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 common disorder.

After starting 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.

Nonetheless with 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.




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