I first experienced
the depressive symptoms of Bipolar II disorder the summer before I
started an Ivy League college. Symptoms waxed and waned-anxiety, fears,
social maladaptation, gastrointestinal disorders, that bad feeling and
depressive thinking. Yet I was able to do well enough to get into
medical school after my junior year. (What my true potential was Iíll
never know). The first two years of medical are normally hellish but my
situation made it marginally bearable. I felt like leaving a few times
during those non-clinical years. But the last two years and internship
seemed much easier although there were some residua of the illness. My
tour of duty in Vietnam was marked by a profound depression and I was
barely able to persevere. I saw a psychiatrist during medical school, in
Vietnam and after returning to the States. They all felt I had an
anxiety disorder. Today psychiatrists would be more attuned to the
Bipolar Spectrum given all the information that has amassed about this
practice I had periods where I needed little sleep and effortlessly
worked 70 hours a week and was exuberant. Then years later over a
period of weeks I felt awful again. But I never suspected a mood
disorder even though I took pride in my treatment and care of seriously
depressed patients. By fortuity I chose a psychiatrist who was himself
bipolar. He advocated lithium and I felt this was a rush to judgement
Eventually a few months later the pain was so great I started lithium
which at first I took reluctantly and sporadically and started an
antidepressant, doxepin(this was over 20 years ago) mostly because of
the insomnia. I weaned off of this slowly over the next 18 months.
Since being on lithium
I have had two mild depressions. About 15 years ago with the first
breakthrough depression I visited an expert in bipolar illness who gave
me such sound advice that I have not had any breakthroughs until a few
months ago. He advised taking all lithium at bedtime, suggested
supplemental thyroid as a mood stabilizer and told me to increase the
lithium levels some should I get breakthrough depression.
Recently there has
been an article in the Journal of Clinical Psychiatry which purports to
show that multivitamins, multiminerals and amino acids seem to help
Bipolars normalize. I have been taking these types of supplements for
many years. Most recently I have added Omega 3 fatty acids to my regimen
purely for cardiovascular health. With my recent depression I increased
my dosage by 50% to no obvious avail.
As a child in grade
school I used to get the blues in the fall and winter, while in the
summer I was outdoors all day long and was ecstatic.
My cousin who attended
all of grade school with me clearly remembers my mood swings.
I realized I had
seasonal affective disorder (SAD) when the work first came out NIMH. I
purchased a light many years ago and used it mostly for fatigue and
hypersomnia rather than depression per se. I didnít seem to need it
anymore and gave it away only to purchase one again several years ago
but hardly ever using it. It is rare not to have yearly or biennial
episodes of SAD. Perhaps my regimen protected me.
Six months ago my
mother died and three months ago I went into semi-retirement. At
Christmas I sensed the depression that had been chasing me for some
time. I ascribed it to life events but about two weeks ago the
hypersomnia approached 14 hours a day and this wounded healer realized
that SAD was back. I got Dr. Rosenthalís books out and re-read parts of
the them and the depression abated within three days of starting the
light. The negative thinking is gone, the thoughts of death have
evaporated. I got to be careful not to induce a hypomania.
Would that there were
a medication that worked that fast for depression(Some day!).
Even if I had been
diagnosed in 1960 not much could have been done as there was no lithium
treatment available in this country until 1970.
lithium I have been able to work 60+ hour weeks and not lost a day of
work. I have taken great pride in helping seriously depressed patients
as a primary care physician, especially the ones who have told me after
they improved that they were seriously considering suicide before coming
for treatment. Almost all serious mood disorders are biologically based
and stress from numerous causes can activate the underlying disorder.
We must all be aware of any recognizable change in our mood and evaluate
it with a health professional because there is an ever-growing
armamentarium of mood enhancing and stabilizing medications.