Okay all you armchair psychiatrists...

[smallworld]

Yes, two ADs -- particularly since one is an SSRI -- are very likely to cause a switch to mania without the protection of a mood stabilizer in a person with BiPolar (BP). Even with the protection of an MS, most people with BiPolar (BP) can't handle two ADs.

People with BiPolar (BP) do well with the traditional BiPolar (BP) treatment of an MS plus an AP.

Most people with severe anxiety and/or depression require two ADs.

 

[klmno]

You ladies snuck in on me...I'll try to clarify but of course, gcvmom asked for an armchair psychiatrist so this is certainly not speaking from expertise- it's my opinion based on my knowledge of myself and my family and our experiences only.

Basicly, I'm agreeing with SW.

First, this person is showing a STRONG compulsion to "fix" something in herself. That tells me she has a susceptibility to addiction, but addiction isn't really the underlying issue- something is there that she is trying to "fix" and that is the underlying issue. The signs of anxiety are a problem but are also a symptom of a bigger problem. Example: a child is abused, has depression and anxiety, turns to drugs and sex. Is the problem addiction to drugs and sex? Is the problem depression & anxiety? Yes, but they aren't the underlying problem - they are "symptommatic problems"- the real problem is to uncover the trauma and treat that and teach the person how to better handle anxiety ridden situations and not have compulsive behavior in order to self-medicate.

If you look at behavior only- it could fit the BiPolar (BP) criteria, schizophrenia criteria, or probably a whole host of other things. Many tdocs and psychiatrists only look at the symptommatic behavior and treat that- like by giveing an anti-anxiety medication which itself is highly addictive- so the "real" underlying issue is never uncovered or untreated. Think about our difficult child's who are diagnosis'd as ODD. We know that a behavior contract alone will not really "fix" this because it is a symptommatic problem- not the underlying problem.

Now, going back to my original example scenario- if the anxiety and/or depression are CAUSED by a chemical imablance in the brain and not the RESULT of something else, then a medication is needed in order for the person to live a normal, healthy life. If the depression and anxiety are the result of something else, a medication might be needed temporarily, but it won't be the ultimate answer-- in the opinion of me and me therapist from my therapy years ago.

 

[gcvmom]

Interesting...

Well, I may never know what sister in law#2's issues are. Not that it changes anything. It's just nice to understand for my kids' sake so that when they are adults and wanting to talk more about this kind of stuff I'll know what to tell them.

husband's psychiatrist has said he feels husband has some type of mood disorder that was more on the depressive end, which explained why he initially did so well on Lamictal -- and it also helped him organize his thoughts and express his feelings better -- it was like he could never access the right words, perhaps because he was always emotionally flooded. But he has historically also had issues with compulsive shopping, gambling, sex-related stuff (I'll spare you the details), coupled with periods of intense concentration on things I'll call "projects" that he will just throw himself into and work on as if nothing else in the world matters (like laying thousands of bricks in our backyard in the middle of February (okay, so it's California winter, but it's still chilly) at night after work until 11pm, midnight with work lights set up so he can just keep on working and working and working (ended up giving himself carpal tunnel from that little project).

Well, thanks for the insight. Gives me more to think about.

 

[gcvmom]

klmno, what you say makes a lot of sense to me, too.

 

[smallworld]

klmno, I understand what you're saying.

But in some families, like mine, anxiety, Obsessive Compulsive Disorder (OCD) and depression are chemical disorders just like BiPolar (BP). They just appear out of the blue without an impetus like trauma.

In either case, I think medications AND therapy play an important role in treatment.

 

[klmno]

You ladies snuck ion on me again darn it! LOL! I just edited and added another paragraph to my previous post.

 

[gcvmom]

I understand (reread your edited post) about therapy being needed to address an earlier trauma that resulted in maladaptive behaviors. But sometimes that trauma can trigger a cascade of changes in the brain that cannot be fixed through therapy. Haven't there been studies that have shown there are sometimes permanent changes to the brain as the result of an extreme stressor/traumatic event?

It's been suggested that difficult child 2's bipolar was pushed into existence because of his Sydenham's episode. But there were signs of something being amiss earlier than that. Could be the potential was there, but the strep infection is what pushed him over the proverbial edge and caused some changes in his brain chemistry.

I can't see husband having suffered the same kind of emotional traumas as his sister who is 5 years older. He would have been 9 and at a different developmental stage. But then I'm not privy to what really happened then.

And then there's my own FOO. My dad had horrible emotional traumas as a child bumped from foster home to foster home most of his life and living in abusive environments. But there are familial mental health issues going back generations, even to his father's mother (who I'll bet was bipolar, or possibly schizoaffective based on stories of her behaviors that I've heard). And his own bio mom who was alcoholic, but not in the picture from the time he was 2 years old. You wonder which came first? The abuse or the mental illness?

And then I look at difficult child 1, whose anxiety is just something he seems to have been born with (although I have to wonder if his exposure in the NICU to heavy sedation medications -- he was in a medically-induced coma for two weeks -- did anything to change him or precipitate anything).

I guess medications can only address so much, and if you still have dysfunctional coping mechanisms, then that's where therapy can fill in the gaps and try to turn things around to a healthier way of living. I've been down that path myself.

 

[flutterby]

I haven't read the responses. But this sounds like Borderline. I would think welbutrin and prozac alone would throw a bipolar patient into mania. Bipolar and borderline look a lot alike.

 

[klmno]

Yes- I agree and think you are really hitting on the issues here. I'm not anti-medication and hope it didn't come across that way. I'm anti- "treat symptoms ONLY and be too unknowing or willing to look deeper" - for psychiatrists and tdocs. Yes, there are times that even if a trauma or being raised in a sick family who couldn't/wouldn't try to teach better skills can leave a person unable to function, be safe, or access therapy without medications. (Not to mention those who really started out with a chemical imbalance). I was just trying to point out that with the scenario you portrayed, there seemed to be a lot of behavior that pointed to a bbigger issue. WTH knows what that might be- but I am a BIG advocate for us parents to push tdocs and psychiatrists to not just treat symptoms in our kids but look for underlying problems and treat those.

And, when someone has shown a tendency to compulsive behavior with drugs, they do need to be extremely careful if they replace that with a rx from a psychiatrist. It is possible to never really get appropriate help because a person just replaced an illegal drug with a legal one, so they never do anything more to get help.

 

[crazymama30]

SW, I am with you. In a BiPolar (BP) person that would be a disasterous mix of medications. What about borderline personality disorder? I know that technically many of the medications they use for borderline are the same as BiPolar (BP), but for some reason I am thinking borderline.


Flutter, I just saw your response and I am all with you here.

 

[klmno]

And, you have to be careful about analyzing trauma survivors- it is very counter-productive to treat them like they can never have a "normal" life or be normal. That isn't to say that sometimes their brains might change, but really, brain problems are the minority. It is supportive of trauma survivors to support that they can be normal, are normal, and can live a normal life. This is because that whole anxiety and depression came from internalizing that they are "tainted".

 

[flutterby]

There are no medications to treat borderline itself. They use medications to treat symptoms as borderline is almost always comorbid with something else, i.e., depression, anxiety, eating disorders, bipolar, etc.

 

[klmno]

I missed your comment before, gcvmom- yes, I think there is ample evidence that if a child is born with a predisposition for bipolar, that a depressive situation or some other type of situation can "trigger" the BiPolar (BP). I have no doubt about that. But figuring out what is what is probably how we all ended up here. LOL!

 

[gcvmom]

I think I need to make a mental illness family tree.... it might help me make sense of some of this.

 

[totoro]

I need one as well!!! My family and husband's is so chock full of them and who knows what medications!!!
Watch you'll find out nothing is wrong with her! LOL

 

[gcvmom]

Oh, no way nothing is wrong with this woman, Toto! But I think a family medical tree will help me understand the big picture...

 

[DammitJanet]

Im gonna throw my hat in here for the possibility of borderline personality disorder. Many times it is treated with antidepressants. People with Borderline (BPD) can sound almost BiPolar (BP) and have anger fits and obsessions. They can be promiscuous. One of the telling things you mentioned is the lack of friends.

 

[Hound dog]

I'm throwing in for borderline as well. Most especially as she has past truama. It would fit well with how you describe her also. I dunno about what medications necessarily work for it though, so can't help you there.

 

[klmno]

Ok, I'm going to play devil's advocate here- but it's an honest question- If I hadn't gotten therapy and quit "those ways" and quit doing drugs and gone to college and turned my life around, would that have meant I was borderline? What if the reason I didn't do those things (but actually, I did) was because I didn't find a good tdco who understood the problem- what if I only got a psychiatrist who handed me a highly-addictive anti-anxiety medication?

 

[flutterby]

K - I haven't read all of your responses, but medications alone will not treat borderline, other than possibly masking the symptoms. Intensive therapy is needed. The average borderline patients spends 1-6 years in weekly (or twice a week) therapy.

Here is the diagnostic criteria for Borderline (BPD):

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

(1) frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
(2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
(3) identity disturbance: markedly and persistently unstable self-image of sense of self
(4) impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
(5) recurrent suicidal behaviors, gestures, or threats, or self-mutilating behavior
(6) affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
(7) chronic feelings of emptiness
(8) inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
(9) transient, stress-related paranoid ideation or severe dissociative symptoms

One can have traits of Borderline (BPD), without meeting the full criteria needed for an actual diagnosis.