Feeling agitated again. I'm having trouble finding words, articulating. I have the urge to speak but I don't know what to say. I had coffee with friends but felt on edge the whole time. My mind kept going blank. I wanted to talk or do something, anything. I'm calming down now.
Sometimes I find it hard to stop myself from speaking, like it flows out without my control. I speak before I know what I'm going to say. I feel embarassed after, for saying too much.
I may be slightly depressed. I feel pretty hopeless about things, about uni, getting a job, and getting treatment, also just life in general. I want my depression to be lethargic like it normally is. I want to just be able to hide. But no, I have the need to keep doing things.
I feel down a lot. But up at the same time. I just feel low, but keyed up. It's like my brain is on fire.
I think I can sleep now.
Showing posts with label agitation. Show all posts
Showing posts with label agitation. Show all posts
Friday, May 14, 2010
agitated depression
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VM1-4BT7JCG-4&_user=915767&_coverDate=04%2F30%2F2004&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1331482145&_rerunOrigin=scholar.google&_acct=C000047922&_version=1&_urlVersion=0&_userid=915767&md5=02921e7b319ac5ff68395f33c25dc103
"Mixed depression was operationally defined by the coexistence of a MDE and at least two of the following excitatory signs and symptoms: inner psychic tension (irritability), psychomotor agitation, and racing/crowded thoughts.
MDE plus psychic tension (irritability) and agitation accounted for 15.4%, and MDE plus agitation and crowded thoughts for 15.1%. The highest rate of mixed depression (38.6%) was achieved with a definition combining MDE with psychic tension (irritability) and crowded thoughts: 23.0% of these belonged to MDD and 76.9% to BP-II. Moreover, any of these permutations of signs and symptoms defining mixed depression was significantly and strongly associated with external validators for bipolarity. The mixed irritable-agitated syndrome depression with racing-crowded thoughts was further characterized by distractibility (74–82%) and increased talkativeness (25–42%); of expansive behaviors from the criteria B list for hypomania, only risk taking occurred with some frequency (15–17%).
These findings support the inclusion of outpatient-agitated depressions within the bipolar spectrum. Agitated depression is validated herein as a dysphorically excited form of melancholia, which should tip clinicians to think of such a patient belonging to or arising from a bipolar substrate. Our data support the Kraepelinian position on this matter, but regrettably this is contrary to current ICD-10 and DSM-IV conventions. Cross-sectional symptomatologic hints to bipolarity in this mixed/agitated depressive syndrome are virtually absent in that such patients do not appear to display the typical euphoric/expansive characteristics of hypomania—even though history of such behavior may be elicited by skillful interviewing for BP-II. We submit that the application of this diagnostic entity in outpatient practice would be of considerable clinical value, given the frequency with which these patients are encountered in such practice and the extent to which their misdiagnosis as unipolar MDD could lead to antidepressant monotherapy, thereby aggravating it in the absence of more appropriate treatment with mood stabilizers and/or atypical antipsychotics."
"Mixed depression was operationally defined by the coexistence of a MDE and at least two of the following excitatory signs and symptoms: inner psychic tension (irritability), psychomotor agitation, and racing/crowded thoughts.
MDE plus psychic tension (irritability) and agitation accounted for 15.4%, and MDE plus agitation and crowded thoughts for 15.1%. The highest rate of mixed depression (38.6%) was achieved with a definition combining MDE with psychic tension (irritability) and crowded thoughts: 23.0% of these belonged to MDD and 76.9% to BP-II. Moreover, any of these permutations of signs and symptoms defining mixed depression was significantly and strongly associated with external validators for bipolarity. The mixed irritable-agitated syndrome depression with racing-crowded thoughts was further characterized by distractibility (74–82%) and increased talkativeness (25–42%); of expansive behaviors from the criteria B list for hypomania, only risk taking occurred with some frequency (15–17%).
These findings support the inclusion of outpatient-agitated depressions within the bipolar spectrum. Agitated depression is validated herein as a dysphorically excited form of melancholia, which should tip clinicians to think of such a patient belonging to or arising from a bipolar substrate. Our data support the Kraepelinian position on this matter, but regrettably this is contrary to current ICD-10 and DSM-IV conventions. Cross-sectional symptomatologic hints to bipolarity in this mixed/agitated depressive syndrome are virtually absent in that such patients do not appear to display the typical euphoric/expansive characteristics of hypomania—even though history of such behavior may be elicited by skillful interviewing for BP-II. We submit that the application of this diagnostic entity in outpatient practice would be of considerable clinical value, given the frequency with which these patients are encountered in such practice and the extent to which their misdiagnosis as unipolar MDD could lead to antidepressant monotherapy, thereby aggravating it in the absence of more appropriate treatment with mood stabilizers and/or atypical antipsychotics."
Wednesday, May 12, 2010
My current state
I'm back to feeling as agitated as I was before abilify. I feel kind of elated, though. I wish I could work on my assignment, but I can't focus. My mind is too crowded. I feel like doing things, not sitting here in the library. I have what they call psychomotor agitation, I think. Leg jiggling. Writing calms me down. I feel disjointed. I don't quite feel safe with so many people around me.
I experienced such a rush of euphoria while I was exercising this morning. I embraced it. I woke up at 3am but I feel energised. Part of it must be a lack of sleep, and because I went to the gym this morning. I think sleep deprivation and exercise can make me more energised or agitated.
I guess I also feel anxious in this agitated state. Maybe it's still the after-effects of abilify, but it's different somehow. I feel clear. My mind is clear yet it is crowded. It doesn't really make much sense. I feel like I'm slipping into insanity.
For hypomania, "the change in functioning for some individuals may take the form of a marked increase in efficiency, accomplishments, or creativity. However, for others, hypomania can cause some social or occupational impairment."
Occupational impairment... does that include not being able to study?
I'm a lot more efficient at some things in this state, like exercising and writing. I can't write anything to do with my assignment, though. I don't feel that worried about uni at the moment. I feel that all will be well, unless of course I can't calm down.
Sometimes I feel this rush that reminds me of the effects of ecstasy.
Anyway, I feel like I can't calm down or slow down at the moment. I feel sort of like I've taken stimulants.
I have intrusive and vivid thoughts. I've always had those. I sometimes feel paranoid in public. My extreme fears/phobias seem to come from intrusive, vivid thoughts. They're not so much phobias, because they are fears about situations I don't actually find myself in. Situations that will probably never happen to me. They are more like obsessions. I can imagine such horrible things happening. The first thing was just death in general, when I was very young. I felt I could imagine what death would be like. I guess this what at an age when I didn't really understand death. I thought of it as unconsciousness, and then I associated sleep with death and sleep seemed scary sometimes. I also pictured the end of the world. That was an obsession for me, for a long time I think. It started when I was around ten. It may have been related to the religious ideas I'd been exposed to. I thought about it all the time, and it scared the crap out of me. Then, in 2008 I became obsessed with my fears of flying and surgery. I knew I didn't have any plane trips or surgery coming up (I've never even had surgery), but I thought about it a lot. I pictured these bad things happening.
I experienced such a rush of euphoria while I was exercising this morning. I embraced it. I woke up at 3am but I feel energised. Part of it must be a lack of sleep, and because I went to the gym this morning. I think sleep deprivation and exercise can make me more energised or agitated.
I guess I also feel anxious in this agitated state. Maybe it's still the after-effects of abilify, but it's different somehow. I feel clear. My mind is clear yet it is crowded. It doesn't really make much sense. I feel like I'm slipping into insanity.
For hypomania, "the change in functioning for some individuals may take the form of a marked increase in efficiency, accomplishments, or creativity. However, for others, hypomania can cause some social or occupational impairment."
Occupational impairment... does that include not being able to study?
I'm a lot more efficient at some things in this state, like exercising and writing. I can't write anything to do with my assignment, though. I don't feel that worried about uni at the moment. I feel that all will be well, unless of course I can't calm down.
Sometimes I feel this rush that reminds me of the effects of ecstasy.
Anyway, I feel like I can't calm down or slow down at the moment. I feel sort of like I've taken stimulants.
I have intrusive and vivid thoughts. I've always had those. I sometimes feel paranoid in public. My extreme fears/phobias seem to come from intrusive, vivid thoughts. They're not so much phobias, because they are fears about situations I don't actually find myself in. Situations that will probably never happen to me. They are more like obsessions. I can imagine such horrible things happening. The first thing was just death in general, when I was very young. I felt I could imagine what death would be like. I guess this what at an age when I didn't really understand death. I thought of it as unconsciousness, and then I associated sleep with death and sleep seemed scary sometimes. I also pictured the end of the world. That was an obsession for me, for a long time I think. It started when I was around ten. It may have been related to the religious ideas I'd been exposed to. I thought about it all the time, and it scared the crap out of me. Then, in 2008 I became obsessed with my fears of flying and surgery. I knew I didn't have any plane trips or surgery coming up (I've never even had surgery), but I thought about it a lot. I pictured these bad things happening.
Tuesday, May 11, 2010
agitation
Agitation and depression. The two most horrible things. When they occur together, it's most horrible. Agitation is like having a lot of energy, but in a bad way. It's the reason I'm writing and not reading or watching tv or doing something else relaxing. Maybe having energy is good when it's energy that can be put to good use (because you can still focus on things) and when it's energy that can be exhausted. It's also not just having the energy to do things, it's a constant pressure to do things. It comes from inside. I don't necessarily want to do anything but I have to. I have energy in my head but I can't so much with it because I can't focus. I can't sit down and focus on one thing for too long. It makes it hard to read a book or work on assignments.
In this state I think that I would rather be depressed, but of course I would think that now.
I thought the agitation was caused by medication, but obviously not.
In the past I've had a lot of energy, but it felt good. I felt driven to do things, but I also wanted to do things. I think "yeah, I was doing so well in 2007". It was the year before I became severely depressed. I was so HAPPY. I had so many friends, and oh how I loved my friends. I worked, I partied all the time, I exercised so much at the gym. I was just so freakin happy. I thought everyone loved me. I didn't bother with things like studying. I didn't get depressed after a night of heavy drinking. Having a hangover was just a relaxing day. Drinking was an ecstatic experience. So was dancing. When I went out dancing I could picture myself doing it forever. It seemed like the most important thing in the world. I felt attractive, alive, charismatic. All this is actually very unlike me. I change a lot, I guess. I miss that person, though. I miss being like that. I thought things would be that way again. I just miss feeling that way. I was on top of the world.
Was this some sort of pathology? Was I actually hypomanic, instead of being a normal, outgoing woman in her early 20s? Normal... no. Not normal for me. Maybe normal in that I've experienced these shifts in my social functioning before. Am I shy or am I that outgoing, confident, social, talkative person?
I remember feeling high sometimes, as if I had taken ecstasy. I didn't need drugs to get high. I just needed some music, some people and some booze. I've been chasing that high. I still go out dancing sometimes, and I wonder what happened to my high. It's not that I'm depressed, I just can't believe the huge shift in my experience. Of course, I'm older now. These things get less fun.
So maybe agitation is just energy without the high. Anyway, it sucks. But everything shifts, nothing stays the same. Maybe tomorrow I'll feel normal and subdued. Or maybe I'll have positive energy and try to write a book. I'm just so glad I'm off the abilify and I don't have to put up with that level of agitation and anxiety. I feel so much better now. No drugs. I'm supposed to take risperidone tonight.
Why am I being prescribed these drugs? I really don't understand. Maybe the doctor has some theories he's not telling me about, or maybe he just likes these drugs a lot. I certainly don't think that people are usually prescribed antipsychotics because they have anxiety. At least he didn't put me on another antidepressant. Well, which is worse? I don't know. I don't want to take anything, I don't want side effects on top of symptoms. It's too hard to know what the drug is doing to me. I feel so much clearer without any drugs.
Hmmm... risperidone. Should I try it? Just so I can say I did? It will just knock me out and make me feel weird. How can I possibly believe that it could be any different?
In this state I think that I would rather be depressed, but of course I would think that now.
I thought the agitation was caused by medication, but obviously not.
In the past I've had a lot of energy, but it felt good. I felt driven to do things, but I also wanted to do things. I think "yeah, I was doing so well in 2007". It was the year before I became severely depressed. I was so HAPPY. I had so many friends, and oh how I loved my friends. I worked, I partied all the time, I exercised so much at the gym. I was just so freakin happy. I thought everyone loved me. I didn't bother with things like studying. I didn't get depressed after a night of heavy drinking. Having a hangover was just a relaxing day. Drinking was an ecstatic experience. So was dancing. When I went out dancing I could picture myself doing it forever. It seemed like the most important thing in the world. I felt attractive, alive, charismatic. All this is actually very unlike me. I change a lot, I guess. I miss that person, though. I miss being like that. I thought things would be that way again. I just miss feeling that way. I was on top of the world.
Was this some sort of pathology? Was I actually hypomanic, instead of being a normal, outgoing woman in her early 20s? Normal... no. Not normal for me. Maybe normal in that I've experienced these shifts in my social functioning before. Am I shy or am I that outgoing, confident, social, talkative person?
I remember feeling high sometimes, as if I had taken ecstasy. I didn't need drugs to get high. I just needed some music, some people and some booze. I've been chasing that high. I still go out dancing sometimes, and I wonder what happened to my high. It's not that I'm depressed, I just can't believe the huge shift in my experience. Of course, I'm older now. These things get less fun.
So maybe agitation is just energy without the high. Anyway, it sucks. But everything shifts, nothing stays the same. Maybe tomorrow I'll feel normal and subdued. Or maybe I'll have positive energy and try to write a book. I'm just so glad I'm off the abilify and I don't have to put up with that level of agitation and anxiety. I feel so much better now. No drugs. I'm supposed to take risperidone tonight.
Why am I being prescribed these drugs? I really don't understand. Maybe the doctor has some theories he's not telling me about, or maybe he just likes these drugs a lot. I certainly don't think that people are usually prescribed antipsychotics because they have anxiety. At least he didn't put me on another antidepressant. Well, which is worse? I don't know. I don't want to take anything, I don't want side effects on top of symptoms. It's too hard to know what the drug is doing to me. I feel so much clearer without any drugs.
Hmmm... risperidone. Should I try it? Just so I can say I did? It will just knock me out and make me feel weird. How can I possibly believe that it could be any different?
apprehension
I'm about to go to the psychiatrist. I hope I get something good out of it, like a referral, and some better medication options (even no medication would be good). I know I have to be realistic about medications, but I struggle with being on them when I don't even know what's wrong with me. Abilify gives me energy and that's about the only good thing. I could get more energy by sticking to a schedule, which I think I should do anyway. I'm already in the habit of waking up early, now. Abilify may have corrected my sleep problems, but then it created more. I woke up at 1am yesterday. I was agitated so I stayed up. It makes me feel so awake, so aware. Aware of every emotion, aware of sounds that might be someone breaking into my house (this has happened to me before, without the help of drugs, but I hadn't experienced it in a while).
Having energy is so good, being agitated is so crap. I think that you can't have one without the other when medication is involved. You can have energy and still be calm, which is ideal. I just want to feel like myself, which I do more so today after not taking abilify.
What if it's also really improving my mood? I almost forgot about how depressed I was before. Well, right before I started abilify I wasn't exactly depressed. I was already a bit agitated. My thoughts were racing and I had more energy. That was one of the things abilify was supposed to help with, but it's made it worse. Sure, I'm not depressed, but I go through so many intense and overwhelming emotions in a day. I've started to use the DBT technique of recognising my emotions without being judgemental. As soon as I feel sad or empty I usually automatically think that I'm slipping into depression. I've realised that's not always the case. It's just an emotion, and I have them a lot. They may be very intense, but that doesn't mean they will last forever. It's a big deal for me to realise this.
Anyway, I think that abilify will be exceptional when it comes to preventing depressive episodes. I would like to go on a lower dose, though. Hopefully then my anxiety and agitation won't be any worse than usual. I feel quite good this morning, and I didn't have abilify yesterday, so maybe the lower levels still do something good.
I'm trying not to think about this medication and black-and-white terms. Abilify is grey, just like everything else. It has good and bad effects on me. I'm supposed to weigh these up, with the help of the doctor.
If the abilify helps me to improve, then that is the most important thing. I'll improve with more energy and less depression, but I'll also be hindered by increased agitation and anxiety, plus the lack of sleep does not help. I don't want to be given seroquel to help me sleep. I have no trouble falling asleep, anyway. I don't want someting that will help me stay asleep, because then I will be sleepy all day, and that will cancel out the good things about abilify as well as the bad things. Or, I could always try. I guess I can't judge a medication until I try it.
I still want to try lamotrigine. It might actually help reduce the agitation. I think it's been months now that I've been feeling agitated. It's not just a transient thing. I haven't sat down and read or watched tv for a long time (or if I try, I feel too restless or get distracted). It's horrible not being able to switch off. It's great that I'm motivated to go to the gym, but I can't be at the gym all the time. I can't be doing things all the time, I need to be able to relax.
I hope this blog will give me some insight and help me along the way. I come up with things that I wouldn't if I were just ruminating. Rumination just leads to repetitive thoughts, anyway. Once I've written something down I'm less likely to write it again, so at least I come up with stuff that's different. I've been doing a stream of consciousness sort of thing, just writing what comes into my head. Hence the writing seems disjointed and abrupt. That's okay, though, I'm not writing a book.
Okay, it's time to go get on the bus.
Having energy is so good, being agitated is so crap. I think that you can't have one without the other when medication is involved. You can have energy and still be calm, which is ideal. I just want to feel like myself, which I do more so today after not taking abilify.
What if it's also really improving my mood? I almost forgot about how depressed I was before. Well, right before I started abilify I wasn't exactly depressed. I was already a bit agitated. My thoughts were racing and I had more energy. That was one of the things abilify was supposed to help with, but it's made it worse. Sure, I'm not depressed, but I go through so many intense and overwhelming emotions in a day. I've started to use the DBT technique of recognising my emotions without being judgemental. As soon as I feel sad or empty I usually automatically think that I'm slipping into depression. I've realised that's not always the case. It's just an emotion, and I have them a lot. They may be very intense, but that doesn't mean they will last forever. It's a big deal for me to realise this.
Anyway, I think that abilify will be exceptional when it comes to preventing depressive episodes. I would like to go on a lower dose, though. Hopefully then my anxiety and agitation won't be any worse than usual. I feel quite good this morning, and I didn't have abilify yesterday, so maybe the lower levels still do something good.
I'm trying not to think about this medication and black-and-white terms. Abilify is grey, just like everything else. It has good and bad effects on me. I'm supposed to weigh these up, with the help of the doctor.
If the abilify helps me to improve, then that is the most important thing. I'll improve with more energy and less depression, but I'll also be hindered by increased agitation and anxiety, plus the lack of sleep does not help. I don't want to be given seroquel to help me sleep. I have no trouble falling asleep, anyway. I don't want someting that will help me stay asleep, because then I will be sleepy all day, and that will cancel out the good things about abilify as well as the bad things. Or, I could always try. I guess I can't judge a medication until I try it.
I still want to try lamotrigine. It might actually help reduce the agitation. I think it's been months now that I've been feeling agitated. It's not just a transient thing. I haven't sat down and read or watched tv for a long time (or if I try, I feel too restless or get distracted). It's horrible not being able to switch off. It's great that I'm motivated to go to the gym, but I can't be at the gym all the time. I can't be doing things all the time, I need to be able to relax.
I hope this blog will give me some insight and help me along the way. I come up with things that I wouldn't if I were just ruminating. Rumination just leads to repetitive thoughts, anyway. Once I've written something down I'm less likely to write it again, so at least I come up with stuff that's different. I've been doing a stream of consciousness sort of thing, just writing what comes into my head. Hence the writing seems disjointed and abrupt. That's okay, though, I'm not writing a book.
Okay, it's time to go get on the bus.
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