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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by HEART~ on July 4, 2006, at 16:44:24
Hi.
Happy Fourth of July All. Can anyone and everyone clarify to me and provide personal examples of these:a mixed state
a hypomanic state
a manic state
a dysphoric stateAnd lastly if people can explain with examples difference between BP I and BP II. How did your Dr. make the diagnosis?
I am seeking personal examples because everything I have read just states what each one is and doesn't really allow me to understand each one or relate to it.
Everyone take care.
Posted by Phillipa on July 4, 2006, at 21:55:58
In reply to Differences of BP, mixed, hypo, manic, dysphoric, posted by HEART~ on July 4, 2006, at 16:44:24
Don't know myself but I think l is depression with out mania. Love Phillipa
Posted by Racer on July 5, 2006, at 1:38:17
In reply to Differences of BP, mixed, hypo, manic, dysphoric, posted by HEART~ on July 4, 2006, at 16:44:24
I'm unipolar with anxiety, which a lot of pdocs these days want to dx as BPII. The bipolars are split over mania: BPI includes full blown mania; BPII is hypomania, which can present as anxiety or irritability. (Frankly, though, I think LIFE can present as irritability, but maybe I'm just snarky tonight...)
I've seen both mania and hypomania, though I haven't actually experienced either. As far as I can tell, at least.
The one time I saw someone in a full blown manic episode, it was during a support group meeting for people with depression and bipolar. He was depressed when he came into the meeting, but he switched during the group. The first thing we noticed was that he was starting to sit up and fidget -- and then he started talking. And he was talking way too fast, making silly jokes that only he laughed at, talking about things that were totally inappropriate, and kinda bouncing where he sat. He was asked to leave the meeting about that point. Later, at another meeting, he talked about another manic episode he'd had, during which he got into a lot of financial trouble. Including putting a Jeep onto his American Express card! (Good reason for BPs to stick with Visa, I guess.)
Hypomania, though, was common with a good friend of mine. I could always tell when he was getting hypomanic, because he'd suddenly get very, very productive. And he'd talk a lot, about a lot of things, and I wouldn't be able to get much into the conversation. The biggest difference is that his conversation was reasonable -- he was just talkative. He's a very interesting guy, and I could listen to a lot of it most of the time, but there was a definite quality of his NEEDING to talk. (Admittedly, that's partly a sort of social anxiety that we all saw in him, and partly these days that he spends way too much time working in his home office. When we talk, he's been silent for a couple of hours, and that's hard for him. lol)
I don't know that any of that's helpful, huh? But it's the best I's got...
Oh, and dysphoria. Dysphoria is low mood, and there's something called double depression, which is major depression on top of dysphoria. Think low level depression that really doesn't much improve, and that's a quick and dirty explanation of dysphoria. An argument can be made that I have double depression, since I am still depressed most days despite Wellbutrin. I disagree, because I remember feeling very different from this. {sigh}
Hope that's helpful. And happy Independence Day.
Posted by Ripley Snell on July 5, 2006, at 7:44:42
In reply to Differences of BP, mixed, hypo, manic, dysphoric, posted by HEART~ on July 4, 2006, at 16:44:24
The first thing to keep in mind is something Kay Jamison talks about briefly in her book An Unquiet Mind--it's looking more and more that "unipolar" depression is a myth; but then again, so is "bipolar"--the problem is that there don't seem to be these "poles." Mania was seen as the *opposite* of depression.
No one, duh, noticed that a lot of the symptoms of "unipolar" depression were at either ends of a scale: eating too much/eating nothing; sleeping too much/not sleeping; anxious and restless/psychomotor retardation. So then they came up with all this stuff about "atypical" and "melancholic" depression--which, it turns out, is mostly beside the point.
They already had BP I. That's not hard to miss. It means you've had at least one episode of full-blown mania. Some of the criteria for mania include: no desire or need for sleep; intense libido and promiscuity; spending money (or engaging in any other normally pleasurable activity) without regard to the negative consequences that may follow; impulsivity; irritability; pressured, rapid speech; thinking that's so fast and disconnected it's hard to follow. If spit is flying out of someone's mouth--hmm. Maybe mania.
Then light dawned on the Marbleheads, and people realized, wait! It's not "agitated depression"--it's a form of bipolar where the mania isn't quite as pronounced. That less-pronouced mania is "hypomania"; in Greek, "under-mania." It's sort of mania-lite. You stay up all night for one night, not three. You get ravenous for sex but you don't cheat; you have spending sprees but you sort of have insight into what you're doing, so you can return some of the stuff later; you're intensely irritable, not raging. Hypomania can also be intensely pleasurable. You can feel, sometimes, as if you were a superhero. The problem is IT NEVER LASTS.
A "mixed state" is a horrible thing. Lol. It's basically hypomania laid over a background of depression. So you've got all the agitation and energy of the hypomania, but the depression makes it nasty, irritable agitation, and angry (sometimes furious) energy. Pdocs are looking at people who have uncontrollable rage attacks as possibly BPII now--the rage attacks are mixed states, wherein there's all this energy and "get it done" feeling, but what you're getting done is insulting your boss, or screaming at a student, or being completely unable to let go of a slight--even to the point of planning revenge.
Bipolars get fired a LOT. We are not good at keeping our heads down and noses to the grindstone.
You asked about dysphoric states, but not euphoric ones. That's simple--dysphoric is "bad mood/affect" while euphoric is "excellent mood/affect." So ANOTHER term for "mixed state," especially if your life is one big mixed state, like mine, is "bipolar dysphoric mania." Again--you're angry and unhappy, but aggressively, energetically so.
The Bipolar I - Bioplar II distinction is still young. Some doctors say that Bipolar II is more crippling because it goes undiagnosed (it's usually diagnosed as depression) for an average of seven years, and the longer you have any form of bipolar disorder without treating it, the worse it gets--so Bipolar II is quite insidious. I went from Serzone to Prozac to Paxil to Effexor to Wellbutrin to Remeron to . . . (the list goes on) . . . getting maybe as much as ten weeks of relief. What I needed was a MOOD STABILIZER.
So diagnosis is often made by giving the patient a mood stabilizer and seeing if he/she improves. If, with a mood stabilizer (Lamictal, lithium, Depakote, Trileptal, Tegretol) the rage chills out, and the spending sprees stop distracting, and at the same time, depression lifts, then it's a case of bipolar disorder. If the patient just gets dulled-out and spacy, then the disorder is supposedly closer to "unipolar." It *is* very interesting how mood stabilizers are being used more and more to "augment" antidepressants.
I wonder if I hit all of the definitions. Mania and depression are both awful, but in different ways. We know about depression; mania is in a way more insidious because while it's happening, it's a lot of fun. It's only after the episode ends, and you look around you and find you've lost your job, you've spent your savings; you've cheated on your spouse--that you realize the good time wasn't worth it--it was a mean trick played on you by your emotional illness.
Hope this helps.
Oh, forgot--how my doctor made the Dx. As I said, it took a while! We saw three things: 1. I was just as depressed as ever. 2. Antidepressants would work for a short time, except for a couple, and those couple (Wellbutrin and Provigil, in my case) made me *extremely combative.* I remember berating some poor pharmacist so much she burst into tears. Gee, I'm proud of that. 3. Even when not taking the poisonous Wellbutrin or Provigil, I was given to frequent rage attacks, where it was a fight-for-your-life situation--or seemed so. The person/people I became enraged with stopped seeming like people, and kind of became monsters, monsters that would kill me if I didn't kill them first. (Bipolar and paranoia *really* are a recipe for violence.) But I kept my violence verbal. Still, after I had lost my fourth job in five years, it was time to consider that something else was going on besides depression.
The original poster wanted definitions of:
> a mixed state
> a hypomanic state
> a manic state
> a dysphoric state> And lastly if people can explain with examples difference between BP I and BP II. How did your Dr. make the diagnosis?
Posted by Tomatheus on July 5, 2006, at 16:44:38
In reply to The Bipolar II Oracle Speaks » HEART~, posted by Ripley Snell on July 5, 2006, at 7:44:42
Ripley Snell,
See below for my responses...
Tomatheus
> No one, duh, noticed that a lot of the symptoms of "unipolar" depression were at either ends of a scale: eating too much/eating nothing; sleeping too much/not sleeping; anxious and restless/psychomotor retardation. So then they came up with all this stuff about "atypical" and "melancholic" depression--which, it turns out, is mostly beside the point.
No, this is not mostly beside the point. Research studies done during the 1970s and 1980s consistently found that "melancholic" depressives tended to respond best to the tricyclics, and "atypical" depressives tended to respond best to the MAOIs of the time, the "old" Nardil and the "old" Parnate -- both of which no longer exist.
> Then light dawned on the Marbleheads, and people realized, wait! It's not "agitated depression"--it's a form of bipolar where the mania isn't quite as pronounced.Do you really think that these "marbleheads" just so happened to "realize" that all of these "softer" forms of bipolarity exist shortly after the introduction of the SSRIs? Don't you think that maybe -- just maybe -- these agitated and/or atypical depressives might not have exhibited any clear signs of hypomania until relatively recently because the TCAs (with their antimuscarinic/antihistamine properties) and the MAOIs (the most efficacious meds for atypical/anxious depressives) never induced hypomania in these individuals as at least some of the SSRIs/SSNRIs do now?
I think that it would be more accurate to say that the light dawned on the big pharmaceutical companies that they can profit a hell of a lot more from these "agitated" or "atypical" depressives if they could convince these individuals that they're actually bipolar and really need two, three, or more medications (preferably newer ones with patents that had yet to expire) instead of just one older unprofitable MAOI. Have you ever noticed that most (if not all) of the published studies advocating the over-diagnosis of bipolar II are funded by not just one, but several pharmaceutical companies? And doesn't it seem just a little conveeeeenient that the two medications that were always shown to be highly effective in the treatment of atypical and anxious depression (as monotherapy, no less) no longer work as well as they used to (and cause more side effects than they used to) in many patients now that they're no longer profitable?
Now that the term "antidepressant" is almost always used to refer to an SSRI, SSNRI, or perhaps Wellbutrin, it is no surprise that all of these so-called "soft" bipolars are responding more favorably to mood stabilizers than they are to "antidepressants." However, I think that all of us can agree that atypical/anxious depressives are no more "bipolar" than they were 20 years ago. In other words, the patients themselves haven't changed. It's the treatments that have changed. And for a majority of atypical, anxious, and/or "non-endogenous/neurotic" depressives (which is essentially what dysthymics used to be called), I think that the treatments have changed for the worse.
But then again, what do I know? I'm not a psychiatrist or a researcher, just a stupid patient.
Posted by capricorn on July 6, 2006, at 18:26:20
In reply to Re: Differences of BP, mixed, hypo, manic, dyspho » HEART~, posted by Racer on July 5, 2006, at 1:38:17
Taken from http://bipolar.about.com/cs/faqs/f/faq_dysphoria.htm
Dysphoric mania, as presented in the Merck Manual, is "prominent depressive symptoms superimposed on manic psychosis." Symptoms include:* crying
* curtailed sleep
* racing thoughts
* grandiosity
* psychomotor restlessness
* suicidal ideation
* persecutory delusions
* auditory hallucinations
* indecisiveness
* confusionIn everyday English, the complex terms above include - trouble sleeping, racing thoughts, grandiosity, mental and/or physical agitation, thoughts of suicide, feeling persecuted for no reason, hearing things, and having trouble making decisions (along with others).
Dysphoric depression, more commonly referred to as a mixed episode, consists of "intrusions of hypomanic symptoms or hyperthymic traits into a retarded major depressive episode" (Merck). Basically, this means that characteristics of hypomania or overactivity occur during a depression that in general has the patient sluggish or listless. Symptoms include:* irritability
* pressured speech against a background of retardation
* extreme fatigue
* guilty ruminations
* free-floating anxiety
* panic attacks
* intractable insomnia
* increased libido
* histrionic appearance with expressions of depressive sufferingOnce again putting this into more common terms, these symptoms include: being easily angered, pressured speech in spite of slowed thinking, being overtired, dwelling on guilt feelings, being anxious in general (for no specific reason), serious difficulty in sleeping, extra sex drive, and being melodramatic about feeling depressed.
This is the end of the thread.
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