Lingering symptoms

[Laurie23]

Within the last month, I have become content (it's hard to explain). I feel that things are going okay, even well in some areas of my life and I am in a place that makes me feel like I am stable. I am on three different medications for depression that control most symptoms, but I still have outbursts of symptoms. They don't last long enough to qualify as a depressive episode, but they are troubling to me. For example, the other day after a stressful weekend (possible trigger), I became so angry that I was mad at everything. The car noises, my partner, the birds, my computer. It was unprovoked anger at everything. It lasted about 36 hours. Sometimes, I will randomly have self-harm thoughts or suicidal ideation (no worries - no intent to follow through). The other one that consistently plagues me is the inability to get out of bed and exhaustion. If I don't have something planned, getting up is really hard. If I do have something planned, I stay in bed until the last possible moment.

I guess what I am asking, is this normal for depression? To continue to have some symptoms occasionally, even when responding well to treatment?

Thanks

[AJ]

I'm not in the space of mind to respond specifically to your post. I just want to welcome you to the forum.

[paul m]

Hello Laurie23. Interesting questions that not even the experts agree on. I can only give you some resources to look at and my own opinion. I fore warn you that I have no medical credentials to back up my opinions and that a lot of medical professionals may disagree with me.

The following is a statement that I have long believed in, but is only recently showing up in medical papers.

"Depressive disorder with mixed features, also known as a mixed episode, a mixed state or agitated depression, is a term used in the 5th edition of the DSM " and is used primarily with someone who has predominately depression, but also mild mania (bipolar)

However even that statement has quite a few qualifiers, that is qualifiers by the experts and not by me. If you read the article at https://www.verywell.com/what-does-d...s-mean-1067282 you will see that a lot of research shows that many people with depression show a symptom or two of mania, but not enough to be classified as having bipolar.

For that matter the symptoms may not last long enough to be officially classed as anything, but that is where the term rapid cycling comes in. Rapid cycling is mostly used to describe bipolar problems but some researchers advise that people with depression can also suffer from it. With rapid cycling , episodes may occur and disappear so fast that they do not qualify under the rigid definition of a depressive episode see http://www.ehow.com/about_6462214_cy...pression_.html This is another relatively new term in regards to depression.

Combine mixed states and rapid cycling and you can have a nasty illness that doesn't meet a lot of generally accepted criteria and often is not well accepted by doctors.

I sometimes have symptoms exactly as you describe, (I have bipolar) and for a long time no experts were talking about mixed states or agitated depression, even for people with bipolar . Even when I used to broach this subject with various doctors they had no idea what I was talking about. I'm not saying that you have bipolar, far from it, I am saying that people can suffer from mixed states even if there primary diagnosis is depression. That is you have depression with a few traits of bipolar mixed in.

Mixed states, especially agitated depression, were really difficult for me to deal with for a long time. Eventually as I learned more and more about them I was able to control them better, partly by medication and partly by being aware of what was happening to me and using some cognitive behavioural training to help control those episodes. I also learned that life style and diet played a part.

For example I learned that certain allergy meds could cause problems as you describe, especially when I was using them a lot during allergy season. Caffeine was another problem at times, I don't drink much coffee, but when I used to find it really hard to get going in the morning I would increase my daily intake by a couple of cups and after a week or so that had a spectacular effect on my mood (and not for the better) . Both of the above examples were hard for me to catch as they occurred so intermittently. It also helped when I started to fully understand what was happening to me and I could try and change my thought patterns or try to avoid situations that would lead to problems. A simple example is when I am in a mood where I'm touchy I try to realize that if I think that the world is full of a**holes, then I'd better try and avoid people that set me off when possible (I know that's not always possible). A change in meds helped me as well. I'm not blaming myself or anyone else for bringing on any symptoms that may occur. However what we don't know can sometimes hurt us. Also realizing that these were real symptoms that I could possible tackle helped.

Anyways I'm getting a little off topic. It can be difficult to track down accurate information on what you describe as the medical community can be a little slow to update. For example rapid cycling was first documented around 1913 for people with bipolar and in 1995 I was still trying to find out why my moods were going up and down so rapidly as a lot of medical professionals in the early 90's hadn't heard of such a thing. Now it is common place to hear about rapid cycling for bipolar, not so much depression. (sorry about my little personal rant there , but I suffered a lot because certain individuals were behind in their reading).

I'm sorry this was so long, and if you have any questions please ask. Take Care, paul m

[Laurie23]

Thanks AJ for welcoming me to the forum. I appreciate it.

Paul - thank you for all of the information that you given me. I haven't been able to find any of that on the internet in my previous searches, but it makes so much sense. I think I am lazy, because some days I have trouble getting out of bed, but not every day. It happens for usually a few days in a row, but not long enough to classify it.

I also agree with you - I don't think I am bipolar, but I think I have had symptoms of mania at times, usually while I am in a depressive state (not very often - maybe twice in the last year). So thank you for giving me a place to start and look for information and a place to start a conversation with my psychiatrist. I have to admit that since being on a mood stabilizer, things have gotten much better.

Thank you again Paul!

[paul m]

Hello Laurie23. Thx for the thx. You said " I think I am lazy, because some days I have trouble getting out of bed, " . You would not believe how many doctors I talked to about that problem over the past 40 years. I've heard such wonderful answers as " You are not disciplined enough, you procrastinate to much, you don't have good sleep habits, you probably aren't taking your medications properly, you are lazy, just force yourself to get up, don't let your problems bother you so much, are you sure that you are taking your medications properly and I could go on.

The correct answer is: I have a difficult illness that is often difficult to treat and often will invade my life in ways that are hard to understand. I don't know who told me that, but it's the correct answer no matter what your diagnosis is when odd ball or irregular problems pop up. Often when you get onto a forum like this you may find that the problem that you have is shared by many and really isn't so odd at all, just difficult.

Or as I always like to put it, "I'm a good person with a bad illness, not a bad person with good excuses and there is a considerable difference between those two personalities". So when I have trouble getting out of bed for a few days and I start to think that I'm lazy I just look in the mirror and say "I'm a good person with a bad illness etc, etc" Good luck with your research, if you need any other help finding websites, just ask. Take Care. paul m

[Laurie23]

Thank you so much Paul M. I needed to hear that. Yesterday, it took my partner a long time to convince me to get out of bed. The only reason I did was because I had an appointment. I did no personal care (shower etc). Just rolled out of bed, put clothes on and went. It was brutal. It feels so much better knowing I'm not alone.

Thanks again!