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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 tabitha on June 22, 2002, at 2:40:49
Hi all,
My meds have been pretty much pooping out over the past few months (AD + mood stabiliser combo for BP2, I've been stable for a couple years on this paritcular combo). As I keep noticing, many things in life are better with less effect from the meds-- mentally and physically I just feel better most of the time, the only problem is (of course) the increased ups and downs.
So I'd kind of decided to stay in the under-medicated state, and just try harder to cope with the ups and downs. As long as I can do my job, don't do anything too self-destructive, and don't get suicidal I thought I'd rather deal with the moods the hard way.
Then a week ago I was crashing, and thinking suicidal thoughts, and suicide seemed like a really logical option since I was convinced my life was a total failure. This was triggered by a disappointment at work (got a bad office assignment) I made a doctor's appt, but couldn't get in for 3 weeks, and didn't push for an emergency session. In the meantime the office thing got resolved in my favor, and I'm back up to a little above baseline.
I'm feeling things more vividly, both good and bad. I miss my family and the mideast where I come from. I'm extra productive at work. My loneliness is more intense. I crave alcohol. Working in the garden is intensely interesting and satisfying. I've become interested in sex for the first time in years. I feel like myself again. But honestly I'm afraid I'm at risk of sudden suicidal impulses or out of control hypomania and doing impulsive things with bad consequences.
There just doesn't seem to be a med combo that just takes the edges off without flattening out my very being. So I don't know what I'm going to do at the doctor's. I'm so conflicted. Why can't there be pills you only take when you start to feel too high or too low? I don't think my doctor will have a good option for me. I don't know if it's him or the state of medicine. It seems pointless to go in, pay the $110 for the 15 minutes, when I expect it will be useless.
But it seems wrong to just keep going like I am. My mother killed herself and since then I feel my most important task in life is to NOT kill myself. And when the meds are working, suicidal thoughts go away (along with so much else that makes life worth living). Terrible irony here! I honestly don't know if it's "safe" to be in a state where I have such thoughts, or if I'm putting myself at risk.
Thanks for listening. Any thoughts would be appreciated.
-tabitha
P.S. I am not really looking for specific medication advice, which is why I didn't put this on PB.
Posted by ST on June 22, 2002, at 3:31:08
In reply to Long rant about med change or not, posted by tabitha on June 22, 2002, at 2:40:49
Tabitha,
First of all, you *should* push for an emergency visit and pay for a half hour at least. (Is there a sliding scale situation you could get yourself in to? I go to a major hospital here that has pdocs-in-residence and I pay $50 for a full hour or $35 for a half hour med visit!)
Secondly, if your meds are pooping out, it's important to keep searching for the right combo. Don't settle for surviving around the baseline. I don't feel "flattened out" on 500 mg of Depakote, but used to be flattened out at 1500 mg. I kept telling my pdoc I think it should be lowered...and now I feel like 500 is good for me. Welbutrin has been the only good AD so far for me. I've been on an off different SSRIs that have been added to the Dep/Wellb combo, but none have *really* helped. Recently - you responded to my post on this - I weaned off Effexor and have been feeling B I Z A R R E.
So, I don't know if all this this helps. But I do think seeing your doc more frequently until you get over this hump or get on different meds or change your dosage is very important. Have you tried weekly talk-therapy?
Sarah
Posted by Fuscia on June 23, 2002, at 18:27:34
In reply to Long rant about med change or not, posted by tabitha on June 22, 2002, at 2:40:49
After reading your post twice, I could only find the good things about your life to make me feel like writing.
You reacted to that bad office assignment with much dissapointment, but look how it turned around for you. I think that is great. If you were dead and gone, then you'd a never known about the change at the office, well, it would have been a waste. As for your ups and downs, well, that is to be expected, isn't it. Be fair to yourself. You've gone through one of the biggest stressors in your life - moving/relocating.
What I read in your letter is you are afraid. Afraid of the hypomania or suicidal urges to take over. I can only plea with you to simply not be afraid. Don't listen to those horrible, uncalled for thoughts that are based on fear. Don't compare yourself with your Mom. You are not her. Don't think for one second that you will end up killing yourself as she did.
I saw an interesting documentary about a very intelligent man that suffered for years from schizophrenia. One day, he simply had had enough and decided to stop listening to the voices. That was all it took for him to lead a normal life, without medication. He decided to not listen to the voices that he allowed to control his life all those years. It was a revelation to say the least.
Enough of the pep talk. I hope the best for you. I hear that Eli Lily is coming out with a new med for bi-polar that is unlike depakote or other anticonvulsants. They claim it doesn't cause depression or mania.
I hope I didn't come across too strong. I can understand how you feel for I too, dislike the flat way I feel on medicines. I feel like a walking tree - medicines have robbed me of much of myself, but at the same time keep me from going over the edge. I know it isn't easy. Talk is.
Sincerely, Fuscia
Posted by tabitha on June 25, 2002, at 1:23:03
In reply to Re: med change or not, posted by Fuscia on June 23, 2002, at 18:27:34
Thanks Sarah & Fuscia. I really appreciate your concern and advice.
Sarah, I do have a weekly therapist who I think is pretty great. She is usually available on a pager between sessions, so there's someone there for a sudden crisis. I think you're right though that I need to get more assertive with the pdoc about my status. I don't have the best relationship with him, though at this point he's the best of the ones I've tried.
Fuscia, all your advice was exactly the "voice of reason". At one point I was absolutely in touch with that. I knew that the suicidal thoughts were just like enemies I had to fight, and not to be taken seriously as reality. I also knew my mother's destiny was not mine. Somehow I've lost touch with that. I think maybe the meds worked so well for so long, that I got out of the habit of dealing with suicidal thoughts. I guess it's time to do the cognitive stuff again instead of relying on 100% chemical solution.
The whole thing is not quite resolved, I'm going to wait on the pdoc appointment, and my therapist agreed to monitor me til then.
-tabitha
Posted by Fuscia on June 26, 2002, at 16:41:49
In reply to an update and thanks, posted by tabitha on June 25, 2002, at 1:23:03
It's good hearing from you, hearing about the update.
I don't know if you've ever gone cold turkey off of a med. or reduced, but I wanted to share a common experience that occurs.
I have gone cold turkey off of 1 1/2 yrs. of Zoloft, 4 mo. of Celexa, and oh yeah, I did take Wellbutrin SR 150 mg in a.m. by itself for only a month - it made me relaxed but irritable. Anyway, I've gone cold turkey and have also tried the slow ween process - either way it was like all the emotions that the drug held at bay came rushing back, and I mean rushing like the dam had broke - I was worse than what I had been prior to starting any behavioural med: I cried over nothing, laughed uncontrollably, became depressed, irritable, high anxiety, mild hypersexuality. I had been in a flat state from the drugs, afterward it was like the dam had broke and my emotions went through extremes - what was my typical response - "Oh no, my old self is coming back, I need to go back on my meds". Many that are panic disorder sufferers experience panic attacks in full force - usually with no stressor to set it off. One experiences frustration and dissapointment thinking that they obviuosly can't live without the drug - so they go back on it or increase the dose.
I mention this because many times when meds poop out, or you reduce or discontinue a drug that effects the neurotransmitters, the brain suddenly has to figure out how to work before the drugs began to adjust the brain chemicals. This process can be a rough ride, and many folks simply think it's their old selves returning and go back on the medicine, either because of their own decision or their doctor's advice. I only know that what I experienced was worse than what I had been before every taking any medicine. How often I have wondered if I just stuck it through would I have eventually come to a more balanced state of being. I have yet to find this out personally for I went back on meds. I just couldn't handle "my old self" and figured I would forever be on a med. for I obviously couldn't be normal without it.
As for what you are experiencing, I don't know if this is what is occuring with you or not, and I am reluctant to say it is - for I don't know. I do know that others that have gone through this rough period that were determined to stick it out eventually got better. It would make sense to me that this would occur, since these drugs alter brain chemicals, and it can take some time for the brain to begin to readjust after going through this withdrawal period. I do know that this does occur with many other drugs. The birth control pill is a good example. Oral contraceptives suppress your hormone output. After stopping the birth control pill after years of use it can take the body several months if not longer, to begin to produce hormones in the balance it did prior to beginning the pill. Corticosteroids are another example.
I always mention this to people that are experiencing "their old selves again" when reducing, or discontinuing a drug, or going through drug poop-out, for sometimes it is just the brain's attempt at readjusting itself to being without the effects of the medicine. This can be a topsy-turvy experience. One day, I'd like to be med. free, but I will plan to do this when our new puppy is older, and not so rambunctious and persnickity. For his sake, I am not willing to discontinue the twice weekly Prozac since it works very well at preventing anger outbursts - which for me is like a man's temper - very ugly - physical - and can put me into a deep depression afterward due to guilt. I am like you, for I do not like the flat feeling of being on drugs. I have lost all creativity and motivation.
Well, I've written too much as usual. I'm glad to see you are keeping in touch. For me, that can really help when I'm going through uncertain times.
Take care, Fuscia
Posted by Roo on June 27, 2002, at 9:36:43
In reply to Re: an update and thanks, posted by Fuscia on June 26, 2002, at 16:41:49
Man--that was all so well said, Fuscia. I too, have
wondered the same thing--if only I could wait out that
crazy feeling, maybe my body/mind would adjust to the lower
dosage or no med---because that feeling is way worse than
the depression I had before I ever took drugs for it....
It's just so hard to make it through those periods and NOT
KNOW if it's the depression returning, or just something you're
body has to go through before returning to some sort of
equalibrium. If I KNEW that at some point, it would settle
down, I'd wait it out.....but I don't know and then I convince myself
that I'm just torturing myself uselessly and being in denial about
needing to be on meds. It's so confusing. The depressions I've
experienced going off meds has been way worse than it ever was pre-meds....
is that b/c of the drugs (withdrawal), or is it b/c I've been on
meds so long and accustomed to being "flat" that I have no tolerance
for emotional pain anymore, or is it because depression is a progressive
illness that tends to get worse with time????Arrrgghhhhh....
This is the end of the thread.
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