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Argh My Doctor is confusing me ><


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For reference on what exactly my symptoms are and what im going through: SEE THIS THREAD

My doctor last week just 7 days ago tells me I have Bi-Polar3 / Cyclothymic Disorder with paranoid thoughts and mixed states as symptoms. So she ups my dose of Wellbutrin to 300mg and that workds great against my downs but makes me a little consistently hypomanic with dips to a mild down or a breakthrough depression and puts me on Risperdal to help with the paranoia and anxiety, insominia, and I suppose the mania as well. I absolutely feel no affect from it on my anxiety and paranoia at all and it causes me to feel a lack of motivation, semi-lethargic, or depressed. Does more bad than anything, just helps me sleep, thats it.

Well today we get into what meds are working, how i feel, and so on .. and I really dont think she is considering I feel certain ways because of what im on at the moment .. But she goes I think you have an Anxiety Disorder (because the Risperdal didnt work) .. and I'm kinda like here we go, in circles again ... So she puts me on Xanax

Xanax, Risperdal at night to sleep,  and wellbutrin XL to fight the downs ....

The Xanax instantly started working 2 -3 hours after taking I've been sitting here feeling like I could just laugh at the thought of laughing ... I feel all fuzzy inside its great .... While it's helping with my overall mood and concentration, I still feel a lingering block of anxiety that is hindering me from doing things and the paranoia doesnt seem significant right now but I havent been in a situation where I get paranoid yet while on it.

I dont think she is consdering my mood changes either as mood swings, I think she thinks some of them are the medicine working or not working when it could very well just be my mood ... I cant distinguish at this point either if certain meds cause mania, I was already manic, if the down is from the med, or if it was a down that just didnt get severe from the med or a breakthrough ...

However she did seem to agree depression, anxiety, and paranoia where her main concerns not the hypomania.. She doesnt mind if the hypomania exists unless it causes me not to sleep because no negative effects have resulted from it.

I'm totally lost now .. can somone give me advice ?

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Hi JPD,

i think you need to stop worrying about diagnosis and just address your symptoms. for comorbid disorders, especially those including bipolar, finding the right med or med combo can be tricky business. just make an honest assessment of the symptoms you want to work on--and both you and your pdoc seem to have done that. plus knowing you can be pushed into hypomania, you have some pretty good parameters. your priority right now is getting better--not getting a label.

anxiety is often part of bp territory. is it your wish to try an anticonvulsant? they can help. should you choose lamictal, keep in mind that it is activating for some and may not be good with yet another ad like wellbutrin--depends how far on the depressive side of bp you live. just putting that out there because you keep mentioning your wellbutrin manias (maybe you should go down in your dose).

from what you say, the xanax appears to have helped you a good deal. as for any lingering anxiety, i suggest you see a Therapist. you can't expect meds to do all the work. they do alot of the heavy lifting but ultimately, the story is about you and your life. it's up to you to mop up the rest. good luck! and keeping posting...i know it helps you ;)

peace,

7

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Hi JPD,

i think you need to stop worrying about diagnosis and just address your symptoms. for comorbid disorders, especially those including bipolar, finding the right med or med combo can be tricky business. just make an honest assessment of the symptoms you want to work on--and both you and your pdoc seem to have done that. plus knowing you can be pushed into hypomania, you have some pretty good parameters. your priority right now is getting better--not getting a label.

anxiety is often part of bp territory. is it your wish to try an anticonvulsant? they can help. should you choose lamictal, keep in mind that it is activating for some and may not be good with yet another ad like wellbutrin--depends how far on the depressive side of bp you live. just putting that out there because you keep mentioning your wellbutrin manias (maybe you should go down in your dose).

from what you say, the xanax appears to have helped you a good deal. as for any lingering anxiety, i suggest you see a Therapist. you can't expect meds to do all the work. they do alot of the heavy lifting but ultimately, the story is about you and your life. it's up to you to mop up the rest. good luck! and keeping posting...i know it helps you ;)

peace,

7

<{POST_SNAPBACK}>

While the Diagnosis isn't important to me getting better it is important to have one to apply for SSI while your trying to get your stuff together and for your doctor to stop changing her mind about just how disabled you are (when its obvious). One week she agrees im too fucked up to consider working and suggests SSI and disagnoses me with Cyclothymia. Then I mention mixed states and she considers BP2... Its almost like she didnt write those down and now shes toying with an Anxiety Disorder perhaps in existence with the Cyclothymia or one alone. All Anxiety Disorders completely contradict my symptoms, Anxiety orders do not cause mood swings like I have, if anything it could be a trigger for some of them but it is ABSOLUTELY not the cause.

If I get an appointment with SSI like I do tommorow (that I am going to cancel now) and she keeps changing her mind about what shes going to tell them then I'm going to get denied. Dont get me wrong I want to work, but it's like ive said several times already I cannot even do things I enjoy or want to do right now without difficulty.

In comparison to anything the Depression is to the point where Apathy and Anhedonia has a tight grasp on things from me trying to bottle it up for some long and ignore things.

The Mania is absolutely nothing in comparison to any other symptoms and the xanax is mellowing me out slightly but keeping me alert and motivated at the same time unlike the other meds (especially seroquel gah).

The only she is willing to say is 100% certain is that my depression is very very dangerous and serious. She seems to be mixing up paranoia and anxiety a lot too ... She isn't listening as well as she has been to me. I am VERY highly considering that I go back to seeing my psychologist saw a few years ago. He was a very great help to me with talk therapy at the time even if he did fuck me up by getting my physician to put me on Zoloft.

Anxiety for me is something like depression but a more of a lack of confidence (then sometimes I am overconfident) , I beat myself down, feel like a failure, and start hating myself ... Racing thoughts like that are complete poison for me.

Then I have this block , I dont know how to explain it that seems to not be anxiety related.. Where I just cant bring myself to do things I need to do .. like sum underlying fear or paranoia that just doesnt show itself... I'll get a job prospect or a prospect to do something social and this sinking feeling sets in that it's just not within my ability to bring myself to go through with it.

I'm starting to notice with the xanax that even though I'm more "moody" .. I think ive gone from a period of crying for no reason .. almost like I should be said bit Im so doped up the feeling just came out that way and then on the other hand I've been very up BUT FOR ONCE THANK JEBUS I CAN CONCENTRATE and get CERTAIN things done that I need too. I'm just hoping that I'm not just in some sort of false mood from a Manic Episode thats being watered down and then when that ends anywhere from a few hours from now to a day or so that I the sedatve effects of the xanax won't send me plumiting back down to hard.

The 300mg of Wellbutrin has made me feel great since it apparently has leveld out  in my sytem, I am feeling things I have long since forgotten how to feel for some time now .. Simply things like being excited over a new CD coming or caring enough to be mad I missed an episode of a TV show I like ... it is overcoming a lot of the Anhedonia, and for every negative there might be there are 10 positives.... I'm a little more irritable but I've always had a short fuse and been impatient. It is probably still very possible. Any type of sedative medication however  totally overrode any effect the 150mg dose was having. If I take Risperdal (or before the seroquel) the way they make me tired either mentall or in seriquels case I really do feel sedated in a druggy way TOTALLY kills any effect of the Wellbutrin and sends me into a mindset that's a little dangerous or more bad than good.

There has to be some sort of balance made. The Depression , Anxiety, and Paranoid thoughts are SO STRONG compared to the Hypomania that whenever something sedates me too much it brings out the worse of those feelings and lethargy which is already a problem I have to begin wtih. So Something activating like Lamictal may be a very interesting choice to try if it's activating since the only real health concern with the mania (unless it ever gets worse) is insomnia Or the potential for a mixed state .. which also wont happen in a harsh way as long as the depression, paranoia, and anxiety can be controlled.

The last thing I need is to be sedated.

It really seems that I may just need different medications to take in different moods. Ie. Risperdal to sleep when I'm manic , Wellbutrin and Xanax to help me survive the day , and some unknown drug to get the moods a little less swining and the paranoid b/s gone....

If Lamictal (or a mood stablizer that wont make me slow) could handle mood swings & paranoia + not sedate me , and the xanax kept the activating features in line with that and the wellbutrin since that is helping SOOOO well with my depression symptoms I would be completely able to help myself get past all of this or perhaps seeing my old psychologist might go smoothly.

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And yes your right talking about all of this does help me... But then writing in my journal during my downs helps a lot too. I write here when I'm more in a state of confusion, need advice, or im a little hypomanic (hence all the talkitiveness)

When I'm down (like I was for a while last night) my rants turn into this:

Stepping back to move forward.

Don't you just hate the feeling that you have been jaded by your own ignorance or your own negativity towards something you once enjoyed or something you shouldn't care about otherwise. The more I sit and think about it, the more I read the lyrics I have been writing, and the underlying meanings of some of the things I have said the clearer it is becoming to me where the source of some of these problems is coming from. The aren't coming from anywhere I have always had most of the problems that are currently causing me to ruin things I hold dear.

These emotional wounds had become so deep and painfully, with things continuously tearing at them, that the only way to deal with it was to try ignore them. I stopped dealing with everything altogether and instantly bottled up anything afterwards with them. These problems never went away and started manifesting themselves in harbored feelings of hatred, regret, envy, and a malignant vanity that caused me to attack myself from the inside out. It's not that I think I'm great, it's a vanity that causes me to be absorbed with anxieties and distrust. I'm very serious when I express my total disgust for my fellow species. Having been picked at one too many times it is obvious these wounds have begin to fester and pus. Unless I take a good step backwards it is clear that my mind will continue to poison itself with or without medication and as a result more things will fall victim to a lethargic Anhedonia.

Except within short periods of lucidness (in between moods) concentration, social interaction, relationships, people and ambitions have seemed to be an unconquerable task hindered only by anxiety or otherwise apathy towards an unwritten future. The only outlet I as I have expressed in other entries lately seems to be writing like this in order to aid sincere thought. Entertainment, sexual impulses, an arsenal of medications, and other such trivial things have been my only source of passing the time with ease instead of frustration.

It disappoints me even more that despite being blessed by the muse with fresh inspiration, inspiration that has blossomed beyond all in my past, that I am otherwise unable to make these ripe ideas a reality without an overwhelming difficulty caused by a new type of block that I have never experienced before (until the beginning of this ordeal).

So I ask myself what needs to be done ? Instead of stepping forward, I need to take a step back and otherwise eliminate these issues from my reality before more things can no longer be undone. I'm like an Alice who can no longer find the white rabbit or a way to wonderland and instead of stepping through the looking glass I would only want to harm the one on the other side for being blinded by his own fake smile. Either way, Stepping back to move forward, when your trying to move forward passed what's behind you, to get passed something in presently in front of you is a strange way to handle things right ?

Then again I may wake up tomorrow and decide this rant is all part of some then passed mood. Who knows ? Perhaps it's just my inability to let go because I know my feelings are justified and in some cases vindication is viable for all parties involved.

It seems to be my only release right now, I'm glad to see that a lot of you are willing to listen to my rants and problems. It helps me think, helps me consider different points of views aside from my own, friends, family, and doctors.. Your views are unbiased.

I have been trying to find posts that I can help people with on here as well. Despite my inability to take good advice I give other people, I do often times know exactly what somone else should do  ;)

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Two questions for ya, JAPD:  First, is your doc a pdoc?  And second, how much experience treating BP does she have?  Going to a few seminars isn't enough.  You need someone who has experience seeing how different meds work for different patients with the same disorder (or variants thereof). 

It sure doesn't sound like your doc is sure of herself.  By now she should have a good working theory of your condition, and a lineup of different drug therapies to try.  She kind of sounds all over the place.  Can you get a consult to get a second opinion or something?

On the other hand, if you've told her you won't take an AC because you need your manias, she may be avoiding pushing you into treatment you won't accept.  It's simply hard to treat patients who want to be treated for only one of their symptoms when that treatment might aggravate the total disorder.

By the way, anxiety and paranoia were two main features of my hypomanias.  I too thought I couldn't do my job without the high energy/paranoia/fear of my hypomanias (I was wrong).  You may like the high energy, but though I certainly can't diagnose you from your posts, it sure sounds like mild hypomnia to me.  And "mild hypomania" might sound all warm and fuzzy, but it's more like a ticking time bomb.  A hybernating grizzly.  You get the idea.

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Hey, I just noticed you haven't tried an AC yet.  I'm doing great on lamictal, as are many others, and there are a bunch other ACs out there to try.  Lami is great for me largely because of its AD properties; it brought me up at low doses, and at 100 and above it has stabilized me wonderfully without any sedation (I did sleep a lot at very low doses, but it was quite temporary).  As with any AC, there are possibilities of other side effects, but whenever you see someone complaining of one remember YMMV.

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I have a question that seems a little more worth answering than the general WHAT IS WRONG WITH ME question...

I have been reading my past journal entries for the past 3 years, in notebooks, my non-public/private online journal posts, and public journal posts where I expressed myself in a way that wouldn't give the wong impression that I was beckoning attention but instead just expressing some views on things.

WOW if I counted how many times I have either said I wish I had drugs, been paranoid about a girlfriend or friend's impending betrayl,  said I wish I could end this life, I have nothing left to look foraward too, I hate all of man kind (especially girls), and on the other end seemed completely motivated, happy, and so on ... in so many more or less words ..... it would reach literally 100s of instances in the same month , 1000s over the past 3 years (Even longer back im sure) ...

Do you think I should bug my doctor by showing her these, I feel like I pissed her off by writing her a rather long e-mail not long ago to discuss when I came in next ... and she seemed a little fustrated with me on the phone when I have called about my medications and me telling her how they arent working and what I dont like about them ...

or do you think I should just get a psychologist brought into all of this.

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