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Very atypical depression. help understanding


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I went through depression years back in highschool. I was never completely treated for it, but after some years, I was able to fight it out myself (more necessity than choice). Now, the depression has hit again, but in a rather different form before. Last time it was diagnosed as melancholic depression. The characteristics of my first period of depression were: feeling hopeless. in despair. frequently feeling worried, sometimes about irrational things (I also have OCD and worry about irrational things like getting brain cancer, i do this a lot more when depressed). I was utterly socially withdrawn. spent a lot of time just pacing around or spacing out or worrying about something. I often had fits of crying and sometimes hitting things. My mood was more or less constant. Occasionally it would get worse for a short bit, like during major crying fits.

I always thought that if it happened again I would be ready for it this time because I know the symptoms and have more knowledge about it now. But now that it happened again, I was caught off guard completely because of how unusual it was this time. I needed the people around me to point it out. I've tried reading around other sites and forums to understand what kind of depression it is, but I can't find much. I'm very much in the dark about this, so any enlightenment would help.

I also have a fear that this new depression was caused by something chemical. I'll explain below.

To summarize the problem:

My mood will be fine most of the time,but occasionally I will have a sudden severe drop in mood that only lasts 3 days. I become depressed sometimes to the point of suicidal during those days, then I'm fine again. On my normal days, my mood may be a little down or anxious. I'm usually a little tired and slow too. I have occasional thoughts of hopelessness, but they are usually tolerable. These are mild symptoms of depression I know, and pretty usual for me. I don't like em, but when they're just this bad, I can tolerate em and go on enjoying life. But once in a while (once every 1-4 weeks) these "mood crashes" will occur, last 2-3 days, then subside as quickly as they came. They don't happen at regular intervals, so they're not following some bodily rhythm (I'm a guy by the way). However they do almost always happen on weekends. It's not always on the same day though; usually Friday or Saturday, sometimes Thursday or even Sunday.

EDIT: Even though these episodes are short and spread out, it is a very difficult interruption to my life and horrible thing to live through, as is all depression i know.

Let me describe the pattern of these mood crashes in more detail: I will first feel a slight emotional feeling, one I've become so familiar with. I would describe it as anxious, precarious, shaky (not physically shaky, just emotionally), on-edge, worried or afraid. It's like a feeling that something bad is going to happen (because it usually does). This beginning anxious feeling seems to happen any time or place, but usually any time after noon I think. The feeling lasts an hour or two. Sometimes it goes away and a mood crash doesn't occur. Otherwise, my mood starts a gradual decline. I've become aware of it enough that I can feel my mood drop, like watching a sinking ship. If I wake up tired, or in a bad mood, the mood sometimes begins its decline from there. Either way it begins, the decline goes from there. It takes a few hours or half a day for my mood to go from normal (my normal) to rock bottom, usually by evening. I'm filled with despair, anxiety, frustration, and anger. I spend the entire day pacing around nervously, constantly ruminating about negative thoughts. I feel like I don't want to do anything, see anyone, think anything positive. The depth of the mood crash can vary in severity depending on circumstance and especially what medication I'm on. They range in severity from just despair, hopelessness, frustration to crying, punching furniture, suicidal thoughts. Once I'm in the lowest state of the mood crash, there is no getting me out of it (I try, believe me). I just have to wait for it to pass. The one comfort is that it always does pass. So I just have to sit in the corner and try not to think until the 2-3 days are over. The crash ends much like it begins. My mood rises again like a hot-air balloon. Sometimes it even goes above normal for just a few hours. I suppose this is like a kind of mood reverberation. It's like a submarine surfacing from the depths; it hops out of the water for a second before leveling out again. This "mood hop" doesn't always happen after a mood crash.

In the months that I have experienced this pattern, I have been on a few different medications, but the mood crashes persist. So they occur mostly independent of whatever I'm on. Some meds seem to make the crashes increase in frequency and severity.

EDIT: I should point out that I don't have any major stressful things in my life at this time other than trying to treat these mood crashes. I just like a healthy, average, student life most of the time.

Two theories I have about why they happen on weekends are 1. On weekends, I am usually around fewer people and have less of the emotional stimulation of just being around people, or 2. When I'm alone, I have fewer people or things to distract me, and thus the negative thoughts are more free to spread and take over like bacteria.

That being said, I try my best to understand and cope with the problem as best I can until I can find the right professional help. It has been very hard to find a good psychiatrist. I've had to just get antidepressants from a regular medical clinic.

The ways I try to cope with, or avoid the mood crashes, based on my theories is by keeping myself around friends or at least people on the weekends. Like I said, sometimes I get the feeling that precedes my mood crash and it doesn't come. I wonder if it is because I successfully preempt the mood crash by doing something social. Then again, there have been times when I will have a lot of fun with friends one day, then completely crash the next day. My doctor also gave me Klonopin, but I don't know how well it helps. I don't feel much difference. I also just started Lexapro, but it is too soon to see if that will help. The problem with using friends to distract myself is, sometimes I have to be alone to actually get work done. That's when the depressing thoughts have more free rein.

I know this is not bipolar disorder (at least I'm pretty sure), because these mood drops are so brief, they definitely seem to be environmentally triggered (though not sure by what exactly), the depressive episodes don't seem to have the same characteristics as what I've read about in literature about bipolar, and I don't have manic episodes. The short mood hop that sometimes follows the mood crash is not a manic episode. It only lasts a few hours and is simply a very good mood, not a feeling of invincibility, high energy, over-ambition, or things like that. Honestly, the way I feel during one of these mood hops is probably how I should feel normally, most of the time; happy, social, energetic, optimistic, but not to an excess. the Mood hops are short, small, and not always there, but when I experienced my most severe mood crash, having a little mood hop at the end of it was probably what kept me from killing myself.

Like I mentioned above, this may likely have been caused by an event. I didn't become aware of this pattern of mood crashes until it had happened several times, thus making a pattern. Once I became aware of it, I checked through my journal to see when the pattern started. It began maybe 6-8 months ago. I was seeing one psychiatrist at the time. She was treating me for severe insomnia. She started me on Ambien. While seeing her, she also diagnosed me with ADD after I explained my frustrations with reading, focus, and cognitive speed. She tried me on Ritalin for it. This was the beginning of a series of unfortunate events. The Ritalin made me depressed, tired, and extremely anxious. After some kind of anxiety attack (not a panic attack) I went off it. Now I was severely depressed. Over a few weeks, my mood began recovering. She added an antidepressant to help the process along. This too had the opposite effect. I once-again became extremely depressed and anxious and in despair. Once I went off of that, my mood recovered somewhat, but now I still wasn't sleeping and I was still depressed more than before. I wasn't eager to start another medication, but I was feeling desperate to get out of the state I was in. She tried me on one more antidepressant. I told her she better have scientific reason to suggest that this one would work when the others didn't. She felt confident that it would. it was a very different class of medication. So I took it. I had the worst experience in my life with this one. After only 3 days of a small dose, I went off. For several days after, I couldn't sleep, day or night. My mind seemed to flood with thoughts of hopelessness and images of killing myself. I desperate l wanted to sleep just so that I could stop these horrible depressing thoughts. When I called, psychiatrist told me to go to emergency. I intended to go. She asked my mom to drive me because she didn't trust me, and I admitted I didn't trust myself either. On the way there though, I began to calm down. We went back home, but were ready to go back whenever needed. As the day went by, my mood went back to normal, and for a brief moment it went just a little above normal (maybe my first mood hop). For just an hour maybe, I felt hopeful that things would get better and that I had the patience for it.

I should point out that I never overdosed on any of these meds. I only took as prescribed. I don't recall the exact doses, but it was always one tablet daily of some small or medium dose-pill. The only one I took multiple pills of was Ritalin. I took 25mg at most, also under the doctor's direction. I think it was some hours later that I had my major attack of anxiety. I was on Ambien throughout this time, but my doctor was careful to check for drug interactions before prescribing. I also checked for interactions myself.

The other meds were Wellbutrin, another one I can't remember, and Imipramine. The last being the worst of them.

In short, I experienced several severely depressing reactions to medications in a fairly short time. I experienced a succession of severe, sudden drops in mood lasting days because of these medications. It seems as though my brain continued this cycle even after all of those medications were stopped. It's almost like I have PTSD from a bad medication experience. I have heard of people getting PTSD from having really bad drug trips, so it's believable. I don't think it's exactly PTSD either though. I have to admit that just writing the history of the medications made me feel very shaken and anxious. I had to take a little Klonopin just to finish this.

It goes without saying that I stopped seeing this psychiatrist after the final incident with the Imipramine, though maybe later than I should have. I stopped seeing her sometime around October 2010. I went off all medications. My mood was still low, my energy was dragging. Life was shit, but I was not going to try another medication again. It was probably around this time that I started having the mood crashes.

I had still been on Ambien this whole time for sleep. I had a couple of mood crashes during this time, but I was not yet aware of them as a pattern. I suspected it was caused by the Ambien. I went off of it. It wasn't until after I became of the mood crashes that I realized this looking back.

It was quite some time before I got the bravery to see another psychiatrist. he tried me on a couple of medications including an antipsychotic, Seroquel. that made the mood crashes more frequent and more severe as the dose went up. I left him too. Now I'm back on the hunt. In the meantime I'm getting my meds from a local physician who is trying me on Lexapro. I just started it.

I should also mention that I don't have schizophrenia or psychosis in case that was ever wondered.

So yeah, any clues about this?

And btw, thank you so much for any helpful info you can offer.

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Since you DO see a pattern, which tends to coincide with the end of the week, I would say that there is a large 'reactive' depression component driven by your life/school/work. You may or may not have an underlying depression.

As much as we say it, yet still offer observations/opinions, I'm not a doc, don't know you and can't be trusted. :)

You really to be seeing a psychiatrist, and some flavor of therapist would be a really good idea to help you identify and work through whatever issues you have.

It sounds like you have been pretty functional so far. This is an important time to get control of these depressive symptoms before they build to the point you crash and burn.

Go find a doc. You can do it!

a.m.

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My advice would be to stick with a med and give it a fair shot. Sometimes meds can make us feel worse at first, but after a few weeks they begin to kick in. Usually, a fair trial of a med is around 6 weeks. Also, it probably wouldn't hurt to ask for a mood stabilizer even if you don't have bipolar. I don't have bipolar, and my best med is a mood stabilizer, carbamazepine, as it cuts off the really low lows.

You have to be patient and stick with it because there is no magic bullet to meds and depression. Some of us have had to go through several trials of meds before we found 1 that works. No antidepressant works quickly and usually takes several weeks. If you are having trouble sleeping, you might ask your doctor about Remeron because it has a reputation of working more quickly than others, but it is very sedating at first.

You might also benefit from choosing an AD and sticking with it, and adding Abilify to it. You have so many treatment options; you haven't even scratched the surface. Just be sure to hang with a med for a few weeks unless you become completely suicidal, then you should go to the ER. And that is not such a bad thing, because as an inpatient they can get you through the start-up effects of a med.

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The way you describe your mood swings into deep suicidal despair, with no control to get out of it except to just wait, sounds very much like what I've been going through for two years. I am (supposedly) bipolar, so of course my perspective on this is coming from that understanding of myself and how my brain works. A few things to keep in mind about bipolar, it's the "cycling" of moods that lead to the diagnosis. Also, the mania side of it can manifest as anxiety and anger. What I have experienced in waves of "cycles" for two years is what I understand to be mixed episodes, depression mixed with mania, which in my case ends up feeling like extreme despair and suicidal thoughts mixed with extreme anxiety and rage. I don't feel all this constantly, but cycle in and out of it like you describe. One other thing one of my pdocs told me is that one of the ways she diagnoses people with bipolar is that they have had multiple depressive episodes that they came out of on their own, and that unipolar depressed people don't come in and out of depressions like that.

I'm not trying to say you could be bipolar, just saying that I can relate to your description of your experiences. Also, just the fact that your moods are going up and down implies that they are not "stable", hence a mood stabilizer could be what is needed, as someone else has said.

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Thanks for any and all information guys. Also I finally just started seeing another psychiatrist. He seems good so far. Nonetheless, I try to know as much as I can about my own problem and the treatments so I know what to ask or what to look for. This new guy is a good listener, but I only get 15 minutes with him.

Let me see if I got this straight: you psychiatrist-hopped, twice, because you were given trials of different meds that didn't work?

I'm not sure I understand your question. I was seeing one psychiatrist for several months. She prescribed all of those meds that had disastrous effects. I i finally stopped seeing her because it was obviously doing me nothing but harm taking her medical advice. I saw no one else for a long time. After that time of no meds or doctors (except ambien), I realized the problems were too much for me to deal with on my own. I finally saw another psychiatrist. He didn't help either so I left him after maybe 3 or 4 months. I think that was a fair enough time. I wasn't willing to stick around with another doctor who wasn't helping.

If that's what you meant by "psychiatrist-hopped," then yes. Was that not a reasonable course of action?

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I was seeing one psychiatrist for several months. She prescribed all of those meds that had disastrous effects. I i finally stopped seeing her because it was obviously doing me nothing but harm taking her medical advice. I saw no one else for a long time. After that time of no meds or doctors (except ambien), I realized the problems were too much for me to deal with on my own. I finally saw another psychiatrist. He didn't help either so I left him after maybe 3 or 4 months. I think that was a fair enough time. I wasn't willing to stick around with another doctor who wasn't helping.

If that's what you meant by "psychiatrist-hopped," then yes. Was that not a reasonable course of action?

Not really a reasonable course of action, in my opinion.

You went to a doctor, they tried out different meds, none of them worked, but they were willing to keep trying, yes? Psych meds aren't like antibiotics, most people don't get cured with the first or second one you take. You're putting the blame on the doctors, saying "it was obviously doing me nothing but harm taking her medical advice" and then avoiding doctors for "a long time." Then you saw another psychiatrist, who "didn't help either." More doctor blaming for something they can't do anything about. Finding the right medication is a trial and error process, unfortunately.

Let me put it to you another way. It took me 4 1/2 (FOUR and a HALF) years to find a medication regimen that made me feel even remotely close to better. I stayed with the same pdoc, because he was helpful, kind, and understanding, and because he was willing to keep trying things, even though most of the medications we tried out for me didn't work worth a good goddamn.

If I had doctor-hopped like you did, I probably never would have found the right meds.

Now I'm not saying your medication journey is going to take 4 1/2 years. What I'm saying is you really shouldn't act like it's the doctor's fault that the meds they try you on don't work. It's not the doctor's fault, it's not the medication's fault, it's certainly not your fault, it's just a ROLL OF THE DICE pretty much. That's why they call it the "med-go-round."

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I stayed with the same pdoc, because he was helpful, kind, and understanding, and because he was willing to keep trying things

I believe you were probably pretty lucky to find a Dr with those qualities, and that helped you stick with him. Not all are that way, and sometimes one has the sense that a Dr. is somewhere on the spectrum of "not a good fit" to "potentially harmful". If you had gotten stuck with a Dr. who was on the more negative end of the spectrum, it might not have turned out so well for you (even though it DID take 4.5 years). I think that as it can take time to find the right meds, it can sometimes also take time to find the right doc....

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If that's your meaning, then I really resent you saying that I "doctor hopped," as if I was shopping for a quick fix, or that I just bailed when I didn't get instant satisfaction. I'm sorry if I made it seem that way. Let me rephrase: I followed this doctor through the entire several-month process of treatment with the faith that it would have gotten better. After what I considered to be a fair amount of time, several months, I thought it was time to reevaluate the benefits of seeing this doctor. After careful consideration, it was quite clear that my life was far worse of a hell than it was when I started treatment with her. I probably am mad at the doctor, but I don't blame her. She was just doing her job. She sincerely cared and listened to me. She had all the positive qualities that you described in your doctor. That made her a wonderful person, but that doesn't mean she's a good doctor. It might just be that her methodology did not match with my neurology. If that's the case, then continuing to get help from her would not help. I kept thinking that each mistake we made with the medications would teach us something new and that it would help us ultimately. It was like asking a plumber to fix your computer.

Saveyoursanity, My first psychiatrist prior to this last one I saw for 5 years. I know all too well that medications are not a perfect science, and that it does demand patience and cooperation between the doctor and the patient. But you you must know there is a reasonable limit to these things. If you're seeing a doctor who has completely misdiagnosed you, no amount of patience and faith is going to make that work. Not all meds work for all people, and not all doctors work for all people. Tell me then how long is long enough? How much snake oil do you drink before you decide it maybe doesn't help?

"doctor hopping" in my case probably saved my life. I respect your choice to stay with a doctor for 4 years if that's what worked for you, but you have no right to judge or condemn my choices on treatment.

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If you're seeing a doctor who has completely misdiagnosed you, no amount of patience and faith is going to make that work. Not all meds work for all people, and not all doctors work for all people.

I absolutely am not saying that all doctors work for all people, but you yourself said "She sincerely cared and listened to me. She had all the positive qualities that you described in your doctor." If that's the case, then why did you leave?

If you felt you were misdiagnosed, that's definitely a reason to leave, but this is the first time you mentioned that.

If you just felt "her methodology did not match with my neurology", you could've made the radical move of talking to her about it, instead of leaving what could have been a very productive relationship.

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My two cents: Start a daily mood chart, and find a good therapist. There are online mood charts, or you can make one with dates along the bottom, and mood scale of one to ten up the side, and then put an 'x' each day for your mood. It gives a quick visual for you and your treatment team, and is a more accurate assessment than the few days right before your appointment that you remember most accurately.

A therapist can help you learn some good skills to deal with your moods before they get out of hand. Also, most psychiatrists these days only do 10 - 15 minute medication management appointments (after a one hour plus assessment), and therapists do talk therapy so will usually spend 50 minutes a week with you. It's common to have both in the same practice, and if not, it can be helpful for them to stay in touch with each other. Good luck to you.

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