Is it possible to be chronically depressed and optimistic at the same time?

Is it possible to be chronically depressed and optimistic at the same time?

A couple of months ago I came across an article in Elite Daily about people who tend to run late and one common feature was that they were optimists. I am one of those people and I tend to run around 5 minutes late for most of my appointments. I can remember being late for school in fifth grade and having to sprint to school most days. A positive byproduct of this was I won a number of awards in track and field. Despite the lack of awards for most of my life this pattern continues and for some reason it is hard to break. read more

 

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Dysthymia, personality disorders and the MBTI

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 I had been diagnosed with Dysthymia (Persistent Depressive Disorder) in the past and was reluctant to accept the diagnosis. Even though I have spent most of my life dealing with depressive like symptoms, for some reason I refused to identify with the label completely. In the past, when a teenager and young adult, I experienced mostly depression and occasionally brief(~4 hr) euthymic/hypomanic periods. As I have stated in my about section, I experienced severe depression in the morning and euthymia/hypomania in the evening with quite a regularity. Many clinicians would describe this as diurnal variation in the context of a mood episode but I am not so sure.

Continue reading “Dysthymia, personality disorders and the MBTI”

Possible connection between migraines and depression with fatigue?

For most of my life I’ve experienced fatigue and headaches. It wasn’t until relatively recently though that it occurred to me that my fatigue might be related to having migraines. In 2009 after reading about the connection between mood disorders and migraines I convinced my GP to let me try Valproate to prevent migraines. During that time though I experienced a psychotic reaction and the focus on treating the migraines was some how lost. I also tried Propanolol but it had such a sedating effect I couldn’t tolerate it for long. I felt like I was about to pass out the entire time I was on it. Continue reading “Possible connection between migraines and depression with fatigue?”

Mood spectrum controversies

An interesting lecture from Nassir Ghaemi on the bipolar spectrum concept. According to him unipolar and bipolar used to both be encapsulated under the phrase “Manic Depression”. “Manic Depression” meant someone who either experienced severe depression or mania. “Bipolar disorder” is defined by an individual having both depression and mania/hypomania. The two phrases differ only by a conjunction….something I hadn’t paid attention to before. Additionally, according to Kraepelin, a well known historic authority on the topic, individuals displaying mixed states were more common than the ones who had more pure states of either depression or mania. This has been noted more recently by other researchers such as Benazzi who published a number of articles about people who experience mixed depression.

Prevalence of mixed depression, a combination of depression and manic or hypomanic symptoms, is high in patients with bipolar disorders. Controlled studies are needed to investigate treatment of mixed depression; antidepressants can worsen manic and hypomanic symptoms, and mood stabilising agents might be necessary

While my depression has been more chronic I have experienced periods of time when it lifted and I felt normal and productive. There has also been a pattern to some of these “remissions”. They often occurred during my menses and when ever I altered my sleep schedule to a minor degree. These remissions weren’t long enough by DSM standards to qualify for hypomania however as Ghaemi states, the threshold for hypomania is to a large degree arbitrary.

I have noticed as well that my depressions didn’t seem pure. They often included good amounts of irritability, insomnia, racing/crowded thoughts, hypersexuality, and a little grandiosity. Somewhat interestingly these symptoms tended to occur in the late evening to the early morning hours. This has been noted by some researchers who study ultra rapid cycling in children. Many clinicians would probably categorize my experience as someone who is experiencing a pronounced diurnal variation but I am reluctant to think that since diurnal variation usually means a slight remission of symptoms throughout the day without hypomanic-like symptoms.

Manic-depressive insanity in the sense here delimited is a very frequent disease. About 10 to 15 per cent, of the admissions in our hospital belong to it. The causes of the. malady we must seek, as it appears, essentially in morbid predisposition.– Kraepelin

Ghaemi’s perspective much like Kraepelin is based on the big picture of evidence and history, not mainly on image. At the moment the DSM-V seems to be ruled by people who are primarily concerned with the public’s image of them. They mainly don’t want to appear like they are over prescribing and over pathologizing normal behavior. The fact that bipolar is no longer grouped with major depression under Mood disorders is one example of their over reaction to anti-psychiatry.

As someone who has experienced chronic depression with a moderate severity, I am tired of hearing how my so called Dysthymia is defined as mild and at one time in the past, a personality issue. Bipolar disorder has been generally viewed as more incapacitating and more endogenous while unipolar depression is more neurotic. Ghaemi and Kraepelin’s theories make sense to me in light of my experience with depression. It has been for the most part, quite incapacitating, miserable and briefly quite pleasant.

Previous mental illness diagnosis and other health problems

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A couple of weeks ago I went to the doctor due to some problems with my sciatic nerve and some other mysterious nerve sensitivity in my hands, face and feet. Googling my symptoms indicated the possibility of nerve damage which gave me some anxiety and I thought possibly there was some treatment for my sciatic problem. The doctor wasn’t my regular one but another one since it was  a walk in clinic. I had initially intended to go to my regular doctor but she insisted that I go immediately to the clinic that day and that she didn’t have any time to see me. My understanding was that my mysterious nerve symptoms overlapped with a description of  someone having a stroke so I indulged her anxiety and went in the clinic that same day.

Once I got there however they treated me like the neurotic one and the doctor insisted in the end that I should go to a psychiatrist despite the fact that I have no insurance coverage for mental disorders. For some reason the male doctor fixated on my irritated hands which were slightly red and dry(possibly due in part to the sun). Judging by his thinking he seemed to think I had OCD and or possibly Lupus. The Lupus could have been due to admission of some joint pain and my previous diagnosis of depression. His impression of my sciatic nerve problem was that it wasn’t enough of a problem for him to treat it at all. I inquired about muscle relaxants (anti-anxiety meds) but he didn’t want to prescribe for some reason. The philosophy of this clinic seems to be that anti-anxiety meds should be prescribed by a psychiatrist.

I have had a similar experience before like this. I mentioned some mysterious nervous symptoms and was referred to a psychiatrist. It seems like when a doctor can’t find a suitable diagnosis they immediately try to label the person as unstable…not terribly logical but it apparently saves them from confronting their own ignorance. Admittedly, part of this problem could be due to an error in communication. Here is an excerpt from an article on the topic of mental health stigma.

From a public standpoint, stereotypes depicting people with mental illness as being dangerous, unpredictable, responsible for their illness, or generally incompetent can lead to active discrimination, such as excluding people with these conditions from employment and social or educational opportunities. In medical settings, negative stereotypes can make providers less likely to focus on the patient rather than the disease, endorse recovery as an outcome of care, or refer patients to needed consultations and follow-up services.

At this point, I still have problems with my sciatic nerve and can’t walk for more than 15 minutes or so without resting due to the pain in my lower leg. Additionally, I have unusual sensitivity in my hands and feet which makes typing at the moment somewhat unpleasant. I am quite sure my previous diagnosis of psychotic depression is giving this doctor an excuse to not take my symptoms seriously and I am not sure what to do about it. Stigma due to mental illness is frustrating and it can impact other health problems which aren’t taken seriously.

update: tests don’t confirm Lupus

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The relationship between diet, inflammation and depression

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A new study by the Centre for Addiction and Mental Health (CAMH) found that the measure of brain inflammation in people who were experiencing clinical depression was increased by 30 per cent. The findings, published in JAMA Psychiatry, have important implications for developing new treatments for depression.

A growing body of evidence suggests the role of inflammation in generating the symptoms of a major depressive episode such as low mood, loss of appetite, and inability to sleep. But what was previously unclear was whether inflammation played a role in clinical depression independent of any other physical illness.

More research has come out which supports the link between inflammation and depression. While this link hasn’t been confirmed my experience has piqued my interest in the topic. For about fifteen years I have been experimenting with Ayurveda which is a form of medicine which originated in India a thousand years ago. In Ayurveda the world is divided up into three different categories(doshas in human body), Vata, Pitta and Kapha. Vata is associated with air, Pitta with fire/water and Kapha with water/earth. In the human body the various categories govern certain functions and areas. Pitta governs metabolism, heat regulation and the immune system. It is located in the eyes and small intestine. Various tastes/qualities are said to balance the doshas. Pitta is said to be balanced by sweet, bitter, astringent and coolness.

For many years I have experimented with Ayurveda and discovered that balancing Pitta was very helpful, even more than balancing Vata which is associated in Ayurveda with the nervous system. Balancing Pitta is helpful especially in regards to anxiety, irritability and depression. Perhaps Pitta’s association with inflammation in Ayurveda might explain this. In addition, Ayurveda recommends a vegetarian diet for a Pitta type of imbalance, a vegetarian diet has been shown in western medicine to help with inflammation.

Balancing Kapha, which is said to be localized in the stomach, has been helpful in regard to lack of motivation and energy. Balancing a dosha can aggravate another. Whenever I balance Kapha I notice Pitta becoming imbalanced. Balancing or pacifying Kapha can increase irritability which is a Pitta imbalance. In Ayurveda there are different methods of balancing more than on dosha. One way is to balance Vata which is believed to govern the other doshas. The second method is to balance the two using the qualities that balance the two doshas. In the case of Pitta and Kapha they are both balanced by bitter and astringent tastes. While this balancing act can be consciously performed I think it is also subconsciously performed when we have desert after a meal that has had too much salty and sour taste to it.

Somewhat interestingly healthy food tends to be higher in bitter and astringent qualities while junk food is higher in salty, sour and sweet tastes. According to Ayurveda salty, sour and sweet all balance Vata which is associated with the nervous system and stress. Perhaps this preference is one reason why western cultures seem to have more problems with inflammation and depression.