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What happened? May I have your opinions?

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Guest Curious

Hi, I've not posted here before but I've been thinking a lot about something that happened to me last year and would really appreciate some opinions from people who have experience in this kind of thing. I've written too much really to expect people to read it all, but if anyone does I'd really appreciate it.

I've had problems with depression since I was 12 (I'm 21 now) and have always had pretty intense mood swings. Last year though was my final year of uni and I was getting steadily more depressed over the year. I confided in a friend about how awful I felt, crying all the time over nothing, completely numb to situations I knew should trigger some emotion, couldn't concentrate enough to follow a storyline never mind write my dissertation. My friend advised me to tell the doctor since I had an appointment anyway for chronic stomach problems. I told the doctor how I felt, including the fact that I had pretty much written myself off years ago since I'd had a problem with anorexia as a teenager (completely recovered from that now, and embarrassed about it) and since my mum who I lived alone with before coming to uni has never been quite 'normal' after she was sectioned (schizo-something episode?) long before I was born. I've always smoked cannabis and drunk somewhat excessively since school but I had cut back on my drinking (too much work to do) although not the smoking.

Anyway, to the point, I was diagnosed as severely depressed at the end of April 2009 and given Citalopram 20mg and an appointment with the uni counsellor. When I first started the ADs I felt amazing. I stopped smoking weed because I didn't feel like I needed it, as long as I had the pills to take I could function without that extra something. I could feel again and was really hopeful for the future, it was like I could see the world the way it was meant to be. Now I know this was not the ADs just me, but that made me very confused, because if I could help myself that way then what had I been doing all these years suffering? Then after a couple of days the good feeling stopped, and I felt numb and depressed again, and hopeless as to how to pull myself out of it. I had some pretty bad physical side effects from the drugs as well, like a speed hangover.

I had my appointment with the counsellor, told him how I felt, and that I kept having a 'moment of clarity' that told me now was the time to end it. He drew a simple diagram that looked like this >< which I felt I understood perfectly. When I went home, my thoughts started racing, and it felt like I could see into my own mind. I 'took a step back' from myself, and saw the bigger picture, even though a big part of me knew it was the perfect time to end it all, and I kept actually seeing myself dead and there was this total calm. I didn't sleep for nearly a week, just sat or paced around thinking, and whenever I could grab someone to talk to, I just couldn't shut up. At all. I wore my emotions on my sleeve, and if something upset me (ie. someone disrupted my train of thought, or tried to get me to be quiet) all the energy went out of me and I just slumped in tears. I stopped eating and showering. I lost track of time and days went by in the blink of an eye. I argued with everyone, I kept talking about grand ideas and the meaning of life and saying that I understood everything about human nature now, that had made no sense to me before. I called up my mum to shout at her down the phone, as well as saying I knew why she had become religious when she was in the hospital, because I could feel that 'clarity' and it felt holy, although I knew it was just me, not religious at all. I realised I was not gay. I convinced myself I would die if I went to sleep because this was too good to be true, and it must not be real. I had panic attacks and hallucinations. Basically, I went manic (or mixed? I'm not sure). My flatmates took me to A&E and the doctor there said it was a reaction to the medication and would go away on its own. I refused to be admitted (due to my mum's experiences) but stopped taking the pills after 2 weeks of being on them. I eventually slept and started slowly to calm down. My housemates made me move out for a couple of weeks because I had stressed them all out so much, so I stayed with a friend from my course. I finished my degree. I was honestly so grateful for the whole experience because I finally felt better, not depressed at all. I felt like I knew myself. I saw the counsellor a couple more times and he said he thought it might have been from being stressed and unable to cope. We agreed I was much better (I am) and didn't need to come and see him again.

Since then I've had one more episode of depression (not as bad as that which prompted me to seek treatment) over the summer. I've been feeling better since then.

The thing is, I know that sometimes ADs can trigger mania and it may never happen again, but I think I've had symptoms of mania before. In summer 08 I went on one of those train trips round Europe and frequently stayed up all night with no problem the next day, was full of energy, had sex with a few strangers in a short time period (I don't normally have a very high sex drive) but got really irritable and tearful over stupid things as well. I jumped into rivers, swam as far as I could out to sea, climbed mountains in the middle of the night just for the challenge and generally acted quite recklessly. I'm not sure if that was just because I was excited though, and was just normal behaviour.

Thank you very much if you've read this far. My questions: what the hell happened? Did I just have a bad reaction to the ADs or was some of that from me? Will it come back? Am I going to keep getting depressed for no reason for the rest of my life? Are there even any answers, or do I just have to wait and see?

Nb. Seeing a medical professional is a bit of a problem since I'm not a student any more and not really entitled to treatment with the uni health practice. Plus I don't have any problems right now (other than generally being quite a moody person). I would seek treatment if I started to feel out of control.

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Hi. I probably don't need to say this to you, but for clarity and just in case I will. No one here can diagnose you. No one is a professional. Some may relate to your experience or give input based on what they know of others, but it's feedback only. There's no way you can put enough info on a page for anyone to say what's up with confidence. No one's input can replace that of an MD, so take it for what it is worth, k?

Where do you live? In the states, UK, and elsewhere there are ways to get help on a low income. Seeing a doc is in your best interest, you know. There are a few threads here on how to go about doing that, and if there's more you need to know on that, just post a thread of your own.

Anyway, yes, it sounds like you had a manic or mixed reaction to the AD. If you've actually had similar reactions w/o ADs, then you may possibly be on the bipolar spectrum. If so, you will continue to suffer bouts of depression and the manic/mixed stuff may intensify as time goes on. It is a progressive illness. Each time you have an episode more damage is done. That is why treatment is so important. Treatment includes see a psychiatrist for medication and a therapist for dealing with the illness, meds, and life. The meds can take a while to sort thru to find what works best for you, but they would be far more effective than ADs. Again, that is all predicated on an IF. You may not have some form of bipolar. Bad reactions to ADs happen for other reasons. Cyclothymia can include mild highs that don't need to be medicated. Regular life after being depressed can appear pretty damn good, too. Is that it? Dunno. Hypothyroidism can cause depression. Some other medical conditions can as well. So, although what you described sounds like it's bipolar spectrum, it could actually be something else. In any case, you should see a GP doctor to get your health and thyroid checked out, and a psychiatrist if the answers don't lie there. Life does not have to be filled with recurrent depression and possibly more mood disorder, but you have to see the right docs to get help.

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NOT a doctor, not trying to diagnose you, but you asked for opinions.

This is my non-medical lay opinion.

Cyclothymia is too mild to describe the severity of your depression (cyclothymia = dysthmia + hypomania of any severity. Your depression sounds considerably worse than dythsmia, which is basically being "down in the dumps", like an extended bad but normal mood... dysthmic people are unmotivated and not very positive, but they aren't like, crying all the time, notably impaired in their usual functioning the way you are; your symptoms are more consistent with a major depressive episode).

Bipolar I is too severe to describe the severity of your spontaneous mania (bipolar 1 = non-drug induced mania + depression of any severity, your spontaneous hypomania in summer 08 did not sound like mania as your thinking was otherwise in tact and you did not report any signs of psychosis... however, if you were abusing a lot of drugs in the summer of 08 it is possible your hypomania then was simply a reaction to drugs).

Bipolar II, however is consistent with recurrent major depression (what sounds like you have, a mild-moderate severity major depression) and hypomanic episodes. (Bipolar II = major depression of any severity + hypomania of any severity, which is what it sounds like you have)

I would say your reaction to the AD sounds manic (as opposed to hypomanic), due to the extreme energy/lack of sleep/psychotic thinking...however AD induced mania is not considered BP I. Some docs will diagnose BP I based on reactions to mood elevating drugs (both legal and illegal), but this is not a proper/correct dx as many non-bipolar people may have a manic episode from an antidepressant but never again have one when they go off. ADs and other mood elevating drugs are supposed to make your brain go faster and give energy, some people are more sensitive to that than others, but this doesn't mean they are necessarily bipolar. However it's pretty clear you've had some kind of hypomanic stuff happen before (assuming in the summer of 08 you wern't abusing drugs, of course), so it's probable that you do have spontaneous hypomania thus it's probable you have bipolar d/o.

Either way, none of us are psychiatrists, and even if we were, we couldnt' properly dx anyone over the internet.

If you're concerned, see a psychiatrist, and maybe another for a second opinion.

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I'm not going to say what I think you have, but I am strongly going to urge you to seek outside psychiatric treatment. The unusual UNI treatment won't cut it for you on this on. Go to a local community health center *usually free or on a low sliding scale and confidential* to get diagnosed and treated.

Get a diagnosis, get treated, and then come back here and tell us what happened.

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Thank you for your replies, I really appreciate your input.

I realise that nobody can reach a diagnosis over the internet and any feedback is purely personal opinion. I just wanted to tell people who might know what I was talking about and hear what they had to say about my experience. I was never really offered an opinion (medical or otherwise) on what happened or if I'm likely to keep having problems in the future. My questions were a bit stupid, really.

I live in the UK so seeing a doc is not a financial problem. The only issue is more that right now I'm just really curious and I want to know more, but I've not felt this emotionally stable for a long time so I don't really have any reason to go. I am still allowed (I think) to use the university health service this year but shouldn't really, although I am going back to university to do a PGCE (qualification to teach secondary school) in September anyway. The uni health service tends to be a bit hit and miss, although they do have a good record of what happened. In a way I'm expecting any problems to show up next academic year because of the stress, whereas this year I'm not really doing anything except part time pub work. I get to have loads of lie-ins as well, which seem to help, mood-wise.

I do agree that regular life seems pretty amazing after being depressed, but I don't think that was it, there was definitely something wrong and it seemed to set in very quickly. In a way I feel like the episode triggered a switch in me, so now I see things differently. I don't think I've got hypothyroidism just because my metabolism's quite high and I find it hard to put on weight, not that I know much about it.

I wasn't using any drugs in summer 08 which is one reason I think it was strange. The only real similarities to the episode I had in response to the ADs was that I got very little sleep without being bothered and for a few days became really talkative and couldn't shut up about scientific theories (most of which, looking back, were crap). That was during a field course at the start of the summer. I realised I must have been acting oddly when one of the professors decided I wasn't allowed to talk unless I was holding a designated banana. I was surprised how upset I felt when I did not have the banana. I'm still undecided about whether there was really something going on there though, or if I was just acting weird. There was definitely no psychosis and I felt very down a while afterwards.

There is another thing that used to concern me a lot, but I rarely ever think about now. When I was young (primary school age) and later whenever I had a high temperature, I used to hear voices. A really sarcastic man and woman arguing with each other, usually about me. I could rarely make out the exact words, just the tone, although I used to know what they were saying. The voices weren't associated with any particular mood, although I could feel them coming when it was very quiet or strangely, if there was dim lighting. That hasn't happened since I had the flu at 13 though, not even when I was manic (thankfully). I've never since heard the voices or had any other spontaneous (not induced by legal or illegal drugs including the ADs) hallucination. I told the doctor this at the time I admitted I was depressed but had never previously told a medical professional.

To be honest, I have not even considered going back to the doctor since I've been feeling better. Is it OK, do you think, to make an appointment when there's nothing wrong? I am thinking I would really like to know if I have a problem that might not just be a one-off. Mostly I am worried about becoming very depressed again when I start to study (and teach), because I've found a career I really want to do and will really be crushed if I mess it up for myself and start hating it for no reason. It didn't really occur to me that there was another option to 'wait and see'.

Thanks so much again for your responses. It is a relief to hear my concerns are valid at least, even though I may well not have bipolar disorder. Right now I am inclined to make an appointment to speak to a doctor, if only for their professional opinion. I don't honestly think I need or would benefit from any drug prescription at this time. If anything comes of this, and if I actually convince myself to see someone before anything else happens I'll let you know.

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My personal opinion again... but it does sound like in summer 08 you had a bit of hypomania. It like, isn't normal to not sleep feel real energetic, and talk a lot/form nutty scientific theories which you later look back on with puzzlement. ... especially if you were drug free at that time, that's really not normal.

Ironic, as, the summer of 08 is when I also started having marked hypomanic symptoms (however, unlike you, my episodes involved some psychotic symptoms afterward, which is truly what bothered me most/made me worry I was losing my mind). SUMMER 08 = SANITY STEALER, LULZ. ;)

Summer 09 was comparatively mild. There were hypomanic symptoms, but nothing like 08.

I've heard of some relationship between fever and changes in brain functioning. I have visual and perceptual hallucinations if I take a very common OTC supplement called tyrosine. People with messed up brains can have messed up symptoms whereas normal people might not have any such issues. Fever changes the brain functioning which, in someone with a mood disorder/bipolar disorder could possibly lead to hallucinations and voices.

Most people who go to psychiatrist for bipolar d/o do it in an episode, usually a depressive one (BPI might go for mania, but it's rare/almost unheard of for other bipolar types to go for their manic stuff as it is usually not a bother/considered a good thing). If you have bipolar d/o you might benefit from a mood stabilizer as prophylaxis against episodes, in which case it isn't unheard of to go to a psychiatrist even if you aren't particularly symptomatic now. However, usually what happens is that some kind of episode brings people with bipolar to treatment and then this leads to seeing a psychiatrist regularly and taking medicine for mood episode prophylaxis (usually recommended).

Anyway, yes, it is a good thing to see a doctor.

I would also see a psychologist (a psyD, PhD). In my experience, PhD psychologists do very thorough assessments, much more thorough than your average psychiatrist, and they have the clinical knowledge/scope of practice to diagnose.

I've seen 3 practitioners in my life. 1 PhD psychologist and 2 psychiatrists, and the psychiatrists both sucked, their assessments were non-existent or very brief/incomplete, they wanted to give me medicine without even seeming sure what they were doing... it was pretty sloppy. However, the psychologist I saw conducted a very, very through interview. They gave me like, 2-3 hours, they went over every aspect of my history and family history (and they even wanted to call my family members for more feedback), and they give me a diagnosis that was supported by evidence.

If at all possible, try to get seen by a PsyD, they do great assessments, and their diagnosis is therefore based in a solid background of evidence.

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My experience has been the exact opposite of Oscillate Wildly's in that I've met some crappy psychologists and had generally good luck with psychiatrists. I have been receiving mental health care for over ten years, and move every few years for work so have worked with several psychiatrists (pdocs) and therapists/psychologists (tdocs). Having said that, whichever one you go to should be able to refer to the other; i.e., if your talk therapist thinks you need meds, or your psychiatrist thinks you need talk therapy.

Although you're not currently receiving treatment, it might be a good idea to see a doctor now while you're well, so that if you do start having an episode, depression or hypomania or whatever, they'll already have some basic history to start from.

Although I have been on meds for years for what was once thought to be major depressive disorder, recurrent, and now is dx'ed as bipolar II, shortly after I moved to my newest location, I found a pdoc for medication maintenance. My first visit with him was for an hour and a half and he did a thorough interview, history and assessment. He said it was good that I came to see him when I wasn't ill, as it gave him a better idea of what "normal" should look like for me.

Since I've moved here, I've been well, but it's comforting to me to know that if / when I get sick again, I have an established relationship with a good psychiatrist. I hope you also are able to find some good medical care.

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There is a MASSIVE benefit to seeing a pdoc when you're well - most of the time, our doctors do not see us when we are *well* and have a hell of a time trying to figure out where we want or need to be (mentally speaking).

So there is nothing wrong or bad or guilty about setting up a doctor's check-up when you aren't feeling necessarily bad. If nothing else, you can talk with him/her about your past experiences and get some quick pointers on how to maintain good mental health. And if you did find yourself in trouble again, you can go back to that doctor and say "I don't feel well" and they will already have a reference point to work from.

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