Odd reactions to stimulants post-illness

[Iritu1021]

I'd much rather collapse the categories in one direction (by seeing psychiatric illnesses as physiological/hormonal/metabolic) than in the other direction, which leads to CFS people being prescribed CBT etc.

Not to say I wholly disagree with all these ideas about neurology, and I want to study the TAAR1 receptor and catecholamines and trace amines a lot more. More that I just think that the findings of metabolic impairment and skeletal muscle impairment will only continue to get more robust.

CBT is pretty much useless in bipolar disorder too since it's a neurologic condition. In fact, other than (maybe) personality disorders, I'm not sure what is a true psychiatric condition would be. Psychiatric conditions are neurologic conditions. When the nervous system isn't working the rest of the body begins to fail too. That's especially true if the neurologic condition involves parts of the brain involved in the autonomic regulation.

The issue you have right now is that you know a lot about CFS but you know little about bipolar disorder which creates bias in your judgment. If you dig deep into bipolar research you will see that there's a ton of subtle metabolomic findings as well. For example such as this:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4832124/

Blood metabolomics analysis identifies abnormalities in the citric acid cycle, urea cycle, and amino acid metabolism in bipolar disorder

 

[Iritu1021]

In their recent review Morris et al., evidenced that mitochondrial function in BD is higher during mania and decreased in depression, and propose that this phasic dysregulation of mitochondrial function is central to BD pathophysiology (Morris et al., 2017)

 

[frozenborderline]

CBT is pretty much useless in bipolar disorder too since it's a neurologic condition. In fact, other than (maybe) personality disorders, I'm not sure what is a true psychiatric condition would be. Psychiatric conditions are neurologic conditions. When the nervous system isn't working the rest of the body begins to fail too. That's especially true if the neurologic condition involves parts of the brain involved in the autonomic regulation.

The issue you have right now is that you know a lot about CFS but you know little about bipolar disorder which creates bias in your judgment. If you dig deep into bipolar research you will see that there's a ton of subtle metabolomic findings as well. For example such as this:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4832124/

Blood metabolomics analysis identifies abnormalities in the citric acid cycle, urea cycle, and amino acid metabolism in bipolar disorder

Okay. yeah I agree with this and I think I phrased what I was saying wrong. Because I do think that many mood, personality disorders, etc, are physiological and neurological conditions. Naviaux's research on autism is a good example, or the research on pregnenolone helping w/ schizophrenia

I guess I am totally fine with looking at psychiatric disorders like this in terms of being on a spectrum or cluster related to physiological disorders, there's no real perfect dividing line.

The problem isn't really you pointing this out in a nuanced way, it's just that the label "psychiatric" conjures to my mind all of the deficiencies and negative aspects of psychiatry as currently modelled and practiced, which is just a reflex I have haha.

I do see how treating the more serious metabolic impairments could then cause other roadbumps related to mood to come up and agree that this makes total sense. In fact I saw this genetic theory of clusters of both psychiatric and physical chronic illnesses that is very similar, on another doctor's blog (https://www.rccxandillness.com/rccx...ng-rccx-theory-to-mitochondrial-shutdown.html)

I do think that PEM is perhaps the core symptom of CFS and not really found in any other psychiatric illnesses tho, even if general fatigue is, which is why I think CFS is somewhat distinct even if comorbid or clustered with these other mood disorders.

All in all i don't really disagree, it's probably just my reflexive opposition to most of what is practiced as psychology/psychiatry; not really a disagreement with what you're saying. I didn't mean to be rude

 

[Iritu1021]

@debored13

Don't worry, I was not offended at all by your comments. And I totally get where you're coming from - if someone told me a couple years ago that I was bipolar I'd probably be super-pissed. But that's the thing about desperation - it breaks down the ego barriers and opens you up to new beliefs. But I know for a fact that the only person who could or would be allowed to diagnosed me with bipolar 2 was myself.

The only reason I'm trying to convince you is not to defend my beliefs but because of the huge impact this change in cognitive attitude has made for my treatment and recovery. I really wish I was able to realize this when I was young, or at least five years ago - now I'm probably stuck with decades of brain damage that's hard to reverse at my age. However, for someone young like yourself and still new to the disease, I think the right treatment can lead to a full recovery and a normal life.

This conversation actually inspired me to write a blog post on the subject:
http://www.chronicfatiguediagnosis.com/2018/10/05/mood-disorders-and-cfs-changing-the-equation/

I took a quick look at the RCCX theory and it sounds extremely complex and fascinating. I will read more of it later. The cluster she describes feels right to me. However, I am like you appear to be the "white sheep" in my family.

 

[Jackb23]

I have this same effect. Used to take Focalin from middle school to beginning of college, but once I got ill I had an odd hyper adrenergic reaction. Drugs that I use to also use occasionally include psychedelics and weed, but these now give me terrible anxiety. I also can't take anything that remotely touches serotonin (like DayQuil) or I have to go to the ER within a couple of hours due to my reaction.

 

[Jackb23]

@debored13
It's a common misconception that manias are supposed to be pleasant. That's just one type of mania that occurs in bipolar 1. The manias in bipolar 2 are not pleasant, not associated with grandiosity, or euphoria or any abnormal thinking. They are characterized as states of agitation, bodily anxiety, overstimulation, insomnia - basically exactly what you described. In other words - they are dysphoric manias. They are probably associated with glutamate toxicity and abnormal cellular metabolism (that probably involves membrane phospolipids or sphingolipids and maybe intracellular calcium regulation) - so I agree with you on that part. The cellular metabolism might be mostly confined to CNS, however, hence the "invisibility" of the disease.

Bipolar 2 is a neurologic condition that desperately needs a new name to avoid the confusion and misconception - and some experts are now advocating for that to happen. Bipolar 2 is not a mild variant of bipolar 1 but a separate, very debilitating physical illness with a different mechanism.

Once I really studied the latest info on bipolar 2 and its natural course of progression (severe brain fog, extreme fatigue, bedbound/house bound, lifelong disability) I began to suspect that some types of CFS and bipolar 2 are pretty much variants or different stages of the same disease. The ratio of depression to hypomania in bipolar 2 is something like 40:1 and when hypomanias do happen they are most likely to manifest as bursts of creativity. And even those completely disappear in the later stages.

If I was correctly diagnosed with the combination of bipolar 2 and hypothyroidism, I wouldn't have ended up with CFS which was largely due to iatrogenic complications that destabilized my already nervous system, which in turn destabilized my immune system. The combination of SSRI/stimulant/T3 was powerful enough to cause an "all systems crash" in my body. But it took me almost five years to figure out this connection.

Can you link me to the studies indicating the new research on bipolar 2 and it’s disparities? Would love to read on it

 

[Thinktank]

@debored13
It's a common misconception that manias are supposed to be pleasant. That's just one type of mania that occurs in bipolar 1. The manias in bipolar 2 are not pleasant, not associated with grandiosity, or euphoria or any abnormal thinking. They are characterized as states of agitation, bodily anxiety, overstimulation, insomnia - basically exactly what you described. In other words - they are dysphoric manias. They are probably associated with glutamate toxicity and abnormal cellular metabolism (that probably involves membrane phospolipids or sphingolipids and maybe intracellular calcium regulation) - so I agree with you on that part. The cellular metabolism might be mostly confined to CNS, however, hence the "invisibility" of the disease.

Bipolar 2 is a neurologic condition that desperately needs a new name to avoid the confusion and misconception - and some experts are now advocating for that to happen. Bipolar 2 is not a mild variant of bipolar 1 but a separate, very debilitating physical illness with a different mechanism.

Once I really studied the latest info on bipolar 2 and its natural course of progression (severe brain fog, extreme fatigue, bedbound/house bound, lifelong disability) I began to suspect that some types of CFS and bipolar 2 are pretty much variants or different stages of the same disease. The ratio of depression to hypomania in bipolar 2 is something like 40:1 and when hypomanias do happen they are most likely to manifest as bursts of creativity. And even those completely disappear in the later stages.

If I was correctly diagnosed with the combination of bipolar 2 and hypothyroidism, I wouldn't have ended up with CFS which was largely due to iatrogenic complications that destabilized my already nervous system, which in turn destabilized my immune system. The combination of SSRI/stimulant/T3 was powerful enough to cause an "all systems crash" in my body. But it took me almost five years to figure out this connection.

Are you currently on medication for bipolar type 2? If so, is it helping and which meds are you on?
I have the dysphoric mania as well.

 

[Jackb23]

Are you currently on medication for bipolar type 2? If so, is it helping and which meds are you on?
I have the dysphoric mania as well.

The only thing I have found helpful are mirtazapine, clonazepam, and lurasidone briefly.

 

[Iritu1021]

Can you link me to the studies indicating the new research on bipolar 2 and it’s disparities? Would love to read on it

I remember reading a review article describing the course of progression to severe physical and cognitive disability in untreated or treatment-unresponsive bipolar 2 which I read a while back but now have trouble finding it. I need to go through the bookmarks on my old laptop.

Apart from that, I would highly recommend Jim Phelps MD website psycheducation.org. He studied bipolar 2 patients for decades and described how bipolar 2 is a great mimicker and the psychiatric illness that's the most likely to be mistaken and misdiagnosed for something else. He also wrote a book for physicians titled "A Spectrum Approach to Mood Disorders: Not Fully Bipolar But Not Unipolar--Practical Management"
where he describes how mood disorders are a spectrum and are not always as clear-cut as DSM-IV (or the public perception) believe them to be. He also has a patient version titled "Why am I still depressed?".

 

[Iritu1021]

The only thing I have found helpful are mirtazapine, clonazepam, and lurasidone briefly.

I use levothyroxine and lithium orotate which is an old school combination which was commonly used to treat bipolar before all the new fancy drugs flooded the market.

Phelps (the doctor I mentioned in another post) seems to be a fan of lamotrigine, especially if depression is an issue - but I think it's because he's skeptical about lithium orotate as a valid substitution for lithium carbonate.

There some genetic markers you can run on livewello to see if you are going to be a lithium responder or not based on your genetics (although I'd take it with a grain of salt).

I was very frail when I began so I had to start with tiny doses of levothyroxine (6.25 mcg a quarter of the lowest dose) and gradually build it up; and then once I was on enough lithium I began to add tiny doses of lithium orotate (I use the one from Advanced Research Institute) because it comes as a pill that you can cut and also because it appears to have an extended release. Now I'm on 112 mcg of levothyroxine and 20 mg of elemental lithium (480 mg of lithium orotate) but I'm still tweaking my doses with both, and the dose of each will vary from person to person depending on weight and body chemistry.

I also use CoQ10, creatine and NAC which have all shown some efficacy. Fish oil has been a mixed bag for me. I recently read that aspirin and celecoxib might be helpful in bipolar as well so I might add one of those too.

 

[Iritu1021]

I have this same effect. Used to take Focalin from middle school to beginning of college, but once I got ill I had an odd hyper adrenergic reaction. Drugs that I use to also use occasionally include psychedelics and weed, but these now give me terrible anxiety. I also can't take anything that remotely touches serotonin (like DayQuil) or I have to go to the ER within a couple of hours due to my reaction.

As far as weed goes, THC has pro-psychotic/anxiogeic effect while CBD has anti-psychotic/anxiolytic effect. Have you tried using pure CBD?

 

[Iritu1021]

The Wikipedia page on bipolar 2 seems to have most of the info that was in the review article I can't find.

I should add that according to the latest (though not yet universally accepted) DSM-V criteria the definition of a hypomanic episode is a simple as this:

• A hypomanic episode is a period of constant irritable mood that lasts for at least 4 consecutive days.

That's it - "constant irritable mood". Nothing more.

@drob31 - thought you can relate to this thread too

 

[Jackb23]

As far as weed goes, THC has pro-psychotic/anxiogeic effect while CBD has anti-psychotic/anxiolytic effect. Have you tried using pure CBD?

I don’t think it’s as simplified as this. Some people turn to THC to lull their anxiety. Also, the reports that smoking weed puts you at an even higher risk for psychosis later in life has been somewhat debunked. In Schizophrenia they don’t just find a hyperactive state in the Mesolimbic area but also a hypoactive in the mesocortical so it’s not just excess dopamine and it’s not just dopamine either. Also, the DSM is a pretty bad diagnostic tool. In fact psychiatrist are the only doctors that don’t directly look at the organ they treat. This isn’t their fault in anyway as the brain is the most protected area in the body so it makes since that in many ways it will be one of the last frontiers in medicine

 

[Iritu1021]

I don’t think it’s as simplified as this. Some people turn to THC to lull their anxiety. Also, the reports that smoking weed puts you at an even higher risk for psychosis later in life has been somewhat debunked. In Schizophrenia they don’t just find a hyperactive state in the Mesolimbic area but also a hypoactive in the mesocortical so it’s not just excess dopamine and it’s not just dopamine either. Also, the DSM is a pretty bad diagnostic tool. In fact psychiatrist are the only doctors that don’t directly look at the organ they treat. This isn’t their fault in anyway as the brain is the most protected area in the body so it makes since that in many ways it will be one of the last frontiers in medicine

That's true, it depends on the origin and source of anxiety. Parkinson patients, for example, have anxiety due to low dopamine. And in bipolar depressive phase a bit of THC might raise your dopamine and make you feel better and in manic phase it would be more likely to make you more paranoid.

But going back to Dr. Phelps book - he advises using only low THC strains for his bipolar patients, at least until fully stabilized. He does think that cannabis can be potentially a useful drug for bipolar 2 if used correctly and in moderation.

 

[Jackb23]

That's true, it depends on the origin and source of anxiety. Parkinson patients, for example, have anxiety due to low dopamine. And in bipolar depressive phase a bit of THC might raise your dopamine and make you feel better and in manic phase it would be more likely to make you more paranoid.

But going back to Dr. Phelps book - he advises using only low THC strains for his bipolar patients, at least until fully stabilized. He does think that cannabis can be potentially a useful drug for bipolar 2 if used correctly and in moderation.

I don’t know how much I agree with the above given how enigmatic neurological conditions are at the moment. I don’t think anyone has it figured out.

 

[Iritu1021]

I don’t know how much I agree with the above given how enigmatic neurological conditions are at the moment. I don’t think anyone has it figured out.

Which part you don't agree with - that cannabis can be useful or that high THC causes anxiety and paranoia? I think the latter doesn't require any scientific evidence for anyone who has experienced it.

 

[Iritu1021]

Which part you don't agree with - that cannabis can be useful or that high THC causes anxiety and paranoia? I think the latter doesn't require any scientific evidence for anyone who has experienced it. You're the one who wrote that weed now gives you anxiety.

Phelps does say that sometimes after he tries all the prescription drugs and they don't work, he just tells the patient to go back to smoking marijuana - because sometimes it's the only thing that works for them.

 

[Jackb23]

This isn’t a stimulant, but I have begun taking valtrex the last couple days and don’t think I’m going to take another one for awhile. Thank god that it has a short half-life and it’s metabolite (cyclovir) has a short half life too. Within 30 minutes of taking the drug the last couple of days my skin starts to tingle all over my body, I get a terrible panicky feeling- so much so that my sentences become extremely convoluted-, and I freeze up due to this reaction. Currently my body won’t tolerate much. Not even the normal recommended dose of DayQuil which features dextromethorphan.

 

[Iritu1021]

I know that state - couldn't tolerate anything for a while after I stopped stimulants. Not even supplements or vitamins. Even eating food would make my brain feel like it was on fire. It really sucks - but hang in there, it'll get better!

 

[frozenborderline]

@debored13

Don't worry, I was not offended at all by your comments. And I totally get where you're coming from - if someone told me a couple years ago that I was bipolar I'd probably be super-pissed. But that's the thing about desperation - it breaks down the ego barriers and opens you up to new beliefs. But I know for a fact that the only person who could or would be allowed to diagnosed me with bipolar 2 was myself.

The only reason I'm trying to convince you is not to defend my beliefs but because of the huge impact this change in cognitive attitude has made for my treatment and recovery. I really wish I was able to realize this when I was young, or at least five years ago - now I'm probably stuck with decades of brain damage that's hard to reverse at my age. However, for someone young like yourself and still new to the disease, I think the right treatment can lead to a full recovery and a normal life.

This conversation actually inspired me to write a blog post on the subject:
http://www.chronicfatiguediagnosis.com/2018/10/05/mood-disorders-and-cfs-changing-the-equation/

I took a quick look at the RCCX theory and it sounds extremely complex and fascinating. I will read more of it later. The cluster she describes feels right to me. However, I am like you appear to be the "white sheep" in my family.

Yeah, I've taken more of a look at Bipolar II and I really don't think that it fits me at all. Getting a little stimulated from a medication that is known to sometimes be stimulating I don't think pushes me into the hypomanic categories. As far as the overlap btwn this and CFS, there might be an overlap, but I don't think Bipolar II causes muscle pain or PEM to the degree that we have it, generally. I also don't have depression. Thyroid caused some mood disturbances, but if these only occurred post thyroid treatment, is it fair to consider them part of a diagnosable mental illness? Before thyroid treatment, I had no mental illness symptoms, and was bedridden not due to mood but because of pain and fatigue.

Again, I agree with a lot of what you are saying, but there's some things that I think ought to be noted. One is that most of the time, if a symptom like being bedridden is considered as caused by a mental illness, it is considered disordered perception. Whereas if we have pain or a low aerobic threshold that forces us to be bedridden, our perception is accurate. There is of course a lot of overlap between psychiatric disorders and physiological ones, but in CFS that specific distinction, regarding perception, seems important. maybe it's not even a distinction between psychiatric and physical illness, but a distinction between "neurosomatic" illnesses and illnesses that involve some kind of peripheral damage/problem. The terminology is tricky.

In my case, it's true that thyroid caused some mood disturbances, but I'm not sure that these categories of mood disorders make sense as static categories. I never had these problems before getting severe infections that kick-started my illness state. And really, what concerns me more than the mood disturbances caused by thyroid (since I can weather those) is that it still hasn't really brought about much physical improvement, beyond an initial reduction in pain. What disturbs me about "hypomania" is less that it's a mood problem, and more that it doesn't seem to be a real increase in physical ability and healing. It's sort of like the fool's gold of energy. I think it's useful to describe these states, but I don't like considering them in the context of broad, static diagnoses, especially if they arise as a consequence of a phenomenon like thyroid treatment.