Tuesday, January 13, 2009

Comments to Bipolar Depression Article

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Imagine for a second the psychiatric profession personified as Homer Simpson, with the trademark gesture of the hand smacking the forehead. The collective "Doh!" you hear is the seemingly overnight realization that depression rather than mania is the dominant partner in manic-depressive illness (bipolar disorder). ...

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  1. I recently realized that my depression was not the same as regular depression. Depression, no big deal. Take your medicine and come back in 3 months. My depression? What works? Nothing yet, plus lithium and other anti-convulsants make the daily walk of life like slogging thru a pool of mud. Stress? Add stress to almost any situation and I go from brilliant to ignoramus instantly. Disorganized,distracted,forgetful. Sleep? Restful, regular sleep is not to be found. Unemployed for a year now, how am I to find and keep a job. Go to bed at 10 P.M. awake at 12:45 A.M. then up or up and down until dawn. I end up sleeping until 11 AM. Takes 2 hours to become alert. Seems every time I start working around the house I spend 2 hours deciding what is most important to accomplish, find tools and parts, then I am exhausted. But I keep working until nearly bedtime, never completing a project. Bedtime, dead tired. Sleep half hour to 2 hours. Then awake, not alert, unable to return to sleep until nearly dawn, AGAIN.

  2. Over many years, I've found that only Buproprion (generic for Welbutrin), has been able to give me any form of stability. I'm bipolar II, and my illness, as you point out, is almost entire about my depressions, which range from moderate, to very severe. Several years ago, while not on any meds, I became concerned about my increasingly suicidal thoughts, and went to a physician. I told her that I'd had great success with buproprion while trying to quit smoking, some months before, and asked to be prescribed it, again. She did not feel competent to treat me, and referred me to the ONLY psychiatrist practicing in this area. I contacted him, only to learn that A) there was a 3 week wait for an appointment, B) he was not in the insurance network of my employer , and C) he required $200 up-front, before treatment. When I finally DID scrape up the money, and after enduring 3 more weeks of very severe depression, he focused ENTIRELY on my mild hypomanic phases, and insisted on treating me with Lamotrigine: a drug which has NO applications as an antidepressant, on label or off, and which takes 7 WEEKS to reach effective levels. At the one month point, I returned to the shrink and reported that I was having horrible nightmares, and that my mild hypomanic phases were now severe and continuous Dysphoric states - rage, interspersed with deep, suicidal depression. I begged for ANY relief, and was told to stick with the lamotrigine for another month. Just in case, however, I was given a scrpt for Geodon, an atypical antipsychotic which, AGAIN, had NO on or off label effect in reducing depressions! 3 more weeks of this, culminating in a furious fit over absolutely NOTHING, in which I broke one of my knuckles against a brick wall. I weaned myself off the drug (another delightful 3 weeks!) Told the shrink he could go screw himself, and went to a GP I trusted, and asked him to let me try Buproprion again. After hearing me out, he wrote the prescription. 7 days later, I found the symptoms miraculously better! I STILL get depressed, though not as severely, and I still get hypomanic, but all of it is manageable, and I'm stable enough to work, and find myself sleeping better, and FINISHING things, for a change... Looking back, I feel the most intense bitterness for the Psychiatrist who simply didn't GET the fact that Mania was never, ever, ever the problem - the depressions threatening my life were!

  3. As someone who has lived with Ultra Rapid Cycling Bipolar 1 for over 20 years, I can say this from personal experience only...
    Focusing on treating the 'depression' side of bipolar and thinking that the mania side is of no great importance because the person is less likely to commit suicide while manic is obserd!
    In my opinion, mania can be just as debilitating if not more so than the depression end of the spectrum! Damage done during a manic phase can stay with you far longer than most of what can be done while depressed. Shame on the psychiatric community for overlooking the mania and focusing solely on the depression.
    Here's a thought for them, why not focus on BOTH! That would be a great change to how bipolar disorder has been treated to date.

  4. depression sucks...mild mania rules---allows us to stay in the game. Yes you should have gotten bupropion much earlier. Combo Lamotrogine & bupropion works for me.

  5. update on my post 6/16/09
    Combo still working...