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Mental Health (Expert Forum)
1)ECT 2) Increased use of bipolar Diagnosis
Answered by
Roger Gould, M.D. - Mental Health, Wellness
Questions posted in the Mental Health forum are being answered by Dr. Roger L. Gould, author of the Mastering Stress and Depression program and affiliated with the UCLA. Department of Psychiatry. Topics covered include anger, attention deficit disorder (ADD), bipolar disorder, dementia, electroconvulsive therapy (ECT), learning disabilities, memory, obsessive compulsive disorder (OCD), panic, personality disorders, phobias, post-traumatic stress disorder (PTSD), schizophrenia, stress, transitions, and work problems.
1)ECT 2) Increased use of bipolar Diagnosis
by dawning, Nov 13, 2002 12:00AM
I have recently been through a series of 8 ECT treatments. On the day of the last treatment 11/1 my Beck score was 2 thouhg I did not feel that well. Initially I started at ~ 49. During the next 4 days I felt like I was in a fog and kept telling my rm mate I felt agitated and afraid something bad would happen. On the fifth day I woke up feeling great, still a little agitated but in a great mood; That night I spent about $1500.00 on the internet clothes shopping. The next day I was looking at catalogs and couldn't believe how attractive everything looked and told a friend I wanted to buy almost everything.
Later that day I realized something was wrong, I was feeling too good. I tried to reach my ECT Dr but he was on vacation and I could not reach his covering MD. I called the psychiatrist who had been managing my medications for the last 5 years (due to managed care and a recent insurance change I'm not supposed to see this Dr.anymore).
Up to that time my meds were Wellbutrin SR 150 2/d, Effexor SR, 150 2/night, and trazadone 25mg/night.
-Dr. N stated I was hypomanic and prescribed Risperdal 1mg ASAP and repeat in 3 hour if needed; Stop Wellbutrin, and call in 3
hrs.
-When I eventually reached the on-call Dr. He stated He would have me come in for ECT in the AM. Based on my being a medical professional and not wanting to resume ECT he agreed for me to manage the event with meds and Dr. N.. He did however state that based on that one episode of hypomania regardless of high doses of antidepressents that according to the new DSM V. I would be diagnosed as bipolar.
-That night I spent another $1000.00 on clothes over the internet. None of the internet purchases were on credit, I used my debit card so essentially paid cash.
(For further background, I had Eskalith twice for augmentation of antidepressents, both times the medication made me feel really badly; the most recent attempt lasted a month and ended in April of '02.)
The next morning I spoke with Dr. N again per his instructions I resumed Eskalith SR 150 mg 2/d, Risperdal 1mg, and Effexor SR 150mg /d. I had to repeat the risperdal 1mg @1400 and .5mg @1600 & 2000 have not used it again since. I have also felt pretty good on the Eskalith.
I have had No more major shopping sprees though I normally shop for clothes that way anyway & try thins on at home & send back 75% which is true in this case as well.
-I have felt a little too good the last few days though. (? too good after 10yrs depression?) I have felt more like my true self then I have in the last ten years and have been behaving like I remember I used to. My family states I'm closer to my 'normal self' as well.
-I still feel just slightly too 'high' though and spoke with my ECT Dr. today about the above events. He wants me to Begin ECT again in the AM. I really don't understand why resuming ECT will help this hypomanic phase and I am extremely concerned about a diagnosis of bipolar being thrown around to readily.
THANKS
Later that day I realized something was wrong, I was feeling too good. I tried to reach my ECT Dr but he was on vacation and I could not reach his covering MD. I called the psychiatrist who had been managing my medications for the last 5 years (due to managed care and a recent insurance change I'm not supposed to see this Dr.anymore).
Up to that time my meds were Wellbutrin SR 150 2/d, Effexor SR, 150 2/night, and trazadone 25mg/night.
-Dr. N stated I was hypomanic and prescribed Risperdal 1mg ASAP and repeat in 3 hour if needed; Stop Wellbutrin, and call in 3
hrs.
-When I eventually reached the on-call Dr. He stated He would have me come in for ECT in the AM. Based on my being a medical professional and not wanting to resume ECT he agreed for me to manage the event with meds and Dr. N.. He did however state that based on that one episode of hypomania regardless of high doses of antidepressents that according to the new DSM V. I would be diagnosed as bipolar.
-That night I spent another $1000.00 on clothes over the internet. None of the internet purchases were on credit, I used my debit card so essentially paid cash.
(For further background, I had Eskalith twice for augmentation of antidepressents, both times the medication made me feel really badly; the most recent attempt lasted a month and ended in April of '02.)
The next morning I spoke with Dr. N again per his instructions I resumed Eskalith SR 150 mg 2/d, Risperdal 1mg, and Effexor SR 150mg /d. I had to repeat the risperdal 1mg @1400 and .5mg @1600 & 2000 have not used it again since. I have also felt pretty good on the Eskalith.
I have had No more major shopping sprees though I normally shop for clothes that way anyway & try thins on at home & send back 75% which is true in this case as well.
-I have felt a little too good the last few days though. (? too good after 10yrs depression?) I have felt more like my true self then I have in the last ten years and have been behaving like I remember I used to. My family states I'm closer to my 'normal self' as well.
-I still feel just slightly too 'high' though and spoke with my ECT Dr. today about the above events. He wants me to Begin ECT again in the AM. I really don't understand why resuming ECT will help this hypomanic phase and I am extremely concerned about a diagnosis of bipolar being thrown around to readily.
THANKS
Doctor's Answer
by Roger Gould, M.D., Nov 13, 2002 12:00AM
, Nov 13, 2002 12:00AM
I am not sure about what you might be asking, but I have some thoughts that might be helpful.
The diagnosis is truly unimportant from my point of view. You are using a combination of medications to manage your state of mind that seem to be working quite well, and can be calibrated whenever you feel "too high". Even when you are in that state of mind, the fact that you exaggerate some shopping and then return 25% and are using cash instead of ruining yourself financially, strongly suggests that the hypomanic episodes about spending that are familiar in the true bipolar don't really fit what is going on with you.
As long as that is true, it is the management of your depression that is important, and for that you seem to be doing quite well, and if you could add some psychotherapy that would even be better. If you like, you might try that online with my masteringstress program( link above).
The diagnosis is truly unimportant from my point of view. You are using a combination of medications to manage your state of mind that seem to be working quite well, and can be calibrated whenever you feel "too high". Even when you are in that state of mind, the fact that you exaggerate some shopping and then return 25% and are using cash instead of ruining yourself financially, strongly suggests that the hypomanic episodes about spending that are familiar in the true bipolar don't really fit what is going on with you.
As long as that is true, it is the management of your depression that is important, and for that you seem to be doing quite well, and if you could add some psychotherapy that would even be better. If you like, you might try that online with my masteringstress program( link above).
Dawning, read my post on the above thread on what I think of ECT.
Chatahan........wildcat