Rapid Cycling in Unipolar Depression?

[s.k]

These are excerts i sent to McLean reg. residential services:

"I am an 18 year old male, and have Major Depressive Disorder, but with a twist. I appear to rapidly cycle on a semi-chronological daily basis. Right now i am looking into if it is a blood sugar issue, but i am not certain if it can be because thus far it doesn't mater when i eat or what i eat, I still get depressed on the the following cycle:
Wake up depressed, stay depressed until about 2pm with a peak at about 1pm, I get a little bit better after the peak, but remain depressed, and then will completely fine around 4, around six or seven occasionaly it will return slightly for a few hours.

This cycle has been known to switch to an evening schedual, getting depressed about 4 to six PM and lasting until morning. Also, some days, lik today, the cycle is not apearant, with virtualy no depression at all.

After extended time in a cycle the effects become more intense and less stable, to the point of completely unpredictable and uncontrolable emotional lows which exhibit sucidal thought with passive atempts, self abuse, irritation and agression on some days. I am usualy active when i am depressed, but i get waves at the lowest periods where i can feel my body slowing down, and everything around me seems to as well. In a few minutes to a few hours I return to a normal state, just to plunge again usualy worse than before.

I have no mania, I simply return to a normal state, and am taking Risperdal and Zoloft. I have responded some to the Zoloft, and very well to Risperdal and has completely stopped my more psychotic features.

Still, i am getting very frusterated living this way, and feeling out of control. I have been been put in brief crisis intervention, but I am not feeling like i am getting anywhere. My cycles are so rapid, i don't feel safe with only counselling.  I have been hospitalized in an acute residential unit in Casper WY when i was younger and my cycles were less rapid, usualy lasting two weeks upto a month. This unit saved my life then, and certainly my sanity, I responded very well to the group theripy I participated in. Unfortunatly, I have no group support here."


I have done lots of research on the web about depression, bipolar, rapid cycling, major depressive disorder, drugs, interaction, ect... but i have not found anything to charicterize my depression. I do not have any of the other charicteristics of hypothyroidism or diabeties, although I do have histories of both in my family among geriatric (sp?) members, but no record this early in life. I am, however, getting tested for both soon. Like I said I am very frustrated living this way, jumping from being suicidal to being normal in some cases less than 20 minutes time. I do notice an increase in wanting to be active when I am normal for a few weeks at a time, but not feeling out of control or even "hyper" or euphoric (sp?) for long periods of time.

Obviously, I have concitered longer term (a few weeks) hospitalization, thus why contacting McLean to figure out how to control this. However, I really feel like I'm the only person alive with such rapid and cyclical deppressions without mania or liklihood of "physical" medical problems. Is it possible to be bipolar with super-suppressed mania? Could my medication drive me into rapid cycling? Could i be a Major Depressive in transition into Bipolar? Are their any special medications for violent mood swings? Do i need to be hospitalized at all?

Sorry for the length of this letter, but I am very frustrated and confuzed right now. I want to live a normal life, but every time I have th oppertunity my illness gets in my way. I am now unemployed, i had to quit my job because of this, I am tired, and cut up and warn out. Every time I am offered help I reject it, so I don't even know deep down inside i want to get better, or atleast my depressive "no point to life" part of me doesn't. Sometimes I feel more suicidal when i'm comming up OUT of a depresion because I'm so tired of living my life the way I must.

GRR!
-shawn

[HFHS-M.D.-HG]

Dear Shawn
The mood swings you are suffering from can occur in Bipolar disorder, in Borderline personality disorder, in people using illicit drugs and several other conditions. Irritability can be a major symptom in people with manic episodes. Even though it is difficult to come to a psychiatric diagnosis without a formal evaluation in an office setting, I would think that a mood stabilizer such as Depakote/Lithium/Tegretol may be helpful and the dosages of Zoloft and Risperdal that you are taking may need to be adjusted. It is very important that you talk to your psychiatrist/therapist about your concerns and let them know when you feel suicidal. Hospitalisation is necessary if a person is difficult to be managed as an outpatient for the safety of the patient and others if suicidal or homicidal ideations does occur. Your doctor will be the best person to give you adequate recommendations regarding your concerns. I wish you all the best.

Sincerely
HFHS-M.D.

[Peter Amsel]

From the sounds of the pathology that you describe you could very well have bi-polar disorder, type II: being a rapid cycler. Mania is NOT indicitive of this disorder, however the deep depressive episodes are characteristic as are the rapid and labile mood changes.

Something that is very important to note is that recent studies indicate that bi-polar disorder is misdiagnosed as uni-polar depression over 40% of the time... so it is not surprising that your depression is being treated while the "cycles" are not. Another thing to note is that Sertraline (Zoloft) and other
SSRI antidepressant medications can be very destabalizing for bi-polar patients who are not on a mood stabalizer as it can cause a conversion to mania, hypo-mania, or simple rapid cycling. Bupropion HCI (Wellbutrin SR) is very well tolerated as an antidepressant for bi-polar type II patients, but... a mood
stabalizer sounds like it is definately indicated.

As Lithium also has some antidepresant qualities, it may be tried in monotherapy as the first course, but it is here that you must really see a doctor and present your full-spectrum of symptoms. I recommend that you chart out your mood for several days so that the doctor has a concrete idea of what you are going
through. Risperidal, by the way, is commonly used in many treatment protocols with a mood stabalizer and no anti-depressant in the treatment of bp disorder.

Good luck,
Peter

[kevin]

I definitely feel that a mood stabilzer is needed. This is definitely hypomania, or bipolarity II. The Zoloft could very well be exacerbating the condition. I would stongly urge a mood stabilzer. As far as SSRIs go, Paxil would be much more appropriate.  There has been some indication that it in fact increases GABA, which would help to assuage the cylcing.

Best Wishes, I can truly empathize!!!!

[Kathrin Kopp]

I agree with the possibility of bi-polar. Isn't it true that often the manic or hypomanic cycles are not in the form of elation, but rather in the form of aggression/irritability?

Kathrin

[s.k]

Lately, since I wrote McLean the cycles have shifted again, and are very accute. Now my cycle starts around 9am and lasts until around 11, returns around 4pm and bounces up and down hourly with an increasing trend until around 6. The super-hyper-rapidness right now is probobly due to it being a new cycle and how the cycles tend to be more brief and less severe when they start.

I have been charting my emotional state for both mediacation reasons and the possibility of something "physical" apposed to psychological.

Yesterday and the night before I had encountered some more psychotic features, including a very strong but not disabilitating halucinations around 11PM after i got ready for bed. The next day i felt very agressive (about a 4 on the agression scale) and was relatively paranoid (about a 6 on the paranoia scale) had several brain blips where I felt like time had skipped a beat and I was "wormholed". This all happened outside, where I had time to myself to try to get rid of my tension. I felt like I was only on a five minute walk, but when I returned it was roughly an hour.

I don't know what to do if my Risperdal stopped working. I spoke to my crisis worker and she told my psychiatrist all that happened the night before (this was prior to the later brain blips and hallucinations)

I don't know if this helps any, but this is the latest in my string of events.

-s.k