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Short periods of depression with agitation


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I've had a few periods lasting only about a day or two each where I am depressed, but very agitated.  I can't sit still, I'll pace, clench my fists, wring my hands, and sometimes let out an audible groan.  Despite all that, I would say that it was never severe.  It didn't interfere too bad with my day, and I wasn't violent or out of control in any way.  It was just annoying, nagging, and uncomfortable.  If it lasted more than a couple days it probably would have become a bigger problem.  I really can't say if anything triggered it.

I told my pdoc about it and he prescribed me gabapentin and hydroxyzine and told me to take one or the other when I'm in that state and they should help calm me down.  I'm actually now taking gabapentin every night as a sleep aid.  I couldn't imagine it doing anything for agitation.  I took a hydroxyzine once just to see what would happen and I felt nothing.

So I was wondering if my experiences with agitation sound familiar to anyone?  Is it more of a symptom of a depressive disorder or a bipolar disorder or something else?  So far I've managed without medication, but should I have something on hand?  What would be the best thing to take?

Oh, and I've never had any symptoms of anxiety.

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What does your pdoc think ? We can't diagnose, but I will say that it's possible to have a mood disorder that. Doesn't fit into the major categories. A lot of Dx require more sustained episodes, but that is not to say that something significant isn't happening. Docs often prescribe prophylactic meds like mood stabilizers to stop episodes before you start but u seem to have a more unusual situation so I'm not sure that the typical protocol applies 

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38 minutes ago, patents said:

I've had a few periods lasting only about a day or two each where I am depressed, but very agitated.  I can't sit still, I'll pace, clench my fists, wring my hands, and sometimes let out an audible groan.  Despite all that, I would say that it was never severe.  It didn't interfere too bad with my day, and I wasn't violent or out of control in any way.  It was just annoying, nagging, and uncomfortable.  If it lasted more than a couple days it probably would have become a bigger problem.  I really can't say if anything triggered it.

I told my pdoc about it and he prescribed me gabapentin and hydroxyzine and told me to take one or the other when I'm in that state and they should help calm me down.  I'm actually now taking gabapentin every night as a sleep aid.  I couldn't imagine it doing anything for agitation.  I took a hydroxyzine once just to see what would happen and I felt nothing.

So I was wondering if my experiences with agitation sound familiar to anyone?  Is it more of a symptom of a depressive disorder or a bipolar disorder or something else?  So far I've managed without medication, but should I have something on hand?  What would be the best thing to take?

Oh, and I've never had any symptoms of anxiety.

I had one of those last year. I think it’s more depression like though it could be mixed. Gabapentin took care if that for me. Hydroxyzine just added fuel to the fire in that case.

sort of had a mini one this week actually. Seems to be handled by switching to Wellbutrin ir which is sort of my middle ground between 150xl and 300xl.

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When I'm coming down from hypomania I often get short bursts of intense agitation where I feel a combination of depressed, overwhelmed and restless. Obviously for me, being on a mood stabilizer that controls the hypomania is the best long-term solution, and lamotrigine has helped cut that down a fair bit. I have had some breakthrough periods though of this and I've found that ativan helps in those moments. I discovered this when my previous psych had prescribed me ativan prn for anxiety and I decided to see if it would help since there is often anxiety mixed in for me. I don't really need ativan for pure anxiety anymore, but when I had some breakthrough hypo this summer that we didn't catch until I was already coming down and I was starting to experience more agitation and uncomfortable energy, current psych was ok prescribing ativan based on my reports of it previously working for similar symptoms and it seemed to work. I leveled off without crashing, which is always good. 

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18 hours ago, Iceberg said:

What does your pdoc think ? We can't diagnose, but I will say that it's possible to have a mood disorder that. Doesn't fit into the major categories. A lot of Dx require more sustained episodes, but that is not to say that something significant isn't happening. Docs often prescribe prophylactic meds like mood stabilizers to stop episodes before you start but u seem to have a more unusual situation so I'm not sure that the typical protocol applies 

I think he's stumped so he said my official Dx is "atypical depression."  It's without question that I have severe, major depression.  It, however, follows an unusual pattern.  I would have it in spells lasting 1-3 months starting in my teens and going through my early 20s.  Then I was depression-free for about 14 years.  Then it came back all of a sudden and lasted a couple months until it almost ended in my suicide.  That's when I started getting treatment for the first time.

After starting treatment, the periods of depression would get shorter as my treatment progressed (therapy and medication changes).  They would go down to a few weeks, then maybe a week, and now I'll have depression for only a day or two at most.  It also now seems to be triggered, whereas before it was random.  The times in between I'd be fine, not depressed at all.  Things started getting a lot better when i started lamotrigine.  I've been very stable for months without much depression to speak of.

Last spring I was in a severe depressive state and one afternoon a switch flipped and I'm 99% sure I went hypomanic (which seems backwards, a lot of people seem to go from mania and crash into depression).  For the next five days I had many classic symptoms.  Talked a lot, started a lot of projects, decided to paint a room at 10pm, went shopping and bought too much.  It happened a couple more times, but would only last 3-5 days.  The first time or two felt great.  The last time was just exhausting.  This was before lamotrigine.

Sprinkled here and there were a few days of the agitation I mentioned earlier.

After the hypomania, pdoc said I was on the bipolar spectrum, and while he personally doesn't adhere to the subtype designations, he said it would be considered BPII.  At my last appointment when I asked about my present Dx he said I wasn't on the BP spectrum at all since my manic symptoms didn't last at least two weeks.  I guess he didn't look at my chart (or didn't make a note of it at the time).

I don't really care about Dx labels other than I really wish I could put a name on it for my own peace of mind.  And some part of me kinda wants to be diagnosed with something severe.  I guess that's something for my next therapy session.

11 hours ago, thunder said:

When I'm coming down from hypomania I often get short bursts of intense agitation where I feel a combination of depressed, overwhelmed and restless. Obviously for me, being on a mood stabilizer that controls the hypomania is the best long-term solution, and lamotrigine has helped cut that down a fair bit. I have had some breakthrough periods though of this and I've found that ativan helps in those moments. I discovered this when my previous psych had prescribed me ativan prn for anxiety and I decided to see if it would help since there is often anxiety mixed in for me. I don't really need ativan for pure anxiety anymore, but when I had some breakthrough hypo this summer that we didn't catch until I was already coming down and I was starting to experience more agitation and uncomfortable energy, current psych was ok prescribing ativan based on my reports of it previously working for similar symptoms and it seemed to work. I leveled off without crashing, which is always good. 

As I mentioned above, lamotrigine has worked wonders for me.  It has done exactly what it's supposed to do - stabilize mood.  It has stabilized the depression cycles.  Although I kinda miss hypomania (my memory focuses on the good parts).

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4 minutes ago, patents said:

I think he's stumped so he said my official Dx is "atypical depression."  It's without question that I have severe, major depression.  It, however, follows an unusual pattern.  I would have it in spells lasting 1-3 months starting in my teens and going through my early 20s.  Then I was depression-free for about 14 years.  Then it came back all of a sudden and lasted a couple months until it almost ended in my suicide.  That's when I started getting treatment for the first time.

After starting treatment, the periods of depression would get shorter as my treatment progressed (therapy and medication changes).  They would go down to a few weeks, then maybe a week, and now I'll have depression for only a day or two at most.  It also now seems to be triggered, whereas before it was random.  The times in between I'd be fine, not depressed at all.  Things started getting a lot better when i started lamotrigine.  I've been very stable for months without much depression to speak of.

Last spring I was in a severe depressive state and one afternoon a switch flipped and I'm 99% sure I went hypomanic (which seems backwards, a lot of people seem to go from mania and crash into depression).  For the next five days I had many classic symptoms.  Talked a lot, started a lot of projects, decided to paint a room at 10pm, went shopping and bought too much.  It happened a couple more times, but would only last 3-5 days.  The first time or two felt great.  The last time was just exhausting.  This was before lamotrigine.

Sprinkled here and there were a few days of the agitation I mentioned earlier.

After the hypomania, pdoc said I was on the bipolar spectrum, and while he personally doesn't adhere to the subtype designations, he said it would be considered BPII.  At my last appointment when I asked about my present Dx he said I wasn't on the BP spectrum at all since my manic symptoms didn't last at least two weeks.  I guess he didn't look at my chart (or didn't make a note of it at the time).

I don't really care about Dx labels other than I really wish I could put a name on it for my own peace of mind.  And some part of me kinda wants to be diagnosed with something severe.  I guess that's something for my next therapy session.

As I mentioned above, lamotrigine has worked wonders for me.  It has done exactly what it's supposed to do - stabilize mood.  It has stabilized the depression cycles.  Although I kinda miss hypomania (my memory focuses on the good parts).

I used to have a pdoc who was inconsistent with her diagnosis. It was very frustrating. Maybe I am wrong but I thought hypomania doesn't have to last two weeks.  A quick google search and I read this: "At least three of the following must be present (for at least four days) before the diagnosis of hypomanic episode is appropriate:

  • an inflated or expansive and even grandiose (but not delusional; not completely out of touch with reality) sense of self 
  • reduced sleep needs compared to normal
  • talks more than usual
  • subjective sensation of racing thoughts (often called a "flight of ideas")
  • distraction or derailment of thought occurring significantly more often than normal
  • an increase in goal-directed activity, or physical agitation
  • a marked increase in participation in risky but pleasurable behavior (such as unprotected sex, gambling, unrestrained shopping, etc.)
 
Maybe you should bring it up again...

 

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6 hours ago, Butterflykisses said:

A quick google search and I read this: "At least three of the following must be present (for at least four days) before the diagnosis of hypomanic episode is appropriate:

Maybe you should bring it up again...

When he said it I knew that the DSM criteria was either four or five days.  I wasn't going to correct him.  He's a cool dude, and I'm getting appropriate meds from him, so I'm not going to cause trouble with him.  Honestly I'm just going to wait and see what happens with me.  Last spring was triggering (which apparently is a thing), so I'll see what happens this spring (although I'm now on a mood stabilizer).  If it happens again I'll take note of everything and report back to him.

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