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Unipolar quick cycling depression ?


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Hi,

 

I just want to find somone who is maybe going through what I am. I'm not sure if I'm heading towards a BP diagnosis, but for now my pdoc denies it.

I have suffered from anxiety/ocd/depression in the past but this phase (for 15 months) is by far the worst.

I do a simple mood diary and it seems that I have a pretty regular 'cycle' of 8-10 good days followed by a bad patch - usually about 4/5 days. This pattern has been happening for over 6 months or maybe more (was not strict with mood diary before then).

I feel ok and quite positive for a patch and then my mood suddenly drops over a day and I get the self-loathing, anxiety attacks, sometimes ocd disturbing thoughts.

I have been on a low dose of clomipramine (anafranil) for about 25 years ! Currently on 60mg. I can't seem to tollerate the side effects. I get massive anxiety whenever I increase. It has taken me over a year to increase from 40 to 60mg.

I am also on 25mg Pregabalin (lyrica) and recently on 50mg lamotrigine (lamictal). The lamotrigine seems to have sent my anxiety through the roof (during my bad phase) and I feel 'dumb' and get headaches. Early days I know and also another subject.

 

Just wanted to know if anyone has had a similar quick cycling depression. I don't think I've had any hypomanic or manic phases (and nor does my pdoc). I just feel like an 'anomoly'.

 

s44

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s44 -

Welcome to Crazyboards. We hope you find the discussions here useful, and find what you're looking for. You'll discover many people here dealing with the many flavors of depression, and you've come to the right board to ask about unipolar depression, or Major Depressive Disorder (MDD). MDD, however, is not cycling in the way that bipolar depression can cycle between depression and euphoric states. Sorry, it just doesn't. That's one characteristic that mental health specialists use to diagnose it. What you might discuss with your doctor, however, is the possibility that you may be experiencing comorbid (occurring at the same time) dysthymia. Dysthymia is a depression-like feeling which may not be as deeply depressive, but may seem to go up and down more frequently. When MDD and dysthymia are found together, it is commonly known as double depression. That's the situation I'm in, and have been in for decades (but mine is treatment-resistant, so don't panic. Yours may respond just fine).

Or, your doctor may find that you are, indeed, on the bipolar end, but that's not so terrible either - it just means a slightly different approach to treatment, and there are effective treatments. Be open to both medicine and talk therapy, because studies have found that when a patient uses both together, improvement happens much quicker.  You'll get there.  You don't have to feel this way.

Stay with us, and let us know how you're doing.

 

Cerberus

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I have wondered at times if I am cycling but, like Cerebus, my diagnosis is double depression, an awful name if I ever heard one. 

I have days of relative calm and normality, days of despair, days of anxiety, days of every emotion available.  I would not call myself manic however. But too many days of definite depression, where I slink down the rabbit hole full of muck and mire by an ill wind that blows no good. 

Over the years I have noticed that most of the people i know who suffer from MDD have different symptoms only in regards to the TIMING. I generally do not go for months at a time depressed. Only for days or weeks.  And when I am not deeply depressed, I can be filled with despair or that grey feeling that colors everything around me - dysthymia. 

In the very beginning of my med search I was only taking wellbutrin.  It was not until I added lexapro that my major depression situations slowed down somewhat.

Lately in the last few years I have been searching out triggers. I find that when I am doing well and my mood suddenly plunges, there is usually a trigger. My depression is triggered by my childhood.

But we are all different. All this to say: The meds, therapy, mindfulness, all of this can help.  You are not an anomaly.  

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The only way my MDD cycles is going from bad to worse to baseline to bad, etc. For this reason, a mood stabilizer (Tegretol) keeps me from falling down into the worst of the worst and helps me quite a bit. 

Have you shown your mood diary to your psychiatrist and talked to him/her about this cycling? 

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I have the double depression flavour as well. To an outsider, I guess my mood "cycles" in the sense that there are times when my outlook on life, myself, others and the world is depressive and I have depressive symptoms, but they don't control my life and functioning as much, and it seems to be more cognitive than emotion, but then there are times when I can hardly function at all and basically sleep my existence away and the suicidiality is worse. 

I can't tell the difference, because I have been in this current additional major depression for so long. I kind of wonder now how much of my depression is dysthymia and how much is major depression, but I am too stuck in it to notice or have any hope of better, more manageable existence. 

Mine seems to be made worse by the fact that I just look depressing to others (yes, they say that) and I am very negative, that is just part of my personality. So mine really gets shrugged off as normal, given my upbringing. 

I have not yet experienced any kind of remission, I have always been in either a dysthymic episode, or a major depression with dysthymic features, so I can't say that my mood has ever "cycled" out of depression. 

I personally don't call it cycling, its not really fitting. I would say that my mood is able to fluctuate within the depressive side of the mood spectrum, if that makes any sense. But for now, its constant doom that ruins my functioning, and has been that way for quite some time. 

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Thanks for all the replies !

I know that a BP diagnosis doesn't fit I guess. Fluctuation is a better word. It's just the massive mood drop that occurs.

In my 'good' days I can sit down and force myself to think about the same things and they just don't have that effect. I can't even imagine what it was like to feel that despair when I'm ok - even though it was just days before. Then over the course of a day or two my mood goes and the anxiety starts with it. Sometimes the OCD too.

I also feel that the lamictal has made things worse. My anxiety has been so bad today and I don't know how I got through the half day of work I went in for. I just had a massive crying spell in my toilet at home. I feel very hopeless.

Sorry. Just very low. I want to say more but can't collect my thoughts.

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  • 3 weeks later...

I know this thread is a little old, but what you're going through sounds somewhat similar to me, except I do have a BP II diagnosis. Hearing about "double depression" makes me wonder if that fits me more accurately, or if my lack of distinct hypomania has just been successfully treated by the meds I'm on. 

A pdoc diagnosed me when I was fairly young, around 14-15. I'm not sure if I ever truly exhibited hypomania. If I did, I think it was somewhat atypical if there is such a thing. I have been on a mood stabiliser since then (lamictal) and I think it has helped. 

What does happen to me is, like you said, a period of feeling ok or even good and then suddenly spiralling down into deep deep despair. This sometimes presents as intense "numbing," not being able to physically move, and wanting to disappear, other times inconsolable crying and agitation with a side of self loathing. This can go on for a few days or weeks. Then I pull out of it, and also like you, can't even remember exactly what it even feels like to be that depressed (this causes me to think "I'm not really sick, I just fake it or I'm lazy").

For me, I think the mood stab. plus an AD PLUS an antipsychotic (plus a couple other things for sleep and focus), make the periods between spiralling down longer, so yay? 

I don't have any concrete advice really, just wanted to say that you definitely aren't alone with your symptoms! 

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  • 1 month later...

A very late thank you for your input Omnishambles.

I was going through a mood drop and searched on 'mood drop' and 'self loathing' and found my own damn thread. Don't you hate it when that happens ? :)

Things got pretty bad after my last post. I went into hospital for a few days. The annoying thing was that I felt fine once I was in there.

I'm still getting the mood drops but I think they may be lessening. I'm now on 10mg of lexapro (in addition to my clomipramine) and I think it may be helping a bit. I had a very rough time from side effects though - very bad constant anxiety - but they seem to be wearing off.

Still no change to my diagnosis. The doc still thinks depression / anxiety / OCD and maybe a touch of ADD (what a great mixture).

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I just want to add on to my reply above. Mood stabilizers like lithium, Tegretol, Trileptal, Lamictal, etc. are not just used for bipolar disorder. They  can be used effectively as adjuncts to antidepressants in people with unipolar depression. I know I'd be dead without them and I have unipolar depression. 

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Hi jt07

Yes, that's exactly what my pdoc said.

I was put on lithium as the first thing she tried after increasing my clomipramine (which didn't help these massive mood drops).

I started in 200mg but felt so flat, even during my good days that when I went into a spiral I was worse than before. I know I wasn't on a therapeutic dose but I chickened out and came off it.

Next we tried lamactil. That made me feel dumb and my anxiety went sky high so I came off that too.

Next we tried Wellbutrin. Started well on that but then massive anxiety. A lot of people say that is 'activating' for them. As I have a massive anxiety element, it was not good for me.

Now we are trying escitalopram (lexapro). Had some very bad anxiety but at last things seem to be calming down as far as side effects go. Here's hoping it does something.

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Hi jt07

Can you share more about how you came to take mood stabilisers for unipolar depression ? You mention quite a few. What was your experience of the side effects of lithium and lamictal and what doses were therapeutic ?

s44

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I was given lithium as an adjunct to my antidepressant years ago and the therapeutic level for lithium has to be determined by a blood test so the dose I took has no relation to the dose you might have to take. Side effect wise, I only got tremors and some thirst.

I take Lamictal now and the effective dose for me has varied between 200 mg and 300 mg. I have no side effects now from the Lamictal. However, I experienced a rocky titration up until about 100 mg or so, After that it got easier and all the initial effects went away once I got to 200 mg and stayed there for a while.

My favorite mood stabilizer is without a doubt Tegretol (carbamazepine). This has been my savior drug. I found out about it when a GP prescribed it to me once when antidepressants didn't help. I have no side effects from it now. Both Lamitctal and Tegretol gave me a headache when titrating up but now they actually prevent headaches. 

As far as how did I get to take mood stabilizers for unipolar depression, mood stabilizers are a tried and true method of augmenting antidepressants. It is not unusual for someone with unipolar depression to be taking a mood stabilizer.

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Thanks jt07

I wondered about your lithium dose because I heard that the dosage for unipolar was usually lower than for bipolar.

i wonder if I gave lamictal enough of a try. I had bad anxiety after a couple of weeks on it. I think I was only on 100mg, not sure now. When I came off it suddenly my mood seemed to get much worse and I ended up in hospital for a few days. Maybe something worth thinking about if my latest AD doesn't give me some relief.

s44

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Hi s44, I've not been on mood stabilisers yet, but find that I can get very abrupt mood changes. In the past trying different ADs has been ok for a while but then made the rollercoaster far worse with big ups & downs. The current one (Prozac) is the only one that's been bearable so far, but even then I still have got the acute, intense stone-on-chest so I'm not moving & feels painful sort of feeling - once it came on in the middle of the day & that was it - bed until the next day, but then it had eased up. This happened as I was recovering from a long few months in a black hole so whether it was again meds related or just part of the healing ups & downs I can't say. I do have to be on an AP as well, for anxiety, but again wonder if the Prozac is activating that a bit. I do know that coming off meds in the past has led to a very rocky time emotional stability-wise, as the biochem mix in body & brain is changing. Bleh I think I'm not expressing this very coherently - just yes I recognise what you describe & it's not just normal dips either.
My pdoc really didn't listen when I tried to explain that I'd had stressed-but-hyper periods too, but I'm not bothered about the label  so much as just getting to feel more stable (not saying it's a bad thing to know a dx, just often in psych it's not clear & they use 'working' diagnoses and trial-&-error because of that). I had to make peace with knowing I just feel how I do, regardless of whether anyone listens or not, and if I get the help to function better that's my current priority. I hope you find a meds combination that works better for you, and a pdoc that is willing to try!

Edited by Silverdraig
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They dosed my lithium according to the therapeutic window - blood tests and all. In those days, they didn't know anything about taking a lower dose for unipolar depression.

If you were only on Lamictal for a short time, I'd say you might want to retry that. Yes, it can increase anxiety a lot when titrating up, But as I said, once you got up to aboiut 150-200 mg and stay there for a couple of weeks, the anxiety will go away. I can promise you that because I also had anxiety going up on Lamictal. On paper, Lamictal looks like it would be the perfect med for you.

Talk to your doctor. You have quite a few options.

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Thanks for your input Silverdraig and jt07. Much appreciated.

My mood has plummeted today. I stayed in bed till midday (which was a mistake) and have been feeling very low. Took some Xanax to stave off anxiety but it made me tired. I fell asleep again and woke in a panic and state of despair. Self esteem is at zero. Have been out swimming with my youngest son but it didn't improve my mood. I just hate this 'roller coaster'. I'm still getting 12+ good days and then I go into a spiral of anxiety and despair. I just hate myself and can't see anything good to cling too. Everything is negative.

I wonder if the lexapro is making the dips worse. Hard to say. They were awful before too.

I may have to speak to pdoc about trying lamictal again.

s44

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I'd support what jt07 says about giving it enough time to stabilise. I don't have experience with Lamictal, but certainly with the ADs & APs & pregabalin I've been on I've had to give it longer to get over the negative side effects & reach a steady state where I know any remaining SEs are likely to stick around. Only then can I see how I feel overall & is it on balance better or worse on diff meds or new amounts of meds. The transition period isn't representative of the medium or long term state, but for Prozac for example it took two months to settle each time I changed dose, with quite emphatic muscular spasm side effects & anxiety so it wasn't a picnic, but now it's manageable and I'm on max dosage. So...give it time. I reason that if I'm going to feel crap I may as well wait and make sure it's a permanant crap with net detriment to my mood before ditching the meds. What have you got to lose when it might just give you that bit of extra help? As long as you're not going up the wall of course.

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If you do decide to give Lamictal a try again ask your doctor if you can take it with the Lexapro rather than instead of. That's a pretty good combination. I don't take Lexapro but I take Celexa (same psychoactive molecule as Lex), and it really helps, especially with anxiety. Lexapro can take a few weeks to work, and I doubt it is the cause of your recent mood dips but, of course, anything is possible. You can also go up on the Lexapro because 10 mg is perhaps the lowest generally accepted therapeutic dose.

I should add that the Lamictal titration is slow. Sometimes painstakingly slow. By the time you reach a therapeutic dose of Lamictal, you will know whether the Lexapro is working or not.

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Once again thanks for your advice and input. I'm in a dark place today.

Silverdraig - I don't plan on stopping any meds without discussing with pdoc and I will try to stick it out to see if things change.

jt07 - I probably wasn't clear in my post. I did mean that I'd add lamictal to what I already take (if I were to try again).

I'm just suffering from this massive self esteem drop. As I first detailed, I have this variation of mood - 10-12 good days followed by 5-7 bad. The difference now is the depth of my hopelessness. I see myself as a 'shell' of a person. I hate myself and my self esteem is non existent. I can't seem to 'see' me doing anything. Everything I think about end up being a comparison with other people.

I just don't understand why this happened. I have a good job, a lovely family (3 kids) and I have always been a sensitive and kind person. I just see myself as a bitter wreck now. I just don't get it.

Sorry for the rant.

s44

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I can relate to a lot of what you wrote. My advice would be to try as much as you can not to compare yourself to others. It's a natural thing to do, but it almost always ends up with you losing the comparison. I think that is true for everyone except maybe narcissists. I do realize that it's easier said than done.

So here's hoping that the Lexapro kicks in and that your doctor puts you on the mood stabilizer.

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