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What is acceptable?

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It's really up to you. like, really, you have to decide, what are you willing to put up with in order to live your life. For some people, it's minimal symptoms, and some, side effects, and apparently, some people choose to turn into their illness, and live their lives completely under the control of whatever. Personally, I think total remission is a rather lofty idea, but if you're willing to do all the work to try and get there, and put up with a lot of shit in the hopes that it'll end, its your choice.

Discouraging as my answer may be, I find it to be the truth.

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Heya jillbelle,

Yah, depends on what your *own* comfort level is.

I want to be okay.

And I would *like* to be happy.

I'm working to be whatever-stable-is.

My goal is remission.

We'll see how that goes.



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I think "remission" differs with everyone.  It (like what others have said) depends on where you're the most comfortable in your own body, happy and functional. 

You should also evaluate what it is you think remission is.  A "normal" person is not ever void of emotions and feelings.  Even they have bad, unstable days.  No amount of medicine in the world can take that away unless you're in a stupor.  Don't get scared off by your own natural emotions and reactions. 

I've just recently become stable for the first time in my life.  After Christmas when the kids were back to school, and I had returned to work, I was very tired, edgy, restless and crabby.  When I got home and I panicked that I was going hypo.  My DH said, relax, this is normal!  I'm feeling the same way!

And yes, therapy is a must IMHO.  It will help you figure out where your own level of "remission" is (unfortunately, "remission" is an ever changing event - most likely).  It will also help you sort out your emotions and what might be contributing to your depression and triggering events.

Good luck!

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Hi Jill:

He says to go for the least amount of meds possible, and use therapy and my inner resources, coping skills, etc. for the rest.


When I started with my current pdoc, he stated up front and quite clearly that medication would only solve part of the equation, and that therapy and hard work would be unequivocally requisite to truly get well. It sounds like your pdoc is telling you the same thing.

For what it's worth, my pdoc was spot on in his assessment.

But I want more meds, dammit. I want a magic bullet.

I flip out on every SSRI, and have been on too many drugs to list.


It sort of sounds like you have answered your own (unasked) question.

Does therapy help?


For me, absolutely. I think the key is to find a good therapist and to find a compatible approach (e.g., in my case, Mindfulness-Based Cognitive Therapy, not so helpful, but Cognitive Behavior Therapy is a great fit). Your pdoc may be able to make a solid recommendation.

Is my goal for perfection unrealistic?


Yes. But remission is not.


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I just want to be happy, at least as much as possible.  If it means being sad sometimes, then that is OK.  I spent many years feeling almost nothing at all and would never go back to that way of life.  So, complete remission, or failing that, as good as I can get (meds and side-effects included).


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I don't know if I'm a weird case or what, but my pdoc has said to me that therapy and all the talky shit won't do anything for me. For me, it's all chemical at this point. Maybe it's because I come to the game already fighting it mentally... I don't know.

But we've also talked about what is acceptable. I think it's an important discussion to have with any doctor, psych or otherwise, just so you're on the same page in approaching treatment.

For me, on our what we both agree is bullshit 0-to-10 scale, with 10 being bad and 0 being absolutely perfect, the minimum we will accept as success is 2, all the time, with no dips further down. (We've only been dealing with depression, as I haven't been manic since I've started seeing this doctor.) That's above functional, but not necessarily total remission.

Of course, total remission is the gold standard. And if I could get to 0, that'd be great. But for now, 2 is the worst we'll accept and say that I'm doing ok on my meds and nothing needs to be changed.


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Sorry to say there's no magic bullet.  Maybe some of us have complete remission just from taking meds, but most of us need to take care of other parts of our lives.  I use two very important methods: lifestyle and therapy.

Lifestyle = getting enough sleep, not drinking or using recreational drugs, paying attention to my moods to catch things before they get out of hand, being honest with my pdoc and tdoc, staying away from destructive relationships, eating OK if not well, that sort of thing.

Therapy = sort of a modified cognitive therapy, in my case.  I've got a Jungian therapist who alternates between cognitive and traditional therapy as I need it.  I couldn't have survived before medication without her, and now that I'm on the right meds I'm making progress by leaps and bounds, making friends with my animus at the same time that I'm noticing how I treat people and starting to change those nagging self-criticizing thoughts into self-support.

Here's the more tedious version: After flipping out on wellbutrin alone my pdoc added depakote.  I was so, so grateful to not be in a mixed state that I took the depakote and wellbutrin for about 5 years, through weight gain, tremors, and residual anxiety and irritability and occasional cycling.  Then I found out I had developed insulin resistance and switched from depakote to tegretol, and when that was a disaster from tegretol to lamictal.  I now can't believe I stayed on depakote for so long; I'm now no more anxious or irritable than the average person and can think clearly.  On the other hand, having realized what a wreck my life was because of MI, I was grateful to depakote for keeping me about 3/4 well.  Now I'm about 90% well, sometimes more like 95%.  I think that's great and am glad I took the risk and went through the unpleasantness of changing meds.

So back to your basic question: it depends.  It depends on how bad your original problem was and how debilitating the side effects of your meds are.  One thing to remember is not to judge how you're doing until you're taking optimal levels of the meds you're on.  That being said, if you've been on your cocktail for a while and are having significant (life-affecting) mood problems then I'd say the cocktail isn't working.  That means your pdoc should be trying either new dosages, new combinations, or entirely new meds.  It strikes me--and take this with a grain of salt--that Trileptal isn't a very strong mood stabilizer for many people, and Klonopin, according to crazymeds, is the benzo most likely to cause depression, and benzos aren't actually good stabilizers at all.  If the klonopin isn't controlling the anxiety and depression it doesn't make sense to me that he's unwilling to try something else.

The thing is that if your pdoc is scared that your mood will flip and you might hurt yourself he may be reluctant to change anything.  But less isn't more.  It's nice if you can do well on one or two meds.  But you're not doing well.  You deserve to do more than just survive.  If he isn't willing to work on making you well maybe you need to push a little.  My old pdoc was very reluctant to try anything besides depakote, but he worked mostly with inpatients in crisis, so me being able to hold down a job seemd wonderful to him.  Now I feel really, really good.  I'm glad I took the risk and went with a more modern, but still quite conservative, pdoc.

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Heya crazies,

One play of the doctor card and that's it, I promise.

My hypertensive patients don't always achieve 120/80, but I keep working to get them there.

Meds, lifestyle, diet, exercise, stop smoking, get off caffeine.

My diabetics don't always get to a blood sugar of 6.0 (no idea what that is in US units, sorry) but I keep working to get them there.

Meds, diet, exercise, weight loss, bloods every 3 months, urines every 6, eye exams, foot exams, stop drinking, stop smoking.

Wackos like us don't always get to stable.  But I keep working to get us there.

Meds, diet, exercise, routine, CBT, other kinds of therapy.



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I think you should work on perfection. Less than a year ago I said to my doc "is this the best it gets"? He said no. He wanted me to go to a pdoc. Waves of shock ran thru me. At 55 yrs. old I was just now going to get the help I needed.

Med after med had not worked for my depression. No mania here.

My pdoc & I have tried different combinations of meds and finally hit on a satisfactory combo now. Lamictal, abilify & xanax.

My point is, keep trying. There's bound to be a med or combination that will work for you. Yes, you can feel good at least part of the time.

Hope I made some sense.


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What is acceptable, remission or amelioration...


If you personally feel fine with the way you are, then stay on your current meds and therapy (and hopefully your situational stuff).  As the German band Megaherz once sang (God I love translating from German bands, despite not having one drop of recently-German blood in me), Es liegt nur an dir in their song Teufel (Devil), meaning "It's all up to you".  Actually, the context of it has NOTHING to do with this situation, but still I like gratuitously quoting this crap. =P

For example, I'm personally rather happy with my current meds combo (granted it's rather large, but still, not so damaging to body and brain, given what the PI sheets say). 

I still have my off-days.  Especially if I'm triggered.  Sometimes it's so bad that I feel bad for a full 48 hours or a little more and might have to drink it off (with my legendary alcohol tolerance in consideration, too, this is BAD!!!!) to prevent going completely off the handle at/to/towards/in the general direction but not directly at someone.

Personally, I consider the above situation *occasionally* VERY uncomfortable as I'm way too sensitive (esp. for a guy), but overall my treatment plan and results, to me, are quite satisfactory.  I don't think a 'normal'/'neurotypical' individual fares too too much better than I do, under poor conditions like that.  I'm happy 95% of the time... for me that's enough, since before, I was only happy, oh, maybe 10% of the time, if that... until I was fixed up under a combo of meds that started in 2005 (so that'd be about 10-12 years of shittiness).

Er, I'm sure someone has repeated all this somewhere in the thread, but I'm too lazy to look upwards in the thread.  Besides, I'm a member of the Department of Redundancy Department.  heheheheheh

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