# What is "normal"?



## Aims (May 9, 2005)

I've been clinically depressed since 1998.  I've been on Prozac and Effexor which both seemed to help, but I had a good three years without medications.  Within the last year I kind of "crashed" and can't seem to pull myself out of it, even though there is no significant drama or anything to be depressed about in my life.  In September I was diagnosed as bipolar, and started on Symbyax,  but I don't really buy that diagnosis.  I don't feel like my "ups" have ever been harmful, other than some heavy drinking binges and sleeping around (most of my single friends in their 20's have been through this stage...are they all bipolar??).   At my last psychologist visit, I was basically told that I was Manic-Depressive, Obsessive-compulsive, Alcohol Dependent, with an anxiety disorder.   That's supposed to make me feel better about myself?

I'm frustrated because unlike heart problems or diabetes, there's no real way to test seritonin levels (is there?) and actually diagnose these diseases.  Doctors just go off subjective symptoms and prescribe medications based on those....  sometimes it seems like it takes years to finid the right combination, but who wants to be in misery that long? 

I'd been sleeping a lot on the Symbyax (like 14 hours a day) and just really didn't feel any emotions about anything.  I guess that's the point, but I couldn't function.

This last month and a half has been a dark one.  I've been severely depressed, and for the first time I've had suicidal thoughts, and it scares the crap out of me.  I mean, I'm constructing a suicide letter in my head, thinking of all the things I'd say to everyone in my life.   I told my psychiatrist this last week and he didn't seem very concerned about it.  He said it was a normal part of depression.  He took me off the Zyprexa, kept me on Prozac, and is going to put me on Wellbutrin.  He seems more concerned with my "ups' than with my depression.   Should I be finding a new psychiatrist??  I'd take the ups any day over this depression I'm having.

I just don't know what to do.  I have a lot of friends who don't understand, and a few who do.  I used to be great at emailing and calling people back, but I just don't want to talk to anyone anymore.  I can't find the energy to do anything enjoyable, I cry for no reason, and I am just not myself. I haven't been drinking at all, I hardly go out.  For the last week, I haven't been able to eat, I throw up everything I try to eat, and I have severe intestinal cramping and diarrhea.  Would this have anything to do with the medication change?

One other thing, I started on birth control at the end of March, and ironically that seems to be when all my problems started.  Does anyone know if birth control and antidepressants are a bad combination?  

I am scared and feel alone, and I hope there is someone here who feels my pain.  Thank you for listening.


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## David Baxter PhD (May 9, 2005)

Aims said:
			
		

> In September I was diagnosed as bipolar, and started on Symbyax,  but I don't really buy that diagnosis.  I don't feel like my "ups" have ever been harmful, other than some heavy drinking binges and sleeping around


I don't know you, Aims, of course, but I would point out that bipolar individuals usually *don't* feel the hypomanic or manic phases are harmful. Subjectively, you may feel better than "normal" during those times -- objectively, you are probably not doing very well at all.



> At my last psychologist visit, I was basically told that I was Manic-Depressive, Obsessive-compulsive, Alcohol Dependent, with an anxiety disorder.   That's supposed to make me feel better about myself?


If you can use that input as a way of more closely examining yourself and your behavior, it may indeed be helpful. In order to acquire motivation for change and the means to do so, one must first identify the problem.



> I'm frustrated because unlike heart problems or diabetes, there's no real way to test serotonin levels (is there?) and actually diagnose these diseases.  Doctors just go off subjective symptoms and prescribe medications based on those....  sometimes it seems like it takes years to find the right combination, but who wants to be in misery that long?


Actually, you can test serotonin levels (and the levels of the other major neurotransmitters), although the tests are expensive and not generally covered by health care insurance, and the results won't tell you everything you need to know for a diagnosis in any case. A good diagnostician isn't just going on guesswork, although there is some hypothesis testing sometimes that is part of the procedure. You are correct that sometimes finding the right medication involves some trial and error, which I understand is very frustrating to the patient, but the end result is worth it...



> I'd been sleeping a lot on the Symbyax (like 14 hours a day) and just really didn't feel any emotions about anything.  I guess that's the point, but I couldn't function.


I presume you have discussd this with your doctor? Of course, this may be a symptom of your deepening depression rather than a side-effect of the medication, but you should discuss this with your physician in any case.



> This last month and a half has been a dark one.  I've been severely depressed, and for the first time I've had suicidal thoughts, and it scares the crap out of me.  I mean, I'm constructing a suicide letter in my head, thinking of all the things I'd say to everyone in my life.   I told my psychiatrist this last week and he didn't seem very concerned about it.  He said it was a normal part of depression.  He took me off the Zyprexa, kept me on Prozac, and is going to put me on Wellbutrin.  He seems more concerned with my "ups' than with my depression.   Should I be finding a new psychiatrist??  I'd take the ups any day over this depression I'm having.


If he has discontinued the Zyprexa and added in Wellbutrin, that would indicate that he is not more concerned with the "ups" than the depression... he has now put you on a second antidepressant, which suggests that he is indeed taking you seriously.



> One other thing, I started on birth control at the end of March, and ironically that seems to be when all my problems started.  Does anyone know if birth control and antidepressants are a bad combination?


Not necessarily but it is an individual thing and there is a reciprocal interaction between brain chemistry (serotonin, dopamine, norepinephrime, etc.) and hormones which are affected by birth control pills. If you haven't already discussed this with your doctor, please do so soon.


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## sonoffaith (May 9, 2005)

I don't know how you feel, but I understand what it feels like to not want to do anything. I know how it feels when you feel the world crashing down on you. I am going through depression as well. You are not alone many people have been in the state of mind that makes you feel like giving up. But don't! Hang on life is worth living. Hope is always alive even in your darkest moments there is a part of you that still wants to try a part that still want to live. If this wasn't true suicide wouldn't be so hard to commit. Hang in there. You have a lot of people here at this forum who can try and help you who can try and comfort you. Best wishes for today and the rest of you life.

- A son of faith


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## wondallace (May 10, 2005)

Aims, I tried to pm you, but some general error ocurred


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## ThatLady (May 11, 2005)

It's pretty common, I think, for bipolar individuals to find it difficult to understand why the hypomanic stages are a bad thing. After all, you feel pretty good, eh? Problem is, that high is bound to be followed by a low. It's the nature of the disease process. I always found, in my daughter particularly, that the higher the high, the worse the depression that inevitably followed was.

I'd definitely speak to your doctor about the way you're feeling. There could be some medication interactions causing problems, since people react differently to different medications based on their own, unique, chemical structure.


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## Aims (May 13, 2005)

I seem to have a hard time distinguishing my manic phases from my states of anxiety.   With both, my head spins, I am overly productive and talkative, I can't sleep and I can't sit still.   Maybe I have ADD too?  For all I know the past 5 years have been one big manic phase and now I'm in the middle of a long depression.   Has anyone else experienced this type of thing?


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## HA (May 14, 2005)

Aims,

This may or may not be helpful to you but I thought it is worth putting out there. 

I recently attended a conference for families in Niagra Falls ON titled "Family Matters" which was hosted by theMood Disorders Association of ON  and the Schizophrenia Society of ON.

One the guest speakers was a psychiatrist who specializes in bipolar. He pointed out that when someone is startting to become manic they are essentailly overstimulated (anxiety?). This overstimulation becomes fueled by further exposure to stimulating events and continues to increase in intensity until a full mania episode is present.

This doctor stresses that it is at the beginning of the manic episode, when the initial overstimulation is starting, that the person needs to be removed from stimulating situations. So, you need to stop doing things that are stimulating (producing anxiety?) rather than adding more and more things to your plate in order to stop the manic episode.

What people with mania tend to do is continue to up the stimulation because they like it, but it inevitably gets out of control. By not fueling the stimulation through avoiding events or situations which increase stimulation, a full blown manic episode can often be avoided.


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## David Baxter PhD (May 14, 2005)

That's a very good description of the sequence/process, HeartArt. Those earlier stages are usually called "hypomania" and, as you so clearly noted, can be used as a way to head off a full-blown manic episode if the individual can be helped to identify it for what it is.


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## HA (May 14, 2005)

Oh...that's what hypomania is. 

Thanks


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## David Baxter PhD (May 14, 2005)

Yes... literally "under mania", like hypodermic means "under the skin".


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## Aims (May 15, 2005)

That makes a lot of sense!  Thank you!

Now, does anyone have any suggestions for reading materials or websites for my friends (especially my roommate) who have no idea how to cope with my depression/anxiety/bipolar disorder?


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## David Baxter PhD (May 15, 2005)

E. Fuller Torrey Fuller & Michael B. Knable. Surviving Manic Depression: A Manual on Bipolar Disorder for Families, Consumers, and Providers. HarperCollins, 2001

PsychLinks Resources on Bipolar Disorder / Manic Depression


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## HA (May 15, 2005)

Aims,

One book that you may find interesting for your own reading is An Unquiet Mind by Kay Redfield Jamison


She is a psychiatrist with bipolar and this is her memoir about her personal experience with the illness.

Wonderful and enlightening read. She has written other good books as well and her most recent book is titled Exuberance, The Passion For Life which I'm looking forward to reading.

All the best


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## David Baxter PhD (May 15, 2005)

That is a good book.

Also:

Jamison, Kay R. Touched With Fire: Manic-Depressive Illness and the Artistic Temperament. Free Press, 1996 

Berger, Diane. We Heard the Angels of Madness: How One Family Dealt With Manic-Depression. William Morrow, 1992

Duke, Patty & Hochman, Gloria. A Brilliant Madness: Living with Manic-Depressive Illness. Bantam Books, 1993 

Duke, Patty & Turan, Kenneth. . Call Me Anna: The Autobiography of Patty Duke. Bantam Books, 1988


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