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Dr. Bob is Robert Hsiung, MD,
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Posted by susan C on June 22, 2001, at 17:57:47
In reply to What's worked 4 folks 4 BP II or other maladies?, posted by Kingfish on June 21, 2001, at 10:32:20
> Hello,
I am on depakote, from my understanding, a long time mood stabilizer/anti seizure med. If it means anything, Dr. Dunner at University of Washington (state)and expert on BPII confirmed my pdoc's dx. They both explained the challenge is not to deal with the lows, but to control the highs. So, once the highs are not so high, the lows are not so low. They both agree (and many pdocs donot-sigh) that AD and SSRI agravate BPII manic and should be avoided. This was my experience. After flying high on prozac (and trazadone to put me to sleep) for 6 years I crashed worse than when I first started treatment. WHen I changed pdoc and diagnosis from depression to BPII, I came down off of serzone, it was terrible. I was so depressed. Med trials took me to depakote, which is the best so far. At this point I am feeling more even.
Posted by MM on June 22, 2001, at 18:50:23
In reply to Re: What's worked 4 folks 4 BP II or other maladies?, posted by susan C on June 22, 2001, at 17:57:47
I'm recently (like a month ago) diagnosed with BPII, and I'm still not sure it's right (I know a lot of people feel that way), but I feel like there should be tests done, like one for ADD, (concentration is one of the main things I'm having trouble with) and anxiety is the biggest thing. Will I know for sure it's BPII when I get on a mood stabilizer (I'm not on any AD's, tho I've tried them, or mood stabilizers, only taking 25mgs seroquel to sleep). Like will I feel really different or something to make it clear that I have BPII?
The past DX's were major depression/anxiety/panic.
Posted by MM on June 23, 2001, at 0:02:53
In reply to Re: What's worked 4 folks 4 BP II or other maladies?, posted by MM on June 22, 2001, at 18:50:23
I guess you can't edit on here. Is one one hour session with me and one with a family member enough for this diagnosis?
Posted by Mitch on June 23, 2001, at 10:17:06
In reply to Re: What's worked 4 folks 4 BP II or other maladies?, posted by MM on June 23, 2001, at 0:02:53
> I guess you can't edit on here. Is one one hour session with me and one with a family member enough for this diagnosis?
Well, if you have met the "criteria" for a hypomanic episode just *once* then according to the current DSM-IV (the book that the APA considers their diagnostic bible) then you are bipolarII. They used to differentiate (I think) however between people that only were hypomanic due to an antidepressant or alcohol/street drugs. But they don't any more. I think some pdocs may still not consider bipolar diagnosis if it is due to alcohol/street drugs/antidepressants.
Mitch
Posted by MM on June 23, 2001, at 14:32:42
In reply to Re: What's worked 4 folks 4 BP II or other maladies? » MM, posted by Mitch on June 23, 2001, at 10:17:06
Well I'm not sure I've had a hypomanic episode, but if I did, it was because of anti-depressants. How do I know if it was a hypomanic episode, or just antidepressants helping with depression and anxiety?
Posted by Mitch on June 23, 2001, at 17:13:23
In reply to Re: What's worked 4 folks 4 BP II or other maladies?, posted by MM on June 23, 2001, at 14:32:42
> Well I'm not sure I've had a hypomanic episode, but if I did, it was because of anti-depressants. How do I know if it was a hypomanic episode, or just antidepressants helping with depression and anxiety?
That's a tough one. So, whatever the *episode* was it occured while on AD's right? I *think* the definition for hypomanic episode is at least four days of elevated mood-racing thoughts, impulsivity or hostility, difficulty sleeping, agitation, etc. But, didn't require hospitalization and you didn't get psychotic.
If I go off of antidepressants entirely my mood cycling settles down and don't have any problem with hypomania. But, I get panic attacks/depression. It is a "sticky" problem.
I don't know just how to solve the dilemma.
Mitch
Posted by MM on June 23, 2001, at 19:58:35
In reply to Re: What's worked 4 folks 4 BP II or other maladies? » MM, posted by Mitch on June 23, 2001, at 17:13:23
> > Well I'm not sure I've had a hypomanic episode, but if I did, it was because of anti-depressants. How do I know if it was a hypomanic episode, or just antidepressants helping with depression and anxiety?
>
> That's a tough one. So, whatever the *episode* was it occured while on AD's right? I *think* the definition for hypomanic episode is at least four days of elevated mood-racing thoughts, impulsivity or hostility, difficulty sleeping, agitation, etc. But, didn't require hospitalization and you didn't get psychotic.
>
> If I go off of antidepressants entirely my mood cycling settles down and don't have any problem with hypomania. But, I get panic attacks/depression. It is a "sticky" problem.
> I don't know just how to solve the dilemma.
> MitchThat's kind of why I was wondering if other people had doubts about their BP dx before going on mood stabilizers, but after they tried them they KNEW it was the right or wrong dx. Thanks for replying Mitch.
Posted by chloe on June 24, 2001, at 11:12:06
In reply to Re: What's worked 4 folks 4 BP II or other maladies?, posted by MM on June 23, 2001, at 19:58:35
Hi MM
I wouldn't get to hung up about the label or "diagnosis". Some pdocs will put a bipolar label on a patient just so insurance will cover them. Finding the right medicine is what is important. AND just because you respond to a mood stabilizer, doesn't necessarily mean you are BP or not BP. It means you are responding well to that medication. Each person is different, and each person needs a certain type of medication(s) to give them relief from their pain.
I hope you find the right treatment regime for you. Whatever your particular "diagnosis" may be.BTW, I not convinced I am BP II but that is the stamp on me! God only knows I guess!
All the best
Chloe
>
> That's kind of why I was wondering if other people had doubts about their BP dx before going on mood stabilizers, but after they tried them they KNEW it was the right or wrong dx. Thanks for replying Mitch.
Posted by AMenz on June 24, 2001, at 15:00:00
In reply to Re: What's worked 4 folks 4 BP II or other maladies? » MM, posted by Mitch on June 23, 2001, at 17:13:23
I have always cycled too frequently to have 4 days of anything, yet have BPII dx. Are severe periods of irritability hypomania? I think they are acompanied by racing thoughts etc but not euphoric at all. Is this really hypomania? Is it a mixed state. And how can I be sure of diagnosis.
This BTW is the diagnosis I've had for over 10 years. I do cycle on AD's and get into mixed states.
Like you anxiety (social not panic) kicks up when on mood stabilizers and very low AD's (so I can keep from cycling). I'm beginning to think that behavioral therapy which seems to work for some anxiety disorders with no BPII comorbidity might be the way to go.
> > Well I'm not sure I've had a hypomanic episode, but if I did, it was because of anti-depressants. How do I know if it was a hypomanic episode, or just antidepressants helping with depression and anxiety?
>
> That's a tough one. So, whatever the *episode* was it occured while on AD's right? I *think* the definition for hypomanic episode is at least four days of elevated mood-racing thoughts, impulsivity or hostility, difficulty sleeping, agitation, etc. But, didn't require hospitalization and you didn't get psychotic.
>
> If I go off of antidepressants entirely my mood cycling settles down and don't have any problem with hypomania. But, I get panic attacks/depression. It is a "sticky" problem.
> I don't know just how to solve the dilemma.
> Mitch
Posted by Chris A. on June 24, 2001, at 18:01:55
In reply to Re: What counts as hypomania Mitch, posted by AMenz on June 24, 2001, at 15:00:00
Mitch,
July L. just shared this link on another thread that addresses your concerns. Registration is required, but worth it.
http://www.medscape.com/Medscape/CNO/2001/APACME/Story.cfm?story_id=2248 >
Chris A.
Posted by Mitch on June 24, 2001, at 18:42:57
In reply to Re: What counts as hypomania - Mitch, posted by Chris A. on June 24, 2001, at 18:01:55
Chris, Went there and checked it out, very interesting. I actually had it wrong (in my mind). The DSM-IV excludes diagnosis of hypomania (BPII) if it is a result of antidepressants. The article below in the link believes that even if AD's cause hypomania-then that persons *should* be diagnosed with BPII.
In my case I have had hypomania in the past without antidepressants so there is not question of my BPII diagnosis. However it apears that *technically* speaking if AD's are the only trigger that is present then BPII should not be considered the diagnosis.Here is the American definition of hypomanic episode:
Hypomanic Episode
A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
inflated self-esteem or grandiosity
decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
more talkative than usual or pressure to keep talking
flight of ideas or subjective experience that thoughts are racing
distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments)The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.
The disturbance in mood and the change in functioning are observable by others.
The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.
The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Note: Hypomanic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar II Disorder.
Mitch> Mitch,
>
> July L. just shared this link on another thread that addresses your concerns. Registration is required, but worth it.
>
> http://www.medscape.com/Medscape/CNO/2001/APACME/Story.cfm?story_id=2248 >
>
> Chris A.
Posted by Chris A. on June 25, 2001, at 13:04:21
In reply to Re: What counts as hypomania - Mitch » Chris A., posted by Mitch on June 24, 2001, at 18:42:57
Not all American psychiatrists and researchers are satisfied with the DSM 1V R bipolar classificaltions. They believe that they are too arbitrary, provide clear categories for easy answers to research, but don't serve those of us who are ill very well. On a technicality I am diagnosed BP I, but don't really fit that category at all because I've never been truly manic. Prozac caused hypomania followed by a horrible crash that I've never fully recovered from. Since I have mixed symptoms and was hospitalized in the midst of that I am considered BPI. My experience always seems to be closer to BP II, though. Some, like Askidal would say BP III since hypomania initially occurred in response to an AD. In all the screening tests I don't even qualify for bipolar. Even so my moods shift suddenly. I'll be doing fair one day and suicidal the next. Hence, I won't fight the BP diagnosis so that I can get the right treatment. ADs make the depressions worse, so I'll stick to the mood stabilizers.
Blessings,
Chris A.
Posted by judy1 on June 25, 2001, at 22:03:52
In reply to Re: What counts as hypomania - Mitch, posted by Chris A. on June 25, 2001, at 13:04:21
Chris,
At the recent BP conference in Pittsburgh, one of the shrinks from the Stanley Foundation said that mood stabilizers turn BP1's into BP2's- that is get rid of the mania and have predominantly depressive symptoms (which seems to be your case). I think my hormones are really kicking in here, it's a great feeling. Take care, judy
Posted by Chris A. on June 25, 2001, at 23:47:26
In reply to Re: What counts as hypomania - Mitch » Chris A., posted by judy1 on June 25, 2001, at 22:03:52
Dear Judy,
I would agree that the researcher at the Stanley Foundation is right. Hopefully more research will be focused on bipolar depression and more interventions will be available for those of us who can't take ADs. Geodon seems to be promising towards that end. If I could only tolerate the akithisia.
I am very happy that you are feeling well during your pregnancy. You deserve it after all of the struggles you have been through. Those were the most euthymic times in my life.
Take good care of the baby and yourself.Blessings,
Chris A.
Posted by Cece on June 27, 2001, at 14:11:02
In reply to Re: What counts as hypomania - Mitch » Chris A., posted by judy1 on June 25, 2001, at 22:03:52
Hi Judy-
Very interesting re BPI to BPII.
I haven't seen your posts re being pregnant. I'm curious, if you don't mind saying, what your diagnosis is, and what meds you are able to take during pregnancy? Also, what are your and your pdoc's thoughts re the possibilities of post-partum depression in a person with an affective disorder?
Thanx, and best wishes,
Cece
> Chris,
> At the recent BP conference in Pittsburgh, one of the shrinks from the Stanley Foundation said that mood stabilizers turn BP1's into BP2's- that is get rid of the mania and have predominantly depressive symptoms (which seems to be your case). I think my hormones are really kicking in here, it's a great feeling. Take care, judy
Posted by judy1 on June 27, 2001, at 18:45:42
In reply to Re: Pregnancy and meds in BP's » judy1, posted by Cece on June 27, 2001, at 14:11:02
Hi Cece,
I'm dxed bp1, rapid cycling and panic disorders. I think my shrink is leaning towards PTSD though, because I have a lot of dissociation problems. Thank you for the best wishes. This was an unexpected pregnancy and as soon as I found out I went off lamictal, risperdal and one other (can't remember). I did stay on klonopin (and still am) with xanax prn. Recently I've been taking zyprexa because I developed TD with risperdal, but I plan on tapering off that also. My pdoc basically treats 'fires' with me, and uses a great deal of psychotherapy. I see him weekly and e-mail him a lot (we have a very good relationship that took a good year to develope). I did have a psychotic depressive episode after my son was born and he and I are aware that there is a strong probability that I will have it again. So I guess we are working on maintaining a strong therapeutic relationship- my biggest problems are lack of insight when manic, and taking each day as it comes (never dull in bipolar disorder!) Hope this answers your questions. Take care, judy
Posted by Cece on June 28, 2001, at 5:10:32
In reply to Re: Pregnancy and meds in BP's » Cece, posted by judy1 on June 27, 2001, at 18:45:42
Thanx for replying. I was curious because post-partum psychosis seems to run in my family (both my mother and sister had it). My mom was probably undiagnosed BP, my sister tends toward anxiety and some depression (rarely admitted to).
I am past the age where pregnancy is an issue (52), and never found the right person to do it with, so never had to deal with the issues. I think that partly I subconsciously held back because of fear re post-partum (I didn't get right diagnosis and good tx. until about 8 years ago). I tried to do some research in my 30's, but couldn't find much.
My neice is BPI and young enough to still hope to have kids, so I wanted to get your info for her.
Thanx again- you sound well-prepared, with your feet on the ground and good support. I'm sure that you will make it just fine!
Cece
P.S. My mother and sister both had PPP with only one of their children: my mother with her second (me), and my sister with her first (my neice). Hopeful news for you.
> Hi Cece,
> I'm dxed bp1, rapid cycling and panic disorders. I think my shrink is leaning towards PTSD though, because I have a lot of dissociation problems. Thank you for the best wishes. This was an unexpected pregnancy and as soon as I found out I went off lamictal, risperdal and one other (can't remember). I did stay on klonopin (and still am) with xanax prn. Recently I've been taking zyprexa because I developed TD with risperdal, but I plan on tapering off that also. My pdoc basically treats 'fires' with me, and uses a great deal of psychotherapy. I see him weekly and e-mail him a lot (we have a very good relationship that took a good year to develope). I did have a psychotic depressive episode after my son was born and he and I are aware that there is a strong probability that I will have it again. So I guess we are working on maintaining a strong therapeutic relationship- my biggest problems are lack of insight when manic, and taking each day as it comes (never dull in bipolar disorder!) Hope this answers your questions. Take care, judy
Posted by Ron Hill on June 28, 2001, at 11:12:44
In reply to Re: What's worked 4 folks 4 BP II or other maladies?, posted by MM on June 22, 2001, at 18:50:23
> I'm recently (like a month ago) diagnosed with BPII, and I'm still not sure it's right
MM,
Use the link below to bring up a good (and free) dx test. It was accurate in my case (BP II). I found it helpful to have someone that knows me well sit with me as I took the test so she could add her perspective regarding the answer most applicable for my behavior.
http://www.mentalhealth.com/fr71.html
-- Ron
Posted by MM on June 28, 2001, at 11:21:16
In reply to Re: What's worked 4 folks 4 BP II or other maladies? » MM, posted by Ron Hill on June 28, 2001, at 11:12:44
> > I'm recently (like a month ago) diagnosed with BPII, and I'm still not sure it's right
>
>
>
> MM,
>
> Use the link below to bring up a good (and free) dx test. It was accurate in my case (BP II). I found it helpful to have someone that knows me well sit with me as I took the test so she could add her perspective regarding the answer most applicable for my behavior.
>
> http://www.mentalhealth.com/fr71.html
>
> -- RonThanks Ron
Posted by Ron Hill on June 28, 2001, at 11:42:51
In reply to What's worked 4 folks 4 BP II or other maladies?, posted by Kingfish on June 21, 2001, at 10:32:20
> Hi all! I just thought it would be great to get a thread going on folks' successful, or somewhat successful, cocktails for Bipolar II ...
> I, myself, am getting frustrated again because my mix of Celexa, 40 mg, Neurontin, 2400 mg, and Topamax, 250 mg, has worked, except for sedation (caused by the Topamax) which is getting worse again, and, frankly, it doesn't seem to be working as well as it was.
---------------------------------------Dear Ms. Kingfish:
I am BP II and doing very well on 600 mg/day Lithobid, 100 mg/day Wellbutrin, and 10 mg/day Paxil. I would like to be able to increase the dose of my SSRI (Paxil in my case, Celexa in yours) because at my current low dose I am somewhat "anal" and somewhat irritable. At 20 mg/day of Paxil I am not anal nor irritable at all, however, I lose almost all of my motivation, energy, and enthusiasm. Further, I want to sleep most of the day. I may try 15 mg/day to see what happens.
In your case, could your sedation problem be due to too much Celexa? I, of course, have no idea. I'm just throwing out the question for you.
-- Ron
Posted by Kingfish on June 28, 2001, at 13:35:55
In reply to Re: What's worked 4 folks 4 BP II or other maladies? » Kingfish, posted by Ron Hill on June 28, 2001, at 11:42:51
Ron:
Thank you for your post. I like the name Ms. Kingfish. :) How'd you know I was a Ms.?
I just switched from Celexa to Prozac. The Celexa wasn't the culprit because when on it alone I didn't have trouble HOWEVER, the Prozac seems to be activating because I haven't been tired the last few days. Then again my pdoc pointed out I seemed quite depressed when he saw me, so it's all quite complicated, isn't it.
What is y Lithobid, if I may ask?
Sounds like you have a similar problem with the sedation and low-motivation. If depression was a big problem for you, you are probably very tired of being tired like I was. :( I have heard Paxil can do that. But then so can Celexa. It's just so frustrating that everyone reacts differently.
- K.
Posted by geekUK on June 28, 2001, at 19:25:25
In reply to Re: What's worked 4 folks 4 BP II or other maladies? » Kingfish, posted by Ron Hill on June 28, 2001, at 11:42:51
I did the test, i dont beleive its very robust. too robotic. said - substance abuse related, I really dont think so. just because the doctors have thought my drug use was possibly causal. thats the problem, I am fairly clean now and generaly 'its' in an episode not before. I am just writing to vent doc related anger. they seem to have a system like this test. no best fit, just 'unspecifyed'. its a pretty 'dont give a damn' type of response. I just hate the entire damn system, nhs -not helping sorry.
Posted by MM on June 28, 2001, at 23:11:22
In reply to online self assesment, posted by geekUK on June 28, 2001, at 19:25:25
I did the test too and after 2 questions it said Diagnosis not made due to absence of elation for 4 days, or irritable enough to throw things or hit someone for 4 days. hmmm.
Posted by Ron Hill on June 29, 2001, at 10:54:05
In reply to Re: What's worked 4 folks 4 BP II or other maladies? » Ron Hill, posted by Kingfish on June 28, 2001, at 13:35:55
> Thank you for your post. I like the name Ms. Kingfish. :) How'd you know I was a Ms.?In an earlier post you mentioned your husband.
> I just switched from Celexa to Prozac. The Celexa wasn't the culprit because when on it alone I didn't have trouble HOWEVER, the Prozac seems to be activating because I haven't been tired the last few days. Then again my pdoc pointed out I seemed quite depressed when he saw me, so it's all quite complicated, isn't it.Prozac is more activating for me as well. I'm taking Paxil now because I am not currently covered by medical insurance (self employed) and I have a boat load of Paxil in my med reserve vault. Overall, I think I like Prozac better than Paxil since I can take a higher dose of the former without losing my motivation, energy, enthusiasm, etc. And I need the higher SSRI dose to alleviate symptoms of irritability, quick temper, and being anal.
> What is y Lithobid, if I may ask?Lithobid is an extended release form of lithium carbonate. As such, it has less side effects than other lithium medications. Have you ever used lithium as a mood stabilizer? It has been a first line medication for BP since the 1940's. It does not work for everyone, but I have had very good success with it. The AED's gave me bad rashes. Perhaps you could talk to you pdoc regarding lithium if you have not tried it before and if you are not happy with your current mood stabilizer.
> Sounds like you have a similar problem with the sedation and low-motivation. If depression was a big problem for you, you are probably very tired of being tired like I was. :( I have heard Paxil can do that. But then so can Celexa. It's just so frustrating that everyone reacts differently.Actually, I'm doing extremely well on my current meds. But, I was in the place you reference in the past and it was not fun!
-- Ron
Posted by Ron Hill on June 29, 2001, at 10:57:23
In reply to online self assesment, posted by geekUK on June 28, 2001, at 19:25:25
GeekUK,
Venting is ok! That's part of what we do here, isn't it?
-- Ron
---------------------------------------> I did the test, i dont beleive its very robust. too robotic. said - substance abuse related, I really dont think so. just because the doctors have thought my drug use was possibly causal. thats the problem, I am fairly clean now and generaly 'its' in an episode not before. I am just writing to vent doc related anger. they seem to have a system like this test. no best fit, just 'unspecifyed'. its a pretty 'dont give a damn' type of response. I just hate the entire damn system, nhs -not helping sorry.
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