Psycho-Babble Medication Thread 7892

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Atypical Depression or BiPolar II?

Posted by Erin on June 26, 1999, at 17:02:08

As I have been off Paxil for three weeks now (in preparation for starting an MAOI) I am becoming suspicious that I might have BiPolar II instead of atypical depression (I've read that the two may be related, any comment on that?).

Since I have been off Paxil I have:
-felt more pressure to speak when I didn't want to
-had more problems with insomnia
-not felt well-rested even when I got eight + hours of sleep
-felt more creative
-been more social
-felt more anxious about problems beyond my control (which results in excessive worrying)
-had problems with my short-term memory (although I think this is primarily related to not getting enough sleep)

From what I've read, these are some of the symptoms of hypomania associated with BiPolar II.

So, here's where I get a little confused- don't anti-depressants frequently increase mania in people with bipolar disorder? In other words, why would stopping Paxil increase what might be viewed as hypomanic symptoms?

I have not been able to find a great deal of treatment info on BiPolar II (plenty on BiPolar I though). What is usually used to treat BiPolar II?

Thanks for any input-


Re: Atypical Depression or BiPolar II?

Posted by JohnL on June 26, 1999, at 19:10:07

In reply to Atypical Depression or BiPolar II?, posted by Erin on June 26, 1999, at 17:02:08

Erin, I've experienced the same. Hypomanic reactions usually occur, if they are going to occur, while getting on an AD or getting off, not so much while stabilized on one. I've had three psychiatrists, and they all had different opinions. One had a shrug of the shoulder. One said it was definitely Bipolar II. The last said I was feeling better because there were no more side effects. Imagine that, three professionals with probably 80 years combined experience/education and such varying views. Just goes to show it isn't always as clear cut as we would like. One doc told me he would be glad to somehow get me into a hypomanic stage and keep me there. The manic advantage it's called. Hypomania's not so bad. Like you said, the creativity, socialness. It's the inevitable fall that kills you! Your symptoms could easily pass as Bipolar, at least with one of my psychiatrists!

Bipolar I, Bipolar II, both treated with mood stabilizers. Lithium probably the most time-tested one. Also Depakote. Others as well. More responders to your post can probably comment more. There are a couple newer ones, of which Lamictal is both mood stabilizing and reported antidepressant.

I can relate to your post. Been there. I would actually like a little hypomania right about now. Just been in the gutter too long. Anyway, others at this site are much more knowledgable on your questions than I am. Just wanted to share what I could with you, and hope it is somehow helpful. Hang in there, stay in touch. JohnL.


Re: Atypical Depression or BiPolar II?

Posted by Erin on June 26, 1999, at 22:30:42

In reply to Re: Atypical Depression or BiPolar II?, posted by JohnL on June 26, 1999, at 19:10:07

Hi John,

Thanks for your reply-

Maybe it's too early in my self-diagnostic stages for me to say, but I feel like my hypomanic episodes may be (and I hate to say this) as disabling as my depressive stages because of the irritability, oversensitivity, anxiety, and insomnia.

Argh! I just can't sort everything out right now and it's driving me bonkers. I am scheduled to see a specialist at the top diagnosis/treatment center in the state but that appointment is a few weeks off. The great thing about all of this is that I have IBS (irritable bowel syndrome) which is triggered by anxiety. So, on top of not sleeping well I also can't eat anything until I get my stomach to calm down (which of course won't happen until I can get my anxiety under control which won't happen until I get in to see the specialist and get some sort of a diagnosis and definite treatment plan). Sorry to unload all of this on you- my reserves are completely exhausted and I guess I just need to vent. Thank you for reading/listening.

And, lastly, I do have a couple of questions-

Seeing as how I don't get up into the high manic phases of bipolar (if that is even what I am dealing with- I don't even know right now), would lithium/depakote/lamictal serve to take the irritability/hypersensitivity/anxiety/insomnia out of hypomanic phases. I thought that those three meds generally "turned down the volume" on manic phases (i.e. were used to prevent someone from doing something that could have serious repercussions like overspending during a manic episode).

Also, and it sounds like you've had the same experience I've had with this, I'd still like to know why hypomania is toned down while taking an antidepressant.

I'm not directing this question (or the previous one) specifically at you so please don't feel obligated to answer.

Thanks again for for your time and replies-



Re: Atypical Depression or BiPolar II?

Posted by JohnL on June 27, 1999, at 4:49:09

In reply to Re: Atypical Depression or BiPolar II?, posted by Erin on June 26, 1999, at 22:30:42

Erin, first an apology to all for my bad choice of words, "'s the inevitable fall that kills you." That's terrible. Sorry for poor choice of words. Didn't realize it until I reread it. Was actually trying to be a bit humorous, but it doesn't come across that way at all.

OK, in a book on Dysthymia, Hagog Akiskal (a respected guru) writes, "A more specific meaning of atypicality refers to reverse vegetative signs (i.e., evening worsening, initial insomnia, tendency to hypersomnolence, fatigue...". Also, "...bipolar, especialy bipolar II, depression often presents with atypical sympomatology...such atypical presentations...have been shown to precede bipolar illness." He also goes on to say that atypical is often just a term used to describe symptoms that deviate from a more classical straight forward depression. Also, atypical and bipolar etc do not refer to distinct affective disorders but represent alternative phases in an ongoing disorder. Another paragraph describes atypical as mood worse in evening, insomnia, tendency to oversleep and overeat, irritability, daytime fatigue. He specifically says there is some evidence of MAOIs being appropriate for atypical. However, if it is a bipolar phase (sounds that way to me) (hypomania mixed with irritation = mixed state), he says ADs can often confuse the situation and make it worse. In those cases, mood stabilizers are warranted.

The more I learn though, the more confusing it all seems. There are so many gray areas, not well-defined black and white. In other countries they typically treat patients with mood stabilizers where we treat the same symptoms in USA with ADs.

I've noticed Ad's tend to stabilize mood in me, like you. Don't know why. They haven't helped depression much in me, but do stabilize.But the mood stabilizer drugs are probably more appropriate. They can relieve the depressive spectrum in addition to toning down any mixed mania. Right now though it seems a couple real good nights sleep would be very helpful to you.

Can anyone suggest a good short term sleep med while waiting for a doc appointment weeks away? Take care Erin, stay in touch. JohnL.

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