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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 79. This is the beginning of the thread.
Posted by floatingbridge on July 29, 2011, at 13:36:41
It's come up again. Amu has a link to an article above.
I don't understand theory on cyclothymia. It's a bipolar spectrum condition? Is that correct?
Why is 'it' so difficult to treat? I am not even sure I know what bipolar is after all this time, though I surely know it exists.
Posted by Phillipa on July 29, 2011, at 13:58:32
In reply to Cyclothymia: SLS and others. What is it?, posted by floatingbridge on July 29, 2011, at 13:36:41
FB I'm not sure as the DSM is changing once again. cyclothymia I always thought was a form of rapid cycling. But not sure. Love Phillipa
Posted by Christ_empowered on July 29, 2011, at 20:49:51
In reply to Cyclothymia: SLS and others. What is it?, posted by floatingbridge on July 29, 2011, at 13:36:41
I think the bipolar-spectrum disorders are being diagnosed differently than back in the day. I guess with all these new anticonvulsants and neuroleptics, doctors call people who once would've been seen as depressed or moody or even anxious as cyclothymic or bipolar of some persuasion. That's my take on it, anyway.
How do you feel about stimulants? The few cyclothymic people I've known responded well to stimulants and xanax. I know you were on a hefty dose of Dexedrine, but maybe something milder, or at least at a lower dose? I don't know...I'm just throwing things out there for you.
Posted by floatingbridge on July 29, 2011, at 21:28:05
In reply to Re: Cyclothymia: SLS and others. What is it?, posted by Christ_empowered on July 29, 2011, at 20:49:51
> I think the bipolar-spectrum disorders are being diagnosed differently than back in the day. I guess with all these new anticonvulsants and neuroleptics, doctors call people who once would've been seen as depressed or moody or even anxious as cyclothymic or bipolar of some persuasion. That's my take on it, anyway.
>
> How do you feel about stimulants? The few cyclothymic people I've known responded well to stimulants and xanax. I know you were on a hefty dose of Dexedrine, but maybe
something milder, or at least at a lower dose? I don't know...I'm just throwing things out there for you.Thanks CE. You are spot on to the two agents that have made a difference. And your ideas about the diagnostic history of the dx are interesting. I 'chose' Emsam because of some notion of responding very well to dexidrine. Originally I thought
parnate, but felt that might be too hard on my body. Who knows? Xanax xr is now adequately dosed and taken like clockwork. My new pdoc is not stressing me to ever get off.I just don't understand the theory/ idea of cyclothymia.
It was called 'soft' bipolar in 1998 when I first presented to
psychiatry. Even that term makes me cringe.Everyone's illness is a bear. I just don't get much of the theory.
Posted by floatingbridge on July 29, 2011, at 22:39:56
In reply to Cyclothymia: SLS and others. What is it?, posted by floatingbridge on July 29, 2011, at 13:36:41
Anyone? Please?
I tried to avoid this cyclothymia thing, but I don't think I can. I really really hate it. I cannot control it on my own. I have taken both depakote and valproic acid ( I thought they were the same.)
Lithium. I can tolerate that. Then there are the meds I don't know about. Trileptil or something. No AP's, just please.
Yes, Emsam helps. I am at the 6mg dose. Xanax xr 2x per day helps.
I have comorbid dx's like social phobia, anxiety, chronic
PTSD. But I am 51 years old and I am looking at the same dx from 12 years ago. And there is so little written about it.
I used to read literature. I still read about art because that is a haven for the unusual and the moody. Now I read these articles I do not understand. I have been medicalized and psychologized.
So, the main difference between BP ll and cyclothymia is duration of mood?
Posted by Phillipa on July 29, 2011, at 23:01:57
In reply to The difference between cyclothymia and BPll?, posted by floatingbridge on July 29, 2011, at 22:39:56
Oh boy will google after ebay okay? Trileptal I took low dose 150mg supposed to boost ad. No side effects at all seriously. Phillipa
Posted by floatingbridge on July 29, 2011, at 23:06:25
In reply to The difference between cyclothymia and BPll?, posted by floatingbridge on July 29, 2011, at 22:39:56
O.K. Maybe I used to have BP ll. What the f*ck do I know? I used to be able to write. It was very difficult with never knowing what f*ck*ng mood I would be in and whether my brain would work that afternoon, that week, that month.
But it was never 'lite'. I just read that in three places. What the heck is 'bipolar lite'? I suppose not having mania. But there is nothing else lite about this. I feel like whatever *this* is is slowly killing me.
It's now like, will my brain work this year? Maybe next? Ever again?
Yeah, I'm a little worked up. I am posting to myself now.
I see my new pdoc in less than two weeks. Do I just beg for lithium? I am really scared :-/
But on the outside, I am o.k.
Posted by floatingbridge on July 29, 2011, at 23:15:54
In reply to Re: The difference between cyclothymia and BPll? » floatingbridge, posted by Phillipa on July 29, 2011, at 23:01:57
> Oh boy will google after ebay okay? Trileptal I took low dose 150mg supposed to boost ad. No side effects at all seriously. Phillipa
Phillipa, I'm sorry. I am just ranting. You are so kind. You don't need to google after eBay, okay?
I get to take my ambien soon, go to sleep, and wake up and will google that med tomorrow.
Really? No big sides for you? Just about everything in the world has big sides for me :-/
Thanks and hugs.
Posted by mellow on July 30, 2011, at 1:02:31
In reply to Cyclothymia: SLS and others. What is it?, posted by floatingbridge on July 29, 2011, at 13:36:41
I am dx cyclo. Basically it is a sub class of Bipolar some consider "soft" because it does not include full blown mania or full blown episodes of major depression. It is the oscillation between dsthymia (spelling?), a mild yet chronic depression and hypomania.
In my case I cycle between being really dissatisfied with life, sensitive to rejection, fatigued, sad, and often suicidal all the way to being the life of the party, full of energy on four hours sleep, grandiose, etc.
One of the major components of my moodiness is feeling like everything is "crystal clear" when I'm high then losing a lot of my confidence when I crash and feeling dull or shameful for weeks on end.
In contrast to those with Bipolar I who may find months if not years of remission and high function between episodes, people with cyclothymia often feel crummy all the time and experience little remission from what most literature shows. For me the only time I feel really good is when I'm not quite fully cranked up to hypomania. About fifty percent up the scale is when I start actually feeling like a normal person. But it is short lived as I end up being way high and psychotic after a couple of weeks.
There is certainly nothing "soft" about it. I've been feeling sh*tty for two months and keep telling myself I just need to have a better outlook on life. It's really up to me. I have a great doc and good therapist. My wife and family are awesome, but no one is going to live this life for me. I have to make the best of it. I don't think meds or a new therapist is gonna change things. I decided it's up to me.
Best of luck if this is your new Dx. I've done ok (at least I haven't been back to the psych ward) on Lamictal. The stabilizers are worth a shot. Exercise and yoga help a lot too.
mellow
Posted by floatingbridge on July 30, 2011, at 1:26:58
In reply to Re: Cyclothymia: SLS and others. What is it?, posted by mellow on July 30, 2011, at 1:02:31
Mellow, thank you. The crushing lows are doing me in. Somehow the entire thing has morphed into recurrent MDD. It is atypical in that it is temporarily responsive to events.
I have a bipolar sibling. I remember what you wrote about your grandfather. Much as meds scare me (sorry) I can't be left to endure this unaided. I am getting very worn down.
What yo describe sounds *more* bipolar. But see, I still don't understand as that comment shows. Suicidal sounds like
major depression to me, but I don't understand these things clearly.Jeez, I have never felt grandiose. On dexedrine I felt bullet-proof. Xanax, too. Usually I just feel sh*tty. That's a kinda' baseline. Bullet-proof means really just equal to my peers
and being able to withstand life. And I'd like to write again.I have been assessed at times with double depressiion. Does MDD rule out the cyclothymia? There is so much conflicting info out there.
You wrote a few weeks back for support. I'm sorry I didn't
know what to say....Yeah. Nothing soft about it. Thank you so much for hearing that and responding. I wish you were not struggling as much as you have been.
Posted by SLS on July 30, 2011, at 6:14:17
In reply to Re: Cyclothymia: SLS and others. What is it?, posted by mellow on July 30, 2011, at 1:02:31
> I am dx cyclo. Basically it is a sub class of Bipolar some consider "soft" because it does not include full blown mania or full blown episodes of major depression. It is the oscillation between dsthymia (spelling?), a mild yet chronic depression and hypomania.
>
> In my case I cycle between being really dissatisfied with life, sensitive to rejection, fatigued, sad, and often suicidal all the way to being the life of the party, full of energy on four hours sleep, grandiose, etc.
>
> One of the major components of my moodiness is feeling like everything is "crystal clear" when I'm high then losing a lot of my confidence when I crash and feeling dull or shameful for weeks on end.
>
> In contrast to those with Bipolar I who may find months if not years of remission and high function between episodes, people with cyclothymia often feel crummy all the time and experience little remission from what most literature shows. For me the only time I feel really good is when I'm not quite fully cranked up to hypomania. About fifty percent up the scale is when I start actually feeling like a normal person. But it is short lived as I end up being way high and psychotic after a couple of weeks.
>
> There is certainly nothing "soft" about it. I've been feeling sh*tty for two months and keep telling myself I just need to have a better outlook on life. It's really up to me. I have a great doc and good therapist. My wife and family are awesome, but no one is going to live this life for me. I have to make the best of it. I don't think meds or a new therapist is gonna change things. I decided it's up to me.
>
> Best of luck if this is your new Dx. I've done ok (at least I haven't been back to the psych ward) on Lamictal. The stabilizers are worth a shot. Exercise and yoga help a lot too.
>
> mellow
This is better than any description I could come up with.I would just add that cyclothymia is sometimes considered a prodrome of bipolar disorder. If left untreated, cyclothymia evolves into a presentation of MDD or BD mood disorder. It can also be allowed to become worse if acute trauma or chronic psychosocial stress are evident, but not treated.
- Scott
Posted by SLS on July 30, 2011, at 6:24:17
In reply to Re: Cyclothymia: SLS and others. What is it? » mellow, posted by floatingbridge on July 30, 2011, at 1:26:58
You certainly have a convoluted set of facts and theories that you are placing importance on.
Perhaps this would be a good time to describe in detail what you observe and not what you think.
How long do your depressive episodes last for?
I think you are too old to be cyclothymic. Quite often, mood disorders and borderline personality disorder (BPD) exist comorbidly. What would this presentation look like? Let's see if it matches a specific set of symptom clusters.
I might not be around later. I look forward to seeing your observations and having others respond to your descriptions.
- Scott
Posted by sheilac on July 30, 2011, at 7:44:36
In reply to Cyclothymia: SLS and others. What is it?, posted by floatingbridge on July 29, 2011, at 13:36:41
Totally understand your frustration.
About 20 years ago a doc told me I was depressed with anxiety. In recent years, one doc said I was ADHD and didn't say anything about bipolar. Another said I was BPII, another said I was "soft bipolar" with "slight" ADHD issues. What?
All I know is I can remember having crushing, low depression since 4 or 5 years old! My "mania" is of the irritable kind and not the crazy highs. Only times I have experienced super high typical mania is from steroids, cold medicine and too much stimulants.
So, who the heck knows. I just know when you feel really low it sucks and I'm still not exactly sure what I have. I tend to think I do have more BPII - due to the bad depressions I have experienced.
Sometimes I feel like docs are just throwing darts at a board and seeing what sticks with diagnoses and meds.
I hope you feel better. I know with me, "traditional" mood stabilizers - lithium and depakote made me depressed unless the dose is pretty low. Maybe that is because I am prone to depression.
Stimulants, surprisingly have been better for my depression than traditional antidepressants. Odd.
Geodon, so far is working, but is a weird drug in my opinion. Still trying to work out the dosage.
Posted by Dinah on July 30, 2011, at 7:49:26
In reply to Cyclothymia: SLS and others. What is it?, posted by floatingbridge on July 29, 2011, at 13:36:41
That was one of the diagnoses on my insurance receipt over the years. I never took it particularly seriously, since like most other diagnoses it didn't fit particularly well. I figured it was my pdoc's shorthand for "mood instability". I'm definitely on the bipolar spectrum somewhere, but cyclothymia doesn't really fit any better than bipolar II.
My mood instability has seemed to mellow out a bit since menopause. Have you checked with a gynecologist about possible hormonal involvement?
Lamictal is some use for me, I think. I take it primarily for migraine prophylaxis, but I think it also has a bit of mood stabilization effects.
Posted by morgan miller on July 30, 2011, at 8:51:03
In reply to Re: The difference between cyclothymia and BPll?, posted by floatingbridge on July 29, 2011, at 23:06:25
> O.K. Maybe I used to have BP ll. What the f*ck do I know? I used to be able to write. It was very difficult with never knowing what f*ck*ng mood I would be in and whether my brain would work that afternoon, that week, that month.
>
> But it was never 'lite'. I just read that in three places. What the heck is 'bipolar lite'? I suppose not having mania. But there is nothing else lite about this. I feel like whatever *this* is is slowly killing me.
>
> It's now like, will my brain work this year? Maybe next? Ever again?
>
> Yeah, I'm a little worked up. I am posting to myself now.
>
> I see my new pdoc in less than two weeks. Do I just beg for lithium? I am really scared :-/
>
> But on the outside, I am o.k.Hey FB...Lithium might not be a bad place to start. I believe you mentioned having an o.k. response to a moderate dose(600mg?) in the fairly recent past. Correct me if I'm wrong.
Some here have suggested lamictal, which might help. Have you tried it? I can't remember. I'm not a huge fan of lamictal, but it does help a lot of people. I just think lithium is a far cleaner substance, with more potential to actually help a brain recover in the long run.
I don't know much about treating cyclothymia, but it sounds like a real pain in the arsh. For you, it may be that starting very simple in the beginning, like a medium dose of lithium, might be the way to go. If you get even some relief, enough to help you feel a little stronger, it would be worth it I think.
The only reason why I'm not crazy about stims and benzos are the potential long term implications. Both of these classes drugs have more potential for neurotoxicity than other ones like lithium and depakote(again, a middle range dose, nothing heavy).
I would be interested to see how you responded to things like holy basil(new chapter supercritical), 4-600 mg magnesium glycinate, uridine plus fish oil(25 mg triacyteluridine and 800 mg combined EPA/DHA), and ayervedic herbs like bacopa and gotu kola. These things would have a more subtle supportive role of course. After a while, they may also help your brain get back to functioning a bit better(this would also improve after you've been stabilized by a medication or two for a while).
Morgan
Posted by floatingbridge on July 30, 2011, at 14:19:34
In reply to Cyclothymia: SLS and others. What is it?, posted by floatingbridge on July 29, 2011, at 13:36:41
I will see my new pdoc and lay it out. Not avoid any bipolar dx nor seek it. Not avoid axis ll comorbidities or seek them.
After some reading this morning, I see that Avoidant Personality really fits. This personality *disorder* dovetails with my persistent (and officially dx'd) social phobia.
Borderline fits only in certain features which are a scary ride unto themselves. They center around a sense of identity disturbance and intensity of emotion. I score off the charts on
MMPI 2 on:Lack of ego mastery
Lack of ego (cognitive)
Lack of ego (conative?)Topping the charts in no order is:
PTSD (*sigh*)
Inversion
Mental dullness
Depression
AnxietyI suspect a bipolar component, esp.given at least one ffirst degree relative with BP l. The cyclothymia may have morphed, but I don't know. Looking back, years ago, I did have hypomania exhibited by increased thoughts clicking together, increased output, lack of sleep (though desperately sought). The grandiose thing didn't happen for me. I think I just suddenly had confidence that I could *perform*, like write, work. If I have BP ll, it expresses itself as agitated or mixed (if that the proper term.). I have been low, very low for years now. I despair about ever is getting back some
functionality.Regarding mania, when I was 18, I left home and went absolutely wild. Not exactly unusual in itself. It makes some sense. But my behavior was wild and very risky, and I had no idea that it was. This stopped pretty abruptly around age
22. If that was manic, then that really was the extent of it. I was in a woman's shelter, was moved out of the area by them to avoid a stalker. I have never hurt anyone or myself
except by avoidance, neglect, and the usual human callousness of ignorance. Being now, as I see, avoidant, I would risk any confrontation possible. I was never combative,
for better or worse. I would though, for some reason, risk putting myself in harm's way for another person. I remember
during my street period of coming upon two young strong men beating an old wino in the gutter. My hair was buzzed and pink. It was three a.m. I walked up to those men and
said, hey, why are you doing to this guy? They looked at me and (in retrospect, thankfully by pure grace) looked very startled and walked away. I can't imagine having the naivety to do something like that again.So, there are times I can put my fears aside for others. The worst symptom of this last break was that I felt myself, my will to be able to protect my son slipping from me. I feel like that urge to care for him is my final anchor.
I am better than that now. I didn't really fail my son as I had feared, and feel even more sensitive to his needs than before. So recovery of some sort is possible. I am just so tired of suffering and failing.
I will just lay this all out to the good doctor. I start personal
therapy with a new therapist. I remember now that more that DBT, MBCT helped me more, and I just need to reconnect
with my good guides here.Much of this break was precipitated by a failure in my therapeutic relationship. I had seen a psychiatrist for
medication and therapy. It really fell apart and left me without any support and a head full of unhelpful cr*p. It also provoked the emergence of the worst reactivation of PTSD to date.Thank you for reading my frantic posts last night. I checked today, and don't think I broke the board's guideline of three posts in a row. Is that the guideline?
You all are so kind for being here. Thanks. Sorry I getbso worked up. (But I really don't fit histrionic. I just looked that up, too.)
Retiring back towards a more lurking stance,
fb
Posted by floatingbridge on July 30, 2011, at 15:52:41
In reply to Re: The difference between cyclothymia and BPll?, posted by morgan miller on July 30, 2011, at 8:51:03
Lithium is what I will suggest. I took 300mg with no sides. Given my sometimes sensitivity, maybe subtheraputic doses will make enough difference.
I did try holy basil (I read you and, I think BB), but with so much going on, I felt zip.
I have added lemon balm to GABA. There is some new souped-up lemon balm from New Chapter set to hit the shelves. You know how the vitamin aisle is in markets. There
is always that next big cure coming. Still, I am giving the lemon balm GABA a good run. Was told the combo was key.Gotu kola. Is that a stimulant? Bacopa? It's a liitle ironic that I can be very sensitive to herbs. I had to discontinue
cucurim-something or other because I swear it kept me awake.Mag and fish oil (krill) but when I feel bad, it's hardvto choke the supplements down. I'm not sure why.
I'm not gonna restart dex. I'm going with the Emsam for now. Xanax xr, well what can I say....? It's on board and I take it gratefully like I used to take the communion wafer.
Thanks Morgan. I can move these questions over to the alt board. I lurk there :-)
fb
Posted by Phillipa on July 30, 2011, at 21:59:35
In reply to Thanks Morgan » morgan miller, posted by floatingbridge on July 30, 2011, at 15:52:41
FB just googled it now and seems it's less than full bipolar but as Scott said it can turn into bipolar . It was Scott? Love Phillipa
Posted by Phillipa on July 30, 2011, at 22:01:01
In reply to Re: Thanks Morgan » floatingbridge, posted by Phillipa on July 30, 2011, at 21:59:35
Scott you said you might not be here are you leaving babble? Phillipa
Posted by floatingbridge on July 30, 2011, at 22:32:54
In reply to Re: Scott, posted by Phillipa on July 30, 2011, at 22:01:01
> Scott you said you might not be here are you leaving babble? Phillipa
What? If so, on to better things....
Posted by floatingbridge on July 30, 2011, at 22:38:20
In reply to Re: Thanks Morgan » floatingbridge, posted by Phillipa on July 30, 2011, at 21:59:35
>
> http://www.angelfire.com/home/bphoenix1/cyclo.htmlThis is helpful. Everything else I read led me to believe cyclothymia was no longer a valid dx after a major depressive episode. I get confused.
Thanks Phillipa.
Posted by Phillipa on July 30, 2011, at 22:53:16
In reply to Thanks Phillipa » Phillipa, posted by floatingbridge on July 30, 2011, at 22:38:20
Sounds like don't treat and may turn into bipolar but not sure I agree. I do see a biological component to bipolar as well as scizophrenia and with my family history of anxiety anxiety as well. So then depression must also be the same. Phillipa
Posted by SLS on July 31, 2011, at 6:30:56
In reply to Re: Scott, posted by Phillipa on July 30, 2011, at 22:01:01
> Scott you said you might not be here are you leaving babble? Phillipa
I'm not going anywhere just yet.
I have been spending a great deal of time helping a friend and her mother, both of whom are fighting cancer. The mother has decided to allow herself to expire rather than undergo more surgery and radiation treatments. It is a difficult time for all.
I have not felt very well over this past week. I fear that I may be stuck, with no further recovery to be expected.
I have restarted taking fish oil. After three days, I have not felt any different, although this might be a good thing. That I don't feel worse is encouraging.
Currently:
Nardil 90mg
nortriptyline 150mg
Lamictal 200mg
Abilify 10mg
Carlson's fish oil: EPA/DHA = 8/5I am thinking of switching to the Omegabrite brand fish oil formulation suggested by Harvard University. It contains 100 percent EPA, the omega-3 fatty acid claimed to be the active component when treating mood disorders.
- Scott
Posted by polarbear206 on July 31, 2011, at 8:54:47
In reply to Re: Cyclothymia: SLS and others. What is it?, posted by SLS on July 30, 2011, at 6:14:17
Psycheducation.org is an excellent resourse for Bipolar. I think your on the right track.
Posted by morgan miller on July 31, 2011, at 9:46:06
In reply to Re: Cyclothymia: SLS and others. Floatingbridge, posted by polarbear206 on July 31, 2011, at 8:54:47
FB, I enjoyed hearing about your story. It's interesting to picture the younger you living on the edge. It sounds like you were almost punk rock back then. Anyway, thanks for sharing.
As far as the fears go that you are experiencing, they are likely, at least in part, manifestations of deeply rooted stuff that just happened to start impacting you and coming to the surface later in life. These types of fears, as with things like OCD and anxiety, are coping mechanisms we use to protect ourself and manage our emotions. In a sick and twisted way, we end up making ourselves suffer, sort of punishing ourselves, so we cannot feel good and fully experience life. This way of coping is a result of the hurt that left us with deep pain and sadness. If we feel anxiety, develop great debilitating fears, and develope crippling OCD, we prevent ourselves from being vulnerable to truly feeling things in life, from being exposed to the world around us. We do this out of fear of being hurt the way we have been hurt in the past. If we remain in a state of suffering and torture, we never are able to feel good enough to be vulnerable to getting crushed and dissappointed by life as we had before. These are deep emotions in our psyche/subconscious that drive these self destructive coping mechanisms. So, I would understand why most would have a very difficult time understanding how we could do something like this. These things that drive us are intangible, they are not concrete like neurotransmitters and such. They are likely a result of the extremely complex system as a whole. It's just not one of those things scientists can pinpoint and draw pictures of.
I hope some of this made sense. I'm sure you already have a good grasp on these concepts. I also hope you don't think I am pinning everything you experience on our very flawed psychological coping mechanisms. I am a beliver that genetic predispositions and maldeveloped biology play a major role. I just believe that things are far more complex than most people want to even begin to try to understand.
Morgan
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