Question:
I’m hoping some MD veteran can toss me some basic do’s and don’ts to prep me for a psych appointment this evening. I’m atypical bipolar II (never manic, sometimes hypomanic, usually depressed), a diagnosis I haven’t much identified (I was just getting used to accepting that I’m a vanilla depressive!) with until recent events pushed the issue in my face. Now the evidence and emotional pain are too strong to ignore and I finally "see" that I must bump my treatment up a notch if I am to survive. For the last several years I’ve had trials of a variety of SSRIs and tricyclics to treat both depression and fibromyalgia (the aim being to reduce the FM pain and improve sleep). Prozac worked the best for psych problems, 0 for FM but I found the sexual side effect unacceptable. The tricyclics helped sleep a bit, did 0 for pain and depression and had unacceptable side effects such as hypotension. After lots of poking and digging I located info that suggested 5-HTP (l-hydroxytryptophan) could help both depression and FM. After reviewing the literature I gathered, my doc prescribed it in September and I’ve been doing fair well day-to-day with depression, pain and sleep. The big "however" is that at the most profound level of my depression the notions that make life worth living are eroding and I’m feeling worthless, hopeless, etc. I’m also mixed state or rapidly cycling between depression and hypomania several times a day now. So. The doc has previously suggested MAOIs, which I refused due to dietary restraints, and lithium, which I refused because it sounds so very "officially mentally ill," the side effects sounded intrusive and it felt like I’d have to be on it for life. Plus, hypomania (never mania) is not a problem–the depression is!–and I understand that lithium isn’t all the effective for the depressive aspect. His other two suggestions which I stopped considering when 5-HTP came along were Depakote and some new MAOI that doesn’t have dietary restrictions. If anyone can spare the time for a note of personal opinion or experience, I’d appreciate it. I want to walk into that appointment tonight armed with info and prepared to make a decision re: meds. Many thanks in advance! —
Response:
> I’m hoping some MD veteran can toss me some basic do’s and don’ts to > prep me for a psych appointment this evening. > I’m atypical bipolar II (never manic, sometimes hypomanic, usually > depressed), a diagnosis I haven’t much identified …<snip> > …and lithium, which I refused because it sounds so very > "officially mentally ill," the side effects sounded intrusive and it felt > like I’d have to be on it for life. Plus, hypomania (never mania) is not > a problem–the depression is!–and I understand that lithium isn’t all > the effective for the depressive aspect.
Thank you – I never knew my ‘official’ diagnosis before, but that’s it. First, get used to the fact that it may take a while to find the right combination of medications. So hang in there, be patient, and be willing to try everything. Personally, I think this is just about the worst form; all of the pain and little of the pleasure. As to what worked for me (plus a lot of therapy): Lithium. Yeah, that’s the big one. It does sound "officially mentally ill", probably because it’s been around for so long and works so well. Even if the hypomania isn’t a problem, you *need* a mood stabilizer. If it helps, refer to it as lithonate, or lithium carbonate. Basically it’s just a form of salt, similar to the stuff you put on your popcorn. It turns out that at a number of places where people used to go to ‘take the waters’ there was a high level of lithonate in the water they were scooping up out of the springs, which is probably why they felt better. Read _Moodswing_ by Dr. Ronald R. Fieve. It’s somewhat out of date, but still one of the best book around on lithonate. How long will you have to take it? This is similar to the "officially mentally ill" problem. If you’re bipolar, you have a mental illness, and you may have to deal with this for the rest of your life. And this is a really hard, nasty idea to get used to, so try taking it in smaller bites. First, you may *not* have to be on it forever. For what it’s worth, I will, but I’ve come to terms with the fact that the trade off is worth it. If it turns out that you do, you’re in the same position as someone who has to take insulin every day – minus the problem of needles. Side effects. They sound really scary, don’t they? To be honest, the only one I’ve encountered is that I’m thirsty more often. It’s not a big deal; I just keep a water bottle in the car, and another with a shoulder strap in the fridge. And I probably have a greater familiarity with public bathrooms and drinking fountains than most people! Oh, I forgot about the tremors. The may come from the Lithonate or from something else, but they *are* a bother. And I’m really tired of people thinking that I’m nervous or asking what’s wrong. My solution when people say something is to check my hands, implying "shaking? what shaking?" and say calmly "Oh, that. Side affect of some medication. Annoying, isn’t it?" and keep on with whatever I’m doing. But it has never kept me from doing anything that I want to do, just slowed me down a bit. I can even still thread a sewing machine needle, I just have to focus a bit more. It’s the worst of my side effects, and one I’m so accustomed to dealing with that I forget about it. Effexor. This deals with the depression while the lithonate evens the highs and lows. Pretty standard stuff. I can’t recall any limitations other than take with food – I get a bit queasy if I don’t. Trazodone. This was added because of the not sleeping problem. The big drawback of this one is that going off of it is going to be a bitch. I hate that. I hate that more than the rest combined. But I’m too stubborn to let my silly discomforts get in the way of my health. So, the full list is: Lithonate, 900 mg (600 AM, 300 PM) Effexor, 300 mg (150 AM, 150 PM) Trazodone, 100 mg (PM) To quote a song, "It’s a drag, it’s a bore, it’s really such a pity," but I don’t *like* being nuts, even if being nuts is better than being mentally ill. So – I take the drugs and get on with life. It’s worth mentioning that a good part of the reason I can be so blase about all of this is that I have a truly wonderful and patient therapist. Just trying out a dozen different drugs would have been impossible without her support, much less coming to terms with all of this. If you’re not seeing someone, I suggest you start. It doesn’t mean you’re mentally ill, it means you’re smart enough to hire a coach to get you through the rough spots. A personal trainer. For the exact names, families, etc. of the medications listed, check one of the web sites – I think that Dr. (Somethings) may be the best one. All of this is probably both more and less than you need, but it’s what I have to offer. Good luck, and e-mail me if I can help. Elspeth
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