MyTherapy Discussion Forums - Depression/Bipolar II or fine?

Š1995-2016 Phillip W. Long, M.D.

Mood Disorder Community

Nickname:	Password:
Save Password

All Forums

Depression: Specific Topics

Diagnosis

Depression/Bipolar II or fine?

New Topic

Reply to Topic

Printer Friendly

Author

Topic

Page: of 21

sean74
Starting Member

12 Posts
Gratitude: 3

Posted - 02/21/2008 : 04:00:05

I've gone through several depressions over the past 15 years. Typically I work for 2-3 years get depressed and sit at home self-loathing for 1-2 years. I work hard when I'm working and have gone through some periods of super-productiveness (working 70-80 hours a week voluntarily, doing my job and other people's jobs without being asked etc.)

So I guess the question is, how do you know if it's "Hyper-mania"?
-I don't go days at a time without sleep.
-The closest thing to a shopping spree I did was buy a $2000 laptop and a $3000 big screen t.v. within 3 months of each other. (celebrating after paying off a credit card by maxing it out again

-I was more irritable, plus people told me that I was cussing at others and I had absolutely no recollection of it
-It took more and more effort to concentrate on what I would say before I would say it

bleh, it's not worth continuing cause I really doubt I was hyper-manic. I do have trouble settling my mind down on rare occasions but I doubt that's typical "racing thoughts"

I seriously have no emotional intelligence. I've gone through enough depressions that I've learned to keep myself occupied on external events rather than allowing myself to think too much about what's going on in my head cause it can lead to losing a job, a girlfriend, an apartment.. etc.

So how do I tell the pdoc what's going on when I don't know myself? (the therapist seriously gets pissed at me cause I answer questions "I don't know" so often, last visit he kicked me out after 30 minutes cause I said it one too many times.. he didn't tell me that was the reason, but I know that's why he ended the session

aquamarine
Amazing Member (1000+ posts)

1238 Posts
Gratitude: 300
Very caring

Posted - 02/21/2008 : 11:18:09

Hi Sean,
The current Diagnostic and Statistics Manual-IV (DSM-IV), the manual used for psychiatric diagnosis, completely distinguishes between Major Depression and Bipolar Disorder. Many psychiatrists are beginning to look at diagnosis of these illnesses in a different way.

My psychiatrist is one of these people. He believes, and I know he is right, that there is a continuum between depression and bipolar. I sit right at the top end of Major depression and the bottom end of hypomania.
The bipolar spectrum idea is something like this:
Mild depression
>
Moderate Depression
>
Major Depression
>
Major Depression with cycling
(this sits at the high end of Major Depression and the bottom of Bipolar II (this depression cycles up and down, but doesn't quite cycle up into hypomania)
- not to be confused with cyclothymia as the depression is too severe)
>
Bipolar II
>
Bipolar I
(and everything in-between all these)

If you google "Bipolar spectrum disorder" you will find lots of info about this approach. Many pdocs do not subscribe to this idea, but I know for myself, I sound almost identical to you and how your cycles have happened. I have a hyperthymic temperament (When I am well I can do a million things at once, I feel higher than most people, I am extraordinarily high functioning, overwork, overplay, etc.) My pdoc says I do not go manic, or hypomanic...My high self is who I am, but he does say my mood cycles.

What does that mean for my treatment? ('cause that is the important question). It means we tried starting me on anti-depressants alone, but my cycling seemed to get worse, and they never really helped...so then we began using similar medical approaches for the treatment of BP Disorder.

We began using mood stabilizers, either alone, or in conjunction with an antidepressant. I still have not found medication that helps me, but I definitely see that of anything that helped me mood stabilizers helped me more than anything (they calmed the irritability and anxiety, but didn't help with the depression).

Also, we work in therapy on regulating my life to try to decrease my cycling...getting enough sleep, eating small meals 5-6 times a day, sitting in front of a special light for an hour/day (or getting outside for 1/2 hr to an hour, trying to reduce stressors in my life (I had to leave work), adding things I enjoy to my life etc. and scheduling my days so I do things.

I hope this has helped. Only a psychiatrist can diagnose hypomania. Often BP disorder is misdiagnosed by GP's for a long time as depression, so It would definitely be worth asking your pdoc if he suspects you become hypomanic. If you are not satisfied with his/her response a second opinion is always a great idea.

sean74
Starting Member

12 Posts
Gratitude: 3

Posted - 02/21/2008 : 13:39:45

Aquamarine,

Thanks, your post helped out a lot. The bipolar-depression spectrum thing sounds very reasonable and I believe I'm probably the same place you are, somewhere between depression with cycling and bipolar II.

My personal opinion is I'm not quite to bipolar II because it seems that for that diagnosis you'd have to encounter some problems caused by a "hypo-mania" and I can't really say that my ups have screwed me up other than maybe taking on more than I could handle without realizing it was going to eventually cause me to get stressed out.

The pdoc seems to want to call it Bipolar, probably mostly because I have a family history of schizo-affective and bipolar; my dad has 11 siblings and at least 5 of them fall into one category or the other.

Right now I'm just on lamictal for mood stabilization and I talked to the pdoc today and he didn't feel inclined to add an anti-depressant; I've gone through half of all the ones on the market so maybe he's given up on that and wants to see what happens if he doubles the dosage of lamictal first.

aquamarine
Amazing Member (1000+ posts)

1238 Posts
Gratitude: 300
Very caring

Posted - 02/21/2008 : 19:57:38

Wow, what you said sounds a lot like me like me...my "hypomanias" have never really caused me any major trouble. I had sex with tons of people, but I loved it, I worked way too many hours, but I was driven, I was sometimes a bit too wild, and felt a tad embarrassed afterwards, but it never really hurt me in any way. I LOVE feeling like that. It's the depression i need to get rid of.
Good luck,
...aqua

PolarOne
Super Member (250+ posts)

456 Posts
Gratitude: 113

Posted - 02/22/2008 : 02:40:50

Hi sean,

Thats a good description from Aquamarine about mood disorders spectrum, agree totally with all that (your PDoc sounds sensible, hold on to him is my advice!).
Theres a lot of folks with cyclothymia/BP2 who get by without mood stabiliser it seems, and lots of people with more severe depression who seem to be taking mood stabilisers in addition to antidepressants these days.

Its nice to know a diagnosis at the beginning, but it often doesn't make much difference to the treatment I mean.I have a few older siblings with mood disorders, and the sequence in my family seems to be a progression from depression +/- anxiety in teens, to Bipolar 2 , to Bipolar1 (untreated) with age. Diagnosis can be a dynamic process with age in my personal experience too, I get more the depression side though.

I came across this classification recently:

Bipolar I: full-blown mania
Bipolar I ˝: depression with protracted hypomania
Bipolar II: depression with hypomanic episodes
Bipolar II ˝: cyclothymic disorder
Bipolar III: hypomania due to antidepressant drugs
Bipolar III ˝: hypomania and/or depression associated with substance use
Bipolar IV: depression associated with hyperthymic temperament

(Psychiatric Clinics of North America 22:3, September 1999)

I'd like to think someone had a sense of humour when they came out with that numbering system, though I'm not holding my breath (!).
I'm Biperfect IX ž

(I think thats what the PDoc said anyway...).

The other thing is that no matter where you are on that spectrum, lifestyle measures are important too. So attention to diet, relaxation, hobbies, sleep, exercise, omega-3's, not overdoing the work etc (my record for the latter is 142 hours in a week btw! ages ago now though). I'm often not good at all that in the depression phase. Ditch the credit cards etc maybe if you feel that overspending might be a problem.

It can be difficult with therapy/discussion with that emotional blunting I know, very much an effect of meds I think. I think keeping mood, sleep and other daily diaries/journals e.g. CBT were helpful for me in that aspect, I know that feeling of drawing a blank in therapy too.

I take lamictal and AntiD, seems to have worked out ok for the moment, I'm hoping that blunting effect might decrease with time.

bw j

sean74
Starting Member

12 Posts
Gratitude: 3

Posted - 02/23/2008 : 10:59:10

quote:
Originally posted by PolarOne

So attention to diet, relaxation, hobbies, sleep, exercise, omega-3's, not overdoing the work etc (my record for the latter is 142 hours in a week btw! ages ago now though).

That's insanity. There are only 168 hours in a week! My max seems to be a relatively pathetic 78 hours. (people loved that voluntary overtime at that place, people were competing to be the first to top 100 hrs)

quote:
Its nice to know a diagnosis at the beginning, but it often doesn't make much difference to the treatment I mean.

This makes sense, I have been kind of preoccupied with the new diagnosis since he sugggested it. (mainly cause I thought it sounded so "off" I wish I had more of the hypo-mania.) I read somewhere that lamictal is sometimes prescribed to people with treatment resistant unipolar depression, and I suppose I can see that, it blunts the moods enough that those periods of "intense self-loathing that I can't seem to stop and makes me just want to bang my head against a wall in an attempt to knock myself out" have slowed since I've been on it. But I don't see it making me "happy"

PolarOne
Super Member (250+ posts)

456 Posts
Gratitude: 113

Posted - 02/24/2008 : 02:52:53

It would be easier for me if I had volunteered for that particular week sean, though it was definately imposed upon me! Insanity is the right word I think (!), reassuring to know all that is alive and kicking in the world of the 'well' too. Spent a week following that horrendous stretch drowning my sorrows on a Greek beach (hols), would cope differently these days though (thankfully).

80 odd hours is still double what most people do though, that used to be about average for me. Definately used to do me no favours at all I remember, couldn't do it now, not a chance. Depends on age to some extent what you can get away with I suppose, I know I'd say 'no' to that now anyway.

I can relate to wondering about diagnosis though, mainly because I've seen BP missed for years on end in family and then myself in fact. I sort of wished I hadn't obsessed so much about it looking back though as it wasn't helful (Rectrospectoscope that one). Its such an individual thing I think, add all the other problems (co-morbidity e.g. anxiety), personality not to mention Med s/e and it all gets a bit complicated. Glad I don't have to try and sort it all out for people anyway!

Lamictal seems a sensible choice for depression/BP2 I think after what I've researched. My PDoc told me it might take up to a year to sound out whether it worked or not, I'd be prepared to give it longer than that. Agree totally with your last sentence, though I hope it helps make things easier.

neal3178
Starting Member

17 Posts
Gratitude: 4

Posted - 05/30/2010 : 23:32:00

A well qualified psychologist can give you the very best information about how to change your thinking and behaviors so that your depression will improve. But you have to take the information and use it before it will help your depression.

warblaster
Super Incredible Member (10000+ posts)