Possible Cyclothymia - are there any definitive diagnostic criteria?

[Kobayashi]

Hi All,

I've posted on these forums for some time now - mostly on the OCD forum.

I've been keeping good track of my moods over the past 6 months and I can see a DEFINITE pattern.

I'll feel just fine for about 6 weeks, with some minor OCD - but generally I feel very good and "normal". So much so that I don't even visit these forums.

This is followed by another 4-6 weeks of feeling very crummy: Highly Increased OCD, Anxiety and depression. These moods cycle throughout the day from being tolerable to terrible. Generally, during these periods, I feel like my life is a mess.

This has been happening for two years now. I'm still taking 100mg of Luvox and .5mg of Risperidone. I take ativan PRN, but don't even touch it during my "good" cycles.

I have not been able to get in to see a psychiatrist in my area as none of them are taking new patients. My Family Doctor has referred me to CAMH in Toronto, but its a 4-6 month waiting list.

My Dr. has screened me for Bipolar, but i don't have any of the disruptive "highs" associated with it. I've been reading lots about cyclothymia lately and was thinking that perhaps I may fall into this category.

Is there anything else I can do to assess if this may be the correct diagnosis? I've read the mood stablizers such as Lamotrigine can help a great deal with cyclothymia and want to suggest a trial of this to my family doc.

Any suggestions?

 

[David Baxter PhD]

I have not been able to get in to see a psychiatrist in my area as none of them are taking new patients. My Family Doctor has referred me to CAMH in Toronto, but its a 4-6 month waiting list.

My Dr. has screened me for Bipolar, but i don't have any of the disruptive "highs" associated with it. I've been reading lots about cyclothymia lately and was thinking that perhaps I may fall into this category.

Maybe. Maybe not.

I realize that wait times for psuchiatrists are long in Ontario (actually 4 to 6 months is relatively short for elsewhere in the province; often it's a year or more) but that probably is your best bet.

In the meantime, are you in therapy for help coping with your symptoms in other ways?

 

[Kobayashi]

Hi,

Thanks for the response. I have had loads of therapy in the past. I've done everything from CBT to mindfulness. It has helped me to deal with things - I don't get completely freaked out like I used to, and I can help myself to "stay in the present". I'm cot currently doing any therapy because I'm not sure I can get any more benefit out of it than I already have. What's going on here is "chemical" in nature. The patterns are quite remarkable.

I'm very disappointed and frustrated with the mental health system in Ontario. It seems that the only way you can get someone to pay any immediate attention to you is to admit yourself to the emergency department. Two years ago when I first started having issues, I did this, and ended up seeing some quack who was over worked and had zero empathy. When I explained my situation to him his exact words to me were "what do you want me to do for you?? Anesthetize you?". I'm not kidding - that's verbatim. After telling my family doctor about my experience, she advised never to go back to the hospital again. So, basically, if you are not suicidal and are a "functioning" member of society - you have to wait months to get in to see anyone and potentially suffer discomfort in the meantime. I live in Barrie - a relatively large city and every single psychiatrist here is not taking on new patients. It boggles my mind. Sorry - I'm just venting.

 

[David Baxter PhD]

What about seeing a psychologist privately for an opinion as to diagnosis?

 

[Kobayashi]

Thats a good idea. I did see a private psychologist two years ago and the diagnosis was GAD. At the time the intrusive obsessional thoughts I was having were viewed as a by-product of anxiety. It was so early in to the condition that I hadn't had time to fully evaluate and communicate everything that was happening to me - (I was basically as freaked out basket case thinking that I was losing my mind). Now that I haven't lost my mind and had two years to observe, record and evaluate my condition(s) I've come to some conclusions myself by reading countless books and spending hundreds of hours researching on the internet. It might be a good time to get a second opinion.

Personally, I think I have varying degrees of comorbid GAD, Pure-O OCD and cyclical depression which elevates in intensity during my bad cycles. The cyclic nature of the conditions followed by periods of "normality" leads me to believe there is some minor bi-polar or cyclothymic component. Funny thing is - I never had the cyclic component until being put on SSRIs. That and the music that plays in my head all the time. Damn SSRI'S.

 

[Kobayashi]

UPDATE!!

After 8 months of waiting, I finally got in to see a new Psychiatrist in Toronto. I found him myself by going to "ratemyMD" and looking for the psychiatrist with the best patient rating. Well - it looks like it was worth the wait.

I was totally shocked because this guy spent nearly 2 hours with me. Highly unexpected and a breath of fresh air - this guy actually LIKES his job and is passionate about it. He's even into hypnotherapy as a hobby.

Apparently I've been misdiagnosed from the onset. It appears that I do suffer from mild cyclothymia and the medications I've been on have just been exacerbating the problem.

He want me off all my current meds and will be working with me to get off them over the next few months. He is totally aware of ssri withdrawal and has emphasized that this needs to be done very slowly. He even mentions using "sandpaper" to slowly shave bits of my pills off. Sound like fun eh?

In the meantime, he has prescribed a low dose benzo to help with withdrawal and told me not to worry about dependence etc. He says "you need it right now".

He's going to look at a low dose mood stabilizer for me (not sure what this is yet) but he did mention Seroquel XR.

Apparently the "Music in my head" is my brain kicked into overdrive by the antidepressants.

Well - just thought I'd update - so wish me luck!

 

[David Baxter PhD]

Good luck.

 

[Kobayashi]

So....I've been put on Lamictal (Limotrigine). 25mg. Took one this am and don't feel a thing yet. Maybe a bit groggy - but thats more likely due to the Benzos. Anyone have any experience with this med? Good/Bad/Ugly? Apparently there is a rare chance of getting an awful rash?

 

[David Baxter PhD]

Apparently there is a rare chance of getting an awful rash?

I've had several clients on Lamictal and none of them have expreienced that. It's mentioned because, while rare, if it should happen that you get "the rash" it's a serious thing and you need to get off Lamictal quickly.

 

[Kobayashi]

How have your patients responded to the antidepressant and mood stabilizing qualities of the med? It seems to be very highly rated.

 

[David Baxter PhD]

How have your patients responded to the antidepressant and mood stabilizing qualities of the med?

As you might expect, their response has been varied. It helped some of them and did little for others. I don't recall anyone complaining about side-effects, though, so I think it's pretty good in that respect.

 

[Kobayashi]

Here is something interesting....My new Doc has come to the conclusion that my Cyclothymia is MEDICATION INDUCED!!!! That's right - SSRI's are causing me to cycle between feeling OK and feeling like black tar. Now the hard part - getting me off SSRI's and on to the Lamicatal. Its a slow torturous process, but it needs to be done.

 

[David Baxter PhD]

It has long been known that SSRIs may trigger hypomanic or manic reactions in individuals with bipolar disorder or cyclothymia, whether previously diagnosed or not.

The notion that SSRIs might do this for individuals who do not meet the criteria for bipoilar disorder or cyclothymia is relatively new and as yet unproven.

I would urge readers to consider this speculative at the present time. I wish you good luck, Kobayashi, with what I would view as an experiment. It will be interesting to see how this works out for you, especially with the use of Lamictal as a mood stabilizer.

 

[Kobayashi]

I'm now on 75mg of lamictal and still slowly coming off Luvox. Overall, my moods have been much more stable. I do get the odd down day, but things have leveled out for me. Side effects are not really an issue for me.

Still have a way to go...Getting off Luvox is tough. I'm now at 37.5mg down from about 150mg. My Dr. has found me a compounding pharmacy which has created some "custom" pills with lower dosages, going down in 5mg increments every 2-3 weeks.

Still taking 1mg rivotril at night. My Doc has told me that this will be the next med I have to tackle coming off after the Luvox. he's acknowledged that the process will take time and I again can use the compounding pharmacy for this.

It has long been known that SSRIs may trigger hypomanic or manic reactions in individuals with bipolar disorder or cyclothymia, whether previously diagnosed or not.

The notion that SSRIs might do this for individuals who do not meet the criteria for bipoilar disorder or cyclothymia is relatively new and as yet unproven.

I would urge readers to consider this speculative at the present time. I wish you good luck, Kobayashi, with what I would view as an experiment. It will be interesting to see how this works out for you, especially with the use of Lamictal as a mood stabilizer.