Posted by Maxime on June 13, 2003, at 13:35:30
In reply to Re: Do you think meds will help, posted by pseudonym on June 13, 2003, at 0:35:27
For me a mixed state is hypomania, but it doesn't manifest itself as a "happy" moment.
http://www.psycheducation.org/depression/frameset.html
The following is from the above URL.Unfortunately, "hypomania" is quite a mis-naming. There are many patients whose "hypomanic" phases are an extreme and very negative experience. As noted above by Dr. Jamison, mania can be negative as often as it is positive. The "racing thoughts" can have a very negative focus, especially self-criticism. The high energy can be experienced as a severe agitation, to the point where people feel they must pace the floor for hours at a time. Sleep problems can show up as insomnia: an inability to sleep, rather than decreased need.
For now, imagine someone with manic symptoms of rapid thoughts and speech, who instead of feeling euphoric, feels terrible: depressed; with negative thoughts, especially about her/himself; full of negative energy, and possibly even delusional (e.g persecutory or paranoid delusions, or delusions of terrible guilt and responsibility). This combined state occurs very commonly in mania, unfortunately.
What do "bipolar variations" look like?Warning: The following represents my clinical experience taking referrals from primary care physicians. Most patients I see have been on 3 or more antidepressants before I see them. This selects very directly for "bipolar spectrum" patients. However, note that none of these descriptions are found in the DSM, nor are they widely spoken of by mood experts. This is my personal formulation based on 5 years of full-time selection for such patients.
Roller coaster depression
Many people have forms of depression in which their symptoms vary a lot with time: "crash" into depression, then up into doing fine for a while, then "crash" again — sometimes for a reason, but often for no clear reason at all. They feel like they are on some sort of mood "roller coaster". They wonder if they have "manic-depression". But, most people know someone or have heard of someone who had a "manic" episode: decreased need for sleep, high energy, risky behaviors, or even grandiose delusions (‘I can make millions with my ideas"; "I have a mission in space"; "I’m God"). So they think "well, I can’t have that — I’ve never had a manic episode".
However, the new view of bipolar disorder means it’s time to reconsider that conclusion. Hypomania doesn’t look or feel at all like full delusional mania in some patients. Sometimes there is just a clear sense of something cyclic going on. Some mood disorder experts consider recurrent depression to have a high likelihood of having a manic phase at some pointFawcett, especially if the first depression occurred before age twenty.Geller, Rao
Depression with profound anxiety
Many people live with anxiety so severe, their depression is not the main problem. They seem to handle the periods of low energy, as miserable as they are. Often they sleep for 10, 12, even 14 hours a day during those times. But the part they can’t handle is the anxiety: it isn’t "good energy". Many say they feel as though they just have too much energy pent up inside their bodies. They can’t sit still. They pace. And worst of all, their minds "race" with thoughts that go over and over the same thing to no purpose. Or they fly from one idea to the next so fast their thoughts become "unglued", and they can’t think their way from A to C let alone A to Z. When this is severe, people who enjoy books can find themselves completely unable to read: they just go over and over the same paragraph and it doesn’t "sink in". They will get some negative idea in their head and go around and around with it until it completely dominates their experience of the world. Usually these "high negative energy" phases come along with severely disturbed sleep (see Depression with Severe Insomnia, below). Thoughts about suicide are extremely common and the risk may be high.Fawcett(b)
Depressive episodes with irritable episodes
Many people with depression go through phases in which even they can recognize that their anger is completely out of proportion to the circumstance that started it. They "blow up" over something trivial. Those close to them are very well aware of the problem, of course. Many women can experience this as part of "PMS". As their mood problems become more severe, they find themselves having this kind of irritability during more and more of their cycle. Similarly, when they get better with treatment, often the premenstrual symptoms are the "last to go". Others can have this kind of cyclic irritability without any relationship to hormonal cycles. Many, perhaps most, men with bipolar variations say they have problems with anger or rage.
Depression that doesn’t respond to antidepressants (or gets worse, or "poops out")
Many people have repeated episodes of depression. Sometimes the first several episodes respond fairly well to antidepressant medication, but after a while the medications seem to "stop working". For others, no antidepressant ever seems to work. And others find that some antidepressants seem to make them feel terrible: not just mild side effects, but severe reactions, especially severe agitation. These people feel like they’re "going crazy". Usually at this time they also very poor sleep. Many people have the odd experience of feeling the depression actually improve with antidepressants, yet overall —perhaps even months later —they somehow feel worse overall. In most cases this "worse" is due to agitation, irritability, and insomnia.
In some cases, an antidepressant works extremely well at first, then "poops out". The benefits usually last several weeks, often months, and occasionally even years before this occurs. When this occurs repeatedly with different antidepressants, that may mark a "bipolar" disorder even when little else suggests the diagnosis.Sharma
Depression with periods of severe insomnia
Finally, there are people with depression whose most noticeable symptom is severe insomnia. These people can go for days with 2-3 hours of sleep per night. Usually they fall asleep without much delay, but wake up 2-4 hours later and the rest of the night, if they get any more sleep at all, is broken into 15-60 minute segments of very restless, almost "waking" sleep. Dreams can be vivid, almost real. They finally get up feeling completely unrested. Note that this is not "decreased need for sleep" (the Bipolar I pattern). These people want desperately to sleep better and are very frustrated.
> For the sake of education, could you tell me what a mixed state is, as opposed to a depressed one? You say that your mixed state is the one that has heretofore been untreatable, right?
poster:Maxime
thread:233294
URL: http://www.dr-bob.org/babble/20030609/msgs/233706.html