[Medicated]

So I've only been out of the hospital for a month, and my mood has not exactly been consistently fantastic since then. Really, it exactly hasn't. The new "maybe" diagnoses conferred upon me as the bipolar II label is peeled off include B cluster personality traits and ADD. Both of these can cause depression, however, they cause a reactive depression. I was okay with the theory of these new diagnoses until a couple days ago.

Yesterday I woke up feeling a bit heavy and unmotivated like maybe I was getting sick. My the afternoon, my mind had caught up with my body and I felt a little depressed. By evening, I felt fairly depressed. Upon waking this morning, I felt even worse. Most of the day, I wanted to do nothing but curl up and sleep and make the world go away. In the early evening, I was crying nearly uncontrollably for NO GOOD REASON AT ALL. I'm not sobbing any more, but I still want to curl up and disappear.

All of this was entirely out of the blue. I can't think of anything that was causing me an added amount of stress, or anything new or different or distressing to me. This just happened. This, in my mind, doesn't fit with my new diagnoses.

Does this happen to "normal" people? Do their moods just spontaneously crash and burn like that? Is this just a part of life and the human psyche that I'll just have to learn to deal with? It's distressing and disruptive, but are my standards too high?

For the time being, I'm still taking lithium and lamictal, although I think the shrink wants to discontinue one or both of those soon. I have not been on an antidepressant since hospitalization... which makes all kinds of sense to me, since I was hospitalized for depression...

Anyway, I just don't know what to expect. I don't want to try to medicate something that is fairly normal and can be dealt with otherwise (like counseling), but at the same time, it is so painful. SO painful. I don't ever want to feel this way again unless there is a darn good reason for it.

Thoughts?

[ilazria]

I think I know what you mean, about the depression, and sometimes the mania, being painful. For me, it's as painful as if someone broke my arm, or I had the worst of migraines, but it's more internal. It's like the damage is being done to my soul. I feel a pain like one would imagine a broken heart would feel. It also is a pain from internalizing so many fears and emotions, that I feel that my soul is stretched beyond capacity, and that while my body may remain whole, the essential component that is "me" is going to explode into a million pieces, leaving nothing but a shell behind.

It I am always hunting for an answer to what "normal" is. It is far to easy for me to question whether my thoughts and behaviors are just "personality defects," especially when I am depressed. With my paranoia and people phobia, I am rather isolated from the rest of the world, and my only points of reference are books, magazines and TV. Not the best places to get a picture of what "normal" is. It is the rare moments of lucidity, a bare few minutes or hours after a mood swing peaks or crashes, that I can clearly see that what is going on is not normal. Sometimes I can see where the mood swing was triggered, and sometimes I can clearly see that the mood swing came from nowhere. It's those swings for no reason that tell me that, no, this isn't just "personality defects." If everyone experienced what we experience when a mood comes out of nowhere, raising us to dizzying heights, or slamming us to the depths of emotional hell, there wouldn't be so much condemnation from other people watching us suffer. If they had ever had to walk in our shoes, there would be sympathy, not sneers.

I would get a second opinion about your diagnosis. You may be told those other doctors were right, or you may be told they're way off base. But, if our problems are mostly dealing with emotional issues, then our care has to come from emotionally compassionate treatment. When I am depressed, one of the things I need most is to feel like someone cares. When I am manic, I won't listen to someone trying to bring me back to reality, if I don't have an instinctive level of trust that that person cares about ME, and is trying to help me. If inner, rational me doesn't feel that trust, then irrational me is going to win the battle. Even when I am rational, I can't see how a doctor can effectively treat an emotional disease by looking at emotions from a clinical, cookie cutter view. Emotions aren't black and white. The are infinite shades of grey, each personally blended from our unique experiences, personalities and thought processes. My shade of grey depression may look the same as your shade of grey depression, but while my grey may be blended from doubts about my parenting, yours may be blended from stress about finances (just an example.) Or the grey could just be straight from the shelf grey, with no idea what blacks and whites made it, but it's dumped all over you just the same, and makes you feel the same way a personally blended, yet visually identical grey, feels.

Wow, ok, cutting myself off now. Sorry to have rambled so long.

[Moreta]

Hey Medicated, Have you tried journaling? If you try journaling once a day, you might be able to figure out what some of you triggers are. It's very suprising what can set you off. Like a husband that won't close cabinets, or put the toilet seat down, or stays on the computer all the time. Once you know your triggers you can at least try to avoid them. I have found out that caffeine is a big trigger for me (or at least when you drink waaaaay too much caffeine on top of taking 45mg of Dexedrine ). Also keep track of what you're eating/drinking, because sometimes that can effect your mood.

Just remember it's OK to have mood swings, just not dramatic ones. Nobody has a constant mood all of the time. The key is to regulate your emotions, and when something happens don't go overboard. Address the situation, then let it go. Don't dwell on it. My psych told me that when you have a negative thought to not nurture the thought. If you do this for 14 days the thought will not come back.

You might want to ask your doctor about an antidepressant. Do you take anything for your ADD? When I went to the hospital back in September, they told me that my ADD was causing my depression. Due to the fact that I have no time management skills, and I was trying to do everything at once. >.<

It does get better but it doesn't happen over night. You have to work on it.

[Medicated]

ilazria - wow. You very eloquently stated my exact feelings on a handful of issues... are you stalking me and reading my mind?? (haha ) I've had a lot of different opinions in the last month - my psychiatry rotation preceptor who sent me to the hospital, the resident I'd been working with (as a peer!) who did my admission, the three different psychiatrists I saw while in the hospital, my psychiatrist I've been seeing for over a year, and the therapist I just started seeing. Seven evaluations... in a little over a MONTH. There are two general camps: one being that I am actually bipolar and had a paralyzing depressive episode, and the other being that I have B Cluster personality traits (I don't even come close to a borderline diagnosis, but I have some similar traits such as trouble dealing with stress, although I think everyone probably has a few, for that matter...). My outpatient psychiatrist is a fan of the latter theory, and now postulates that I might have also ADD which is also causing/contributing to my depression. I've been kicked back and forth between diagnoses a lot lately, and I fear that yet another evaluation would do me little good. In fact, I almost feel that even if my psychiatrist is wrong, right now I need the stability and peace of mind of being able to devote my thoughts to one diagnosis and stop worrying so much about other possibilities. Maybe I'll change my mind later on, but for now, I really can't handle any more drama, change, or even just the work of trying to find another opinion. At least this is established, and he HAS known me for over a year...

QueenAccountant - Following the personality disorder (ish) diagnosis, my psychiatrist sent me to a DBT clinic. Part of that program is that each night, I fill out a "Diary Card," on which I evaluate and record a number of feelings and behaviors on a 0-5 and y/n basis. I just started doing this a week ago, but I realized when I talked to the therapist last, and she asked me why I put a 4 for 'misery' on the Thursday, and what was going through my mind... and I couldn't answer, I realized that I'd have to write some things down too. My notes have been pretty thorough lately, and that's why I can fairly confidently say that there isn't really anything that triggered this recent episode... except that I realized this morning that it may have been PMS/PMDD. Oops. I also have the treatment journal in my signature, but that's more just for my thoughts about how things are going in general, not the daily details.

I just started ritalin for the ADD, and I find it entirely useless thus far. I want to switch to something different at my appointment tomorrow. I have mixed feelings on starting an antidepressant. The psychiatrist doesn't seem to think that they help me, and I'm fairly sick of taking pills. It isn't my first choice, and if this episode really was PMS, then I think I'd rather just learn to brace myself for it every few weeks.

If my psychiatrist is right and my depression is due to ADD and an inability to deal with my emotions effectively, then maybe I'm not the only one who has been hospitalized for the effects of ADD! Who'd have thought?

[Moreta]

I've never taken ritalin, so I can't comment on the effectivness of it. I have taken, Adderall, Adderall XR, Concerta, and Dexedrine (i think i'm missing one). But I have found that the non-stimulant ADD drugs don't work as well for me, because I need that kick in the morning to actually wake up (stupid seroquel). I can say though that I loved the Adderall XR over all of them because I lost 60 lbs. but then it stopped working. Now i'm on dexedrine, which seems to work pretty well, makes me a little jittery though if I have too much caffeine.

There are also some antidepressants that are prescribed for ADD. I think Welbutrin may be one of them. Maybe do some research before you go in, cause you might be able to help 2 problems with 1 pill. Just a thought.

[Medicated]

Interestingly, I was taking wellbutrin before, but it was discontinued while I was in the hospital with the plan that I'd start an MAOI after discharge. But the outpatient psych disagreed, didn't start the MAOI, and didn't have me resume the wellbutrin, either. However, since I ended up in the hospital, I guess it wasn't helping too much with either the depression or the ADD...

It is my understanding that the stimulants can have an antidepressant effect, so I'm hoping they can do the two-in-one job. (Three-in-one would be okay too... I'm only slightly overweight, but I could stand to lose about 20 lbs.)