In need of some advice (antidepressants)

[Hobin]

Hello people at PF,

I'm having a... little problem, and because (in my experience) the people at PF are quite smart, I'm hoping some of you might be able to help me out here.

For a couple of months now, I'm seeing a psychologist/psychiatrist because of some issues with my mental health. I've had some very bad cases of depression, and other periods where I'm extremely productive (although this isn't a problem, per se), so I figured I might be having a form of bipolar. I wasn't sure, of course, so that's why my doctor sent me to see a shrink. Yay.

In any case, a psychologist diagnosed me with either bipolar disorder or recidivistic depression (not quite sure whether that's the correct term in English - it practically means 'cyclical depression'.) The differences between those two - apparently - are that while bipolar disorder is caused by a brain anomaly, we call it recidivistic depression when my depressive periods are caused by circumstances and conditioning. It's an important distinction, because the first one would 'doom' me to rely on medication, whereas the second one can be more easily deal with using therapy (of course these are extremes, some medications and therapy is likely in both cases). So... I was sent to see a psychiatrist to find out which one it was.

This psychiatrist, however, didn't ask me one question about this. Rather, he was one of those people who thinks you should just take some pills, hope for the best, and if you're feeling better you can *then* see if there are any unresolved issues. More importantly, however, is the problem that if what I have *is* bipolar, then taking only antidepressants == not very smart. (As these can induce mania.) In essence, I still don't really know what I have, but a.) if it's recidivistic depression, I don't want to take antidepressants and would rather work out these issues with a therapist, b.) if it's bipolar, taking these antidepressants might do only harm, and c.) that idiot gave me antidepressants and said I was supposed to take them and see 'how things might change'.

What would you do in this case?

And yes, I know we're not giving people diagnoses here, yadda yadda yadda. I'm just interested in your thoughts on this.

 

[micromass]

If you feel unhappy with your current psychologist, then go see another one.

There are many crappy doctors out there, and even more crappy psychiatrists. You will probably need to see quite a few people in order to find one you like.

But that's all I can say, because I'm obviously not qualified to make any medical statement.

 

[lisab]

In my rather limited experience with docs, this is done a lot.

The doc takes a guess at what's wrong and begins treatment. If it works, great - the guess was correct. If it doesn't work, the doc must go to the next step in the process.

In other words, they use treatment as part of their diagnostic toolbox. And this isn't all bad or lazy. It can be the most efficient approach.

For example, if you show up with a urinary tract infection (UTI), most docs will give you antibiotics right away for the most common UTI pathogen, and take a urine sample to culture it. If the treatment works, the doc was right and you're cured. If the treatment doesn't work, they look at the culture to see what they're dealing with. This approach works most of the time, in my experience.

 

[Evo]

See a different psychiatrist for a second opinion.

 

[jim hardy]

Mentors - is it okay to share my experience here? If not, delete.

You're not alone, observe self-help section in any bookstore.
i think i read every self help book known to man in my forties. Depession came in waves a few weeks apart. Fortunately i had a job into which i could escape entirely.

The books i remember best -

Road Less Travelled - Peck
Man and his Symbols - Jung
Avoid the Hostility Trap - Leyden
Iron John - Bly
Erroneous Zones - Dwyer
People of the Lie - Peck, again...

This one's not a self help book, but "The Brain" - Restrak, esp chapter on "The old brain and the new". The edition that's companion to PBS series of same name.

Not a diagnosis just my experience.

good luck !

 

[Moonbear]

I strongly vote in favor of a second opinion from another psychiatrist. I'm not in favor of the approach of diagnosing by response to medication, but of prescribing to treat the cause after making a diagnosis. If a second psychiatrist takes the same approach, then explain your concerns. There is a possibility that there just isn't a good way to distinguish the two disorders in a single visit, and the approach is to give relief from symptoms with longer term monitoring and follow-up, but then they should be able to explain that, or any other reason they're taking that approach.

 

[Hobin]

Thanks for the advice, everyone. I'm having an appointment with my psychologist (not the psychiatrist) in a few days, and I'm most likely going to ask him about this, too. But, yeah, if he can't give me a good explanation for why I'm suddenly supposed to be on medication, I'm going to see if I can find another psychiatrist (to at least get a second opinion).

 

[LegallyBlonde]

If this is any help at all.. I have NO medical training and no background in medicine, but I have had a great deal of experience with(have tried) almost every anti-depressant/anti-convulsant/mood stabilizer/bi-polar med out there in the last 10 years. My doctor(s) are trying to diagnose properly between depression, bi-polar disorder, ADHD, etc. It seems that most people go to their doctor's appts when they are depressed, but if also have a manic cycle, they don't feel the need to go! The doctor only sees the depression side of the illness and may not see the mania side. He/she then prescribes an anti-depressant for you to try.

The list is long/most of the prescriptions are written for "off label" use (not directly what it was intended for). Don't get stuck with names of diagnoses/etc. It all boils down to a chemical imbalance. Most people find that they try up to 10 different medications until they find one that works for them.
Don't bother with any that have side effects that are unacceptable to you; such as weight gain, loss of sexual urges, etc. There are so many variations out on the market; you will be able to find one that works for you. (I'm assuming your doctor feels that you need to be on something); there is nothing unusual about coupling talk therapy while taking an antidepressant for a number of months until you feel better, then dropping off the antidepressant after your chemicals are back in balance.

Any major surgery, life change(s), or plain old DNA can cause a chemical imbalance that could be helped (temporarily or longer term) by medication. I feel it should be an adjunct to therapy, not substitution. If your doctor is just "Writing Scripts", you may want to switch to one that has a more balanced approach.
You can "fire" your psychiatrist at any time, do not go to one you do not genuinely believe in, admire, and especially trust. Treat your first appointment as if you are interviewing THEM for a job. Interview three or more, or keep going until you find one that you feel you connect with. It does not have to be a love-fest, but you must be able to respect and trust him/her.
Hope this helps - Take care and I hope you find a combination that helps you feel better.

 

[neyzenyelda]

for discussing this issue with experienced people.

www.depressionforums.org
www.mentalearth.com
www.bipolarworld.net

depression is a brain disorder, too. psychotherapy is useless.
I have been on antidepressants for 19 years. they are wonder drugs for me.

 

[pharmacyst]

Yoho- I am a pharmacist but unfortunately my knowledge of the situation is quite limited, so I am throwing some opinions and Ideas:

Most people seem to think that Cognitive Behavioural Therapy (CBT) seems to be one of the best methods to treat uni-polar depression. Most times when you read anything about depression it is implied that it is in reference to unipolar depression.

When your case is concerned then its important to know what medications you are currently taken or were taking to regulate bipolar. Things like valproate and carbamazepine have been used as mood stabilizers and can adversely affect negative symptoms. You'd be told this by your pharmacist if you tell them what you are taking it for (often the assumption is epilepsy for some strange reason).

Another approach often involves the use of quetiapine or olanzapine. But these also have their risks and benefits; obviously not being the best medications out there for depression alone, although very good in bipolar.

In all of these (so far) adherence to the medication and regular (at least monthly) consultations are quite necessary.

You're on the spot when you say that antidepressants can exacerbate mania but this depends on the regularity and intensity of it for you. Manic episodes often become prominent in the first week on the course of some antidepressants but as you adjust to them, over the course of 4-6 weeks- this adverse effect tends to diminish. Its on that note I'd like to say that most antidepressants also take about 4 weeks before they kick in.

It would be best to seek a second professional opinion if you are not entirely satisfied with the therapy your current psychiatrist is giving you. But you have pharmacists and other professionals who can give you advice free of charge and give you more confidence in the quality use of your medication.

The previous examples are to highlight that there are a lot of potential avenues that can be tried to give you the best outcome. Often a prescriber may chose the most appropriate one for you based on simplicity, effectiveness, safety and relevance to you as an individual. More often than not, every 3 months you may get some alteration to the regimen to further enhance outcome. There is no real silver bullet to this and its best to always start, stop and change your medications strictly under a single prescriber (one who is aware of the whole history).

<3

 

[mcknia07]

If you aren't happy with the current doc or don't like the meds they are giving, as stated before, get a second opinion. It can't hurt anything.

 

[Hobin]

Yay!

(Am I allowed to revive my own thread instead of creating a new one to keep you posted? I hope so.)

So I've been to another psychiatrist for a second opinion, and the whole conversation felt much better than the one I've had with the first one. He was a skeptical man who doesn't just prescribe meds for the heck of it, which I liked, because I, too, am rather skeptical (at least as far as my mental disorders are concerned - I'm not one of those people who goes all "oh noes my mood has shifted once, I must be having the bipolarz!") So we had a good talk about it. In the end, he agreed that I was most likely bipolar, so now I have to do a blood test in a few weeks to check some serum levels before getting a lithium prescription. I really hate needles, but I'm glad finally something is being done about it. I mean, sheesh, I first went to the whole psychologist-central-thingy in December... *rantetyrant*

Ok, so, anyway, just thought I'd keep you all posted. Have any of you ever been on lithium, and if so, did it help? (Ah, this is bad. Asking for anecdotal evidence. Bad me. Don't worry though, I did go through most of the clinical reports I could find. ) Also, I'm currently manic, so I'm trying very hard to suppress the feeling of trying to make myself look like a Final Fantasy character (among other, perhaps less stupid but still ridiculous things). Doing everything you're supposed to do with no driving force other than your intellect != fun.

 

[lisab]

Yay!

(Am I allowed to revive my own thread instead of creating a new one to keep you posted? I hope so.)

So I've been to another psychiatrist for a second opinion, and the whole conversation felt much better than the one I've had with the first one. He was a skeptical man who doesn't just prescribe meds for the heck of it, which I liked, because I, too, am rather skeptical (at least as far as my mental disorders are concerned - I'm not one of those people who goes all "oh noes my mood has shifted once, I must be having the bipolarz!") So we had a good talk about it. In the end, he agreed that I was most likely bipolar, so now I have to do a blood test in a few weeks to check some serum levels before getting a lithium prescription. I really hate needles, but I'm glad finally something is being done about it. I mean, sheesh, I first went to the whole psychologist-central-thingy in December... *rantetyrant*

Ok, so, anyway, just thought I'd keep you all posted. Have any of you ever been on lithium, and if so, did it help? (Ah, this is bad. Asking for anecdotal evidence. Bad me. Don't worry though, I did go through most of the clinical reports I could find. ) Also, I'm currently manic, so I'm trying very hard to suppress the feeling of trying to make myself look like a Final Fantasy character (among other, perhaps less stupid but still ridiculous things). Doing everything you're supposed to do with no driving force other than your intellect != fun.

Good to hear you're making progress, Hobin, and I'm glad to hear you found a doc you like - that can make such a big difference.

 

[zoobyshoe]

Yay!

(Am I allowed to revive my own thread instead of creating a new one to keep you posted? I hope so.)

So I've been to another psychiatrist for a second opinion, and the whole conversation felt much better than the one I've had with the first one. He was a skeptical man who doesn't just prescribe meds for the heck of it, which I liked, because I, too, am rather skeptical (at least as far as my mental disorders are concerned - I'm not one of those people who goes all "oh noes my mood has shifted once, I must be having the bipolarz!") So we had a good talk about it. In the end, he agreed that I was most likely bipolar, so now I have to do a blood test in a few weeks to check some serum levels before getting a lithium prescription. I really hate needles, but I'm glad finally something is being done about it. I mean, sheesh, I first went to the whole psychologist-central-thingy in December... *rantetyrant*

Ok, so, anyway, just thought I'd keep you all posted. Have any of you ever been on lithium, and if so, did it help? (Ah, this is bad. Asking for anecdotal evidence. Bad me. Don't worry though, I did go through most of the clinical reports I could find. ) Also, I'm currently manic, so I'm trying very hard to suppress the feeling of trying to make myself look like a Final Fantasy character (among other, perhaps less stupid but still ridiculous things). Doing everything you're supposed to do with no driving force other than your intellect != fun.

I suggest you look into Cognitive Therapy. I have previously posted links to peer reviewed studies on its remarkable effectiveness vs meds. It's easily googled. It is aimed at depressed thinking but works just as well when you're feeling hypomanic tendencies because it's all about replacing unrealistic thinking with realistic.

The main book that's out there is called "Feeling Good", by David Burns, M.D. (It's ubiquitous. You can find a used copy for cheap if you're skeptical and don't want to invest too much in checking it out.)

My diagnosis is Major Depression so I haven't ever been offered lithium. I take Depakote for the separate condition of simple partial seizures and that functions, incidentally, as a mood stabilizer which helps with the depression. The main turning point, though, was learning about Cognitive Therapy and applying it to my own thinking. As LegallyBlonde pointed out, some people whose dx is depression have hypomanic episodes their shrink never sees, and I often wonder if I wouldn't be given some sort of dx of bipolar if a shrink observed me at certain times when I'm a bit too "up". Because of the Cognitive Therapy I can keep a lid on these moods, recognizing my thinking has gotten unrealistically positive, as it were.

 

[Hobin]

Thanks lisab and zoobyshoe!

@zoobyshoe:
Cognitive therapy is a particular form of CBT, right? If it is, I'll make sure to discuss it with my psychologist/psychiatrist/thingy next time. *searches the Google for information*

 

[zoobyshoe]

Thanks lisab and zoobyshoe!

@zoobyshoe:
Cognitive therapy is a particular form of CBT, right? If it is, I'll make sure to discuss it with my psychologist/psychiatrist/thingy next time. *searches the Google for information*

CBT is a more comprehensive adaptation of Cognitive Therapy where they go beyond cognitions and address behaviors you may be engaging in that are contributing to your condition. I think it's an unnecessary fixing of something that wasn't broken, because if you do the plain Cognitive Therapy properly those behaviors crumble away by themselves in their own good time. Cognitive Therapy was the original, and that is what the book I mentioned is about (unless they've tampered with it in more recent editions).