Posted by kate9999 on March 4, 2001, at 3:54:03
In reply to A BIPOLAR (II) EXPERT *PLEASE* (longish), posted by JahL on March 3, 2001, at 10:31:22
Does the diagnosis really matter? The more relevant question is - can you benefit from a mood stabilizer? It sounds like it's very worth a shot. A strong family history of bipolar disorder alone would suggest that.
> The background: I have unremitting life-long depression characterized by DYSPHORIA, IRRITABILITY, ANXIETY & suicidality. 20+ meds has had little impact. Extensive interpersonal, group & cognitive-behavioural therapy (in both public & private settings) achieved nothing & was not a little insulting towards my intelligence. Systemized common sense. I taught myself everything therapy has to offer (me) by age 11.
> Anyway I am not confident in my current dx (dysthymia+double depr.) & am pondering a possible BIPOLAR II DX. During my years of mistreatment I have noticed the following:
>
> 1/ First ever AD (Paxil) brought about the fabled miracle cure overnight. Over the next month my mood swung wildly (RAPID CYCLING?) btwn agitated depression & (never b4 experienced) euthymia. When this petered out, the introduction of Prozac brought about another short period of euthymia.
>
> 2/ The above remissions/relapses were induced by a circadian 'switch' (would wake up cured or relapsed-no inbtwn).
>
> 3/ Sub-therapeutic doses of Paxil & Celexa brought about hypomania (8 days of).
>
> 4/ All these events were precipitated by a REDUCTION in dose (v strong correlation).
>
> 5/ Every mood stabilzer (Zyprexa, Risperdal, VPA, Lamotrigine) save Lithium (indicated for classic BP I) has quickly eliminated suicidal ideation.
>
> Also to be considered:
>
> 1/ *V* strong family history of this disorder.
>
> 2/ Have been diagnosed Social Phobic + ADD (high Bipolar co-morbidity)
>
> 3/ No mood reactivity.
>
> 4/ Have never related to depression per se, or to those suffering. No problems with self-esteem, tearfulness etc. Cannot understand illogical depressive thought constructs. My symptoms are akin to schiz. neg. symptoms; dysphoria.
>
> I am not so much depressed as wholly dysfunctional.
>
> 5/ I have a volatile temper.
>
> 6/ Have always been considered intellectually 'gifted'
>
> 7/ THE CLINCHER: started on Lamotrigine 25 mgs 10 days ago & already my derealisation has improved, my intellectual powers are returning & well I feel a little *hypomanic* (last night posted as much as I have in my whole PB 'career'!) This is a v low dose to be feeling such effects!
>
> Well, do I have a case for possible BP II dx, or have I already answered my own question?
> Or is this stretching the BP spectrum too far?
> (Sorry 4 length of ths; wanted to get my facts straight)
>
> All replies gratefully received (& may be used in my next pdoc meet)
> ta,
> Jah.
poster:kate9999
thread:55442
URL: http://www.dr-bob.org/babble/20010302/msgs/55504.html