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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by bonnie on June 2, 2002, at 0:59:19
hi. after two years of being diagnosed as depression (medicated with zoloft), ive been rediagnosed as bipolar II (to take lamictal and some neurontin now as im experiencing a lot of anxiety about...stuff). in speaking with other people about this, ive found that a fair number of folks seem to have been rediagnosed in this way recently. what do you all think: is this for real? is this some sort of doctor-inspired trend? im just wary that docs are finding well, not everyone's responding to depressive meds so let's try this next diagnosis. thanks.
Posted by optimistic on June 2, 2002, at 6:00:07
In reply to rediagnosis: bipolar II, posted by bonnie on June 2, 2002, at 0:59:19
same thing happened to me..After not responding well to AD's one doc then suggested BP II..then after not responding well to the next set of drugs I was back to major depression..I don't think most of them know what they are dealing with and just make it a crap shoot with the diagnosis and the meds they try. If I ran my business with the random success that most psych docs get I would be out of business in no time.
Hope it works out for you.
NOT SO OPTIMISTIC
Posted by katekite on June 2, 2002, at 10:20:14
In reply to rediagnosis: bipolar II, posted by bonnie on June 2, 2002, at 0:59:19
Were you hypomanic? what happened and for how long?
kate
Posted by lizbeth on June 2, 2002, at 12:58:08
In reply to rediagnosis: bipolar II, posted by bonnie on June 2, 2002, at 1:00:23
Hi Bonnie,
I'm in the same boat, except I was only diagnosed BPII after 8 years of being on various antidepressants. Before I go any further, a good website to check out is Psycheducation.org. I don't agree with everything the doc says (like necessarily stopping AD's altogether for BPII), but he's got some good info. Click on the right section of info for primary care physicians.
The problem for me was that the antidepressants stopped working after a while, or made me more agitated. A big flag for p-docs is when a person has weird reactions to antidepressants. For me, I always got an instantaneous boost from any AD I tried--the worst was Wellbutrin, which darn near made me manic.
I'm surprised your p-doc didn't try you on depakote or lithium first line. They're really the gold standard and like a lot of other medical conditions that are treated empirically (by the reaction of the patient), a diagnosis of BPII can usually be made if someone responds great to one of the two. I, for one, felt much calmer the morning after I took my first 500 mg. dose of Depakote. I've been tweaking the combo of mood stabilizer and AD since last Spring 2001, and I'm now on 600 mg. of Lithium (don't be scared of this one--I just started a couple of weeks ago and it seems to have finally lifted any residual depression), 250 mg. of Depakote Sprinkle, and 20 mg. of Prozac. I may try to wean myself off the AD, or at least down to 10 mg--we'll see.
I think that at least 30% of people being treated by Primary Care docs with AD's have underlying BP, whether it be I, II, or III. The reason we may be seeing more diagnosing of it is because the AD's are being used a LOT more than used to, because SSRI's are less of a OD risk than old-school TCA's. And, the longer people are on AD's without a moodstabilizer, the worse the BP gets.
Hope that helps and good luck--work with your PDoc and don't hesitate to find another if he/she doesn't work with you. People on this board can help you find a good one. I'm in Chicago area and can get you the name of mine (excellent). Or, email Dr. Bob and he'll help you.
Take care,
Elizabeth
Posted by noelle on June 2, 2002, at 15:22:41
In reply to Re: rediagnosis: bipolar II, posted by katekite on June 2, 2002, at 10:20:14
I agree that pyschiatry is more of a guessing game then an exact science. The last time I went to my pdoc after another cycle ( stimulant med, great for 6 months, depression ( ad med) poop-out) then in the office crying. He basically put his hands up and said "I don't understand you" gave me some provigil samples and told me to get a secound opinion) I have two cousins with bi-polor disorder, but I don't get manic. I think there is a disorder out there to describe those of us that cycle that way but don't get manic. Also be careful of those bi-polor meds they can make you gain weight
Posted by AllieD on June 2, 2002, at 16:37:58
In reply to Re: rediagnosis: bipolar II, posted by lizbeth on June 2, 2002, at 12:58:08
Elizabeth,
I'm aware of the differences between bipolar I and II, but hadn't heard of III -- can you tell me what this is?
I'm interested, of course, because I'm one of those for whom antidepressants never worked, but they didn't necessarily make me manic, either. Who knows -- my doctors tend to tell me that the actual diagnosis doesn't matter much, but of course I'm always looking for something that I "fit".
Allie
> I think that at least 30% of people being treated by Primary Care docs with AD's have underlying BP, whether it be I, II, or III. The reason we may be seeing more diagnosing of it is because the AD's are being used a LOT more than used to, because SSRI's are less of a OD risk than old-school TCA's. And, the longer people are on AD's without a moodstabilizer, the worse the BP gets.
>
Posted by lizbeth on June 2, 2002, at 19:19:09
In reply to Re: rediagnosis: bipolar II » lizbeth, posted by AllieD on June 2, 2002, at 16:37:58
Hi Allie--
I believe BiPolarIII is when people have cycling moods of depression and hypomania (same as BPII--I've never had a true, manic state which can elevate into a psychotic episode). The main difference is that the III's only get the hypomania when they are use an AntiDepressant--so it's pharmaceutically triggered.
Hope that helps,
Elizabeth
Posted by JohnX2 on June 2, 2002, at 19:44:32
In reply to rediagnosis: bipolar II, posted by bonnie on June 2, 2002, at 1:00:23
> hi. after two years of being diagnosed as depression (medicated with zoloft), ive been rediagnosed as bipolar II (to take lamictal and some neurontin now as im experiencing a lot of anxiety about...stuff). in speaking with other people about this, ive found that a fair number of folks seem to have been rediagnosed in this way recently. what do you all think: is this for real? is this some sort of doctor-inspired trend? im just wary that docs are finding well, not everyone's responding to depressive meds so let's try this next diagnosis. thanks.
I think this has partially occured.
I think part of what has happened has to do with the
introduction of the new medicines:- Lamictal (a mood stabilizer with antidepressant properties and no sexual side effects).
- atypical APs Zyprexa,Geodon,etc. (Quick acting medicines that can treat anxiety,depression,bipolar,psychosis).
- Neurontin (a tolerable non addictive anti-anxiety medicine, previously classified mainly as bipolar).These medicines all can be used very effectively strictly to treat
unipolar depression. They have in many cases advantages over the
older SSRIs, etc in terms of patient complience, etc. This may lead
to greater efficacy and the illusion of less instability.Also these medicines are anticonvulsants (clasically viewed as bipolar
meds) and APs (classically viewed for schizophrenia and now bipolar psychosis),
so there may be a disassociation from an indication for depression usage.Just my take.
John
Posted by Chris A. on June 2, 2002, at 21:13:36
In reply to rediagnosis: bipolar II, posted by bonnie on June 2, 2002, at 1:00:23
In a consult ten years ago the expert PDoc referred to an "unstable mood disorder." That's honestly the most accurate diagnosis I have ever had. We are all so different and the classifications don't say everything. The bottom line is that most anyone with a mood disorder that is unstable can benefit from a mood stabilizer. ADs are more disruptive of homeostatic mechanisms - all of those feedback loops that keep our whole system in balance. That's why, in simple terms, some of us end up a whole lot more depressed as a result of having taken an AD. Prozac started out feeling good for several months, then I became irritably hypomanic, and then crashed into a depression that has taken years to resolve. My formal dx is mixed state bipolar, which technically fits under Bipolar I. My hubby will vouch that I don't fit the definition of having had a true manic episode and that BP II is a better description. Sometimes it's a matter of technicalities. I think we need to look at the larger picture. In my prejudice, I consider mood stabilzers much safer than ADs. Hope you're able to sort this out.
Chris A.
Posted by JohnX2 on June 2, 2002, at 22:50:15
In reply to Re: rediagnosis: bipolar II » bonnie, posted by Chris A. on June 2, 2002, at 21:13:36
> In a consult ten years ago the expert PDoc referred to an "unstable mood disorder." That's honestly the most accurate diagnosis I have ever had. We are all so different and the classifications don't say everything. The bottom line is that most anyone with a mood disorder that is unstable can benefit from a mood stabilizer. ADs are more disruptive of homeostatic mechanisms - all of those feedback loops that keep our whole system in balance. That's why, in simple terms, some of us end up a whole lot more depressed as a result of having taken an AD. Prozac started out feeling good for several months, then I became irritably hypomanic, and then crashed into a depression that has taken years to resolve. My formal dx is mixed state bipolar, which technically fits under Bipolar I. My hubby will vouch that I don't fit the definition of having had a true manic episode and that BP II is a better description. Sometimes it's a matter of technicalities. I think we need to look at the larger picture. In my prejudice, I consider mood stabilzers much safer than ADs. Hope you're able to sort this out.
>
> Chris A.Chris A,
Nice write up.
My experience with mood stabilizers has been filled with
so much more joy than with ADs. They don't make me
feel like "someone else" like the ADs sometimes seem
to be forcing on me.John
Posted by oona on June 3, 2002, at 0:03:51
In reply to Re: rediagnosis: bipolar II » bonnie, posted by JohnX2 on June 2, 2002, at 19:44:32
Bonnie:
I agree with John but also wanted to add that the insurance and major medical providers may also add to the pot here.In order to get approval for more visits to your pdoc and if you were referred by your GP to monitor your medication, then you have to be on some sort of regime that requires close follow up i.e. bipolar II and the new meds. I may be wrong but it makes sense. Some insurance companies only "OK" two visits at a time and then the pdoc has to ask for more to follow up medication changes and as you can see from this board, every one has different reactions to different meds.
This is just me. I do not trust the docs much.
I guess the one positive is just to find the meds that works for you then proceed with therapy if needed.
oona
PS: I have also been previously diagnosed with depression (zoloft)
> > hi. after two years of being diagnosed as depression (medicated with zoloft), ive been rediagnosed as bipolar II (to take lamictal and some neurontin now as im experiencing a lot of anxiety about...stuff). in speaking with other people about this, ive found that a fair number of folks seem to have been rediagnosed in this way recently. what do you all think: is this for real? is this some sort of doctor-inspired trend? im just wary that docs are finding well, not everyone's responding to depressive meds so let's try this next diagnosis. thanks.
>
> I think this has partially occured.
>
> I think part of what has happened has to do with the
> introduction of the new medicines:
>
> - Lamictal (a mood stabilizer with antidepressant properties and no sexual side effects).
> - atypical APs Zyprexa,Geodon,etc. (Quick acting medicines that can treat anxiety,depression,bipolar,psychosis).
> - Neurontin (a tolerable non addictive anti-anxiety medicine, previously classified mainly as bipolar).
>
> These medicines all can be used very effectively strictly to treat
> unipolar depression. They have in many cases advantages over the
> older SSRIs, etc in terms of patient complience, etc. This may lead
> to greater efficacy and the illusion of less instability.
>
> Also these medicines are anticonvulsants (clasically viewed as bipolar
> meds) and APs (classically viewed for schizophrenia and now bipolar psychosis),
> so there may be a disassociation from an indication for depression usage.
>
> Just my take.
>
> John
Posted by bonnie on June 3, 2002, at 1:13:08
In reply to Re: rediagnosis: bipolar II, posted by katekite on June 2, 2002, at 10:20:14
> Were you hypomanic? what happened and for how long?
>
> katewell, apparently i was hypomanic for a while--at least according to pdoc & second opinion pdoc. after six months of being on zoloft for the second time i started to experience the euphoria i got from benig on zoloft right at the beginning. i felt on top of the world, was spending too much money, was traveling whenever the whim hit me, was feeling very grandiose about myself etc. but my question was always: what if im just going through a phase? what if i just happen to feel like letting off some steam right now? what if i just feel like im cool right now? why does that mean im bipolar II? but their point was that i had a pattern of cycling depression/hypomania. and that was very true--months and months of being down, followed by happiness and striving and glory, only to be followed by more depression. but doesnt everyone. isnt that just being human...it just makes me wonder: when i say "i feel down" what does that really mean to someone? isnt everyone's "i feel down" so different that it's impossible to gauge how depressed someone really is? i wish they just had a little test for these psychological diagnoses, a pap smear we could all take to figure out what's wrong...
Posted by automatedlady on June 3, 2002, at 18:53:56
In reply to Re: rediagnosis: bipolar II, posted by bonnie on June 3, 2002, at 1:13:08
I've only ever taken ADs (i don't think UK doctors are quite up to bipolar yet), and they have never worked for me.
I tend to feel better quite quickly and have a few weeks of feeling like my old self (sociable, optomistic, able to enjoy life) and then I just crash and although I'm not miserable particularly, I just don't have any energy or interest in anything. I stop bothering with things and after a while my life gets so empty and narrow I start thinking I might as well kill myself. At that point I realise I should just stop taking the drugs and see what happens.
I stop the drugs and within a few weeks the anxiety kicks in. At first it seems preferable to the lethargy of being on the drugs but after a while it gets unbearable (or I move from that into a stage of obsession with some depressing thought and get paralysed by it) and then I start thinking "hmm, maybe I am better off on the drugs after all.."
I'm at the "thinking of going back on them" stage now. So, to get back to my original question, what is the difference (in effect) between a mood stabiliser and an AD? I mean, personally, what does it feel like?
tHANKS
Posted by Cece on June 5, 2002, at 0:39:10
In reply to So what does a mood stabiliser feel like?, posted by automatedlady on June 3, 2002, at 18:53:56
Well, if a mood stabilizer is working right, it doesn't feel like much of anything except the absense of extreme moods. There can be side effects, but if they don't even out, the dosage can be dropped or another one tried (or a mix).
BP ups and downs are different than normal ups and downs. In fact, normal ups and downs feel great after tortuous extreme and unstable moods that come out of nowhere. I was never manic, but hypomanic with much more depression. I thought that the hypo was the real me, cuz I was productive and outgoing. But it was never euphoric, and thus not seductive, and eventually the extra energy would turn on me and I'd get more and more irritable and agitated as I sunk back toward depression.
Zoloft by itself felt good for awhile but put me over the edge into real mixed state crisis within less than a year. I had a hard time accepting the BPII diagnosis since I had never been manic, and I didn't understand it. But I was desperate and began treatment.
In the time that I have been in treatment, 10+ yrs, new meds have come out. I have tried many, many meds, often becoming discouraged, but always determined to feel better- so I just kept on plugging away. I've been an assertive patient, fully participating in choices and ideas, and luckily have not had doctors who are paternalistic or dismissive (I've chosen my 2 very carefully). When the first one seemed to become less effective for me after 8 yrs (doctor-patient burnout), I got a new one (not easy to leave someone you've been with so long).
I take a mix of meds. Some of them are 'historic'- left over from earlier times before the newer meds. Some old meds have just been swapped out for new ones, but others have been kept because it wasn't clear whether I still needed them or not. Now I'm slowly taking out older ones to hone my mix down to the essentials.
Lamictal is my main mood stabilizer and works well for me- it is activating with some AD properties. Neurontin, which is calming is a good adjunct. I still take a tiny bit of Depakote- my first MS, which has its own special tweak. And I take a small dose of Trimipramine, an atypical TCA which helps the quality of my sleep. There is an interesting thread on board right now re Trim if you want to check it out. I don't want to mention my other meds right now because it is too confusing and these are the most important ones.
To all who are suspicious or afraid of meds I say "good"- keep a healthy skepticism! But it's not healthy to cheat yourself out of the chance to feel better. Be brave! And choose a pdoc who is up to date, smart, and who you trust.
Best wishes,
Cece
Posted by 3 Beer Effect on June 5, 2002, at 10:59:41
In reply to So what does a mood stabiliser feel like?, posted by automatedlady on June 3, 2002, at 18:53:56
Posted by Krazy Kat on June 5, 2002, at 11:01:34
In reply to So what does a mood stabiliser feel like?, posted by automatedlady on June 3, 2002, at 18:53:56
That's a tough question. Basically, it doesn't feel like much (as Cece said), though I have seen some people say that a calming effect comes over them after about 2 weeks on a stabilizer (if they're bipolar). I don't know how it affects one if one's not Bipolar...
I am bipolar, and Depakote at first makes me really sedated (esp. if I'm in a mixed state - which is why I've started it in the past). Then, after about 2 weeks, I notice, "heh, I haven't had an extreme high or low in the last two weeks!"
Then, I notice that my thought patterns aren't as scattered (though they are by no means "focused"). I am more grounded in reality (which means I'm still pretty "out-there";)) and I can handle everyday problems a little more easily.
Now, I also get "fuzzy-headed" from Depakote, which I'm trying to offset with Ritalin.
I can not take SSRI's- they make me manic.
If you're considered Bipolar, I would think trying a stabilizer first is a necessity (we've had that discussion here). If you start to get depressed, let your pdoc know. But I would think, because they act so quickly, that within 2 weeks you'd have an idea of what's going on.
- kk
Posted by Krazy Kat on June 5, 2002, at 11:21:54
In reply to What does a mood stabiliser feel like? A Zombie! (nm), posted by 3 Beer Effect on June 5, 2002, at 10:59:41
3Beer:
I'm sorry, I can't recall your 'diagnosis'. Do you think you felt like a zombie because you're not really bipolar, so it "overcomensated" so to speak?
I'm just curious - still trying to understand how they work, why they work, and everything in the universe...
- kk
Posted by Denise528 on June 5, 2002, at 13:39:02
In reply to Re: So what does a mood stabiliser feel like? » automatedlady, posted by Cece on June 5, 2002, at 0:39:10
Are there any experiences of this. I consider myself to be dysthimic and I found Lithium just made me feel sick and sluggish. Are there other unipolars/dysthimics out there who have tried a mood stabiliser. If so what were your experiences?
Denise
Posted by Krazy Kat on June 5, 2002, at 18:42:18
In reply to How does mood stabiliser feel if you're Unipolar? , posted by Denise528 on June 5, 2002, at 13:39:02
Posted by Schuyler on June 6, 2002, at 12:03:19
In reply to How does mood stabiliser feel if you're Unipolar? , posted by Denise528 on June 5, 2002, at 13:39:02
> Are there any experiences of this. I consider myself to be dysthimic and I found Lithium just made me feel sick and sluggish. Are there other unipolars/dysthimics out there who have tried a mood stabiliser. If so what were your experiences?
>
> DeniseCheck out: http://www.dr-bob.org/babble/20000128/msgs/20861.html
Schuyler
Posted by LRS on June 6, 2002, at 19:33:57
In reply to rediagnosis: bipolar II, posted by bonnie on June 2, 2002, at 0:59:19
I've also been re-diagnosed recently..after about 9 years of being on & off ADs and on & off therapists. In my case, I think the issue was two-fold:
1) I have had & still have a tendancy to want to appear "normal". I've never let out too much info on "manic" periods(due to embarrassment and guilt)in therapy, making it hard for me to actually get to where I need to be. "Hey, if they can't diagnose it, you can't have it...and you don't want it." had been my line of thinking. Typically when things started getting too close to the bone, I discontinued treatment and meds until I got in deep doo doo again...to put it mildly. Kinda like running away from home. When I went back in, it would be with more or less a clean slate as I never disclosed more information than I had to.
2) When I first started getting help, I rarely heard the term BiPolar. I'm not too up on the history of medical diagnosis..but it seems fairly recently that more attention has been put into bi-polar symptoms in screening processes & such.Take care,
LRS
Posted by Tabitha on June 7, 2002, at 4:42:16
In reply to Re: rediagnosis: bipolar II, posted by LRS on June 6, 2002, at 19:33:57
I had a similar experience to LRS, for many years diagnosed unipolar depressed instead of BPII, since I kept the details of the upswings hidden from the doctor. I think it was embarrasement over the behavior and also true ignorance that the symptoms were actually "symptoms". I only knew about the symptoms of full-blown mania, which I didn't have.
I don't notice any effect of mood stabilisers, just the absence of hypomanic periods.
I also tried going on and off treatment several times, but the depression was unbearable. I haven't tried going off the stabilisers though, too afraid of wrecking my relationships and reputation with nutty behavior. Whenever I start doubting that I need the stabilisers, I look at my journal writings from my last upswing. Scary crazy obsessed babbling!
This is the end of the thread.
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