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Mental Health (Expert Forum)
How long do you need anti-depressants?
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.
How long do you need anti-depressants?
by Beth, Nov 08, 1999 12:00AM
I'm 29, with several health problems (diagnosed MS- allergy problems severe enough to qualify for Voc Rehab to assist college I have also been diagnosed with a supraventricular tachycardia, and am scheduled in one month for an ablation procedure) I am typically hyper and happy, and having dealt with health problems since I was a child, tend to just see them as an annoyance in life, much like getting my car retagged. =)
For the last 3 months, I have been in an emotional rut and couldn't get out. I was given Klonipin, for muscle spasms, which inadvertantly doubled as an anti-anxiety med, and that was when i realized something was seriously wrong. About 2 hours after taking the Klonipin, I would feel the bubble of anxiety begin to deflate in me-- and around 3 hours later, it would begin refilling, until I felt like I was about to explode. I constantly felt like glass, about to shatter, and would suffer long crying jags (3-4 hours) over normal everyday events (missing a sock while folding laundry...) I also get/got exceptionally angry over little insignificant things, and seemed to completely lose my normally abundant sense of humor. Initially, my neurologist upped my dosage of Klonipin to 2 mgs a day (total) and Thursday 11/4 at an appointment, he prescribed Zoloft. On Saturday 11/6 evening, something "snapped" in me, and it was like someone flipped a light switch back on- For the first time in months I felt like *me* again.
My neuro is attributing the roller coaster to MS (emotional lability) but I have some concerns that I might be Bipolar... My sister was diagnosed when she was 26 (now 41), I see similar patterns in our behavior and reactions to things, our violent mood swings and the extremes to which our moods go- her mania is scary- frantic, explosive, she's as liable to cry while she's flying around happy as when she's depressed (which is 90% of the time) I tend to be the opposite- manic 90% of the time, and when I drop into a depression the sheer change in my personality worries people.
I am currently seeing a psychologist, who feels I need a psychiatrist & a more thorough psychiatric evaluation. When I asked my neuro to refer me, he refused, saying I didn't seem depressed to him, and that he felt confident prescribing Zoloft. I do not need to referral for insurance coverage- I wanted the name of someone he trusted, who had experience dealing with severe health &/or disability issues. (I have since contacted both my voc rehab counselor and my GP for their recommendations)
My psychologist gave me a few basic assessment tests, and I registered "severely depressed, in need of psychiatric assistance" as well as "potentially obsessive compulsive &/or Bipolar disorders"
My concern is this- I'm taking Zoloft, (the panic pack, 25 mg a day for a week then on to 50mg thereafter) and I know that there can be a slight rebound effect of mania- I don't think there was enough of the drug in my system (between thursday and Saturday) for the "snap" that I experienced to be caused by the drug. So I have a few questions-
1) I no longer feel "depressed"... how do you know when you don't need an anti-depressant?
2) How is Bipolar disorder treated in comparison to Zoloft being prescribed for depression/anxiety? (My sister takes Prozac. but nothing for her mania, since it happens so rarely)
3) In the event I do not receive a referral (GP on vacation) and must scour the yellow pages- how do I go about weeding through the lists of psychiatrists to find someone with clinical experience re: MS/disability. I tried calling some on Friday, and was told by a few that, "We do not do interviews".
For the last 3 months, I have been in an emotional rut and couldn't get out. I was given Klonipin, for muscle spasms, which inadvertantly doubled as an anti-anxiety med, and that was when i realized something was seriously wrong. About 2 hours after taking the Klonipin, I would feel the bubble of anxiety begin to deflate in me-- and around 3 hours later, it would begin refilling, until I felt like I was about to explode. I constantly felt like glass, about to shatter, and would suffer long crying jags (3-4 hours) over normal everyday events (missing a sock while folding laundry...) I also get/got exceptionally angry over little insignificant things, and seemed to completely lose my normally abundant sense of humor. Initially, my neurologist upped my dosage of Klonipin to 2 mgs a day (total) and Thursday 11/4 at an appointment, he prescribed Zoloft. On Saturday 11/6 evening, something "snapped" in me, and it was like someone flipped a light switch back on- For the first time in months I felt like *me* again.
My neuro is attributing the roller coaster to MS (emotional lability) but I have some concerns that I might be Bipolar... My sister was diagnosed when she was 26 (now 41), I see similar patterns in our behavior and reactions to things, our violent mood swings and the extremes to which our moods go- her mania is scary- frantic, explosive, she's as liable to cry while she's flying around happy as when she's depressed (which is 90% of the time) I tend to be the opposite- manic 90% of the time, and when I drop into a depression the sheer change in my personality worries people.
I am currently seeing a psychologist, who feels I need a psychiatrist & a more thorough psychiatric evaluation. When I asked my neuro to refer me, he refused, saying I didn't seem depressed to him, and that he felt confident prescribing Zoloft. I do not need to referral for insurance coverage- I wanted the name of someone he trusted, who had experience dealing with severe health &/or disability issues. (I have since contacted both my voc rehab counselor and my GP for their recommendations)
My psychologist gave me a few basic assessment tests, and I registered "severely depressed, in need of psychiatric assistance" as well as "potentially obsessive compulsive &/or Bipolar disorders"
My concern is this- I'm taking Zoloft, (the panic pack, 25 mg a day for a week then on to 50mg thereafter) and I know that there can be a slight rebound effect of mania- I don't think there was enough of the drug in my system (between thursday and Saturday) for the "snap" that I experienced to be caused by the drug. So I have a few questions-
1) I no longer feel "depressed"... how do you know when you don't need an anti-depressant?
2) How is Bipolar disorder treated in comparison to Zoloft being prescribed for depression/anxiety? (My sister takes Prozac. but nothing for her mania, since it happens so rarely)
3) In the event I do not receive a referral (GP on vacation) and must scour the yellow pages- how do I go about weeding through the lists of psychiatrists to find someone with clinical experience re: MS/disability. I tried calling some on Friday, and was told by a few that, "We do not do interviews".
Doctor's Answer
by HFHS MD-JM, Nov 10, 1999 12:00AM
Beth,
Its not entirely clear what your diagnosis is but some of the possibilities are Mood disorder secondary to a medical condition (MS), unipolar depression vs bipolar depression. It would be very helpful to have a psychiatric assessment to clarify this issue. Nearly every psychiatrist is able to manage MS/disability. If you would like to see a Henry Ford psychiatrist then call 313 874 6677 to set up an appointment.
Antidepressant medications are generally prescribed for about six months to a year in an initial depressive episode. Sometimes the antidepressant is continued as maintainance to guard against a relapse. The main difference between treating unipolar depression and bipolar depression is that a mood- stabilizing agent (Depakote, lithium, tegretol) is essential in bipolar disorder. I suggest you search this forums archives for a further discussion of these topics.
Keep in mind that this information is provided for general educational purposes only. Consult your personal physician for specific health concerns.
Sincerely,
HFHS MD-JM
Keywords: Depression, Biploar disorder, Multiple sclerosis
Its not entirely clear what your diagnosis is but some of the possibilities are Mood disorder secondary to a medical condition (MS), unipolar depression vs bipolar depression. It would be very helpful to have a psychiatric assessment to clarify this issue. Nearly every psychiatrist is able to manage MS/disability. If you would like to see a Henry Ford psychiatrist then call 313 874 6677 to set up an appointment.
Antidepressant medications are generally prescribed for about six months to a year in an initial depressive episode. Sometimes the antidepressant is continued as maintainance to guard against a relapse. The main difference between treating unipolar depression and bipolar depression is that a mood- stabilizing agent (Depakote, lithium, tegretol) is essential in bipolar disorder. I suggest you search this forums archives for a further discussion of these topics.
Keep in mind that this information is provided for general educational purposes only. Consult your personal physician for specific health concerns.
Sincerely,
HFHS MD-JM
Keywords: Depression, Biploar disorder, Multiple sclerosis
