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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by Phillipa on June 2, 2006, at 13:34:24
It seems as if a person doesn't respond now to an antidepressant they are termed treatment resistant and some type of bipolar. Do you think it's true or is it a marketing ploy or the fact that pdocs don't know what to do with people who don't respond to antidepressants. Should make for a good discussion. Thanks Maybe we can all learn something
Posted by bipolarspectrum on June 2, 2006, at 14:57:09
In reply to What Do You Think Of All the New Types of Bipolar?, posted by Phillipa on June 2, 2006, at 13:34:24
Hey P,
I LOVE the new open classification... I'm a firm believer in the depressive spectrum, which unipolar on one side and bipolar on the other... and most people fall somewhere in between... I make the analogy of the 'arts/science' spectrum in life... pure arts on one side (poets, painters) and pure science on the other (math)... with most people falling somewhere in between.. Personally, my illness was not remotely near what classifies as bipolar in the current DSM-IV, but all the 'unipolar' drugs failed horribly for me... but with the proper combo of bipolar drugs, I seem to be doing quite well... just my opinion!
Peace P!
bps> It seems as if a person doesn't respond now to an antidepressant they are termed treatment resistant and some type of bipolar. Do you think it's true or is it a marketing ploy or the fact that pdocs don't know what to do with people who don't respond to antidepressants. Should make for a good discussion. Thanks Maybe we can all learn something
Posted by linkadge on June 2, 2006, at 15:36:25
In reply to Re: What Do You Think Of All the New Types of Bipolar?, posted by bipolarspectrum on June 2, 2006, at 14:57:09
I think its mostly B.S.
I personally think that there are simply a lot of unipolar people who are given bipolar meds simply due to the lack of effectiveness of antidepressants. Psychiatry likes to think they have the answers and treatments for every illness. They diagnose these disorders by "process of elimination". That is wrong.
I think a lot of the currently medications act like stimulants and are making a lot of people bipolar.
Am I going to take medications for bipolar because a treatment gave me symtpoms resembling bipolar?
We're all capable of depression or mania. Those parts of the brain exist in all of us. But we don't all exhibit mania or hypomania on a daily basis. You'd be hard pressed to find me in a manic or hypomanic state. To say that 40% of bipolars are unipolar is nonsense in my opinion.
Linkadge
Posted by Caedmon on June 2, 2006, at 16:00:04
In reply to Re: What Do You Think Of All the New Types of Bipolar?, posted by linkadge on June 2, 2006, at 15:36:25
What are the "new types" of bipolar disorder? You mean like bipolar-III, bipolar spectrum disorder, and all that?
- Chris
Posted by iforgotmypassword on June 2, 2006, at 17:49:15
In reply to Re: What Do You Think Of All the New Types of Bipolar?, posted by linkadge on June 2, 2006, at 15:36:25
"They diagnose these disorders by "process of elimination". That is wrong."
Not really entirely the case. I mean aside from incoherent chatacterological/personality disorder diagnoses they refuse to put their finger on, they avoid all diagnoses for me. No process of elimination for me. I cannot even think, be around people properly, keep a job or keep clean or go outside regularly, and they won't even take the liability of making any sort of diagnosis. I am on no medication, though I can to some extent if I try to prod them, be put on meaningless dosages they only very reluctantly incresae after months and of medications that do nothing. I am basically at the level of functionning of a homeless person, and that isn't the type of person doctors enjoy trying to relate to.
Posted by holymama on June 2, 2006, at 18:00:47
In reply to Re: What Do You Think Of All the New Types of Bipo, posted by Caedmon on June 2, 2006, at 16:00:04
Personally, I feel like the term 'bipolar' is used much more frequently these days because of the broad use of antidepressants. I know that, personally, I have always had a problem with depression, (slight, if any hypomania), but it was the use of an antidepressant that caused me to get manic, start cycling rapidly, get suicidal for the first time...I became much more 'bipolar' in my moods -- much more extreme on either end. Many doctors told me I needed to continue to search for the right combination of mood stabilizers/antipsychotics/anti-depressants...and that I would need to be on these drugs for the rest of my life. It was deemed entirely irrational of me to consider going off meds, even though my moods were so much more extreme and I was hospitalized 4 times in the three years following the antidepressants.
I have since gone off meds (4 months now), and though 4 months is not a very long time, my agitated depressions (mixed states) have ceased, and I am functioning so much better. I am still dealing with some depression for sure, but those antidepressants almost ruined my life, so I am looking for alternative routes.
Now, I don't know how common this story is, but I have heard a couple of mental health professionals say that they have heard this before -- the start of mood altering drugs causing more problems. And if it happened to me, I'm sure there are others. And if I hadn't listened to my gut, and if I hadn't gone away for a month and a half this winter to detox off the drugs, and if I had continued to listen to my doctor, my therapist and my husband...I would still be taking the pills, and I'm guessing I'd be in the hospital again right now.
I know there are many who benefit from meds, and many who need them (hell, I could use a pill that stops my depression! But there isn't such a thing! They all make me manic and crazy!). But I am afraid there are many who get crazy on antidepressants and who then are labeled 'bipolar' for the rest of their lives. And is that enough justification for the bipolar label? I don't know what the answer is, except that I am far better off without the craziness of medication, and I am questioning the bipolar diagnosis altogether. I know I'm not alone.
Posted by Phillipa on June 2, 2006, at 18:39:15
In reply to Re: What Do You Think Of All the New Types of Bipo, posted by Caedmon on June 2, 2006, at 16:00:04
Chris that's what I mean. Love Phillipa
Posted by Caedmon on June 2, 2006, at 19:17:56
In reply to Re: What Do You Think Of All the New Types of Bipo » Caedmon, posted by Phillipa on June 2, 2006, at 18:39:15
Okay, thanks Phillipa. Well as far as the bipolar spectrum/ BP-III-V or however high the number goes, I don't have a problem with it. The spectrum concept makes some sense to me. If you chart people's moods over time, there probably is a spectrum in how they vary, ranging from flatly unipolar with little variation, to more "atypical" depression, bipolar II, to classic "manic-depression".
I guess my main concern would be the notion of applying bipolar I treatment strategies to the more "downwind" disorders. The idea of prophylactic mood stabilizer use, for example. To my knowledge, it's not even that well studied in bipolar II let alone the experimental mixy-topsy-turvy mood disorders.
The other problem would be using the diagnostic classes to justify lots of off-label use of atypical antipsychotics. But enough has surely been said on this matter.
I think right now it's mostly a theoretical discussion. If it helps clinicians find better drugs for their patients, then that's good. Hopefully it is doing just that, I guess that's my point.
- Chris
Posted by deuce224 on June 2, 2006, at 22:54:07
In reply to What Do You Think Of All the New Types of Bipolar?, posted by Phillipa on June 2, 2006, at 13:34:24
I think there must be a spectrum. Antidepressants haven't been working for me, but they haven't made me manic either. I have the classical symptoms of atypical depression, but my last psych thought I might be bipolar 2. I was reading a journal article ,"Atypical depression: a variant of bipolar II or a bridge between unipolar and bipolar II." This would explain the reason why often times when lithium is added to an antidepressant that works best for atypical depression/treatment resistant depression. So the way I see it the spectrum goes like this: Bipolar I, Bipolar II, "Bipolar III", Atypical depression, Unipolar depression.
Does anyone else think that this is the case?
joe
Posted by linkadge on June 3, 2006, at 0:59:21
In reply to Re: What Do You Think Of All the New Types of Bipolar?, posted by deuce224 on June 2, 2006, at 22:54:07
Just because a mood stabilizer works in a depressive disorder, doesn't mean that one has bipolar disorder.
For instance, there is new research showing that certain unipolar disorder may be associated with low levels of inhibitory gabaergic neurotransmission, and perhaps overactive glutamate, and PKC and such. Many mood stabilizers can modulate gaba and glutamate, and may help depression in this manner.
But calling you bipolar gives people the impression that you have manic episodes which may not be true.
The 5-ht1b autoreceptors are supposedly overactive in depression, leading to a decrease in serotonin release. Lithium blocks this inhibitory autoreceptor, leading to increased serotonin release. This effect may be completely independant of its antimanic effect.
From another point of view, many mood disorders may have a common link being a abnormal stress responce. You raise cortisol, and one person may become very suicidal, another may become psychotic. So, some of these agents may be helping mood disorders by a common mechanism on the HPA axis.
Depakote can downregulate corticosteroid receptors, and modulate PKC, which could theoretically be of use in unipolar too.
Linkadge
Posted by Meri-Tuuli on June 3, 2006, at 6:25:58
In reply to Re: What Do You Think Of All the New Types of Bipolar?, posted by linkadge on June 3, 2006, at 0:59:21
> Just because a mood stabilizer works in a depressive disorder, doesn't mean that one has bipolar disorder.
I think this is very very true.
Does it really matter what specific diagnosis you have - its the symptoms that count!!
I simply think that bipolar has become a very fashionable term, and is pretty liberally applied, espically in Northern America.
I honestly think that the number of people with true bipolar, is relatively small, and there is a alot of people in the unipolar spectrum (I'm calling it).
I mean, the thing is, mood disorders are so incredibly complicated, that it doesn't make sense to simply label someone unipolar, or then bipolar. It really isn't as simple as raising sertonin levels or whatever.
Anyway, here in the UK nearly everyone is unipolar -- I get the impression that you're only bipolar if you have had 'proper' manic episodes. Mind you, its pretty archaic here for mental health.
Well, I went completely crazy on prozac, which might get interpreted as SSRI induced mania, but seriously, it wasn't. Just because SSRIs might make you appear manic, doesn't always mean that you're bipolar.
Nothing is black and white (or unipolar or bipolar) when it comes to the brain.
Kind regards
Meri
Posted by Meri-Tuuli on June 3, 2006, at 6:56:31
In reply to Re: What Do You Think Of All the New Types of Bipo, posted by Meri-Tuuli on June 3, 2006, at 6:25:58
I also forgot to add, that I tend to think that people use the term 'mania' pretty liberally too. I think that people tend to describe highly auguished, highly stressed, and distraught episodes as 'mania'. I often wonder if they really are.
Now, I have never had a manic episode, but if you're having one, aren't you just feeling really absoulately great, not sleeping much, not eating much, talking more, full of energy... I wonder if you're going to really pick up on the fact that you're manic at the time of the episode?
Well anyway here's what wiki says:
http://en.wikipedia.org/wiki/Mania
'It can also often be complicated by the sufferer's lack of judgment and insight regarding periods of exacerbation of symptoms. Manic patients are frequently grandiose, irritable, belligerent, and frequently deny anything is wrong with them.'
Well anyway, its just something I've noticed. Obviously I'm not saying that everyone who says that they're manic really aren't, I'm just pointing out the difference between the medical term and the way its used in common language sometimes.
I don't know if this is a useful observation or not.
Kind regards
Meri
Posted by SLS on June 3, 2006, at 8:35:22
In reply to Re: What Do You Think Of All the New Types of Bipo » Phillipa, posted by Caedmon on June 2, 2006, at 19:17:56
It is interesting that Kraepelin originally described manic depression to include both unipolar and bipolar variants. The illness was defined by its recurrent nature rather than its polarity.
- Scott
Posted by Sobriquet Style on June 3, 2006, at 8:48:47
In reply to Re: What Do You Think Of All the New Types of Bipo, posted by SLS on June 3, 2006, at 8:35:22
>The illness was defined by its recurrent nature rather than its polarity.
I agree, cyling is the key, or more so what the treatment is there to relieve - stoping cyling from extream mood states, very down, to extreamly high and those disgusting bits inbetween that combine both.
~
Posted by SLS on June 3, 2006, at 9:05:32
In reply to Re: What Do You Think Of All the New Types of Bipo, posted by Meri-Tuuli on June 3, 2006, at 6:56:31
> I also forgot to add, that I tend to think that people use the term 'mania' pretty liberally too. I think that people tend to describe highly auguished, highly stressed, and distraught episodes as 'mania'. I often wonder if they really are.
I agree with you.
> Now, I have never had a manic episode, but if you're having one, aren't you just feeling really absoulately great, not sleeping much, not eating much, talking more, full of energy...
Mania can be euphoric or dysphoric or of a mixed-state. Euphoria feels great. Dysphoric and mixed-states are uncomfortable and usually present with agitation and irritability. Anhedonia frequently exists. These states are sometimes conceptualized as being a combination of mania and depression. It is often difficult to identify mixed-states because they present so differently interindividually. I think Kraepelin proposed a mixed-state spectrum that included six subtypes.
> I wonder if you're going to really pick up on the fact that you're manic at the time of the episode?
In the past, I have failed to recognize my manic reactions to antidepressants. I refused to acknowledge them, even when they were identified accurately by others. Some people with hypomania recognize and acknowledge it, but it probably depends on the degree of mania and personality temperament.
> I don't know if this is a useful observation or not.
It definitely is.
- Scott
Posted by CEK on June 3, 2006, at 13:07:04
In reply to Re: What Do You Think Of All the New Types of Bipo, posted by SLS on June 3, 2006, at 9:05:32
What is Bipolar 3 and how is it different from Bipolar 2? And what's the difference in atypical depression and unipolar depression?
Posted by llrrrpp on June 3, 2006, at 13:52:56
In reply to Re: What Do You Think Of All the New Types of Bipo, posted by CEK on June 3, 2006, at 13:07:04
Tripolar, quadripolar, polarbear
I think the exercise of trying to diagnose a patient based on what medications he/she has or hasn't responded to is a waste of time.
I'm someone who has MDD, not a hint of the other pole (the mania pole, that is). I have anxiety too, but probably not severe enough to merit seeking treatment.
So my pdoc, who I respect muchos, starts me off on my very first medications about a month ago. Cymbalta, which (according to Larry) was first approved as a treatment for overactive bladder, and seroquel, which is an atypical antipsychotic/mood stabilizer.
And I think I'm responding pretty well. But this doesn't mean that I suffer from psychosis or overactive bladder. It means that the drugs are a very very blunt weapon, and they kind of kick-start the system, in ways that are not well-understood.
Also, the designation of a drug as an AD means that it has survived clinical studies in depressed patients and improves symptoms of depression. A drug (i.e. cymbalta) can simultaneously be a treatment for overactive bladder, fibromyalgia, depression, and anxiety. If it survives another clinical study for treatment of baldness, it might even be considered an anti-baldness drug.
Well, the drugs treat the symptoms. and the disorder ("bipolar"-whatever) is a useful diagnostic tool for predicting which symptoms tend to occur in clusters. But just because the symptoms occur in clusters doesn't necessarily mean that they all share the same neuro-chemical cause, or the same structural abnomality, or the same developmental origins. It doesn't mean that all the symptoms will respond equally well to a treatment. I guess it's back to the same old advice... keep tinkering and maybe you'll find something that works for you. It's an empicial science, and you're the subject. for better, hopefully.
Good luck Phillipa, I hope you find a combination that's right for you, and your body, and your symptoms and your psyche. you deserve to feel the best.
-ll
Posted by heaven help me on June 3, 2006, at 13:58:10
In reply to Re: What Do You Think Of All the New Types of Bipo, posted by llrrrpp on June 3, 2006, at 13:52:56
well said
:)
mary
Posted by bipolarspectrum on June 3, 2006, at 16:39:29
In reply to Re: What Do You Think Of All the New Types of Bipo, posted by heaven help me on June 3, 2006, at 13:58:10
Hi,
Everyone has made some great points regarding this subject and I think this healthy discussion is very useful for many of us... I just wanted to make one more point regarding the new idea of a bipolar spectrum... More pdocs will be more open to using 'bipolar' type drugs for difficult-to-treat mood disorders... I think this type of liberal approach to prescribing benefits patients... its time to think a little outside the box, the box being bipolar I and II... At the end of the day, all this theoretical talk is nothing more than mental masterbation.. the reason we are all (or most of us) here is that we suffer from some form of mental illness.. and a greater array of drugs is just another tool that will help many of us..
bps
Posted by Caedmon on June 3, 2006, at 17:48:24
In reply to In the name of the new classification!, posted by bipolarspectrum on June 3, 2006, at 16:39:29
I think it's might be mostly a semantic quibble. Maybe the term "bipolar" is too grating to use; we could call it "yucky mood spectrum disorder" instead. :-P
- Chris
Posted by Phillipa on June 3, 2006, at 19:33:38
In reply to Re: What Do You Think Of All the New Types of Bipolar?, posted by linkadge on June 3, 2006, at 0:59:21
What about Lamictal? Love Phillipa
Posted by linkadge on June 3, 2006, at 20:01:04
In reply to Re: What Do You Think Of All the New Types of Bipolar? » linkadge, posted by Phillipa on June 3, 2006, at 19:33:38
I've got nothing against doctors using lithium or perhaps other anticonvulstants to try and treat certain mood disorders.
I don't like to see unipolar patients using antipsychotics unless there are no other options.
I guess the big problem with labling unipolar people as bipolar based on poor responce to antidepressants, is that it may worsen future treatment.
Ie, say I don't respond to current antidepressants, but do get mild benifit from a mood stabilizer. Now, in the future an antidepressant with different mechnism comes along (which may have cured me) but because I am incorrectly labled as bipolar, my doctor will be less inclined to try that drug.
For instance, if a patient responded to selegeline, that doesn't mean we should say they have parkinson's disease and not depression, because down the road, when the mechanisms of the illnesses are better understood, the correct diagnosis is what still may help the most.
Linkadge
Posted by Nina78 on June 4, 2006, at 5:58:48
In reply to Re: What Do You Think Of All the New Types of Bipo, posted by CEK on June 3, 2006, at 13:07:04
> What is Bipolar 3 and how is it different from Bipolar 2? And what's the difference in atypical depression and unipolar depression?
============
Here a link with some explanations:
http://www.psycom.net/depression.central.lieber.html
http://www.tourettesyndrome.net/mood_bipolar.htmMost commenly used defenitions:
Bipolar I: Mania and depression
Bipolar II: Hypomania and depression
Bipolar III: Cyclothymic disorder
Bipolar IV: Hypomania or mania precipitated by antidepressant drugs
Bipolar V: Depressed patients with a family history of bipolar illness
Bipolar VI: Mania without depression [unipolar mania]
Posted by bimini on June 5, 2006, at 8:04:25
In reply to Re: What Do You Think Of All the New Types of Bipolar?, posted by bipolarspectrum on June 2, 2006, at 14:57:09
>I make the analogy of the 'arts/science' spectrum in life... pure arts on one side (poets, painters) and pure science on the other (math)... with most people falling somewhere in between..<
As an arts/science person the opposite ends of the spectrum merge. This would make the spectrum not linear but a circle.
I know nothing about pb spectrum.bimini
Posted by ttee on June 5, 2006, at 17:05:49
In reply to What Do You Think Of All the New Types of Bipolar?, posted by Phillipa on June 2, 2006, at 13:34:24
I think the new bipolar diagnoses are great. My disability insurance does not pay longer than 24-months for any mental illness, disorder, etc., excluding Bipolar Disorder, or Schizophrenia.
I think it is totally wrong that disability policies limit benefits for most mental illness, but I am glad there is a loop hole for bipolar. I don't care if I really am bipolar or not, I know I am very ill and have symptoms of some sort of mood disorder and disabled because of it. Getting my monthly disability check from the insurance company is helping to keep me alive and hopefully I will find a treatment that works someday.
So for me, the recent hoopla about bipolar is a blessing for those with treatment resistant mood disorders, so at least some can collect some benefits, just like anyone else on disability for other "non-mental" diseases.
This is the end of the thread.
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