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Re: bipolar NOS - Elaine

Posted by Elizabeth on April 14, 1999, at 17:51:11

In reply to Re: bipolar NOS - Elizabeth, posted by Elaine on April 14, 1999, at 0:19:40

Hi Elaine.

I figured out where I heard about "anger attacks" in depression: some people at Mass. General have been researching the connection between anger attacks, depression, panic disorder, etc. for about a decade. The site listing current research is

Anyway, anger attacks are linked mainly with unipolar depression - not manic-depression or (despite some obvious similarities) panic disorder. You didn't mention whether you experience symptoms of autonomic arousal (rapid heartbeat or palpitations, sweating, nausea, difficulty breathing, etc.) during your "spells," but that's what distinguishes "anger attacks."

Anyway, irritability can occur in depression as well as mania. (I think it's only recognized "officially" in childhood depression, but there's no reason to suppose that adults couldn't show irritability as a symptom of depression too. Especially since, well, they do.)

I'm sort of startled by the idea that if you are depressed but don't seem to respond to antidepressants, you must be bipolar (even if you've never had a manic episode). Which antidepressants have you tried, and how is your current cocktail working out? (I'd never heard of Neurontin being used for depression as such, although I have seen its increasing popularity for use in anxiety disorders.) The name doesn't matter too much, as its main purpose is to communicate with other clinicians about you (e.g., if you're hospitalized, or if you move and need to get a new psychiatrist). (Well, that and to communicate with your insurance co. :-P) But given what you've said, "bipolar" seems like a misleading description.

I know of a number of people who, like me, seem to have "bipolar III" - informally, this designation is sometimes used to describe a syndrome of recurring major depression with one of: (1) antidepressant-induced manic or hypomanic symptoms; (2) family history of bipolar disorder; or (3) "hypomanic temperament." I think most people who develop mania or hypomania on antidepressants have milder symptoms than I did (I had a minor episode on Paxil and a severe mixed episode (psychotic) on Effexor). My depressions are pretty "classic," though.

Buprenorphine works pretty well for me, but it has a lot of side effects so I'm not sure I'd recommend it unless you've exhausted most of your other options.




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