idea to use psychotherapy to treat less severe residual depressions. However, it depends on the circumstances surrounding the individual, though, whether or not this residual is amenable to psychotherapy. Sometimes, residual depression is not the result of remaining biological pathology, but, rather, of psychological pathology. A good doctor may not be able to predict if Abilify will help, but in an ideal world, they should be able to evaluate the need for psychotherapy. However, I would not want to be denied a biological treatment for depression when no treatable depressive psychopathology exists.
Quite simply, there are some people who don't need psychotherapy to be free of depression - just as there are some people who don't need antidepressants to be equally free.
> Are we talking about 75 percent recovery and looking for the remaining 25 percent to be taking care of by Abilify?
25% can mean the difference between living out one's remaining days in a state of passive contentment, and being able to actively pursue happiness and fulfillment. I don't think every case of residual depression will respond to psychotherpy or the holistic healing arts. If Abilify brings one to remission, it is difficult to argue against using it.
I like Abilify. I hate Abilify.
Abilify reduced the severity of my depression to a degree. It was enough of an improvement to continue taking it, despite gaining 50 pounds and elevating my triglycerides. My choice demonstrates the value I place on the difference Abilify made in my life over the last 10 years.
Since my initiating prazosin treatment and my beginning to respond to it, I have discontinued Abilify using a taper. So far, I have not relapsed. We'll see what happens over the course of the months to come. In a prior attempt to discontinue Abilify, it took 2 months before I relapsed.
- Scott
Posted by morgan miller on January 25, 2012, at 13:53:12
In reply to Re: morgan a ? » morgan miller, posted by SLS on January 25, 2012, at 7:51:49
Hey Scott..I agree Abilify will be good for some people in cases where all else fails and the depression is pretty bad. If the lingering depression is mild to manageably moderate, and you are already having some success with an antidepressant, Abilify should not be a go to as far as I'm concerned. Time, exercise, diet, psychodynamic and cognitive behavioral therapy, introspection, and life changes will likely get someone back to living more the way they want to.
Maybe I should not have used the word "Scam". It is all in the advertising Scott. They simply say something like, "If your symptoms of depression are not totally resolved, then Abilify may help". It is such an aggressive advertising campaign, this is where the injustice lies. People are so vulnerable to and easily impressed by these ads. Ads like this reinforce this idea that we need to medication in order to completely resolve issues with depression. People that are depressed will do anything just to feel better, and the makers of Abilify are totally taking advantage of this.
Morgan
Posted by morgan miller on January 25, 2012, at 13:57:17
In reply to Re: morgan a ? » morgan miller, posted by SLS on January 25, 2012, at 7:51:49
I don't think we need psychotherapy to be free of depression. What I do believe is that psychotherapy is the only way to resolve the inner conflicts that make it harder for us to get what we need in life out of ourselves and relationships. If we cannot reach as close to our full potential from within, loving ourselves as much as possible, and getting the most out of good people in relationships, we cannot have the kind of full lives that provide lasting contentment.
I have obliterated depression with antidepressants before, but in the end, it was what was lingering inside me that always came back to bite me and make it harder for me to maintain what I needed to be happy and avoid stress.
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