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Unipolar BP vs. plain vanilla depression


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Does it make a difference in med choice or anything? (for instance my pdoc finally consented to try me on Lamictal which I see is indicated for unipolar depression, but not major depressive disorder). (?????)

I've often thought I got the shit end of the affective stick - as in a bipolarity without the mania, Or let's say instead, a manageable hypomania to energize me once in a while. (Betcha BPs have cleaner houses than depressives. Take a poll?).

For at least 20 yrs I rarely even get much of an ordinary OK feeling, except through my very off-label use of meds - which SOME might consider abuse, but I call Survival. (Oddly, this period coinciides with when my older son began showing signs of severe disturbance ;) ) "Been down so long, looks like up to me" could be my theme song. .

I actually DO realize mania is not at all a piece of cake, especially rapid cycling and all (and especially if you merely want to hold down a job or raise non-freaked out kids). Still I HAVE talked at length to severely BP people (this was in hospital) who balked at lithium or other stabilizers. Near-bankruptcies and other acting-out notwithstanding, they didn't feel they could live without the big highs.

Anyhow, end of digression. And please don't pile on me. I do NOT mean to trivialize the pain of bipolarity! I'm just reflecting as I do occasionally, about my status (amenable to partial alleviation, granted). I assume there's a spectrum of affective natures, acquired or inborn. Well, somebody has to wind up with her mood thermostat permanently set at DOWN, right? (and I guess I'm one),

I give up, though. Could I still be called Unipolar or just Depressive? Unipolar sounds to me like saying someone has Multiple Personality Disorder with only one Alter. (I realize DID is the current term). What IS the difference? Or maybe...there is none ?!

(I didn't even know which forum to post this on)

rt

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I'm going to give this a shot. Honestly, I read this 3 times, and I'm still not quite sure what i'm reading.

The name of your post is in itself confusing. The bipolar label in itself, infers that there are two equal and opposite extremes. To be unipolar infers one extreme. This would be like, altering between mania and normalicy (which is still lumped under "bipolar" for all intensive purposes) or depression and normalicy (which is simply, major depression/depressive disorder, clinical depression, whatever you choose to call it.)

So yes, you could have a unipolar mood disorder. If I am reading your post correctly, you feel as if your problems are entirely depressive, and you're not getting the mania/hypomania you've heard so much about. If this is true, you would be suffering from depression, not bipolar disorder.

Generally, yes, your symptoms (which are the basis for a label) are indicative of what treatment you would receive. To my knowledge, bipolar patients are ideally treated with anticonvulsants, antipsychotics, and lithium. Antidepressants are used mainly when depression remains an issue, or perhaps treating something else, like OCD. The confusion you may be experiencing, is that people with unipolar depression, may also be treated with same medications. Not everyone finds relief with drugs grouped under "antidepressant." This would be where doctors start trying things out, and how people with major depression end up on "bipolar" medications.

Honestly, it seems like you're not feeling relieved of your depression via lamictal. Or perhaps, dysthymic is more appropriate. Dysthymia (and yeah i probably butchered the spelling) is a condition similar to depression, only more chronic and less extreme. it would be more like, not feeling good, rather than feeling really bad.

Either way, be sure you talk to your therapist and/or physician about it. Only the zoloft blob deserves to feel depressed.

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I think the confusion probably lies in the terms 'Unipolar Depression' and 'Major Depressive Disorder', which tend to be used interchangeably, though the DSM only uses Major Depressive Disorder as an official diagnosis.

I am not sure why this is. Unipolar Depression distinguishes it from dysthymia or a depressive episode in the context of bipolar disorder, but I am not entirely sure about why one would be chosen over the other besides that. [anyone else?]There is no diagnosis of Bipolar Depressive Disorder, but there is diagnosis of the BP depressive episode.

But as far as I know Unipolar Depression= Major Depressive Disorder, so it wouldn't make a difference in med choice.

Unipolar makes sense to me in relation to bipolar.

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Oh, crap. I should have Googled this first (I just did - late). And to think I ordinarily LIVE on Google.

I'd never have posted. Everyone ignore this,

I see Unipolar Depression IS in fact, the same as "ordinary" depression.. I thought (obviously) that it was an exotic variant of Bipolarity.

Maybe I'll tiptoe back and edit the thread title at least. (Guess that will confuse everyone still more. What to do - except sit here and blush at my momitor, thankful forums are not on cams yet?)

Thank you for taking a stab at an answer ehygon and NavySurya.

:embarassed: :embarassed: :embarassed:

rt

EDIT: JFTR my dx is " Severe Atypical Depressive Disorder, Treatment Resistant". Lamictal is sort of my last stab at an on-label med. NOTHING else works. Believe me, I've tried . Correction, nothing works but NARDIL and sadly it nearly killed me with idiosyncratic side effects. Like heart failure, among others.

As I've written elsewhere, I am surviving now on stimulants and the use of a narcotic (prescribed for my back but used for mind pain as well. ). But the Lamictal is at only 200 mg now so I have at least another 200 mg to go before throwing in the towel on it.

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Navy, I think you got it half right.

Major Depressive Disorder is the common name for depression.

In the Bipolar Model, the two poles are Mania, and Depression.

So, their are two types of depression with names based on the overarching diagnosis:

A Bipolar patient would have "Bipolar Depression"

A Major Depressive Disorder patient would have "Unipolar Depression". Since by definition they don't have mood swings they only experience 'one pole'.

Hope I have explained the more clearly.

Now, the next question might be, is one depression different than the other? I don't know, have never seen anything indicating that there is any difference. Now how long they last, what the recover modes are, and how they respond to medication are very likely different. There is a Nobel prize in those answers.

a.m.

[edit] RT, we crossed posts while I was drafting this. Two other comments. Mood stabilizers are used for MDD. Hey depression is a mood that needs stabilizing *Upwards*. The literature typically mentions that this often done an rx of last hope, and can work. My gut feel is that this usage may increase as Pdocs become more familiar and comfortable with mood stabilzers.

Second, you mention using a narcotic vs a stimulant for present meds. With no medical justification, conceptually I could envision that combo as a very crude mood stabilizer. However, warning bells went off, as I recall that narcotics/opiodes are known to have the potential for INCREASING depression. So, keep in mind that this worsened condition you are in could be medication worsened.

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A Bipolar patient would have "Bipolar Depression"

heh. oh...

I kind of get messed up with the fifth digit thing- most recent/current episode?

That makes more sense. Because... you wouldn't diagnose someone every goddamn episode they have. yeah. I think. Right? Did I just understand it more or less?

aahhh... [s-M-R-T.]

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Now, the next question might be, is one depression different than the other? I don't know, have never seen anything indicating that there is any difference. Now how long they last, what the recover modes are, and how they respond to medication are very likely different. There is a Nobel prize in those answers.

a.m.

some conjectures are made about the differences between these two types of depression: http://www.mcmanweb.com/article-221.htm

a 2000 Australian study of 83 bipolar depressed and 904 unipolar depressed patients that found bipolar patients were more likely to be melancholic (69 vs 37 percent), and were significantly more likely to demonstrate psychomotor disturbance and guilt. A 2001 study by Dr Mitchell of 270 depressed patients found those with bipolar were less tearful than those with unipolar depression, but felt more worthless, exhibited greater loss of pleasure, and experienced more subjective restlessness, leaden paralysis, and hypersomnia than their unipolar counterparts.

very accurate for me.

also, regarding, mood stabilizers, they flatten. that's how they take away the ups and suicidal downs...but for most depressives, being flat is a big part of the problem. which is why a stimulant works to perk up depressed people. and narcotics obviously produce euphoria. but also as am points out, ultimately, addiction and severe depression.

you're not going to know what the lamictal is doing or not doing for you so long as you continue to abuse other drugs. The drugs you are using, the stimulants and narcotics, are extremely powerful short term unstable solutions. You're throwing money & time out the window by playing this charade with lamictal. it's a delicate drug.

i met 2 major depressives who said their depression was hard to treat. both tried lamictal (monotherapy for one; i don't know how the other did it) and they said it turned their brains into mush, brainfreeze, oatmeal. ..so they quit. lamictal is fda approved for bipolar. and it's used off-label as an Adjunct to an antidepressant etc. for MDD aka unipolar which is what you're doing i assume...

good luck,

7

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Air Marshall:

you mention using a narcotic vs a stimulant for present meds. With no medical justification, conceptually I could envision that combo as a very crude mood stabilizer. However, warning bells went off, as I recall that narcotics/opiodes are known to have the potential for INCREASING depression. So, keep in mind that this worsened condition you are in could be medication worsened.

Good to know. But actually, I'm NOT in a worsened state. Except for um, ah, er...Internet Addiction, I actually feel pretty good with this little palette of meds I've improvised (add Klonopin, Ambien and smidge of Neurontin to the mix...)

But there are problems with the LORTAB. For one, it's unstable. I go up and down with it. Sometimes when it wears off, like say I stay up all ngiht (as I often do), by morning I've often planned my funeral or something. In detail. (It actually creates a kind of cyclothymia if I've got THAT term right - which I probably haven't.)

When my kids were here, they said I was like two people (that was especially since I tried to do without it in the evening, and crashed. Irritable?! and then some. It was awful for them).

But now I have a pretty steady supply thanks to my back going to hell, so it's OK for the time being. I DO realize a tolerance will build up, In fact, one a day (10/500) used to be fine and now I need two...That's within a year. .Still...

Not to mention that the Tylenol will kill my liver if it gets too high.

I'm hoping the Lamictal will help (It may already BE helping for all I know. Part of the feeling OK).

And if not, I have a backup plan in the form of a local shrink willing to prescribe Buprenex for depression (and he's one of only two locally licensed to dspense it) . Very daring of him. Plus the guy who ran the classic (only) Buprenex/Atypical Depression study (I had the gall to telephone himl) says he's willing to act as consultant! Won't mention his name as he might be swamped.... Nice guy. Too nice for his own good.

But that could - knock lots of wood (raps her skull after starting this thread) - replace the Lortab with all its limitations. How my back might feel is another question. ;)

Thanks loads for advice, AM!

Best,

realityt.

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Well you have already answered part of your own question, and it should be hitting you between the eyes.

You stay up planning your doom, but say it isn't making you worse. You know that the Lortab is destabilizing your moods. Your kids know it. Your tolerance has doubled. You are just whistling in the dark.

IMHO this is a warning sign that should be going off like atom bombs, and indicating that you need to move on to safer meds.

You mention lithium and objections of people to it. I'm not clear whether you have tried it.

a.m.

Buprenex:

here is a link that is supposed to be a full copy of a citation from 1995. (I"m too tired to wade thru it tonight).

http://balder.prohosting.com/~adhpage/bupe.html

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Well you have already answered part of your own question, and it should be hitting you between the eyes.

You stay up planning your doom, but say it isn't making you worse. You know that the Lortab is destabilizing your moods. Your kids know it. Your tolerance has doubled. You are just whistling in the dark.

IMHO this is a warning sign that should be going off like atom bombs, and indicating that you need to move on to safer meds.

You mention lithium and objections of people to it. I'm not clear whether you have tried it.

a.m.

Buprenex:

here is a link that is supposed to be a full copy of a citation from 1995. (I"m too tired to wade thru it tonight).

http://balder.prohosting.com/~adhpage/bupe.html

[WARNING ANOTHER LONG ONE] My life right now - present Tense (haha)

I wasn't complete in my post right above, A.M - also not that clear, it seems.

I USED to be unstable on it when I didn't have enough for a full day. I do now. I am also careful not to take more than I need to be "OK" and with just enough hope to continue plugging away at the extensive remediation needed on my (as if) post Katrina life. That means I avoid (mostly) the euphoric/hypomanic effect . I need to break pills (easy given their composition and shape) , estimating just how down I am at that point.

I AM OK now (well, at least except for sadness from life events - My kids, ya know?).

That's not endogenous expression, though it may be to a degree, hyper-reactivity. I try not to just "medicate that away" (though sometimes I do take a little to smooth the jagged edges). Life has sorrows. Who wants to take a pill and feel cheery right after his father dies? (On Paxil, an emotional general anesthetic for me - I COULD have been unfazed!)

To be exact, I'm OK - UNLESS, I stay up way after the second dose wears off. But even then, the funeral planning doesn't happen all the time. Now that I think of it, it seems to only happen only after the Lortab’s worn off AND I’ve gotten bad news about a son.

It's also entirely possible (and this would indeed be grounds to cheer) that this greater equilibrium is also on account of the Lamictal. I’m experimenting with taking my usual morning Lortab later and later, to see how I feel. The answer it seems, is definitely better. (Not great or even at the "all right" level, but less hopeless. at least).

Since Lortab works immediately (just as it wears off immediately), it's possible to test out the Lamictal that way.

I realize Lortab is not a permanent solution, A.M. - especially owing to tolerance.. My plan is to switch to Buprenex/Suboxone if and when I have to. Similar to Lortab but no disequilibrium, no tolerance, and not quite as cheering. I’m hoping I won' t need to.

1. I 'd have to leave my present much admired pdoc..

2. Mt BACK!!

3. It would mean a BIG hassle with my insurance company and I'd probably end up paying full fee. Unless, that is, I want to be classified as an addict (as you know it's mostly used in detox under highly controlled conditions).

4. Hopefully (godwilling) the Lamictal WILL make a difference.

5. Most of all, because I hope RL changes will make it unnecessary.

Much of my hopelessness is due to a concrete physical situation (ignoring the kids for now) - poverty and lack of a profession , with all that entails in social identity, worry, dependence. Most of all, I’m handicapped by a neglected, humiliatingly disordered house. I can’t manage there - or work or entertain. I can’t even reliably flush the damned toilet. Not a one. (No, it’s WAY beyond the plunger stage).

That's NOT - mostly - owing to maintenance or cleaning (which I can, unaffordably , delegate). It’s from clutter, paperwork and Accumulation, which I CANNOT.

Remember, ill health has been building, and I am now physically disabled. I could end up in a public nursing home within five years if things don't change (opinion of my case worker)..

You think all that's not depressing? It's not “learned helplessness”. It IS helplessness. A lot of it, anyhow.

But I still have SOME control. With these medications (stimulants and Lortab) , I’ve been able to get going on what I CAN do . That’s much more than I ‘d thought, partly owing to mental fog, I’d just given up, completely overwhelmed. Having clinical depression added to the mix, clinched it. ("Leaden paralysis" plus all that !?!?) .

Hopefully, I can set up a studio, arrange things so I can find them (two storage areas designed), and have a dwelling presentable enough to have people over. Right now, I only crack the door even for the UPS man! It would also be nice to have my house, my only real asset, at least, I used to. Work I'd love)

But all this depends on getting the house and yard in shape - including tackling massive amounts of overdue paperwork (four years of tax filings for two people? :embarassed: :embarassed: ) I paid - next to nothing, of course - so that part’s OK. But….BUT..!!! I need to find and hire the right people ( just found them), and somehow work alongside them. A lot.

That's where the stims and Lortab really come in, to keep me going. Boy, do I need them! This is a MESS. All of it. And at every turn, I have to face down (and grieve) reminders of all I've lost, what my kids have lost.

If I can pull this off, it would mean the world to them too. They worry about me, they’re ashamed of me, they love me, they’re furious at me – the whole mixed bag. This way I might even be a role model – someone who fought back from the bottom.

Maybe - I HOPE AND PRAY - this will greatly reduce med needs. At least, the mood elevator ( the Lortab). I'll tell you, A.M, after Jonny cleaned my garage, I felt like a cloud had lifted from my head - or more accurately, a shroud. It was as good as Nardil (and that was good!).

Now the question is, can I keep going with all this regardless of what happens with my kids? I've figured out, that in a way, I’m held back by the feeling that I have no right to be happy if they are suffering, Partly from guilt, partly from motherly empathy. Well, I have a great new tdoc, which will help, but we'll see. (Hey, maybe I DON’T deserve to be happy, you know? ;) )

It's extra hard because I need to remain involved with many salvage interventions with them. (And take inhuman flak to do it). I'm not just watching a sad movie. It’s my life. It’s their life. I’ve been watching (and trying to ward off the disasters I saw coming) for decades. The Tsunami came all the same. It’s still crashing around them. So now what?

rt

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A note from what I have read from above ,, and I just did so quickly.

there are no clear lines wrt uni and BP or antisocial behavior// etc that

THis is for That and so on ,, it is a blur and so then will be the meds tried

..

let's not forget where some of the most common drugs came from.. a pool of water

rich with Li, a med for seisures and so on...

Many of the meds I am on now were not indicated as mainline

drugs for ANY psych disorder,, but report were out there, and

when you have gone through the POP ones a couple of times

you are willing to push the boundries ...

Hell , Cymbalta, an ex drug for me,, isn't avail in CAnada ,

so I buy it from India.. go figure,,

you can't rely on what works for most , nor limit yourself

to the most handy.. 'in '' med

..

David

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RT,

Ok you win the long post award. ;)

Not my intention to beat you up or dismiss out of hand your condition and difficulties. I can fully appreciate that when the whole package isn't working every day is an uphill climb.

I still have an unease about your meds, but will trust that you are being honest and open with your pdoc. The best insurance.

I'm dragging again tonite and spent little time looking further at Buprenex use for depression except for one thing that caught my eye:

http://www.crazymeds.us/buprenex.html

It is partly anecdotal, but Jerod makes the point that Suboxone is not a substitute for Buprenex and is not equivalent for depression treatment because it has a different compounds that inhibit anti-depressant effects. Off hand, this makes sense to me. Worth looking at to be sure you don't get short changed and sold a (possibly) legally more convenient but ineffective med (Suboxone).

Cheers, A.M.

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Since Lortab works immediately (just as it wears off immediately), it's possible to test out the Lamictal that way.

when an opiate wears off, you start to enter the withdrawal phase. withdrawal is painful and comes with a whole set of powerful mood symptoms. so those are your options. high or in withdrawal. there is no in between (until you detox which takes 1 or 2 weeks). so...in your current opiate cycle, i'm not sure where there's space for "testing out" the lamictal.

has a psychiatrist or psychopharmacologist prescribed your usage of these drugs for your mood disorder? (opiates + stimulants + lamictal) and are you being monitored? does the person who prescribed the lamictal know what else you're doing?

Many who abuse substances are self-medicating. i'm not going to lecture you on that. i know you're going through a really rough time. ...but i wouldn't kid myself about it either. addicts often have noble dreams and plans and rationales for the current situation. but it's always just one more day or fix away. fwiw, i think you should reach out to some of the community help resources for substance abuse. you'd be surprised how many addicts on painkillers do it just the way you do. "controlled, temporary, etc."

sorry if i've misconstrued and come off sounding harsh. just my 2

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when an opiate wears off, you start to enter the withdrawal phase. withdrawal is painful and comes with a whole set of powerful mood symptoms. so those are your options. high or in withdrawal. there is no in between (until you detox which takes 1 or 2 weeks). so...in your current opiate cycle, i'm not sure where there's space for "testing out" the lamictal.

has a psychiatrist or psychopharmacologist prescribed your usage of these drugs for your mood disorder? (opiates + stimulants + lamictal) and are you being monitored? does the person who prescribed the lamictal know what else you're doing?

Many who abuse substances are self-medicating. i'm not going to lecture you on that. i know you're going through a really rough time. ...but i wouldn't kid myself about it either. addicts often have noble dreams and plans and rationales for the current situation. but it's always just one more day or fix away. fwiw, i think you should reach out to some of the community help resources for substance abuse. you'd be surprised how many addicts on painkillers do it just the way you do. "controlled, temporary, etc."

DITTO - DITTO - DITTO!!!!! i couldnt agree with this more! and im speaking from experience. i 'temporarily' used narcotics... for over 4 years. hows that for 'temporary'?

RT - please make sure that each doc who's prescribing each of your meds knows of the others youre taking. please make sure youre being monitored. and please consider non-narcotic alternatives. i KNOW it will be hard to stop taking them and because of this, alternatives may not look like an option for you but i do hope that you will take an honest look at your narcotic usage and at least try to consider the alternatives.

as for buprenex, one thing i found from the crazy meds link provided by AM that stuck out for me for you is this:

As Buprenex is an opioid agoinst-antagonist, it gives you that lovely endorphin warmth as it binds with the opiate receptors favored by morphine. However, as it is also an antagonist it does so without as much of a physical dependence. That's right, it's like lesser-addictive morphine. I had previously written "non-addictive" but that's not the case in the long run, as Mouse has found out from long-term usage. Anything that does opiod agoinism, even with the antagonism built in, will cause a physical dependency. Duh.

good luck rt and godspeed....

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I'm a little late to the party here, but I figure I'd pipe in and say that I've been diagnosed with somthing along the lines of "cyclic unipolar depression" (pdoc likes dx's that in the book). The idea is that my cycle runs from the the bottom of the pit to normal without ever breaking into mania of any kind, though I may have had some mixed states. It's basicly bp wearing a recurrent depression mask. That's the theory anyway. I want to try lamictal but pdoc wanted to go with the temporal lobe affecting ones first. I've not been on the full dose (100mgs) of topamax long enough to tell if it's doing anything yet.

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Thank you all for your well thought out and experiential advice. I really appreciate your concern too, and am considering what you said.

I know I'm addicted. It was a conscious decision. I'd rather be addicted than dead. Or to be fair, among the living dead. After ending Nardil, I basically spent eight months in what would have been called a state of catatonia if I'd had a thought disorder. My "only" thought disorder was being totally fuzzy. I can't recall doint anything during that time. Certainly, I have nothing to show for it. I ate and shat.

I don't even think it was hugely better for my kids (my reason for not offing myself), as the mom they ended up with, was so completely dysfunctional it was deeply distressing for them. (And with NO sign of improving). After all, if you're not moving forward or even treading water, you're sinking! )

And I DO have the backup plan in the form of the Buprenex/Naproxene. Basically it's going into permanent detox without the stigmatizing label (which has all kinds of repercussions legally, in insurance, and otherwise).

About the Lamictal. I respectfully disagree with Seven:

when an opiate wears off, you start to enter the withdrawal phase. withdrawal is painful and comes with a whole set of powerful mood symptoms. so those are your options. high or in withdrawal. there is no in between (until you detox which takes 1 or 2 weeks). so...in your current opiate cycle, i'm not sure where there's space for "testing out" the lamictal.
On the contrary, if, when it's wearing off, I feel less shitty or even almost OK (as compared to in a total black funk - which is how I used to feel), I'd say it's a reasonable supposition that the Lamictal is working somewhat. It's even possible it's working by evening out my mood states (picturing giant iron). It would be clearer without the Lortab, true. But it IS used as an augmenting agent, so what's the diff?

has a psychiatrist or psychopharmacologist prescribed your usage of these drugs for your mood disorder? (opiates + stimulants + lamictal) and are you being monitored? does the person who prescribed the lamictal know what else you're doing?

Yes. I am getting all my meds, except the Lortab from either a shrink or an MD (DO same thing for these purposes) who specializes in stress and psychotherapy. He is prescribing the Adderall or Concerta (depending on when I wake up). My pdoc is prescribing the Provigil. Also depending on when I wake up (always struggling for a normal sleep cycle. The Provigil in me. lasts at least 18 hours). Both know about each other (and like and admire each other too!). Both have given me the green light for the treatment and both prescribe the Lamictal.

The pdoc said he himself would not prescribe any stimulant except Provigil unless I passed some kind of test for adult ADD, but said of the other doc, "well, if he's willing to take responsibility..." As for the screening, well, much as I like him, that's basically BS as it would only be paper and pencil self-report, but he refused to believe me.

JFTR I went over the new DSMIV criteria for ADULT ADD (they're just being written for the next edition. It was belated recognized that "has trouble waiting turn in line", and "grabs toys from others" etc. weren't totally applicable :cussing: ). I fit every criterion for the Inattentive type. And the list I refer to was compiled by the very team writing them (see Medscape).

I've also been following the lit on Adult ADD. It's very talked about now, as it used to be considered that kids outgrew it. An article was also recently published, in fact, on treatment recommendations. Ritalin and Adderall were first. So "all" I really have to watch for is CVS "events" . And, yes, it is "all" for me, as an alternative to the situation I was in. Besides, if it happens, I don't need to do the honors myself!

The only thing that doesn't fit like a glove is that I didn't have childhood ADD.

I've been making the following JK remarks to friends for a long time ("Insanity is hereditary - you get it from your children." and that I have AADD - Acquired Attention Deficit Disorder), but actually I firmly believe both. .

A) It's belatedly recognized in Psychology/Psychiatry that parents are deeply affected and changed by their children's disposition much less their EXTREME disturbances. Not only the other way around! It's reciprocal. And if Mother Theresa had had to raise my first son, she'd have turned out to be "Batty Aunt Terry" instead of a saint.

B ) Brain chemistry, the works, are definitely affected by life events and not just physical trauma. Well, emotional trauma is where it's been at with me in adulthood. The ten years of malignant insomnia I went through alone (and that was very far from all), I KNOW caused brain damage. I could feel neurons popping. I was in a complete fog, and only recovered after many years, about half the function I'd lost. (I had NOT expected to).

This happened basically since Ambien was brought out and my-then family doc, smart, came up with the Ambien Neurontin Klonopin combination. I'd completely lost the drowsy response (And meanwhile my poor kids were regularly treated to a mother who had gone without sleep, as much as three days in a row - and scarcely slept, soundly the rest of the time. No, I was not at my best. ;) )

About the Lortab. First of all, ALL my MDs are aware of ALL the medications I take.

They are not aware that I am taking the Lortab for psychic pain in addition to the back pain. I won't tell them because I don't want to risk its being cut off. How could they not realize I'm addicted for whatever reason, knowing I take it regularly at that dose?

I have clearly told one pdoc and also UNclearly told the second. As in saying it, but casually and without emphasizing that without this affective prop, the stims would not suffice. It's all in how you say things (as any mother learns fast).

JFTR I have been addicted to Lortab twice before and self weaned over a period of months, remained off it eachj time for from over two years each time. It WAS hell. This time I consciously decided on it as treatment, since I was only getting it on a tssk-tssk, doled out basis (never knowing if it would be stopped suddenly and I'd crack). When that changed, I realized I could take enough to remain stable.

So now I get out of bed and I'm recovering some function, except for the rest which is primarily will-power and regaining my self respect. I feel well enough, clear-headed enough most of the time, that I have no excuses. ("self-respect". Ha! What's that?)

The only excuse I have, if you want to call it that, is the horror of looking at the MOUNTAIN of remediation needed and the very limited resources I have to tackle it all. (I am not young, have little money and am clinically physically disabled. Uh, not to belabor it, but I also suffer from Internet Addiction which is far more disabling to me than anything chemical).

Hopefully, me and my great new tdoc working together can deal with that. It will be hard. partly because I am not used to trusting anybody, and partly because -- it will just plain be hard!! (BTW he is aware of all my meds and my reasons for taking them. His response: "Good. You know the risks and you've made the decision to take them anyhow.")

OK, I won't tie myself again for A.M's longest post award :embarassed: (actually, my response about the sex-depression link and to dan about discontinuing Risperdal, were WAY longer! MS Word has a word counting feature. :wtf: )

I hope all this doesn't come off as mere typical addict rationalization and defensive argumentativeness. To repeat, I freely admit I'm addicted. But I'd rather be addicted and getting out of bed and be putting my house in order, however slowly (and much more), than not addicted. You must understand something. I had completely, completely lost hope. Not suddenly. Slowly, very slowly and absolutely. To the degree where I was able to take out a huge life insurance policy involving years of planning.

It's a CHOICE.

I know painkiller addiction is a major problem these days. It's far from ideal. However, it appears that no medication around right now, can deal with my emotional/brain chemistry problem. It was crushing when I had to give up the Nardil. For me, though, this combination is saving my life. If it can be saved at all, that is.

And don't forget that until recently, cancer patients were denied pain-killers. What about psychic pain?

I know it's different in that I am not physically terminal. I was however, mentally terminal. If I end up being mentally terminal anyhow, well, at least I've gotten that many more years of life.

And hopefully I will have put my house and papers in order first too. Sad but true, for now this is my primary goal . I have NOT cancelled my hyper expensive Term Life insurance. . Shit, what a fall from all my youthful ambitions (which were, I believe, well within my potential. Nuff said about that, as it's a line of thought I try to steer clear of)

And maybe, just maybe, I will achieve more. If my kids and witnessing their pain, don't topple me. (A big if). I've been repeatedly advised to just forget them, since I "can't do anything about the problem". First of all, I CAN. And secondly, who the hell ever heard of just "forgetting" her own kids?? I mean, who with a heart and conscience and soul? [thereby excluding X :) ]

I so wish all this hadn't happened. And my poor, poor children. They didn't really have any fun first as I did. Especially #2. And they've both seen almost all their great potential (and dreams) crushed out of them. They know it too, tho #2 may kill himself fighting it. Or worse. That's what hurts the most.

Again, I'm really touched by your obvious caring. Thank you.

Gratefully,

realitytest

PS V.E. "Cycylic Unipolar Depression:" YESSSSS!

DAMMIT. I have beaten my own A.M. award now. Will just go eat some worms…

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About the Lamictal. I respectfully disagree with Seven:

when an opiate wears off, you start to enter the withdrawal phase. withdrawal is painful and comes with a whole set of powerful mood symptoms. so those are your options. high or in withdrawal. there is no in between (until you detox which takes 1 or 2 weeks). so...in your current opiate cycle, i'm not sure where there's space for "testing out" the lamictal.

for the record, lortab is the opiate - not lamictal. lamictal is an anticonvulsant. what seven was trying to say is if youre always high on lortab, it will be hard to test out the lamictal.

About the Lortab. First of all, ALL my MDs are aware of ALL the medications I take.

They are not aware that I am taking the Lortab for psychic pain in addition to the back pain. I won't tell them because I don't want to risk its being cut off. How could they not realize I'm addicted for whatever reason, knowing I take it regularly at that dose?

how do you know the physic pain isnt caused by the lortab withdrawl. ie: my brain hurts - i need more.... thats withdrawal talking to you making you crave more.

JFTR I have been addicted to Lortab twice before and self weaned over a period of months, remained off it eachj time for from over two years each time. It WAS hell. This time I consciously decided on it as treatment, since I was only getting it on a tssk-tssk, doled out basis (never knowing if it would be stopped suddenly and I'd crack). When that changed, I realized I could take enough to remain stable.

remain stable or not have to go into withdrawal?

OK, I won't tie myself again for A.M's longest post award :embarassed: (actually, my response about the sex-depression link and to dan about discontinuing Risperdal, were WAY longer!
i was on risperdal for a time and id like to read that. do you have the link???

I hope all this doesn't come off as mere typical addict rationalization and defensive argumentativeness. To repeat, I freely admit I'm addicted. But I'd rather be addicted and getting out of bed and be putting my house in order, however slowly (and much more), than not addicted. You must understand something. I had completely, completely lost hope. Not suddenly. Slowly, very slowly and absolutely. To the degree where I was able to take out a huge life insurance policy involving years of planning.

It's a CHOICE.

i believe you are are correct in your assumption and i do hope that the choices you make will help you to eventually get off the lortab and not be so dependent on them as you are now. as i said before, i was addicted to them for four years and i know how hard it is to not have good reasons to take them. youve gone off of them before so im sure you know as well. just be careful and take care of yourself. and good luck with your kids.

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Hiya-

so many folks with more pharm experience than me have already given their opinions, but mine will be short and less full of the pharm stuff.

the type of depression i experience as a BP is different from what my unipolar depressed friends feel. i get very actively suicidal, very fast, and there is no BLAH stage. it goes right to the bottom.

my manias are also that way. no stopping a full-out mania. i'm there and dancing with a wet t-shirt on the bar!

my advice is to see a pdoc who will give you a free consultation, and run it by him/her. just to check up on the situation.

Loon

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