Low motivation relapse

April 27, 2015 12:05 PM

I started cymbalta in February. I have been diagnosed with dysthymia, low vitamin D, diabetes, and Hashimotos. I take metformin for diabetes and klonopin for anxiety as needed, which is once or twice a month. Two weeks later I had a friend staying with me and while she was there I woke up regularly. I ate breakfast every morning and had a nice routine going. I got a lot of exercise and felt less avoidant and irritable than usual.

The feeling and routine lasted about two more weeks after that. However I noticed myself shopping a bit more than I liked. I would really like something and order 10 of them as gifts for friends. I ended up doing about $500 in shopping after returns. Not financially devastating but unusual for me.

Now after three weeks of good energy and routine I have returned to my usual self. I wake up late. I didn't go to class for two days. I'm not sad, but feel tired, cold and avoidant. Anything I need to do feels like it can be put off, whereas in my good period I didn't put anything off, I just did.

Thoughts? Anecdotes? My thyroid isue is not treated - my endocrinologist says it's up to me whether I want to try a medication, but the levels don't support it. For years I've wondered if I need thyroid meds, or ADD meds, and I wonder what this recent shopping episode was about.

posted by charlielxxv to Health & Fitness (8 answers total)

This is just a stab in the dark and might not be your issue at all, but what you're describing (period of good mood/functioning, impulsive shopping, followed by poor mood, excessive sleeping, avoiding necessarily tasks) could be a sign of bipolar disorder (more likely the milder version, bipolar II). People with bipolar disorder are sometimes misdiagnosed as depressed or dysthymic, and SSRIs can actually trigger episodes of mania/hypomania. The timing of this occurring shortly after you began Cymbalta makes me wonder a bit.

Again, this might not apply to you, but it could be worth talking with your doctor about it if any of the other symptoms seem to fit you.

http://www.nimh.nih.gov/health/publications/bipolar-disorder-in-adults/index.shtml?rf
posted by odayoday at 12:20 PM on April 27, 2015

This may not align with anything at all, but you mentioned a friend was over when you were feeling better. Could it be that you are craving more human company? Maybe you need to get together with people more. I know isolation makes me terribly depressed.
posted by xingcat at 12:27 PM on April 27, 2015 [1 favorite]

Seconding what was said above about bipolar disorder. I don't think it's a stab in the dark, but don't jump to quick conclusions either. Besides unusual shopping watch for trouble sleeping and or feeling good on far less sleep than your can normally handle and increased talkativeness and speed of talking (beyond what is normal for you - not depressed-normal but normal-normal). There are other symptoms too, of course.

Antidepressants are not generally used without a mood stabilizer in bipolar disorder. They tend to cause mania/hypomania, which is why the increased shopping happening with beginning the Cymbalta is worth seeing your doctor about.
posted by kitcat at 12:43 PM on April 27, 2015

Wondring if it would be possible for you to get a dog, or better yet foster one for a while? Dogs offer companionship and give you reason to get out of bed and get moving (they need their food and walks)

Be sure to tell your doctor about the periods of higher energy and impulsive spending. The way you report it, it may not be enough by itself to qualify as even hypo-mania but it might be a reason to change to a medication that less is likely to cause problems if the tendency to mania is there. (NOT any kind of expert on the meds myself but live with someone who has very clear mood swings that doctor says don't hit the level of bipolar II)
posted by metahawk at 12:47 PM on April 27, 2015

Best answer: I used to be perpetually cold and tire easily, and thyroid medication has done a lot for that. I was only borderline hypothyroid, don't have Hashimoto's, and am on the lowest dose I can be (I think it's 50?), but it's still made a big difference. So I think some thyroid medication would probably worth trying for you. There aren't any side effects because it's just a synthetic version of a hormone your body makes (or is supposed to make!) anyway, and you can go back off of it if you want to, so it's also pretty low-risk.

The spending doesn't sound excessive or worrisome to me, especially on its own -- imo, it sounds like a normal sign of you feeling a bit better. I also noticed a relatively large increase in spending when I started doing better w/r/t depression, but that wasn't because my spending was suddenly too high, that was because when I was depressed, I was a hermit and didn't like/want anything enough to buy it anyway, so I spent basically nothing (as a consequence of depression). But of course, YMMV.
posted by rue72 at 2:24 PM on April 27, 2015 [1 favorite]

Yeah, you should treat the thyroid stuff and then figure out what else you need. It's simple and cheap and might make you feel a lot better as a baseline.
posted by Johnny Wallflower at 3:35 PM on April 27, 2015 [2 favorites]

$500 in shopping after returns.

What was it before returns? This does sound a little worrying, but maybe your new meds left you a teeny bit manic.

This time of year, make sure you don't have any allergies, feeling down is a symptom of many allergies, not just a result of having a blocked nose.

If the social contract was helping, make a goal of seeing more people each day, and having a friendly interaction with them, even just getting a head nod from a stranger.
posted by Elysum at 1:09 PM on April 28, 2015

Response by poster: It was probably initially $800, and then I returned $300 worth of stuff for a total of $500 spent. I initially planned on spending about $300 as a treat.

I appreciate all the responses so far. I do think rue72 is right: part of my shopping was feeling relaxed and better after a long period of not being interested in or liking anything. I had been reading about ssri's triggering bipolar and was getting concerned. Also that I can't actually afford being in a good mood!


I was also concerned that since my low energy relapsed maybe I didn't really need the cymbalta. Not sure how to gauge that but I'll stick with it.
posted by charlielxxv at 1:37 PM on April 28, 2015