Posted by andsoitgoes on October 17, 2007, at 17:54:19
In reply to Re: Difficulty in Diagnosis? Bipolar II?? » andsoitgoes, posted by Racer on October 17, 2007, at 17:15:08
> Hi, Nick,
>
> Well, I'm having concentration troubles today, so I'm not sure I have much useful input, but here's a try:
>
I appreciate any advice :)> First of all, I'm not entirely convinced that all of that adds up to bipolar to me. If you're being literal when you say "Sometimes I'll have a few hours to where I think I'm a genius and what I type is pure gold, but it never lasts for an extended period." -- a few hours does not a manic episode make. Also, some of your other descriptions do not sound like bipolar -- the social issues, the work issues, etc.
>Bipolar, no. Bipolar 2 with heavy depression matches with EVERYTHING but the hypomanic periods, which I do get similar to descriptions from the DSM, *except* for durations.
My mood swings are akin to ultradian cycling, and there ARE mood swings there, which doesn't fit depression, or MDD. It only fits with the rapid constant cycling.
And the irritability comes with no rhyme or reason, as well. So many things really point to Bipolar 2... continued below :)
> Yes, you do have symptoms suggestive of ADHD -- the disorganization, etc -- but I'm not sure I'd go for that, either.
>I have no "H", I'm never hyperactive, sometimes I have a bit of a zing, but it's not hyperactive. However, ADD is a part of my being, however it also fits in Bipolar 2.
> Honestly, it sounds like some combination of depression, anxiety, and probably one of the anxiety-related personality disorders -- or more likely Cluster C personality traits, since it doesn't sound like a personality disorder, either, really.
>Well, see - this is why Bipolar II seemed so right. It has the "add" symptoms, it has the depression, it explains the spurts of "hypomania" along with irritability and... continued below..
> (I'm sorry for being so skimpy on comments -- I'm having an allergy attack today, with burning skin, fever, nausea, and I can only think a little bit... I will try to get back to this when I'm more myself.)
>OUCH... well, that's something to put a person into perspective!
> As far as treatment goes, I would very strongly recommend psychotherapy as a main focus -- a lot of what you've described can be approached behaviorally, and it's more likely to be effective than any medication on its own. You won't necessarily need to discuss how you were potty-trained, just learn some more adaptive coping strategies. (Although I'm a big fan of psychodynamic therapy -- I get to talk about myself for fifty minutes? And no one says I'm being selfish? WHOOHOO!)
>See, I have a very, very difficult time talking about myself. The anxeity, which needs to be talked about, limits my ability to talk about it, which in turns creates more anxiety.
See the problem?
> In terms of medications, I'd think in terms of cocktails -- a lot of the issues you've brought up would likely improve with serotinergic drugs, so maybe include Zoloft into the mix -- or pick your favorite SSRI -- add in some Provigil for focus, and if that doesn't help, try Ritalin again; and add something in to augment the antidepressant effects, while maybe offering a bit of stabilization in case I'm totally off base about your dx -- I'd say Lamictal is pretty helpful for a lot of people, Seroquel is also quite helpful. A lot of people seem to be finding Abilify helpful, too.
>I've never had luck with SSRIs, I've done the gamut. Wellbutrin and Zoloft make the anxiety worse. Effexor I won't try again due to the risk involved, and it was my first and the most HORRIFIC AD in terms of how it messed with my brain. I seriously felt stoned for weeks, and that was at 75mg.
The Zyprexa is similar in acting to the other mood stabilizers, which is why I'm hoping that will help. I do like the thoughts of Lamictal, which I've found on Jim Phelp's site, along with some others - it seems very low as far as side effects as long as you don't get a rash.
However, the Zyprexa is not causing much of an increase in weight gain. It also helps that I'm chunky, and it's been said that the weight gain is mostly when you start off thin.
> Good luck!Thanks, I AM GOING TO NEED IT!
I do plan on doing psychotherapy/CBT - however I need, NEED to get a handle on the overlying issues. I can't be a dad to two girls and deal with the depressive episodes taking me down so much again. I also cannot subject them to being frustrated with rage, it's not fair to them. And I just can't handle it any more. Urgh.
Nick
poster:andsoitgoes
thread:789780
URL: http://www.dr-bob.org/babble/20071009/msgs/789811.html