BP or Major Depression?

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bevhea
Regular Member


Date Joined Sep 2005
Total Posts : 240
   Posted 9/24/2005 3:27 AM (GMT -7)   
My daughter's boyfriend told her to get out.  She began counseling at that point, and the counselor wanted her on drugs.  I found out about this when she called and amoung the things she said was that she has thoughts of suicide and "everytime I go to the counselor, I find out more horrible things about myself."  She listed off nearly 100 of the negatives (I was writing).  That's after 3 sessions. 
 
I didn't like the sound of the counseling and was afraid of her going to the recommended (person) for the meds.  I got her into my doctor the day after the phone call to avert that.  He put her on Cymbalta, two 20mg a day.  One of the things he told her was that it takes time and if she woke up feeling good the next morning, it wasn't right.  Well, she did wake up feeling good. 
 
I told her to call the doctor, but when I talked to her late in the evening, she had decided that she woke in a good mood, because this was her last day working the night shift.  Now it's the weekend, and I will probably have trouble reaching the doctor, to find out if that was a warning or just a gentle way to say feeling better would take time. 
 
SO QUESTION 1:  Does anyone know if feeling better after 24 hours is a bad sign? 
 
I've read the fine print product information from Lilly--the one you have to ask for. It says it's for major depression.  I looked MD on the internet, she's got all the symptoms.   Also I find out because of this episode that 8 years ago (age 19) she attempted suicide for the same reason she was threatening this time--that boyfriend had enough of her.
 
My daughter has abandonment issues.  First father left (when she was age 3), then he took the older bother (when she was age 6) then middle brother (when she was age 9)--complicated by father never wanting to see her again after he took the middle brother.  Prior to that when there were visits, her brothers and the new wife told her things like she would never be a real woman, because she was being raised by her crazy mother.  Her father just made promises he didn't keep and ignored her
 
As a result she has difficulties in relationships.  She starts a relationship by being the wonderful girl she is (not depressed, interested and caring about others), when there is no man in her life.  Then she "falls in love" and becomes passively dependent.  She jumps into or at every crack pot idea that she thinks will improve the relationship.  She won't listen to anyone and dumps her friends and interests.  Even though we live in the same town, I rarely see her when she is in "love."  After blowing all her money and loosing her personality and sense of self worth, she gets depressed and the fellow dumps her. 
 
It leaves her a shambles, which is exactly where she is now.  Her father is an alcoholic and I made sure she understood the genetics and the addictive personality (booze and drugs).  She has never done either.  Too bad I didn't include being addicted to men!  She is a long term employee and an excellent worker.  Her work is not affected by this or other mildered depressions.   
 
QUESTION 2:  Does she sound bipolar or major depression?
 
I was tossed into a two year depression when loss of our business, home, sons and my ovaries all occured within a year (she was about 10), but otherwise depression isn't a family trait. 
 
QUESTION 3:  Assuming she resolves her abandonment and relationship issues, is she likely to need long term medication? 
 
I'm sorry to write such a long thing and for not reading more of the forum to learn the what things are generally presented.
 
bev 

psychnurse
Veteran Member


Date Joined Mar 2005
Total Posts : 807
   Posted 9/24/2005 4:04 AM (GMT -7)   

Hi, bev,

I am sorry for your daughter having such a hard time.  Actualy, the more you write about her, the  better we can help.  Why do you think she could be bipolar?  The symptoms you have mentioned really don't apply so far.  To be bipolar a person has to have had at least one episode of mania lasting 4 days or more.  I will list some symptoms of bipolar at the end.   She sounds more like possibly borderline personality/dependent personality disorder, and depression.  Cymbalta would help the depression, but probably not much on the other two.  Her counselor was probably correct in her assessment of your daughter; there are many "negative" things that go with these disorders and people with them need counseling desperately.  It is a hard pill to swallow (pun not intended) to hear negative things, but that's what people go to counselors for, to find out what to work on.

I am not diagnosing her; only telling you a couple of strong possibilities for the symptoms thus far.

Did she see a GP or a psychiatrist?  It is highly recommended people seek treatment from a psychiatrist for mental disorders, since GPs aren't really that educated on them other than prescribing an antidepressant for just depression in most cases.
 
Sometimes, people will feel better the next day on an antidepressant because they believe they will.  It's called placebo effect and is extremely common.   Your doctor is looking for symptoms of hypo/mania, because bipolars aren't supposed to take SSRIs/SNRIs which Cymbalta is, because they actually induce mania in the vast majority of bipolars, ESPECIALLY without a mood stabilizer added with it.
 
Here is the list of mania/hypomania:

Signs and symptoms of mania (or a manic episode) include:

  • Increased energy, activity, and restlessness
  • Excessively "high," overly good, euphoric mood
  • Extreme irritability
  • Racing thoughts and talking very fast, jumping from one idea to another
  • Distractibility, can't concentrate well
  • Little sleep needed
  • Unrealistic beliefs in one's abilities and powers
  • Poor judgment
  • Spending sprees
  • A lasting period of behavior that is different from usual
  • Increased sexual drive
  • Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
  • Provocative, intrusive, or aggressive behavior
  • Denial that anything is wrong

A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present.


Variety is the spice of life, BP is the key

Post Edited (psychnurse) : 9/24/2005 6:34:04 AM (GMT-6)


bevhea
Regular Member


Date Joined Sep 2005
Total Posts : 240
   Posted 9/24/2005 5:29 AM (GMT -7)   
Why did I think she might be bipolar?  I really didn't, but the earlier reading I did on the internet made me think perhaps that is what the doctor had in mind when he said that if she woke up in a good mood the next day, it wasn't right.  That sounds like what you are saying in the paragraph before the symptoms.
 
I've been after her to go to counseling since she began dating (age 14), but she wouldn't.  I don't know the right name for what I think, but dependent personality disorder sounds like it--only it doesn't feel borderline. 
 
She did go to a local counselor after her last break up.  She seemed to really feel good about what she did there, then abruptly it was over after 4 sessions.  She said the counselor moved away.  I never believed that. 
 
The doctor is a GP.  His forte is diagnosis.  He sees and catches things all the others miss.  I trust him totally, and my daughter does too.  He will see her often, ask about her counseling, make it important, and maybe keep her going.  If he gets an inkling she isn't going, he'll guess (or I'll snitch) and he will get her with someone else.  I really believe he is the right person.
 
I don't think it's a placebo effect, because he said 2 weeks to feel better.  I found a week to two weeks somewhere and told her that.  My kids were all brought up on "oh that will take 10 min (or whatever) to stop hurting" and their wounds always quit hurting on time.  I was thinking that it might just be the relief of having taking action (counselor and med) plus like she said going to days next week.  Or who knows, she may have talked to the boyfriend and been perked up by that.
 
When she isn't with some guy, poor judgement (may just be that she does things differently than me) and denial that anything is wrong (I assume something has to be wrong on occasion).   Toward the end of relationships:
 
A lasting period of behavior that is different from usual--her break ups are so extended that being happy may be what is different.
Distractibility--to some degree--concentration and memory bad this time
Provocative--asks things as if to start fight and that push people away 
Spending sprees--never a saver, but never overdrawn or with maxed credit card until relationship starts deteriorating
 
Even between relationships, she is rarely available.  Then she's busy doing things.  Once she gets in one, it's even less.  I didn't see her for a straight week here junior in high school.  Although she didn't spend the night, her boyfriend's mother basically took her in and did the you poor thing.  That was a sick woman.
 
Frankly, I've been waiting for a crisis for half her life.  I knew it was the only way she would ever face the things that bother her.  However, I was surprised with this breakup, by the complete lack of ego strength.  (I spent 3 years in counseling, in case you are wondering.)\
 
I don't think there is a question in that, but I do have one.  If she is showing signs of mania over the weekend and I can't find the doctor, should she stop taking those pills--as if I could get her too. 
 
bev
 
 

kittycat27
Regular Member


Date Joined May 2005
Total Posts : 438
   Posted 9/24/2005 4:02 PM (GMT -7)   
This is simply my opinion and my experience with SSRI's and SNRI's. I took a few and I went into full blown mania, I called my doc ( also GP), he said immediately stop the med and I went in a few days later, due to the feeling that I was going to get attacked or something. I literally felt nuts, crazier than thou.... He said the next time I went in , basically oops... I was put on an ANTI-D, callled Wellbutrin. I am already on a mood stabilizer. Now I am not telling you to tell your daughter to do anything, because she is not dx Bipolar and could possibly have a different effect. ( PLus to cover all ends, I am not a doc) If you notice signs, call the hospital and say her doc is away or out of the office, what should you do. Call for medical advice.They can ADVISE you. Does she live with you, how old did you say she is? She needs to probably be in some serious counseling, with dependency and others you mentioned. Sorry if I missed that you said she was or not, I am really not feeling that well today. Please let us know. Take care, Nickie

bevhea
Regular Member


Date Joined Sep 2005
Total Posts : 240
   Posted 9/24/2005 6:04 PM (GMT -7)   
She came by this afternoon.  Thankfully she simply acted like she does at her best.  Not one sign of mania, as I know them.  While I know some things and would probably recognize a full blown mania, she seemed about the same as yesterday (24 hours after the first dose). 
 
She lives 40 miles from here.  She is calling each day as asked, which in 4 days makes it the most contact we've had in a long while.  I explained that if she shows signs of mania (and told her what I knew) that she needed to call the doctor right away.  After what she described as a year of depression, I'm not sure that she would.  But for now, she seems not just ok, but fine.
 
She asked about her father and brothers, and the things they've said to over the years--things that she's never wanted to talk about.  I gathered that they were things she and the counselor talked about at the last session.
 
So for now, I'm relieved, but sitting on pins and needle about what the med will bring--I hope it's as good as it looks so far--but .....  it's scary to think of what could happen if it were wrong.  The things I read about her getting off of it someday, are also scary, but no sence borrowing trouble.  There's enough of that.
 
Thank you both for the help.  I'm sure I was better able to respond to her and her concerns, because I got pointed in the right direction.
 
bev 
 
 

kittycat27
Regular Member


Date Joined May 2005
Total Posts : 438
   Posted 9/25/2005 7:48 AM (GMT -7)   
 Bev glad to hear you talked to her and best of luck. Anytime you need to talk you are more than welcome. Nickie 

schmoe
New Member


Date Joined Mar 2006
Total Posts : 1
   Posted 3/22/2006 10:34 PM (GMT -7)   
Hi.

For whatever it's worth, it seems worth while to consdier borderline personality disorder. There are plenty of sites on the internet. Go to google.com and search for borderline+personality+dsm or something and take a look at the diagnostic criteria (it might take your looking at a few sites to get a decent sense). For example, look here:

http://www.borderlinepersonalitytoday.com/main/dsmiv.htm

Hope that helps. Hopefully, out of all the possibly equally valid opinions you recieve, you'll get a good sense of how best to handle things.

Best of luck, life, and love to you.

hammilton
Regular Member


Date Joined Feb 2006
Total Posts : 152
   Posted 3/22/2006 11:15 PM (GMT -7)   
I can't think of anything less pleasant sounding than a potential Borderline diagnosis, but schmoe is right. The needy-dependence issues, coupled with suicide threats, really sounds like it.

with or without actual intent to carry them out, they can often be control mechanisms. Have they ever succeeded in getting her getting the guy back? Either answer to the question, only leads to more questions. Whenever suicide threats are combined with intense dependency like you describe, really means that Borderline needs to be looked into.

GPs aren't psychiatrists by any stretch of the imagination. The training they recieve is minimal in this area. He may have been great at finding warts and colds, but this is way out of his training. Going to a GP for psychiatric medication is a bit like going to the gas station attendant and asking him to fix your transmission. He might have a general idea of whats going on, but without special training, he's probably going to mess it up.

Your daughter really needs to be seeing a psychiatrist. In the best situation, she would have made contact when she first exhibited the suicidal tendencies. Suicide, in something like 80% of all cases, involves a mental illness. That fact should have prompted everyone involved to get her in to see one, and not just for a single visit, either.

Because she started to have a better mood after one day of taking the medication doesn't neccessarily mean much. I've often felt better after one day on an antidepressant, and no stabilizer (i've did it just to get out of a depression, a few days on, into hypomania and then off... but thats risky), and I would have become manic if I kept on it- guaranteed, but that one dose didn't do anything. Moods are very subjective things. They vary quite a bit without psychoactive drugs. I once read a comment, something like "Today's antidepressants don't have much of an abuse risk, not because being happy isn't wanted, they're just *so* ineffective that it'd take days before any enjoyment was gotten" If they were that quick working SSRIs and Tricyclics would be the crack of bipolars :)

Thats really too early (mostly) to tell if theres going to be a major reaction- like mania. Most of the drug will be flushed via various excratory functions. It takes quite some time to build up a good dose. The ED(50) is something like 3-7mg/kg if I remember right. If she isn't having severe reactions, and it doesn't sound like it, I wouldn't even mention your concern to her. No need to create a possible placebo reaction. A person close to me with undiagnosed borderline personality disorder (it doesn't take a diagnosis to see it, though I've had plenty of schoolin in the area), I told him to try fish oil if he really thought he was bipolar. Within two days he called me telling me how he was doing great and that all his problems were behind him. Bah. they weren't behind him, he just found a way to pretend it was doing better.

Oh well, I'm gonna quit this for a bit. I'm hypomanic right now. Have a good night for you sleeping types :)

hammilton
Regular Member


Date Joined Feb 2006
Total Posts : 152
   Posted 3/22/2006 11:32 PM (GMT -7)   
I just wanted to add a response to your third question because I don't think anyone really addressed it, and I know I didn't.

The relationship and abandonment issues make me think this isn't a depression issue at all. Could it hurt to medicate with an SSRI or rather an SNRI, as Cymbalta is, probably not. I've taken a lot of these things for longish periods of time and had no problem quitting any of them, or any negative effects (besides getting fat, which poverty and drug abuse got rid of). They're about as safe as candy for a diabetic. They're probably safe when normal amounts are used, but you start using too much, yer gonna get fat and have seizures- not that those two are connected... or are they?

Anyway, more to the point, the answer is, NO. If it isn't depression, she won't need any medications. What it does mean is far less encouraging. It means a long time and a lot of money spent on therapy, if a suitable therapist can even be found- a good many hate to deal with borderlines. Her past definitely fits the supposed causative events for borderline.

Because she says bad that therapy is entirely negative isn't neccessarily true or neccessarily bad, if it is true. Borderlines are manipulative, especially regarding relationships. Very prone to love/hate sorts of things. If the therapist thinks borderline, my first thought is that *its* doing some sort of boundary setting. This is a huge issue with borderlines. What she considers negatives may be important parts of her personality that need work. If the therapist isn't demeaning her or otherwise mean spirited, and I would be surprised if it were, I think that it might have very valid reasons for doing what its doing, but it'd be difficult to even guess what that may be not knowing her or the therapist. Feeling bad about oneself isn't wrong, its a normal part of life, and a lot of good can come from it. We tend to live in a coddled society and never want to look at our dark parts, and become angry when someone forces us to. However, there have to be limits with that sort of thing, of course. Don't want to push a depressive over the edge or dare a borderline to actually go through with a suicide.

Okay, i'm gonna go now for real.
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