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Re: I know I've asked before but... what type Bipolar? D minor

Posted by Larry Hoover on April 23, 2005, at 9:20:21

In reply to I know I've asked before but... what type Bipolar?, posted by D minor on April 22, 2005, at 23:16:06

> I know I asked this question a while back, but things have changed a little since then. Sorry. I'm just really curious about what type of bipolar I might have. I don't think my pdoc will tell me, though I'll ask him (again) when I see him next thursday.
>
> I looked at the mood charts I've been keeping for the past six months and came up with several patterns. About a week before a serious depression hits me, I begin to hallucinate. Then comes the terrible low, along with the hallucinations.
>
> This time I took Cymbalta and went up, up, up. I don't think I quite hit mania, but my pdoc said "it seems like you're bearly hanging on." And that's exactly how I felt. I felt like I was loosing control. Starting to climb walls and things. Almost went to the hospital. The hallucinations stopped though.
>
> So, what do you make of this mess? Do you think that without the increase to 600mg Seroquel and the starting Topamax I would have kept going up into full mania? Hard to tell huh? Even with the meds I've still had some bouncing around.
>
> dm

How about "Bipolar Spectrum Disorder"?

Giving an antidepressant to a bipolar patient without a mood stabilizer to block induced mania is on the verge of medical malpractise, unless of course, the doctor doesn't think you're bipolar.

Being "switched" into mania by an antidepressant is part of the differential diagnosis for bipolar disorder. What that means is that a medication-induced manic (or hypomanic) incident cannot count towards a bipolar diagnosis. In fact, it's an exclusionary factor. Only if you have been seen to display hypomania or mania, absent any drugs, can the bipolar diagnosis be made (according to the current DSM).

There is a growing concensus, though, that the current DSM is too restrictive, and that your exact description of induced mania falls into a broader category of bipolar, which some call "Bipolar Spectrum Disorder(s)". In that new diagnostic paradigm, there are six different kinds of bipolar, not the two that exist now. And you clearly fall into at least one of those six bipolar diagnoses.

Anyway, your mood charts are a superb tool. Way to go, keeping those up.

What you described sounds a lot like psychotic depression, except the typical presentation is depression first, then psychosis.

Whatever you call what you have, it looks very much like successful treatment is going to be based on a mood stabilizer. If you're otherwise not afflicted with serious depression (at this time), getting used to a mood stabilizer is probably the best thing, and then you take a wait-and-see attitude about the need for other medications, if and when symptoms arise.

That's this guy's opinion, anyway.

Lar

 

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poster:Larry Hoover thread:488204
URL: http://www.dr-bob.org/babble/20050423/msgs/488289.html