Posted by Ripley Snell on July 5, 2006, at 7:44:42
In reply to Differences of BP, mixed, hypo, manic, dysphoric, posted by HEART~ on July 4, 2006, at 16:44:24
The first thing to keep in mind is something Kay Jamison talks about briefly in her book An Unquiet Mind--it's looking more and more that "unipolar" depression is a myth; but then again, so is "bipolar"--the problem is that there don't seem to be these "poles." Mania was seen as the *opposite* of depression.
No one, duh, noticed that a lot of the symptoms of "unipolar" depression were at either ends of a scale: eating too much/eating nothing; sleeping too much/not sleeping; anxious and restless/psychomotor retardation. So then they came up with all this stuff about "atypical" and "melancholic" depression--which, it turns out, is mostly beside the point.
They already had BP I. That's not hard to miss. It means you've had at least one episode of full-blown mania. Some of the criteria for mania include: no desire or need for sleep; intense libido and promiscuity; spending money (or engaging in any other normally pleasurable activity) without regard to the negative consequences that may follow; impulsivity; irritability; pressured, rapid speech; thinking that's so fast and disconnected it's hard to follow. If spit is flying out of someone's mouth--hmm. Maybe mania.
Then light dawned on the Marbleheads, and people realized, wait! It's not "agitated depression"--it's a form of bipolar where the mania isn't quite as pronounced. That less-pronouced mania is "hypomania"; in Greek, "under-mania." It's sort of mania-lite. You stay up all night for one night, not three. You get ravenous for sex but you don't cheat; you have spending sprees but you sort of have insight into what you're doing, so you can return some of the stuff later; you're intensely irritable, not raging. Hypomania can also be intensely pleasurable. You can feel, sometimes, as if you were a superhero. The problem is IT NEVER LASTS.
A "mixed state" is a horrible thing. Lol. It's basically hypomania laid over a background of depression. So you've got all the agitation and energy of the hypomania, but the depression makes it nasty, irritable agitation, and angry (sometimes furious) energy. Pdocs are looking at people who have uncontrollable rage attacks as possibly BPII now--the rage attacks are mixed states, wherein there's all this energy and "get it done" feeling, but what you're getting done is insulting your boss, or screaming at a student, or being completely unable to let go of a slight--even to the point of planning revenge.
Bipolars get fired a LOT. We are not good at keeping our heads down and noses to the grindstone.
You asked about dysphoric states, but not euphoric ones. That's simple--dysphoric is "bad mood/affect" while euphoric is "excellent mood/affect." So ANOTHER term for "mixed state," especially if your life is one big mixed state, like mine, is "bipolar dysphoric mania." Again--you're angry and unhappy, but aggressively, energetically so.
The Bipolar I - Bioplar II distinction is still young. Some doctors say that Bipolar II is more crippling because it goes undiagnosed (it's usually diagnosed as depression) for an average of seven years, and the longer you have any form of bipolar disorder without treating it, the worse it gets--so Bipolar II is quite insidious. I went from Serzone to Prozac to Paxil to Effexor to Wellbutrin to Remeron to . . . (the list goes on) . . . getting maybe as much as ten weeks of relief. What I needed was a MOOD STABILIZER.
So diagnosis is often made by giving the patient a mood stabilizer and seeing if he/she improves. If, with a mood stabilizer (Lamictal, lithium, Depakote, Trileptal, Tegretol) the rage chills out, and the spending sprees stop distracting, and at the same time, depression lifts, then it's a case of bipolar disorder. If the patient just gets dulled-out and spacy, then the disorder is supposedly closer to "unipolar." It *is* very interesting how mood stabilizers are being used more and more to "augment" antidepressants.
I wonder if I hit all of the definitions. Mania and depression are both awful, but in different ways. We know about depression; mania is in a way more insidious because while it's happening, it's a lot of fun. It's only after the episode ends, and you look around you and find you've lost your job, you've spent your savings; you've cheated on your spouse--that you realize the good time wasn't worth it--it was a mean trick played on you by your emotional illness.
Hope this helps.
Oh, forgot--how my doctor made the Dx. As I said, it took a while! We saw three things: 1. I was just as depressed as ever. 2. Antidepressants would work for a short time, except for a couple, and those couple (Wellbutrin and Provigil, in my case) made me *extremely combative.* I remember berating some poor pharmacist so much she burst into tears. Gee, I'm proud of that. 3. Even when not taking the poisonous Wellbutrin or Provigil, I was given to frequent rage attacks, where it was a fight-for-your-life situation--or seemed so. The person/people I became enraged with stopped seeming like people, and kind of became monsters, monsters that would kill me if I didn't kill them first. (Bipolar and paranoia *really* are a recipe for violence.) But I kept my violence verbal. Still, after I had lost my fourth job in five years, it was time to consider that something else was going on besides depression.
The original poster wanted definitions of:
> a mixed state
> a hypomanic state
> a manic state
> a dysphoric state> And lastly if people can explain with examples difference between BP I and BP II. How did your Dr. make the diagnosis?
poster:Ripley Snell
thread:664021
URL: http://www.dr-bob.org/babble/20060701/msgs/664138.html