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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by JennyJen on June 2, 2002, at 23:29:02
Hey Everyone,
I am new to this board and find it packed with so much great information. It seems several individuals here have been re-diagnosed as bipolar II and finding good results with mood stablizers. I have failed several antidepressants and am starting to wonder if I am bipolar II. No mania or hypomania that I can recall.
Can those individual who were misdiagnosed and really bipolar II tell me what there behavior was like during there 20's and 30's. What are some tell tale signs of bipolar II?
Thanks everyone.
Jenny
Posted by JohnX2 on June 3, 2002, at 0:27:22
In reply to Help-I think might be Bipolar, posted by JennyJen on June 2, 2002, at 23:29:02
> Hey Everyone,
>
> I am new to this board and find it packed with so much great information. It seems several individuals here have been re-diagnosed as bipolar II and finding good results with mood stablizers. I have failed several antidepressants and am starting to wonder if I am bipolar II. No mania or hypomania that I can recall.
>
> Can those individual who were misdiagnosed and really bipolar II tell me what there behavior was like during there 20's and 30's. What are some tell tale signs of bipolar II?
>
> Thanks everyone.
>
> JennyI'll make a quick post before I nod off.
You don't think you have any hypomania symptoms.
Can you explain?Have you and your physicians discussed issues/symptoms of:
intense agitation/anxiety,rage,or symptoms of attention deficit
disorder comorbid with the depression? Racing thoughts?Is all this a recent phenomina (in your 20's or 30's)?
Bipolar disorder can kick in during the 20's.
It's possible be hypomanic and not euphoric.
This is sometimes called a dysphoric hypomania.
It's characterized by possible symptoms of
agitation, racing thoughts, possible anger, and
more. This is generally concurrent with being depressed.
A lot of times the agitation and racing thoughts
are hard to differentiate from anxiety and ADD
symptoms.It would be nice to know what your exact depression
symptoms are like and how you responded to the antidepressants.
What types of ADs did you take? Did they ever kick in?
Did they work for a while and then peter out?IMO, I think the brain is really complex and the mood stabilizers
are good medicines in general to help calm the mood in a lot
of situations. Some people are just cyclothymic and have cylcical
mood swings but aren't bipolar per se. Some of the mood stabilizer
that have been released lately also have good AD properties.
And the APs (atypical antipsychotics) that are approved for bipolar
are also useful to treat generic anxiety/depression. Sometimes
peoples body chemistries just click better with thesee meds
than the mainstream antidepressants.FYI, I probably tested at least 8 antidepressants before going the
bipolar route and getting stabilized on mood stabilizers.John
Posted by JennyJen on June 3, 2002, at 22:12:14
In reply to Re: Help-I think might be Bipolar » JennyJen, posted by JohnX2 on June 3, 2002, at 0:27:22
Dear JohnX2,
Thanks sooo much for your time. Here is some answers to your questions.
I have always been very shy and anxious. I actually was so nervous, I had irritable bowel syndrome (bad stomach cramps, always having to go to the bathroom, etc.). I started getting panic attacks at age 24 during grad school. Klonopin 0.5mg/day stopped that, but depression ensued 1 year later. SSRI and TCAs helped by about 50%, but still disabled. Then I was giving parnate .... all of the anxiety lifted and I was finally able to socialize and date. I also got insomnia and the diet was tough. So I tried lamictal and neurontin .... once again maybe 50% improvement, but still disabled.
Then I started reading about bipolar II, and I thought that with my failure with SSRIs and TCAs, maybe I was bipolar II. So I tried lithium and depakote, which made me feel more depressed and apathetic. My pdoc says I am just anxious/depressed, but I don't want to make this disease worse with parnate (I heard antidepressants can induce rapid cycling).
Jenny
Posted by Ritch on June 3, 2002, at 23:10:55
In reply to Re: Help-I think might be Bipolar » JohnX2, posted by JennyJen on June 3, 2002, at 22:12:14
> Dear JohnX2,
>
> Thanks sooo much for your time. Here is some answers to your questions.
>
> I have always been very shy and anxious. I actually was so nervous, I had irritable bowel syndrome (bad stomach cramps, always having to go to the bathroom, etc.). I started getting panic attacks at age 24 during grad school. Klonopin 0.5mg/day stopped that, but depression ensued 1 year later. SSRI and TCAs helped by about 50%, but still disabled. Then I was giving parnate .... all of the anxiety lifted and I was finally able to socialize and date. I also got insomnia and the diet was tough. So I tried lamictal and neurontin .... once again maybe 50% improvement, but still disabled.
>
> Then I started reading about bipolar II, and I thought that with my failure with SSRIs and TCAs, maybe I was bipolar II. So I tried lithium and depakote, which made me feel more depressed and apathetic. My pdoc says I am just anxious/depressed, but I don't want to make this disease worse with parnate (I heard antidepressants can induce rapid cycling).
>
> Jenny
Jenny,It sounds like a possible combination of Klonopin and Parnate would be ideal-have you tried that combination? You said you didn't have any hypomania to report about. Well... you have got to have that one to be BPII. You tried antidepressants and still didn't experience any hypomania. I think your pdoc might be right-you have troubles with mixed anxiety and depression, not bipolar mixed states. That is where things do get *very* blurry for many folks, but the most reliable tip-off for bipolar is hypomanic reactions to antidepressants AND problems with AD "poop-outs" on top of that, AND cyclical recurrent major depressions.
Mitch
Posted by JohnX2 on June 4, 2002, at 2:53:59
In reply to Re: Help-I think might be Bipolar » JennyJen, posted by Ritch on June 3, 2002, at 23:10:55
> > Dear JohnX2,
> >
> > Thanks sooo much for your time. Here is some answers to your questions.
> >
> > I have always been very shy and anxious. I actually was so nervous, I had irritable bowel syndrome (bad stomach cramps, always having to go to the bathroom, etc.). I started getting panic attacks at age 24 during grad school. Klonopin 0.5mg/day stopped that, but depression ensued 1 year later. SSRI and TCAs helped by about 50%, but still disabled. Then I was giving parnate .... all of the anxiety lifted and I was finally able to socialize and date. I also got insomnia and the diet was tough. So I tried lamictal and neurontin .... once again maybe 50% improvement, but still disabled.
> >
> > Then I started reading about bipolar II, and I thought that with my failure with SSRIs and TCAs, maybe I was bipolar II. So I tried lithium and depakote, which made me feel more depressed and apathetic. My pdoc says I am just anxious/depressed, but I don't want to make this disease worse with parnate (I heard antidepressants can induce rapid cycling).
> >
> > Jenny
>
>
> Jenny,
>
> It sounds like a possible combination of Klonopin and Parnate would be ideal-have you tried that combination? You said you didn't have any hypomania to report about. Well... you have got to have that one to be BPII. You tried antidepressants and still didn't experience any hypomania. I think your pdoc might be right-you have troubles with mixed anxiety and depression, not bipolar mixed states. That is where things do get *very* blurry for many folks, but the most reliable tip-off for bipolar is hypomanic reactions to antidepressants AND problems with AD "poop-outs" on top of that, AND cyclical recurrent major depressions.
>
> Mitch
Hi Jenny,I fully concur with Mitch. Another medication option that may be really helpful
is Nardil. It's less likely to cause insomnia than Panate, and it's really a
Gold standard for treating anxiety/panic related symptoms. Also I wouldn't be too
concerned about the risk of cycling etc,. It doesn't sound from your description like
this has been a problem in the past and you seem to have done well on the MAOI medications.
I know the diets can be tough.FYI, my experience on standalone antidepressants has been either no-response, they made me
feel much more depressed, or they quickly made me feel very manic and then stopped working
(within hours or days). This was an indicator of possibly being bipolar for me.Hang in There.
Best Regards,
John
Posted by JennyJen on June 4, 2002, at 6:37:58
In reply to Re: Help-I think might be Bipolar, posted by JohnX2 on June 4, 2002, at 2:53:59
Mitch/JohnX2/everyone,
Thank you for your help .... that clarifies alot of questions I had about bipolar II. So my final question, I have restarted parnate and am feeling better. Some weird behavior is returning and I was wonder how you guys interpret this (for example):
I feel the need to clean my radiator. It is real dirty, been painted several times and smell like fumes when turned on. It is really gross. What bothers me is I have this "need" to clean it. I actually attempted to strip it with paint thinner before when on parnate! I was thinking about taking it apart to clean it as well, I went on line to find out how to do that but no luck! My old shy/phobia self could care less ... let it be dirty!
Does this sound like me get finally getting better .... or the dreaded hypomania.
Thanks again,
Jenny
Posted by Ritch on June 4, 2002, at 7:51:01
In reply to Thank you, Thank you- one more question?, posted by JennyJen on June 4, 2002, at 6:37:58
> Mitch/JohnX2/everyone,
>
> Thank you for your help .... that clarifies alot of questions I had about bipolar II. So my final question, I have restarted parnate and am feeling better. Some weird behavior is returning and I was wonder how you guys interpret this (for example):
>
> I feel the need to clean my radiator. It is real dirty, been painted several times and smell like fumes when turned on. It is really gross. What bothers me is I have this "need" to clean it. I actually attempted to strip it with paint thinner before when on parnate! I was thinking about taking it apart to clean it as well, I went on line to find out how to do that but no luck! My old shy/phobia self could care less ... let it be dirty!
>
> Does this sound like me get finally getting better .... or the dreaded hypomania.
>
> Thanks again,
>
> JennyThose might be symptoms of OCD, but OTOH, you seemed to have "gotten into" cleaning it, which often are symptoms of depression lifting (when you get depressed everything may all pile up-and then when it lifts you start getting everything tidied up). I notice I am into all sorts of projects when my depression lifts, but that isn't always accompanied by hypomanic symptoms. John's idea about trying the Nardil instead of the Parnate is a good suggestion-Parnate definitely is more activating than Nardil. I would tell your pdoc about the "cleaning" stuff and see what he thinks. Of course, the bottom line with that is are you going through a lot of thinking "loops" (ruminating) about cleaning something well in advance of doing it (and feeling discomfort), or do you just find yourself in the middle of getting it done and feel pleased that you accomplished something? If you are doing a lot of ruminating prior to the cleaning I would be more concerned.
Mitch
Posted by Leighwit on June 4, 2002, at 18:16:16
In reply to Re: Help-I think might be Bipolar » JennyJen, posted by Ritch on June 3, 2002, at 23:10:55
> Jenny,
>
> .... You said you didn't have any hypomania to report about. Well... you have got to have that one to be BPII. ....>Mitch
Mitch,
I'm confused. I looked up BPII again and see that a hypomanic period requires "four days of expanded mood to meet the criterion." It sounds like it's a "positive" vs. a "negative" mental state. I have angry outburts, but I don't meet that DSM-IV criterion ~ I've never had a manic episode ~ as in a state of increased energy and productivity wherein less sleep is required.
I am, however, tomorrow starting Topomax, (I already tried Lamictal you might recall ~ can't take it because of rapid-fire weight gain) to address dysthmia, and/or irritable temperament. The Pdoc mentioned cyclothymia, but I can't recognize any patterns. I used to be hyperthymic I think ~ having at one time been a very happy workaholic/overachieving executive. That was nearly ten years ago. Now I'm lucky if I can comprehend the business section of the morning paper.
Anyway--does it make any sense to you for someone without mania to take mood stabilizers?
Laurie
Posted by Ritch on June 5, 2002, at 0:30:46
In reply to Re: Help-I think might be Bipolar » Ritch, posted by Leighwit on June 4, 2002, at 18:16:16
> > Jenny,
> >
> > .... You said you didn't have any hypomania to report about. Well... you have got to have that one to be BPII. ....
>
> >Mitch
>
> Mitch,
>
> I'm confused. I looked up BPII again and see that a hypomanic period requires "four days of expanded mood to meet the criterion." It sounds like it's a "positive" vs. a "negative" mental state. I have angry outburts, but I don't meet that DSM-IV criterion ~ I've never had a manic episode ~ as in a state of increased energy and productivity wherein less sleep is required.
>
> I am, however, tomorrow starting Topomax, (I already tried Lamictal you might recall ~ can't take it because of rapid-fire weight gain) to address dysthmia, and/or irritable temperament. The Pdoc mentioned cyclothymia, but I can't recognize any patterns. I used to be hyperthymic I think ~ having at one time been a very happy workaholic/overachieving executive. That was nearly ten years ago. Now I'm lucky if I can comprehend the business section of the morning paper.
>
> Anyway--does it make any sense to you for someone without mania to take mood stabilizers?
>
> Laurie
Laurie,Go to www.mentalhealth.com and click on the "disorders" menu and click on bipolar disorder. Then go to BipolarII and then the American Description. You will see that it
mentions:"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."
So, it can be marked by irritability, but
it still needs to last at least four days or so.I never stay pissed off that consistently. I tend to blow my fuse over shorter spans of time as well. However, I do notice that many antidepressants and prednisone have triggered hypomanic episodes and brief hostility episodes that have *recurred* on a daily basis for several days in a row. I just didn't wake up pissed, or necessarily go to sleep that way, but I inevitably got really upset and angry every day about something or other. I might have had ruminative angry thoughts for a good part of any given day as well. I was told once that I might simply have recurrent major depressions, and that I am just antidepressant sensitive with a tendency for short-fusedness. I was told "Intermittent Explosive Disorder". But, I don't think that is techically a DSM-IV condition (anyone feel free to correct). I found that low-dose Depakote works great for the explosive temper spells *and* hypomania.
Mitch
Posted by JohnX2 on June 5, 2002, at 0:59:43
In reply to Re: Help-I think might be Bipolar » Leighwit, posted by Ritch on June 5, 2002, at 0:30:46
> > > Jenny,
> > >
> > > .... You said you didn't have any hypomania to report about. Well... you have got to have that one to be BPII. ....
> >
> > >Mitch
> >
> > Mitch,
> >
> > I'm confused. I looked up BPII again and see that a hypomanic period requires "four days of expanded mood to meet the criterion." It sounds like it's a "positive" vs. a "negative" mental state. I have angry outburts, but I don't meet that DSM-IV criterion ~ I've never had a manic episode ~ as in a state of increased energy and productivity wherein less sleep is required.
> >
> > I am, however, tomorrow starting Topomax, (I already tried Lamictal you might recall ~ can't take it because of rapid-fire weight gain) to address dysthmia, and/or irritable temperament. The Pdoc mentioned cyclothymia, but I can't recognize any patterns. I used to be hyperthymic I think ~ having at one time been a very happy workaholic/overachieving executive. That was nearly ten years ago. Now I'm lucky if I can comprehend the business section of the morning paper.
> >
> > Anyway--does it make any sense to you for someone without mania to take mood stabilizers?
> >
> > Laurie
>
>
> Laurie,
>
> Go to www.mentalhealth.com and click on the "disorders" menu and click on bipolar disorder. Then go to BipolarII and then the American Description. You will see that it
> mentions:
>
> "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."
>
> So, it can be marked by irritability, but
> it still needs to last at least four days or so.
>
> I never stay pissed off that consistently. I tend to blow my fuse over shorter spans of time as well. However, I do notice that many antidepressants and prednisone have triggered hypomanic episodes and brief hostility episodes that have *recurred* on a daily basis for several days in a row. I just didn't wake up pissed, or necessarily go to sleep that way, but I inevitably got really upset and angry every day about something or other. I might have had ruminative angry thoughts for a good part of any given day as well. I was told once that I might simply have recurrent major depressions, and that I am just antidepressant sensitive with a tendency for short-fusedness. I was told "Intermittent Explosive Disorder". But, I don't think that is techically a DSM-IV condition (anyone feel free to correct). I found that low-dose Depakote works great for the explosive temper spells *and* hypomania.
>
> Mitch
I think you may have better luck with Depakote or maybe
Neurontin. Topamax is a great medicine for people with a
history of trauma, btw. However, some people report
becoming more irritable on it. Your results may vary, etc...Good Luck,
John
Posted by JennyJen on June 5, 2002, at 8:22:52
In reply to Re: Help-I think might be Bipolar, posted by JohnX2 on June 5, 2002, at 0:59:43
Posted by Leighwit on June 5, 2002, at 9:04:22
In reply to Re: Help-I think might be Bipolar » Leighwit, posted by Ritch on June 5, 2002, at 0:30:46
Mitch,
What you've written below about your experience with irritable mood compared to the DSM-IV is illuminating and helpful. Thanks for the directions to and around mentalhealth.com also.
I have the same experience you describe. If low-dose Depakote works for you, perhaps Topamax will work for me. God knows Wellbutrin alone isn't the answer.
Thanks very much,
Laurie> Laurie,
>
> Go to www.mentalhealth.com and click on the "disorders" menu and click on bipolar disorder. Then go to BipolarII and then the American Description. You will see that it
> mentions:
>
> "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."
>
> So, it can be marked by irritability, but
> it still needs to last at least four days or so.
>
> I never stay pissed off that consistently. I tend to blow my fuse over shorter spans of time as well. However, I do notice that many antidepressants and prednisone have triggered hypomanic episodes and brief hostility episodes that have *recurred* on a daily basis for several days in a row. I just didn't wake up pissed, or necessarily go to sleep that way, but I inevitably got really upset and angry every day about something or other. I might have had ruminative angry thoughts for a good part of any given day as well. I was told once that I might simply have recurrent major depressions, and that I am just antidepressant sensitive with a tendency for short-fusedness. I was told "Intermittent Explosive Disorder". But, I don't think that is techically a DSM-IV condition (anyone feel free to correct). I found that low-dose Depakote works great for the explosive temper spells *and* hypomania.
>
> Mitch
Posted by Ed O`Flaherty on June 5, 2002, at 12:47:52
In reply to Re: Help-I think might be Bipolar » JennyJen, posted by JohnX2 on June 3, 2002, at 0:27:22
At a psychiatric conference in Sweden recently I heard a speaker claim that up to 5% of people have some type of BP.The highest incidence seems to be in Germany,the lowest in Iceland (perhaps related to the high level of omega-3 fish oil in the diet there.)
Posted by Leighwit on June 5, 2002, at 13:15:57
In reply to Re: Help-I think might be Bipolar, posted by Ed O`Flaherty on June 5, 2002, at 12:47:52
> At a psychiatric conference in Sweden recently I heard a speaker claim that up to 5% of people have some type of BP.The highest incidence seems to be in Germany,the lowest in Iceland (perhaps related to the high level of omega-3 fish oil in the diet there.)
Well now there's an argument for omega-3 fish oil supplements if I've ever heard one. Hope my Omegabrite order comes in soon.
Laurie
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