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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by yesac on June 7, 2005, at 21:39:16
Does anyone know if having that sleep thing where lack of sleep makes you more hypomanic/manic is necessary for a diagnosis of bipolar?
Posted by Phillipa on June 7, 2005, at 23:35:40
In reply to bipolar sleep problems, posted by yesac on June 7, 2005, at 21:39:16
Isn't one of mania's signs an ability to not need sleep? Fondly, Phillipa
Posted by PM80 on June 8, 2005, at 7:45:52
In reply to bipolar sleep problems, posted by yesac on June 7, 2005, at 21:39:16
I think the not sleeping much is a sign of hypomania/mania itself - it doesn't make the hypomania/mania worse.
From stuff I've read, the getting-less-sleep thing is almost always a part of hypomania/mania. This can be seen either as simply not sleeping much, such as going to bed laste and getting up early so that you only sleep for a few hours, or in some people feels more like insomnia, such as trying to maintain regular sleep hours, but being unable to.
For me, I have always been morning person. I have always gone to bed relatively early and woken up relatively early - I do not generally like staying up past my bedtime. When I am hypomanic, I usually still go to bed at a normal hour, but without some kind of drug, I cannot fall asleep for hours and/or I wake up a lot during the night. So to me this feels more like insomnia becuase I am not inclined to be active in the middle of the night. I never was as a kid or teenager so I lay there becasue what the hell else am I going to do. But even if I only get 2 or 3 or 4 hours of sleep I am totally fine the next day.
Posted by yesac on June 8, 2005, at 10:45:03
In reply to Re: bipolar sleep problems, posted by PM80 on June 8, 2005, at 7:45:52
Hmmm, okay, that's interesting. I guess my issue is that I've always-- I mean always, even when I was a little kid-- had serious insomnia issues. There are times when it's much much worse. I've taken sleep meds for about 4 years (trazodone and Seroquel) which have sometimes helped, but I still have sleep issues.
I usually have a hard time falling asleep, wake up many times during the night, sometimes for a long time. But I wouldn't say that it doesn't bother me the next day. I mean, I guess I'm usually okay for the most part, but I think I usually feel tired. I don't know, sleep meds have messed things up, especially Seroquel lately, because that makes me really exhausted, and I actually feel better (less tired) without it, even if I don't get that much good quality sleep.
This problem isn't really episodic I don't think. It's kind of constant, although like I said there have been times that it's much worse for a month or more.
Anyways, I don't know, I was just wondering because I'm not really sure if I'm bipolar or not. I have a number of hypomanic type symptoms, but none of them really seem to be episodic-- it's more like a mixed state that comes and goes, or sometimes feeling hyper and speedy, but the symptoms are usually rather brief, a day or two or even less.
Posted by PM80 on June 8, 2005, at 11:51:52
In reply to Re: bipolar sleep problems » PM80, posted by yesac on June 8, 2005, at 10:45:03
My guess would be that you are likely not bipolar, but I am not by any means an expert. It sounds like anxiety and depression to me. Have you talked to a T or a pdoc about this?
Posted by yesac on June 8, 2005, at 13:28:17
In reply to Re: bipolar sleep problems, posted by PM80 on June 8, 2005, at 11:51:52
I know that I'm definitely not bipolar I or bipolar II even... but perhaps more bipolar NOS/spectrum kind of thing, if you know about that. Yes I have a psychiatrist and I've been in therapy for a long time. He agrees that I have some bipolar symptoms, but hasn't actually diagnosed me as such, probably because I don't have clear episodes of mania. I just tend to get very agitated and irritable, have suicidal and homicidal thoughts, talk fast and have racing thoughts sometimes, feel hyper or activated, and of course the sleep problems I mentioned.
These things have gotten worse in the last few years. Also, antidepressants don't seem to help me, but mood stabilizers do--- not that that's diagnostic, but it's an interesting problem to me.
Anyways, I don't know. In some ways it really doesn't matter, except for my own peace of mind. I just hate the ambiguity of diagnoses.
Posted by PM80 on June 8, 2005, at 13:36:45
In reply to Re: bipolar sleep problems » PM80, posted by yesac on June 8, 2005, at 13:28:17
I guess though that with ambiguity of diagnoses there is also freedom from the constriction of discrete labeling. I'm glad that you have found some meds to help you, although it seems that perhaps you can do better. Do you discuss your meds with your pdoc?
Posted by yesac on June 8, 2005, at 13:55:09
In reply to Re: bipolar sleep problems » yesac, posted by PM80 on June 8, 2005, at 13:36:45
> I guess though that with ambiguity of diagnoses there is also freedom from the constriction of discrete labeling. I'm glad that you have found some meds to help you, although it seems that perhaps you can do better. Do you discuss your meds with your pdoc?
Yes, I guess you're right about that. I have mixed feelings about diagnoses! On the one hand they really annoy me, but on the other hand I'm obsessed with finding an accurate diagnosis for myself. But I don't know if that will really ever happen, because they are so subjective anyways. I'm not sure why it matter so much to me lately, but it does.
I could definitely do better with meds. I have gotten only minimal improvement from a few meds... right now I'm back on lithium, and my mood is certainly more stable and I'm more calm and less agitated... but it's not really good enough. I'm still quite depressed. I've been on a lot of drugs though, so it's hard to know where to go from here. I know there are options, but I'm just not sure what to do. For the meantime, I'm trying to tweak the lithium to find the optimal dose (just went up to 900mgs).
I do talk a lot about meds with my psychiatrist... I saw him at first just for meds, for about 6 or 7 months. But then things weren't working out with my therapist, and I liked my psychiatrist so much that I decided to see him also for therapy. I've seen him now for a little over 2 years total. He changed my opinion of shrinks. Before him, I didn't really like them that much! But he's really different than others that I've seen/known. He actually cares.
Posted by Minnie-Haha on June 9, 2005, at 10:52:42
In reply to bipolar sleep problems, posted by yesac on June 7, 2005, at 21:39:16
FWIW, my understanding of Bipolar Disorder and sleep problems is that during a manic phase you tend to not feel like you need much sleep... as opposed to feeling like you need sleep, but you can't (exhaustion, insomnia).
Also, diagnoses used to be real important to me, but I'm not nearly as hung up on that as I once was. (I figured once I got a DX, all my problems would be solved... or solvable anyway.) Now I just concentrate on making the lifestyle changes, and finding the treatments plans and therapies to make me feel and function better.
Posted by PM80 on June 9, 2005, at 13:16:01
In reply to Re: bipolar sleep problems » yesac, posted by Minnie-Haha on June 9, 2005, at 10:52:42
> FWIW, my understanding of Bipolar Disorder and sleep problems is that during a manic phase you tend to not feel like you need much sleep... as opposed to feeling like you need sleep, but you can't (exhaustion, insomnia).
>Well, yes and no, I think. What if you like to sleep and do not like to be wide awake in the middle of the night? Mania and its accompanying lack of sleep presents differently in different patients. I have actually read about this in some books specifically about bipolar. I, personally, just do not like to be awake in the middle of the night unless I am at a party or a bar/club, which is not that often now. I do not feel physically that I need sleep, but I have never been a night person. But I'll get up at 5am for the hell of it. Insomniacs usually suffer from their lack of sleep, but someone with mania does not. I think this standard is more telling.
Posted by barbaracat on June 12, 2005, at 21:58:39
In reply to Re: bipolar sleep problems » PM80, posted by yesac on June 8, 2005, at 13:28:17
Your symptoms sure sound like bipolar to me. I went through 25 years resisting the label because of the standard descriptors of 'manic' we all think we're familiar with. One does not have to to manic in the classic sense. Irritability, agitation and severe anxiety can work just fine as the 'manic' phase, and depression should be in there somewhere as well.
The real proof in the pudding is how you feel on the varioius meds. You don't do well on ADs but feel better on mood stabilizers? Well, that's something to consider very strongly and as diagnostic as anyone can hope for.
In retrospect, after I'd become stabilized on lithium and overcame my horror of the stigma of being 'really crazy' instead of just depressed, I started allowing myself to recognize full-blown episodes of manic symptoms throughout my life and started recognizing them in both my parents as well.
Racing and pressured thoughts, and feelng hyper and activated combined with suicidal ideation is as classic as you can get for bipolar and sounds like a simple measure of degree. Maybe you don't get flamingly psychotically manic, but it sure sounds close enough for jazz and should be treated accordingly.
> I know that I'm definitely not bipolar I or bipolar II even... but perhaps more bipolar NOS/spectrum kind of thing, if you know about that. Yes I have a psychiatrist and I've been in therapy for a long time. He agrees that I have some bipolar symptoms, but hasn't actually diagnosed me as such, probably because I don't have clear episodes of mania. I just tend to get very agitated and irritable, have suicidal and homicidal thoughts, talk fast and have racing thoughts sometimes, feel hyper or activated, and of course the sleep problems I mentioned.
>
> These things have gotten worse in the last few years. Also, antidepressants don't seem to help me, but mood stabilizers do--- not that that's diagnostic, but it's an interesting problem to me.
>
> Anyways, I don't know. In some ways it really doesn't matter, except for my own peace of mind. I just hate the ambiguity of diagnoses.
Posted by Maxime on June 13, 2005, at 1:57:32
In reply to Re: bipolar sleep problems » yesac, posted by barbaracat on June 12, 2005, at 21:58:39
Hi Barbara Cat
You described bipolar 2 very well. Actually often people are misdiagnosed as depressed with anxiety when it's BP2.
I hope you don't think of yourself as "really crazy" because that just a load of BS!
Hugs,
Maxime
> Your symptoms sure sound like bipolar to me. I went through 25 years resisting the label because of the standard descriptors of 'manic' we all think we're familiar with. One does not have to to manic in the classic sense. Irritability, agitation and severe anxiety can work just fine as the 'manic' phase, and depression should be in there somewhere as well.
>
> The real proof in the pudding is how you feel on the varioius meds. You don't do well on ADs but feel better on mood stabilizers? Well, that's something to consider very strongly and as diagnostic as anyone can hope for.
>
> In retrospect, after I'd become stabilized on lithium and overcame my horror of the stigma of being 'really crazy' instead of just depressed, I started allowing myself to recognize full-blown episodes of manic symptoms throughout my life and started recognizing them in both my parents as well.
>
> Racing and pressured thoughts, and feelng hyper and activated combined with suicidal ideation is as classic as you can get for bipolar and sounds like a simple measure of degree. Maybe you don't get flamingly psychotically manic, but it sure sounds close enough for jazz and should be treated accordingly.
>
>
> > I know that I'm definitely not bipolar I or bipolar II even... but perhaps more bipolar NOS/spectrum kind of thing, if you know about that. Yes I have a psychiatrist and I've been in therapy for a long time. He agrees that I have some bipolar symptoms, but hasn't actually diagnosed me as such, probably because I don't have clear episodes of mania. I just tend to get very agitated and irritable, have suicidal and homicidal thoughts, talk fast and have racing thoughts sometimes, feel hyper or activated, and of course the sleep problems I mentioned.
> >
> > These things have gotten worse in the last few years. Also, antidepressants don't seem to help me, but mood stabilizers do--- not that that's diagnostic, but it's an interesting problem to me.
> >
> > Anyways, I don't know. In some ways it really doesn't matter, except for my own peace of mind. I just hate the ambiguity of diagnoses.
>
>
Posted by yesac on June 13, 2005, at 11:14:03
In reply to Re: bipolar sleep problems » yesac, posted by barbaracat on June 12, 2005, at 21:58:39
> Your symptoms sure sound like bipolar to me. I went through 25 years resisting the label because of the standard descriptors of 'manic' we all think we're familiar with. One does not have to to manic in the classic sense. Irritability, agitation and severe anxiety can work just fine as the 'manic' phase, and depression should be in there somewhere as well.
Yeah, in the past 2 or 3 years I've started to wonder about the bipolarity thing, mostly because I wasn't having any success with antidepressants, and because of the extreme agitation that I experience. I resisted even just having a diagnosis of depression... but at this point if I was diagnosed as bipolar I probably wouldn't mind that much. I almost feel as though I'd be more comfortable telling people I'm bipolar just because it feels a little bit more accurate to me than unipolar.I certainly have never had any kind of full blown manic episode, and I don't expect that I ever will, but I do experience these other more hypomanic types of symptoms. But also I've never ever felt *good*. If anything, it's always been more of a mixed state type of thing, really extreme irritability and agitation without any kind of happiness or euphoria or elated mood. And I'm not sure that it's episodic exactly... it's more like chronic, waxing and waning, but never really going away.
Oh well. I know in the end it's not the diganosis that matters, but more the treatment that happens to work, regardless of what my diagnosis is. And I think that with the lithium, I might be on the right track... but it's going to take more work (and unfortunately more drugs) to feel better, because I still don't feel very good at all. It just seems like lithium has reduced my depression to a more *normal* type of depression, without all the crazy, hyped up, activated feelings.
Posted by yesac on June 13, 2005, at 11:15:03
In reply to Re: bipolar sleep problems, posted by yesac on June 13, 2005, at 11:14:03
Posted by barbaracat on June 13, 2005, at 19:36:29
In reply to Re: bipolar sleep problems, posted by yesac on June 13, 2005, at 11:14:03
**You're on the right track. If lithium is helping even somewhat, that's as good as a formal diagnosis, as far as I'm concerned. People who don't need lithium don't respond very well to it. And I'd take the blah couch-potato life sucks type of depression any day to the above WITH anxiety, agitation and panic attacks.
All you probably need at this point is a small dose of an antidepressant that agrees with you. Remember, lithium augments ADs and vice versa so you won't need as much to start so don't let anyone talk you into taking the 'standard' dose of an AD. Just my humble opinion, but my circuits have been fried too many times and I didn't know why.
Bipolars are very sensitive to SSRIs, as you know. We need just a smidge to start and increase from there. I'm having wonderful results with Cymbalta but I only take 6mg vs the 30mg standard dose. Good luck to you. One thing about us mood challenged folks - we're a tenacious lot. - Barbara
> Yeah, in the past 2 or 3 years I've started to wonder about the bipolarity thing, mostly because I wasn't having any success with antidepressants, and because of the extreme agitation that I experience. I resisted even just having a diagnosis of depression... but at this point if I was diagnosed as bipolar I probably wouldn't mind that much. I almost feel as though I'd be more comfortable telling people I'm bipolar just because it feels a little bit more accurate to me than unipolar.
>
> I certainly have never had any kind of full blown manic episode, and I don't expect that I ever will, but I do experience these other more hypomanic types of symptoms. But also I've never ever felt *good*. If anything, it's always been more of a mixed state type of thing, really extreme irritability and agitation without any kind of happiness or euphoria or elated mood. And I'm not sure that it's episodic exactly... it's more like chronic, waxing and waning, but never really going away.
>
> Oh well. I know in the end it's not the diganosis that matters, but more the treatment that happens to work, regardless of what my diagnosis is. And I think that with the lithium, I might be on the right track... but it's going to take more work (and unfortunately more drugs) to feel better, because I still don't feel very good at all. It just seems like lithium has reduced my depression to a more *normal* type of depression, without all the crazy, hyped up, activated feelings.
>
Posted by yesac on June 14, 2005, at 11:58:08
In reply to Re: bipolar sleep problems » yesac, posted by barbaracat on June 13, 2005, at 19:36:29
> People who don't need lithium don't respond very well to it. And I'd take the blah couch-potato life sucks type of depression any day to the above WITH anxiety, agitation and panic attacks.
Do you know how lithium affects people who are *normal*? My guess would be that it just kind of dulls them out, flattens them... I've heard that lithium has neuroprotective properties though, so maybe our brains are better off somehow than the rest of the world who doesn't take it. We just have to risk the thyroid and kidney and other problems!
> All you probably need at this point is a small dose of an antidepressant that agrees with you. Remember, lithium augments ADs and vice versa so you won't need as much to start so don't let anyone talk you into taking the 'standard' dose of an AD.> Bipolars are very sensitive to SSRIs, as you know. We need just a smidge to start and increase from there. I'm having wonderful results with Cymbalta but I only take 6mg vs the 30mg standard dose.
I'm not sure what to take. I've been on SO many drugs with no luck. I'm thinking of trying Lamictal again, but I don't know if that's pointless. It really didn't do much of anything for me when I took it before, but I'm kind of hoping that combined with lithium maybe it would work better. I'm not too excited about any of the antidepressants, and wonder if I maybe should just stay away from them. I could possibly try a TCA. I've only tried one of those and got off it pretty quickly after I found that I was unable to pee! My other thought is Strattera, which would be good if it worked, because I have a lot of attention problems too in addition to the mood problems. So it would be an ideal drug, except that I've heard it frequently doesn't work very well and it has a lot of unpleasant side effects.But I guess there's no way of ever knowing until I try, with any drug.
>Good luck to you. One thing about us mood challenged folks - we're a tenacious lot. -
Thanks! And- I think that we have to be tenacious-- what other choice do we have?
Meghan
Posted by barbaracat on June 14, 2005, at 14:35:49
In reply to Re: bipolar sleep problems » barbaracat, posted by yesac on June 14, 2005, at 11:58:08
> Do you know how lithium affects people who are *normal*? My guess would be that it just kind of dulls them out, flattens them...**That's my understanding. They get sort of drooly and dumb. The ones taking it for neuroprotective benefits are using very small amounts, and yes, we should be grateful that there is that aspect to lithium. We may have screwed thyroids and kidneys, but by God, our dendrites are popping!
>
> I'm not sure what to take. I've been on SO many drugs with no luck.**What all have you taken? Let me give you my list just for grins: Elavil, tofranil, suromontil (these were all in the late 80's),then trazadone, prozac, zoloft, celexa, buspar, wellbutrin, serzone, remeron, nortriptaline, St. John's Wort, ritalin, SAM-e, Lamictal, lithium, topmax, depakote, seroquel, zyprexa, Cymbalta.
I liked the way nortriptyline made me feel but couldn't stand the side effects. So far, low dose Cymbalta along with lithium has been the best by far. Too many highly sensitive people start out at the standard 30mg dose, freak out and swear off ADs forever. No need to. One 60mg capsule lasts over a week for me, no side effects, and provides a very nice lift.
Nothing's perfect. I'm not euphoric and I still have periods of grief and irritation, but it's appropriate and manageable emotion, not the toxic overwhelming kind. I can't guarantee that a few pellets of Cymbalta will be as miraculous for everyone as for me, but certainly worth a try.
I personally wouldn't go on Lamictal again for anything, but that's only I had an extreme allergic reaction to it. All of these drugs have risks, but Stevens Johnson rash has been known to kill people. You don't think these kinds of things will ever happen to you. I sure didn't.
> >
> Thanks! And- I think that we have to be tenacious-- what other choice do we have?**Well, there is an alternative, but one we tenaciously refuse to give in to.
>
>
Posted by yesac on June 16, 2005, at 11:04:05
In reply to Re: bipolar sleep problems » yesac, posted by barbaracat on June 14, 2005, at 14:35:49
> **That's my understanding. They get sort of drooly and dumb. The ones taking it for neuroprotective benefits are using very small amounts, and yes, we should be grateful that there is that aspect to lithium. We may have screwed thyroids and kidneys, but by God, our dendrites are popping!
People actually take it for neuroprotective benefits!? Interesting.
> > I'm not sure what to take. I've been on SO many drugs with no luck.
>
> **What all have you taken? Let me give you my list just for grins: Elavil, tofranil, suromontil (these were all in the late 80's),then trazadone, prozac, zoloft, celexa, buspar, wellbutrin, serzone, remeron, nortriptaline, St. John's Wort, ritalin, SAM-e, Lamictal, lithium, topmax, depakote, seroquel, zyprexa, Cymbalta.How was the Topamax?
Let's see if I can do a list of my drugs... Wellbutrin, Celexa, trazodone, Effexor, Paxil, Lamictal, Ativan, desipramine, Parnate, Risperdal, Ritalin, Adderall, Provigil, lithium, Prozac (really bad idea!), Depakote, Trileptal, Klonopin, Abilify, Zyprexa, Seroquel, Cymbalta. Also St. John's Wort and omega-3s. I think that's it, but I might have forgotten one or two. Several of them I've tried multiple times.
Fun, isn't it?
I'm not sure what to do now because I still have a lot of attention and depression problems. Maybe Strattera? It seems like possibly the best choice, but I've heard it has a lot of nasty side effects, plus it seems like it often doesn't work.
> > Thanks! And- I think that we have to be tenacious-- what other choice do we have?
>
> **Well, there is an alternative, but one we tenaciously refuse to give in to.
Yes, I am very well aware of that other option. I've been tenaciously battling against it for quite a while.
Posted by barbaracat on June 16, 2005, at 17:01:30
In reply to Re: bipolar sleep problems » barbaracat, posted by yesac on June 16, 2005, at 11:04:05
>
> People actually take lithium for neuroprotective benefits!? Interesting**Oh, yes. Do a google search for lithium+neuroprotective or lithium+neurogenesis and you'll get huge hits on very promising research in this area. It seems to encourage production of new dendrites and memory pathways.
>
> How was the Topamax?**It made me edgy and speedy and more depressed.
>
> Fun, isn't it?**Expensive too.
>
> I'm not sure what to do now because I still have a lot of attention and depression problems. Maybe Strattera? It seems like possibly the best choice, but I've heard it has a lot of nasty side effects, plus it seems like it often doesn't work.**Yeah, there does seem to be that overlap with ADD. In my bipolar frenzies, I'm a disorganized wreck. It's interesting. On that subject, I had some Ritalin left over from when my pdoc was trying everything. I've been on a cleaning, clearing out phase and decided to pop a little helper. It really helped keep me focused and calm. My illegal drug of choice in my youth was amphetamines which would leave me calm. I don't do well on stims on an ongong basis because I'm so prone to stress, but - oh jeez, I just don't know.
>
> Yes, I am very well aware of that other option. I've been tenaciously battling against it for quite a while.
>
**I just figure I'd have to come back and do the whole dang thing over again.
Posted by Sabino on June 17, 2005, at 18:16:10
In reply to Re: bipolar sleep problems » yesac, posted by Minnie-Haha on June 9, 2005, at 10:52:42
Minnie,
Just curious, what meds are you trying now? Seems to me I read that you took Effexor at one point. I did a lot of reading up on it here at PB. I have been giving it a trial run, but just started Lithobid yesterday, and felt better (sort of at peace for once) than I have in a long time.
This is the end of the thread.
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