Euphoric Depression? Anyone Have This Experience?

[ILADVOCATE]

Yesterday I started on Guanfacine. That is used as an experimental mood stabilizer in the same class as Clonidine (alpha blocker). For me its controlling tardive dystonia and what they are identifying as tardive psychosis. But when I said I was recovered from schizoaffective with the Phase II experimental antipsychotic, glycine, a glutamate antagonist, that is not a mood stabilizer. And this is mitigating my moodswings further.
So aside from an unknown disability and experimental medications, here's a question that part of the standard bipolar that I wonder if people have experienced. Its very common to have an agitated mixed state, that is where you have the speeded up affect of mania but the depressive aspect so it seems like you are angry at the world. I and most people with bipolar (or bipolar with psychotic features or schizoaffective in my case) have been through that. But have people experienced the opposite, a euphoric depression, that is you had the negativistic affect of depression but an elated feeling? I am a relatively ordinary guy but during the periods off mood stabilizers (which I wasn't, the Zofran was helping on that aspect but not enough) I got into gothic literature and music, an obsession with the Victorian era and death overall. But there was an elated feeling about it. And as my moods are being stabilized it is stopping. So part of it may be some form of "tardive psychotic depression" (there's one factual case study on this) but obviously there are the standard mood swings of untreated bipolar as well. But I wanted to know if other people have been through this? An obsession with death and despair but you somehow enjoyed it? With so many unknown quantities I want to figure out a known one, that may happen to people with bipolar. But I needed to know if other people go through this uncommon form of mixed state and what it was like and what treated it?  

[monkeyc]

Dysphoric mania is what is commonly know as a mixed state or mixed epsiode.  Ive been there and they are the most dangerous state to be in for a bipolar.

You get all the fun stuff - manic energy, deep depression, anger, hallucinations, delusions, paranoia.

Ive been there once all the way and it ended up with me in hospital after a suicide attempt - I was psychotic, parnoid and delusional and in a great deal of pain.

Treatment.  Stop taking the drugs - g to hospital, tell them how you feel, let them take you off the drugs in supervision and then keep you until you stabilise.  The other way is keep going until you either end up losing it or something worse happens.

Do not mess about with dsyphoric manic is my advice

[ILADVOCATE]

Actually this was before the medication. Its mitigating this experience. Thanks for telling me the name of that state. I knew there was a clinical name and that it was the opposite of an agitated mixed state. Yes of course if a medication causes this I agree the best thing to do is speak to your psychiatrist and have them change the medication. I've never been on a medication that caused this particular aspect though Trileptal caused an agitated mixed state and Keppra caused suicidal ideations. The difficulty is Guanfacine is a mood stabilizer experimentally but not an antipsychotic so obviously it will help on dystonic spasms (which its known for) and mitigate any moodswings. But the fact that it stopped that dissociation that was clearly psychotic (and I was never psychotic otherwise after recovery) but only experienced during the wide variety of spasms from the advanced tardive dyskinesia does indicate something to me.
   Alpha blockers are used as mood stabilizers experimentally, quite often for dystonic spasms, sometimes for Tourrette's (though now antipsychotics are more used but before everyone in the Tourrette's group I went to used the Clonidine patch) but in one case experimentally for tardive psychosis. Before recovery when I went off mood stabilizers before, I had rapid cycling, an agitated mixed state, the works, something I'd never do again. But with this when I was on a full dose of Lamictal and Neuronton in 2007 I had the dissociation and when I went off them as well and it was only the Clonidine and Tizanidine that stopped them but I couldn't tolerate their personality altering effect though Guanfacine is supposed to milder in this regard (have not have problems so far).
  But rhodiola mitigated it also and that helps on tardive dyskinesia and Parkinsonian depression. And Zofran helps on tardive dyskinesia and Parkinsonian psychosis. So although there may have been aspects of mania this may have been (as one case study confirmed) "tardive psychotic depression". But with the psychosis mitigated and the moodswings better under control I can describe this better to the movement disorders specialist and once they can write it up then they can figure out how to treat it in other people. The whole experience (including physically) was exactly like the psychosis from Parkinonism described in the book "Awakenings". Once they can confirm how to spot the emergence of this long term side effect they will be able to monitor for it and treat it (and be another reason to fast track the glutamate antagonists which can't cause it) but while I was explaining that it was essential to get some standard bipolar episodes out of the way. And in some way it was a mixture of both.

[LetaB]

Isn't "euphoric depression" an oxymoron? I hate to seem stupid but could somebody give me a definition that doesn't make you more confused about it's meaning than you were before you heard it? Talk down to me please.

[LeftCoastChick]

I have mixed states and I rapid cycle, fun for everyone!  I can my hyper, yet be really depressed all at the same time. I can get very anxious pace, rapid thinking, yet have been deeply depressed with thoughts of self-harm. I was in the state in July, and I walked into my local hospital, where I got my diagnosis. Most people aren't mixed/rapid, and it can be hard to treat, but you have to be super vigilant every day and keenly aware of your moods you can catch it before you go into those states as well as the corrects meds like Seroqual alongside a mood stabilizer. .

[ILADVOCATE]

I'll have to ask my psychopharmocologist the correct term. Perhaps that one is wrong. However, to many people who don't experience it manic means "happy". They are wrong of course. Its not always that way. An agitated mixed state is someone who is speeded up as is typical for mania but they are depressed in their emotions so it can seem to someone who doesn't know them that they are "angry at the world" but if they were just depressed they wouldn't be speeded up.
   What I was experiencing was the opposite end. It was depression, that is it was certainly a fixation on death and despair and the downside of life but there was an enjoyment in this. That's why I said I am an ordinary person. The people, usually younger people who call themselves goths, you know the kind that dress in black, spend their whole lives thinking this way but its a game for them but for some its not. I've been to a mood disorders support group in the past and some of the people who were experiencing depression including disturbingly enough some of the cutters enjoyed the depression.
   Usually depression is something people want out of but there was a fixation on it and that was part of the psychiatric disability. Someone experiencing that would more likely have bipolar or borderline personality disorder. If someone is clinically depressed only then they are undermotivated and can't do anything. Someone in this state that I would call a euphoric depression does think in a negativistic way about death and despair but they want to emote about it in a manic way. My psychopharmocologist says it exists. I'm not sure if I have the correct term. I was never as badly off as these people and there was something underlying that's neurological complicating the whole picture but this form of abnormal moodswing was part of it. The Clonidine took me out of it and that was when I wrote that poem about that jazz musician. Hopefully I'll be able to tolerate this new medication that has the same effect clinically but time will tell.

[ILADVOCATE]

Exactly and that's where I was years ago as well. Seroquel and all of atypical antipsychotics (if I'm not wrong there's another similar to Abilify that might be due for release soon) have a mood stabilization effect but require a mood stabilizer as well. They are effective. The problem is when someone develops tardive dyskinesia if they take them they will worsen it but if they go off them they will become psychotic. In the past it was a grim choice of worsening the tardive dyskinesia or becoming psychotic. Then they developed Clozaril. For some people Clozaril is highly effective but for all people it has severe side effects and requires weekly blood monitoring (which changes to bi-weekly after half a year and after a year to monthly if no blood dyscreias emerge).
The problem is what do you when you are a person such as myself who had tardive dyskinesia and could not tolerate Clozaril and when I mean could not tolerate I mean I had suicidal ideations from it and extreme extra pyramidal side effects (which are a rarity, cases of tardive dyskinesia from it are a statistical rarity but its complex because all the other antipsychotics mask it while its occuring, so on Clozaril it can often appear to worsen but Clozaril in reality just doesn't mask it). That was when I found out about glycine and if you wondering why I ended up on such an experimental medication one essential reason is I have no other choices. But with my recovery rate had it not been for the advanced tardive dyskinesia it worked out for the best and when the glutamate antagonists are released as antipsychotics, other people will see the difference as well.

[monkeyc]

The correct term is dysphoric mania.  Google can provide lots of information.

Most AD drugs and many other drugs have the capacity to cause it - SSRI class anti depressants can do it very easily and this is why they need supervision - it can also manifest if drug therapy is withdrawn suddenly.

[ILADVOCATE]

  Thanks. Its good to know the exact terminology. It does seem to be mitigated by the Guanfacine but I know the alpha blockers in me tend to bring on elation which eventually leads to an agitated mixed state. So in mitigating the standard bipolar symptoms and some form of Parkinsonian depression and psychosis (what is in research criteria tardive psychosis for me) it is something to watch out for. However, although the Clonidine did that and Tizanidine was a disaster (it caused suicidal ideations) and alpha blockers as a class of medications are not generally used as mood stabilizers because of the potential of depression, in controlling the dystonic spasms it seems rather neccesary and the movement disorders specialist did say the Guanfacine had much less of a potential to cause this so I intend to stick it through unless things get bad (in which case because they are blood pressure pills I'd have to be titrated off very gradually).
   I think the biggest difficulty with SSRI's or anti-depressents overall is not the class of medication its misdiagnosis but that can come from the person. Some people report that they feel suicidal and they are given an anti-depressent but they neglect to tell their provider about what they think are "good days" which are really when they are manic or hypomanic. The most important thing in speaking to a psychiatrist is to explain everything fuller not to assume any diagnosis. Then it makes that person wildly manic and go off medication and become suicidal. I've seen it happen too many times. Its not so much that Prozac is used but that it and other drugs are advertised everywhere so people go into a psychiatrist asking for it and don't understand its used to treat depression not "make them happy". Its a shame when public figures in the media joke about it as "happy pills" as well.
Regardless, I was informed that some of writing of my own experince from the two studies (glycine recovery and tardive psychosis) will be incorporated into it so I definitely intend to look up "dysphoric mania" and see what was going on in me. Then my psychopharmocologist can better explain the exact mechanisms of how its being treated. Thanks.

[MakeThatSacrifice]

I know that feeling soo well!, I'm their right now, I have the urge to slide a blade down my arm. To feel a breach of the barrier between life and death! I walk past buildings, posts, benches, and people and have the urge to lick them, to touch them, to have an intimate encounter with them! I feel like throwing rocks through windows...and orchestrating my public disgrace on a global scale! I want to be punched in the face, I want to bleed from my face, I want to smile while I taste my blood! I want to have sex with God and then jump off a building!

[amylove21]

I've had that problem when I was on some medicion. I don't remember what it was called. All I know it felt so weird. Haven't had it since.

[ILADVOCATE]

Well since that thread was bumped I will tell you the follow up. As it turns out after further study the dysphoria was neurological in origin (since its part of an extremely rare medication side effect, itself under clinical study, I confine postings of it to my journal entries) and in better understanding it after multiple treatments failed I was tried on the anti-convulsant Vimpat for dystonic spasms (I am literally the first person for it to be tried for this outside of the animal model) and as it turned out it was also effective as a mood stabilizer for standard moodswings. They are most probably going to go ahead and write up a case study on this but as always its a clinical "finding" not a fact and it all depends on what future studies will find but in understanding dysphoria and discussing it with my providers I was able to obtain information that was helpful to both of us and physically and mentally my life is far more stable these days. Understanding aspects of your psychiatric disability and discussing it with your providers does help. Thanks.

[zzzmykids]

Yes, before more but medicated yes. Worst when meds not right and taking pain pills..thought they were called ultrim..the pain pills, sister recommended them, the doc prescribed them, I took them...yummy pain was tolerable.  But I felt like I was in a tornado emotionally and physically and then I would want to bake things for the neighbors or drive across town to say hi to a friend then the tornado and my brain was busting at the seams.  I KNEW I was going crazy, overtalkative, under the covers in the darkness, it is like I was splitting in two and reforming into different parts. Sensitive to medications and at that time seeing only a gdoc  it was not a good place.
So yeah know the "feeling" but definately don't know all you have been through Iladvocate. You are brave, intelligent and you'll make it through this.
Get better,
zzzmykids