Posted by Elizabeth on February 15, 2002, at 10:36:09
In reply to Re: Puzzle » Elizabeth, posted by Blue Cheer 1 on February 14, 2002, at 12:20:55
> I've never known anyone who was diagnosed as bipolar II.
That's surprising -- they're really easy to find (hard to avoid, I'd say :-} ).
> I know that in the lithium clinic where I was treated for 7 years, we were just plain "bipolar." I assumed everyone had at least one manic episode, but then I never asked.
Did you get to know the other patients? Or did you all just take lithium? ("Lithium clinic" -- what a weird concept.)
> All these numbers after the diagnosis don't seem justified.
Well, I think the reason for them is to diagnose a whole lot of people who don't have manias with bipolar disorder (and therefore, to give them Depakote).
> Two helpful links: http://www.mhsource.com/bipolar/insight0128gha.html http://www.mhsource.com/bipolar/insight0126gha.html
The problem is, as Ghaemi says, that nobody knows just what counts as "hypomania." And some clinicians and researchers think that a lot of the things he classifies as bipolar NOS or "soft signs" should count as bipolar II. I'm rather at a loss to see how, e.g., atypical depression with no history of mania or hypomania (which isn't all that uncommon) could be considered bipolar.
> > (The docs never seem to care much about that aspect of mood disorders, do they?)
>
> You mean the time?Yes, the lost time.
> LOL.. Yeah, you're lucky what you experienced didn't happen in the 70's or earlier. Your "agitation" might've been treated with antipsychotics.
In fact, I did have shrinks trying to give me Zyprexa and Risperdal, not just Depakote and Lamictal. (The Risperdal, in particular, sucked.) Oh, and I once got prescribed Mellaril for insomnia. (!)
> Yeah, that's what I meant to say -- "priority" - mood stabilization is prioritized.
That makes sense, I guess, although in severe mixed states I'd wonder if perhaps eliminating suicidal ideas should fall higher on the list. Is this something that would happen naturally with "mood stabilization," do you think?
> I was never "mixed" until I had serial high-dose trials of Prozac, Zoloft, Luvox, Paxil, Effexor, Parnate, Deprenyl, etc. - for about 4 years straight (with lithium).
This strikes me as paradoxical, that mixed states frequently seem to occur in response to antidepressants. Is that why there are no tricyclics on your list? TCAs seem to have a reputation for causing mixed/dysphoric mania more often than MAOIs.
> Then, when there was no response, the headcase psychiatrist decided to take me off lithium (after 20+ years and no consultation with my primary psychiatrist who'd been prescribing it!).
Uh-oh.
> Well, you know the rest of the story... anyway, that's how I became mixed. My present psychiatrist tries to tell me I'm a rapid cycler, too, but I guess he hasn't seen it defined in the DSM yet. :)
Uh, how does he justify this diagnosis?
> Actually, he wrote it up in an admissions note when I was going to have ECT (along with about a dozen other lies - all designed to justify me *having* ECT and relieving him of liability in case things went, ahem, "wrong."
Well, if people weren't constantly sueing each other left and right, doctors probably wouldn't be so paranoid. But yeah, medical records always seem to be full of mistakes and/or lies. I once read a note which said "sertraline" instead of "selegiline;" imagine what problems this could cause if someone happened to take it seriously.
> I'll never forgive him for making up these lies. (He had my wife walk me over to the inpatient unit, and we stopped at the cafeteria where we both read the note. (I never would've bothered except for a parting remark he made: "Of course, if you try to sign out, they'll commit you." That was uncalled for since it was a voluntary admission, and not the kind of send-off one would expect!!
That sort of threat is an abuse of the law, IMHO. Yet doctors do it routinely.
> He *even included* an e-mail I'd sent him the night before, in which I said I wanted ECT. From the initial consideration and discussion of ECT through the hospitalization (18 days), it was one lie after another. Finally, I refused to sign the informed consent and walked out.
Did you change your mind about the ECT? Or just didn't want to entrust your life to this doctor who kept making things up about you? (Or something else?) I know how you feel; some of the things that hospital doctors do and say are just unconscionable.
> I've taken every AD ever marketed in the U.S. and some abroad (with the exception of Serzone), and they just weird me out and agitate me.
Really? *All* the tricyclics??? (What a waste.)
> I can't tolerate them at all now. Not until I read this board did I see that I wasn't the only bipolar who'd never responded. The psychiatrist who dragged me through all the AD trials used to say that I "got side effects no one else gets," and that "you get the same ones with every drug." He made it sound as though it were *my* fault I was a non-responder.
They do that a lot. Really helpful, huh?
> I'd like to try Dexedrine with Lamictal and Trileptal - if I get in a bad depression again.
Hopefully you won't have to. The stimulant-anticonvulsant combo is a weird one, though; how'd you come up with that?
> I just d/cd lithium last night (started on 1/23) because it was somehow making me depressed again.
Again: uh-oh!
> I only wanted it for its neuroprotective/neurotrophic properties, but not at the expense of worsening depression. Plus, it was causing some dyskinesias.
That sucks. I've been lucky enough to avoid that (well, I've also made a point of staying away from the typical antipsychotics, except for that one time I tried using Mellaril).
> That's strange you had a seizure. I read about that here, I think, but it's vague. I'm concerned about their affect on cognition, and maybe the liver.
I'm not sure that the AEDs had anything to do with it, but it's one thing that could have contributed. On the other hand, I had at least one seizure when I was taking desipramine (which I wasn't metabolizing normally or something, so my serum level was on the high side).
Trileptal is ****ing expensive. I've been thinking that maybe I should switch to Tegretol. I don't know. Waffle, waffle.
> Yeah, I side with the "splitters." You're right: just as it was lithium in the 70's that uncovered so many "bipolars" (many of whom dropped out of treatment, I *know*, after discovering that they weren't really bipolar), now I think another generation is getting the BD diagnosis, in part, due to the advent of AEDs.
Tegretol was always here (well, it's old enough, anyway), but now the AEDs have the power of drug ads behind them.
> I've been hospitalized with some people who had no depression or mood elevation, or even a history of mood problems, but when they were assigned to psychiatrists who specialized in mood disorders, they were asked all kinds of questions about mood. Even when they said that's not me, you know, they were pressed.
They didn't have any mood problems? That's kind of weird; what were they in the hospital for? Most psych disorders have *some* effect on mood, at least.
> At least most people with bipolar disorder aren't being misdiagnosed with schizophrenia - like in the 70's and before that.
I've heard it said that schizophrenia was the wastebasket diagnosis not too long ago, yeah.
> I was depressed on and on for 10 years before getting a bipolar diagnosis. It's not fun going into a VA hospital for 8 months, in a severe depression, and getting dx'd as schizophrenic (sometimes by FMG's who did their residencies in OB-GYN at Bombay U. or somewhere); then getting bombarded with high-dose antipsychotics - which actually *did* make you appear to be withdrawn and schizophrenic.
They don't help much with the depression, either. Some people say that *low*-dose antipsychotics help (even the typicals), but I didn't get much out of the DA antagonists I tried (up to 10 mg of Zyprexa).
> Back then, in retrospect, I think you wouldn't get a manic-depressive dx unless you were maybe an ultra rapid cycler, or had clear-cut manias. I remember only one guy dx'd as manic-depressive (before lithium). You'd see him out on open ward one day, talking a mile-a-minute and multiplying 3-digit numbers in his head, super-personable, and then the next morning you'd wonder where he was -- and he was back on the locked end so bad off he had to be spoon-fed.
Really blatant and clear-cut, in other words. Whereas now, there doesn't have to be any evidence of anything resembling mania! As usual, the truth probably lies somewhere in between.
-e
poster:Elizabeth
thread:92727
URL: http://www.dr-bob.org/babble/20020215/msgs/94246.html