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Everything posted by tryp

  1. It can mean a million things, up to and including nothing at all. Easier said than done, I know, but try not to get too anxious until you speak to your doctor. A visit to your primary care provider is probably in order.
  2. It did for me. When I started Lamictal I was literally suddenly falling asleep basically without warning in the middle of the day. It wore off after the first few months. I wanted to try the XR but it's not available in Canada. Splitting the dose helped a lot with side effects in general but I was still really tired.
  3. There has been some association found between depression and elevated homocysteine (an amino acid) levels (as well as between elevated homocysteine and low serotonin), though the nature of the relationship is not totally clear and there isn't enough high quality evidence on how that might guide treatment to where it's a widely used test, at least in my area. Elevated homocysteine is also a marker of B9/B12 deficiency and B9/B12 are involved in processing/getting rid of homocysteine. Vitamins B9 and B12 deficiencies have been implicated in depression such that some pdocs will check and if it's low it should be supplemented. If your homocysteine levels are high and/or your B9/B12 are low, your pdoc may want to have you take B9 and/or B12 supplements to see if that helps with your depression, is basically the upshot.
  4. So, this is how I have come to understand it based on both my own experience, as well as a lot of reading and study. The historical perspective is probably helpful. The DSM is phenomenological for the most part - and while there is now gathering evidence on causes and underlying biology etc., the early DSM editions were basically just psychiatrists describing what they saw and clumping people into groups based on that. The original PTSD diagnosis came out of "shellshock" and soldiers returning from war. At that time, there wasn't much thought about other kinds of trauma and that PTSD could result from those. So the criteria emphasized (and still do) hyperarousal symptoms like anger and startling as well as traumatic intrusions. The original BPD diagnosis started to be talked about in the 1930s based on a group of patients (mostly women) who appeared psychotic at times (they thought it was related to schizophrenia), especially under stress, and it was added to the DSM in the 1980s. So the diagnoses came from very different roots and two different demographic populations (soldiers versus young women). Over the years, our understanding of both diagnoses has grown and evolved. People have become more interested in PTSD resulting from other types of trauma including childhood and sexual trauma, and revisions to the criteria have been made to incorporate that (e.g. adding the negative alterations in mood and cognition, and the dissociative subtype). Judith Herman coined the complex PTSD label, I believe, which is not in the DSM at all, in order to capture the specific developmental effects of childhood trauma. Because children are doing tasks like learning emotion regulation, secure attachment, and identity consolidation, trauma in the developmental period affects this, and therefore these types of symptoms are part of the complex PTSD constellation. At the same time, Marsha Linehan was working on the etiology and treatment of BPD and noticed that there are psychosocial factors that seem to lead to it - the biosocial theory constructs BPD as a combination of genetics and an invalidating environment where the child is told that their emotions are wrong/not okay. Many (but not all) people with BPD have been abused. If you look at her description of the invalidating environment - most likely all abusive environments are invalidating in some way, but not all invalidating environments are frankly abusive, if that makes sense. So traumatic environments by definition have the makings of BPD (along with genetics) but it is possible to get BPD without frank trauma. And both disorders involve some kind of childhood adversity. So historically that is how the two sets of nomenclature have grown together. My guess would be that when early psychiatrists were looking at young women and calling them hysterical or borderline, a lot of that was trauma, but because of how PTSD came to be, and because of societal stigma and denying of trauma, there was no understanding of the role of trauma, and BPD came up as an atheoretical diagnosis (there was no theory on what caused it) until Marsha. So most likely in many cases what was then called BPD would be called complex PTSD just as easily. I see it as sort of an overlapping Venn diagram, personally. Many people could be diagnosed with either, some people clearly have one or the other. In terms of differences, this is a really interesting paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4165723/ It basically compares a bunch of women with histories of abuse to see if they have BPD, PTSD, cPTSD, or some combination, and what makes the difference. Cloitre (the author) concludes that frantic efforts to avoid abandonment (versus just fear of abandonment), unstable sense of self (versus stable negative self image), unstable and intense interpersonal relationships, and impulsiveness are the four BPD symptoms that distinguish it from complex PTSD. Emotion dysregulation, interpersonal problems in general, and negative self concept were common between both groups. Insecure attachment (frequently disorganized attachment style) is also a common factor, as is dissociation. I think as time goes on, we are slowly parsing out what is cPTSD and what is BPD. However, looking solely at the phenomenology and the symptoms that are listed in the DSM (especially since cPTSD is not as yet in the DSM) there is still a fair bit of overlap in my opinion and many people with BPD also meet criteria for PTSD. In terms of treatment, many people with cPTSD benefit from specific work around traumatic memories, where as BPD without PTSD, this would be less so. But in terms of stabilization, the main issues causing instability (difficulties with people, difficulties with emotions) have enough commonality that some of the same treatments can be helpful. So, you can definitely have both, especially if you are being diagnosed strictly based on the DSM, where cPTSD still does not exist and therefore PTSD + BPD may be the best way to capture the symptoms within a limited diagnostic system. I wouldn't say that one can lead to the other - more so that the traits and symptoms co-exist and can feed each other. When PTSD symptoms are very bad, people can look very Borderline just from being so unstable, but it can settle with PTSD treatment. I'm not undervaluing the importance of diagnosis - I think it's very important - but to some degree psychiatric diagnosis will always be messy. Where does unipolar depression stop and bipolar disorder begin? What is the difference between someone who is schizoaffective and someone who has bipolar 1 with psychosis? Can one person really have five different psychiatric disorders, or do they have one underlying problem that we haven't got a good name for, so we pin labels on it like the five blind men and the elephant? To some degree the categories are artificial, because the line has to be drawn somewhere, and there will always be people who don't fit neatly.
  5. Yeah I'm not sure either. It looks like there's some scientific literature suggesting that practically, aspirin does not increase lithium level. Perhaps it is different in how it interacts with the enzyme or something.
  6. I wasn't talking about your experience specifically, or your effort, or your diagnosis. I have complex PTSD too, and had a BPD diagnosis for a long time, so I've come at things from both angles. The BPD diagnosis was useful for me in the early days, especially the piece around attachment. I learned a lot about myself through that lens. And then over the years it became less useful to me, and I probably also no longer meet criteria, so cPTSD makes more sense. But when I look back on my own story, I see a lot of the overlaps, and I see how BPD treatment helped me a lot, and I think the diagnoses are in many cases not all that far apart. I still mod the personality disorders section and I feel comfortable with that both because of my past diagnosis but also just because of the similarities in some of the core issues. Maybe for you the two diagnoses are very far apart, all I'm saying is that that isn't always the case, and it's by no means an accepted fact that the treatments are entirely different (though of course DBT isn't the right therapy for everyone with cPTSD).
  7. I don't think it's "cheating". It's your therapy and you have the right to (and deserve to) find a therapist who feels like a good fit, and who works with you in a way that feels helpful and productive. It's ideally something that should happen out in the open between the two of you - mostly for your benefit. For one thing, it may be that your therapist can adapt in order to be more useful. For another thing, while it may be that her attitude is preventing you from talking about some things, there may also be a part played by your own self-judgments, and you will take that with you wherever you go. So talking with your therapist about how you feel uncomfortable discussing certain subjects is really important to try to parse out where that comes from. Also, there can be a lot of learning to be had in the process of asserting yourself and saying that something isn't working. That being said, you can only do what you can do, and if you don't feel able to bring it up, it may still be better to switch than to sit around in a therapy that isn't working. Also, if what you're looking for is a more directive, problem-solving approach, you may want to look for someone who is trained in CBT or one of the types of therapy that focuses more on that. Some types of therapy are more directive than others and it's important to have a good fit not just with the therapist, but with the type of work they do.
  8. I would be cautious with aspirin. The reason that NSAIDs are dangerous is that they inhibit/block an enzyme called COX, and therefore reduce the production of prostaglandins (which are involved in pain/inflammation). However, prostaglandins also increase blood flow through the kidneys. Since lithium is entirely flushed from your body by the kidneys, reducing the blood flow through the kidneys reduces your body's ability to clear out lithium, potentially resulting in toxicity. Like NSAIDs, aspirin is a COX inhibitor, so I would imagine that it could be an issue. Tylenol/acetaminophen does not affect COX or have much to do with the kidneys - it's cleared in the liver and is totally fine with lithium. A great source for questions like this is your local pharmacist. If you walk up to the counter and ask, they will know exactly which over the counter pain medications are safe for you to take. They sometimes even are more familiar with the over the counter stuff than physicians.
  9. It's interesting, because if you read Marsha Linehan's books, properly done DBT would actually say the opposite. The foundation of DBT is that emotions are useful, valid, and have a purpose, AND that we may at times want to try to change them anyway, if they are not serving us. It's both. Stage 1 PTSD treatment, for some people (not all, because not everything works for every brain) can look very similar to BPD treatment - I did DBT and benefited from it greatly. I never liked CBT initially, but I'm doing some now specifically for PTSD and thus far tolerating it better than I anticipated that I would. To be honest I think BPD vs cPTSD is a bit of a false dichotomy. There are a lot of symptoms in common and even BPD in the absence of PTSD is frequently linked to trauma. As to meds for BPD, there is mixed evidence for almost everything, and no high quality evidence that any particular medication is useful in treating BPD itself. I've found antipsychotics (particularly quetiapine) very useful for meltdown emergencies. Far more so than benzodiazepines. Lamotrigine has been okay I think, but I've been on it for a long time, and doing lots of therapy concurrently, so it's really hard to say for sure.
  10. My heart rate never went back to normal until I came off Seroquel. That being said, I did see a cardiologist for it and he said it wasn't dangerous at all, at least in my specific case.
  11. Antipsychotics like Seroquel can increase heart rate - mine was consistently in the 110s when I was on regular Seroquel.
  12. It depends where I am symptom wise. When I was much more unwell I was willing to take medications that caused weight gain, but now I’m not. I also won’t do stuff that makes me more anxious or screws up my sleep. Sexual side effects are also a dealbreaker right now, but weren’t in the past Other stuff I’ll mostly deal with. I have really bad nasal congestion from prazosin that makes it really hard to breathe but it’s better than nightmares. I’ve tried a ton of meds and I’ve stopped very few for side effects. Benzos because they made me suicidal, quetiapine because I needed to be able to work night shifts, and lurasidone because it just fucked me up so badly physically that I ended up in the ED. Otherwise it’s mostly been due to lack of helpfulness.
  13. This happens to me too - not all the time, but not infrequently. I also get stuck on having to repeat particular thoughts out loud over and over again. Same as you - no anxiety or anything, it just happens. I do not know the solution though I typically try to mindfully note it and then just keep going about my business while just allowing it to happen. The more I focus on it, the longer it lasts.
  14. Yeah it’s tough. The pines all tend to cause substantial weight gain and the dones all come with risk of EPS. Lurasidone was horrific for me. Quetiapine was good but caused pretty bad weight gain. It seems to be a case of picking your poison.
  15. As long as you’re doing productive work, I think it totally makes sense to keep going for as long as it feels helpful.
  16. It doesn't make everybody gain weight - but it is more prone to it than some other antidepressants. I did gain on it. Only way to find out is try it and see.
  17. Psychopathy is a clinical construct with specific criteria - there is a psychopathy checklist. Psychopathy is likely a subset of people with ASPD. Many people with ASPD would not meet threshold for psychopathy but most people who do also meet criteria for ASPD. Sociopath is actually not a clinical term. It’s a colloquial term that is not really used in psychiatry. Or at least that’s my understanding.
  18. That being said, the confidence interval for most of the medications listed under “weight gain” crosses zero, which limits significance.
  19. Your girl needs you, melli. Nobody else will ever be the same for her. There is no replacement for her having you as she grows up. I know your life isn’t how you want it and that is terribly unfair. And I also know that there’s a part of you that is determined to be there for your kid and build the best life for yourself that you can. Thinking of you.
  20. Yeah some psychiatrists will say that the weight gain is dose dependent and maybe it is worse at high doses, but low ones will do it too unfortunately.
  21. It typically causes neither. Every so often someone gains some weight on SSRIs but it's atypical.
  22. therapists and gifts

    Just ask. Therapists tend to have pretty idiosyncratic policies, beyond that gifts of substantial value are always a no. Some therapists have a no gifts policy and some will accept nominal value gifts. Almost all accept cards. Most professional organizations for therapists stipulate nominal value only but there are definitely some therapists with a no gift policy.
  23. I'm not sure that it's the law (I believe some states do have laws requiring periodic UDS for controlled substances but not sure about Michigan specifically) - but it may be part of that doctor's practice. Some doctors don't feel comfortable prescribing substances with significant street value/abuse potential without hard proof that the person is actually taking them themselves and not diverting them. That said, even a UDS isn't proof that someone is taking the entire prescription consistently themselves - but it is what it is. And it's basically garbage that insurance won't cover it. Kind of sucks, I wouldn't feel good about it myself, but it's not totally out of left field, especially non-psychiatrists, who are sometimes more nervous about those medications.
  24. I honestly think that's amazing - I keep all of the info in a word document, which works well for me, but I love your overlapping timeline.
  25. To be honest, diagnosis in psychiatry is a muddy business, because it's phenomenological, which means that it's based on constellations of symptoms rather than anything objective, like a blood test or scan or something. Now, there's nothing wrong with that, nor does it mean that the diagnosis is invalid. However, in my opinion, MDD is probably not a single illness. It's probably a whole bunch of endophenotypes. So long story short, it doesn't surprise me that anticonvulsants work better than antidepressants for some people.