Tuesday, July 10, 2007

Dear Carla (Part 1)

I just received a comment by Carla on my earlier post, which I feel I need to respond to right away. She's undergoing a depression, is medication-resistant like I am, and would like advice. I am going to write a public letter in case it helps anyone else.

Dear Carla,

First of all, although I was deemed medication resistant early on, it wasn't actually true. What was true was that the four mood stabilizers they commonly prescribe--Lithium, Valporate, Tegretol, and Lamictal--didn't work. Years laters I took many more cutting edge drugs, which were supposed to have mood stabilizing effects but they didn't work either.

Over a period of ten years, I saw five of the very best psychiatrists in Los Angeles. What was interesting to me was that it was only the last doctor--my current psychiatrist--who suggested that the stimulant Adderrall might end a nine-month depression in a day.

While he also said it shouldn't be a long-term strategy, it is the only medication that works for me. I take the lowest dosage possible although over time I've needed to take more when I had a lot of depressive episodes. The minute the depressive episode ends, I have to get off it or it will cause a hypomania.

The downside is that it can throw a person into a hypomania. I always thought this is a ridiculous concern (for me) since my depressions were so horrific and lasted so long. And my hypomanias weren't that bad although they did get worse (I'll need to explain this in another post).

The point is that unlike antidepressants, which take weeks to kick in, Adderrall kicked in in one day. While some doctors hesitate to prescribe it, I must say that if they really understood the devastation of depression, they wouldn't hesitate.

The bottom line with me is that I don't abuse drugs or alcohol (and never have). A very little amount of a medication has a major effect. I kept daily mood charts for 6 years and was very conscious of any fluxuation. I always made sure that I got enough sleep. I am very responsible, very motivated, and very proactive.

Tomorrow, I'll tell you more about my overall strategy. Best of luck!



Marie said...

Susan, thanks for the comment you left on my latest post. It seems whatever new med cocktail I am perscribed it does not seem to work very well. I will keep on trying until they can get it right.

Carla said...

Dear Susan,
Thank you sooo much for addressing my question overcoming depression. I am really touched by the depth of your thoughts and your honesty. The letters seem so personal and caring and at once very informative:) Somewhere something gave me the impression you hold my 'key' to wellness...so the thought of Adderall was intriguing because I did get relief one summer (my depressions have evolved to full blown summer depressions!) by taking an allergy drug Seldane (now off the market)...it was truly a stimulant but it worked dually on my allergy and gave me that extra boost out of my hole. Thanks for reminding me of that...depression is so self absorbing you feel like you lose all connection and perspective.

Have you had any experience with SAM-e...supposedly it has a very similar response?

Thank you, Susan, you have given me new hope. :)

Bipolar Wellness Writer said...

I didn't have any success with SAMe but that's not to say that you won't. Maybe someone else can talk about their experience with it. Also, there's a site Remedyfind where people talk about what's worked for them and what hasn't.

Also, I must gently caution you, "I only hold the key to my own depressions," but I'm certainly willing to share what's worked for me.

For years, I hoped that the "next" psychiatrist or medication would help me. I finally found a doctor of integrative medicine who did help me but once a major depression came, even she was unable to provide help. And the holistic psychiatrist she recommended was a total sham.

In this odd way, I believe we all hold the "keys" to our own illnesses. Like detectives, we have to keep copious notes of the triggers, and keep mood charts to determine if we can see patterns, find a psychiatrist or counselor who can help us explore our inner selves or help us develop new skills for dealing with "old" behavior.

If your depressions are seasonal, then there might be a Season Affective Disorder element and there is a seminal book on that by Norman Rosenthal, M.D. and he also has a web site.

If you're not happy with your life's work, I recommend Parker Palmers's book that I discussed in another post.

Sometimes, it's a lengthy process but what I believe is extraordinarily important is that we all maintain "hope," which is easier said than done in the darkest hours.