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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on March 19, 2006, at 22:19:58
In reply to Re: Never thought I'd hear this....., posted by JahL on March 19, 2006, at 22:00:19
Hi JahL.
This schema is not at all official. However, it is accepted among some authors and is derived from the work of Young and Klerman (1992).
http://www.mentalhealth.com/rx2/bp-can1.html#Head_3
I think Hagop Akiskal, MD promotes a similar classification system.
- Scott
> > One proposed scheme:
> >
> >
> > THE BIPOLAR SPECTRUM
> >
> > BIPOLAR I: Both mania and major depression
> >
> > BIPOLAR II: Major depression and hypomania
> >
> > BIPOLAR III: Cyclothymia. Mild depression and hypomania
> >
> > BIPOLAR IV: Depression and usually no mania. Mania may be triggered by some antidepressants.
> >
> > BIPOLAR V: Depression and no mania. Some blood relatives have had mania
> >
> > BIPOLAR VI: Mania and no depression
> >
> >
> > http://www.bipolarworld.net/Bipolar%20Disorder/Diagnosis/dis.html
>
> Thanks Scott.
>
> It took me three years to have my dx recognised (I had always known what it was) - the main reason being my illness doesn't match any of the traditional descriptions of Bipolar - and I had a particularly nasty response to Lithium. Anything with 5HT action can get me switching however. So I guess I'm BP IV. Cool.
>
> How 'official' is this scheme? Can I go and impress pdocs by quoting a dx they've never even heard of (this is England remember)?
Posted by Phillipa on March 19, 2006, at 22:31:15
In reply to Re: Never thought I'd hear this..... » Phillipa, posted by SLS on March 19, 2006, at 22:05:13
Scott 1. Anxiety and panic. 2. Anxiety panic now fatigue 3. Benzos have been on all of them. Never could tolerate an Ad. Love Jan
Posted by Phillipa on March 19, 2006, at 22:33:32
In reply to Re: Never thought I'd hear this..... » JahL, posted by SLS on March 19, 2006, at 22:19:58
Ps Scott what I'd do just for one day of energy. Love Jan let alone hypomania or mania.
Posted by SLS on March 19, 2006, at 22:39:01
In reply to Re: Never thought I'd hear this..... » SLS, posted by Phillipa on March 19, 2006, at 22:31:15
>
> 1. Anxiety and panic.
>
> 2. Anxiety panic now fatigue
>
> 3. Benzos have been on all of them. Never could tolerate an Ad. Love JanAs has been suggested along another thread, you might be experiencing extreme anxiety and agitation as a reaction to the Luvox. It might subside over the next few days. The addition of fatigue is probably a side effect of the Luvox. You might be feeling depressed as an emotional reaction to your current discomfort and treatment uncertainty. Are you obsessing over things that might be going wrong inside your body? Is that why Luvox was chosen?
What is it about antidepressants that you cannot tolerate?
- Scott
Posted by Caedmon on March 19, 2006, at 23:16:44
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 14, 2006, at 16:15:04
I suppose it's a semantic game. People aren't necessarily "bipolar" or "not bipolar", it's not an either-or situation. I have *symptoms* of bipolarity; the extent of my symptoms directs my Tx. If you want to call it bipolar, that's fine, or if not, then whatever.
Posted by corafree on March 20, 2006, at 0:39:29
In reply to Re: Never thought I'd hear this..... » JahL, posted by SLS on March 19, 2006, at 22:19:58
This is too much info to handle ... joking, sort of.
I guess I'd have to stand in the Bipolar IV group. (I envision all these groups in a high school auditorium wearing different colored vests.)
Seriously, I remember one time I was put on Zoloft. I took one either that morning or the eve before. I arrived at the meeting point for a camping trip. Anyway, for about an hour, I was actually singing and dancing around, "We're going camping. We're gonna' have lots of fun and make a fire! It's gonna' be real cold and we're not gonna' care!"
I went on and on for about an hour, full of energy and optimism. My son and everyone got a real kick out of it.
But, when that hour ended, it really ended, ended. I hit rock bottom for about three days straight. It was the biggest 'drag of a camping trip' I've ever had.
I've referred to it here before as being like being in the movie 'Awakenings'.
Just saw new P and will p/u Abilify tomorrow. Never tried it before. I brought it up and P said he was thinking of it also, it and Lamictal. I'd been on Lamictal and shared a side effect I would not tolerate. So, if anyone has been down Abilify Road, that could 'choose their words carefully re: their reaction', I'd be interested in hearing those 'carefully chosen words'. (Forgive me, but I'm so easily responsive to suggestion!)
I should prob' post Abilify on med board.
bestwishes, cf
Posted by linkadge on March 20, 2006, at 15:10:48
In reply to Re: Never thought I'd hear this....., posted by SLS on March 19, 2006, at 20:59:24
The problem with calling my antidepressant withdrawl "mania", acutal mania is that, when I went back on a bit of celexa, and then tapered off more slowly, all of the symptoms improved.
You would expect that if one is bipolar that the opposite would happen, (ie coming off the drug would reduce mania, and going back on would increase mania).
Just the fact that my problems slowly disolved back into my baseline send the message to me that it was the drug.
Linkadge
Posted by linkadge on March 20, 2006, at 15:20:47
In reply to Re: Never thought I'd hear this..... » linkadge, posted by Caedmon on March 19, 2006, at 23:16:44
This is the thing. Everybody's mood fluctuates to a certain extent. However, not everyone benefits from mood stabilizers.
I guess I am not so much angry about the lable, as I am about what it implies for the patient.
These drugs are not perfect. But whenever there is a problem at hand, psychiatry likes to put the blame on the patient. Ie. the drugs are perfect, and the flaw lies with the patient.
Now thats fine and dandy, but being put on mood stabalizers for extended periods of time, when much simpler measures could be taken is not so fine.
Linkadge
Posted by linkadge on March 20, 2006, at 15:26:47
In reply to Re: Never thought I'd hear this..... » SLS, posted by corafree on March 20, 2006, at 0:39:29
All of these categories also serve the drug companies. We can prescribe SSRI's for everything from a bad hair day to major depressive disorder.
With the extension of the bipolar spectrum or whatever, we are probably going to see mood stabilizers prescribed a lot more.
I personally see cause and effect. Cause: SSRI's being prescribed like candy - effect, mood stabilizers being prescribed like candy.
Just like with stimulants, as prescriptions for stimulants increase, so with that of benzo's and beta blockers etc to try and reduce the negative effects of the stimulants.
Linkadge
Posted by SLS on March 20, 2006, at 15:30:35
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 20, 2006, at 15:10:48
Hi.
> The problem with calling my antidepressant withdrawl "mania", acutal mania is that, when I went back on a bit of celexa, and then tapered off more slowly, all of the symptoms improved.
I think that's what one would expect from a rebound-mania.
> You would expect that if one is bipolar that the opposite would happen, (ie coming off the drug would reduce mania, and going back on would increase mania).
It might depend upon how long you waited to add back the drug once the mania appeared. I really don't know. It was the discontinuation of the drug that triggered the mania, not its introduction or chronic administration.
How did you go about discontinuing the drug the first time the mania was triggered?
How long did you wait before reintroducing the drug?
My guess is that if the drug is reintroduced immediately, the mania would subside. Conversely, should the drug be reintroduced after an extended period of mania, the mania might get worse.
* I have no emotional investment in needing to believe that either one of us is bipolar.
- Scott
Posted by corafree on March 20, 2006, at 15:57:16
In reply to Re: Never thought I'd hear this..... » linkadge, posted by SLS on March 20, 2006, at 15:30:35
You said ...
>* I have no emotional investment in needing to believe that either one of us is bipolar.<
I agree completely. I feel this way also.
cf
Posted by linkadge on March 20, 2006, at 20:36:44
In reply to Re: Never thought I'd hear this..... » linkadge, posted by SLS on March 20, 2006, at 15:30:35
"* I have no emotional investment in needing to believe that either one of us is bipolar."
No, no, I understand. I came off 20mg of celexa (been on it for about 5 years) almost overnight. Symptoms started with panic attacks, severe mood swings thoughout the day, rage attacks, rebound sexual function, periods of extreme emotional intensity (it was kindof beutiful). I went back on about half 2-3 weeks weeks later and a lot subsided. A tapered more slowly, and eventually things normalized. Certain things have never improved since stopping the SSRI's. I have some movement problems that are fairly persistant.
Linkadge
Posted by SLS on March 21, 2006, at 7:53:03
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 20, 2006, at 20:36:44
> "* I have no emotional investment in needing to believe that either one of us is bipolar."
>
> No, no, I understand. I came off 20mg of celexa (been on it for about 5 years) almost overnight. Symptoms started with panic attacks, severe mood swings thoughout the day, rage attacks, rebound sexual function, periods of extreme emotional intensity (it was kindof beutiful).That doesn't sound like mania to me. It sounds more like a common cluster of SRI withdrawal symptoms plus a return of emotions that might have been blunted for those years you took the drug. From everything I have read of your experiences with your illness, I never saw anything that jumped out at me as demonstrating bipolarity.
- Scott
Posted by corafree on March 21, 2006, at 8:29:10
In reply to Re: Never thought I'd hear this..... » linkadge, posted by SLS on March 21, 2006, at 7:53:03
Scott re: Linkadge
Linkadge: So what are you going to do? R U stopping any anti-psychotic bipolar stuff?
Scott: You thought it might be ok for me going though this high anxiety period, right?
Are either of you anti-AD (I have been since last bout w/ Eff-XR)?
I awakened feeling all sore and swollen this a.m. just after first night of smallest dose Abilify. I have a ring on my finger that will prob' have to be cut off, as 'circulation is being cut off'.
I've been off everything except for a small dose 'trazodone for sleep' (which is an AD unfortunately)! The county has no Rozerem or any sleep med on its formulary, just traz and wouldn't give me Restoril. Then, since had a nervous breakdown a year ago, I've been on Valium.
Anyway, you know how you said, Linkadge, 'it was kind of beautiful', .. Well feeling, just 'feeling feelings' again was/is for me too. But then recently, sad feelings have become overwhelming.
My longest stint (10yrs) w/ the best P I've ever seen was while still working. My husband filed for a divorce because I called the police when he said he was going to break my finger.
It was then that I knew I wasn't going to have enough $ to carry on and found out about the 'county system' and how to get in it. Anyway, this P that had known me for 10yrs 'had a little trouble w/ finding anything bipolar about me', so just mentioned it was a possibility, for the sake of my 'receiving county benefits' (which I now disdain).
I've posted to you because there have been people that I've met that are bipolar and they 'seem anxious to have you join they club'. Forgive me if I offend anyone, but I have met a couple that are like that. One person said I should not be on any ADs.
I just don't seem to have enough symptoms of bipolar. It's never been obvious to me or anyone who has know me for a long period of time. There's no fam hx.
I've become very disliking of 'diagnoses'.
I hope this Abilify gets better faster than it gets worse.
(Who cuts off rings, docs or jewelers?)
Scott: Tks for response last night.
cf
Posted by linkadge on March 21, 2006, at 8:54:43
In reply to Re: Never thought I'd hear this..... » SLS, posted by corafree on March 21, 2006, at 8:29:10
There are no hard and fast rules. I would take medication changes at your own pace.
I'm not against medications if they improve the quality of your life.
I guess I am really against misdiagnosis and overmedication.
Linkadge
Posted by detroitpistons on March 21, 2006, at 8:58:01
In reply to Re: Never thought I'd hear this..... » linkadge, posted by SLS on March 21, 2006, at 7:53:03
Scott,
Would you say that the symptoms that I described in an earlier post would describe bipolarity?
> > "* I have no emotional investment in needing to believe that either one of us is bipolar."
> >
> > No, no, I understand. I came off 20mg of celexa (been on it for about 5 years) almost overnight. Symptoms started with panic attacks, severe mood swings thoughout the day, rage attacks, rebound sexual function, periods of extreme emotional intensity (it was kindof beutiful).
>
> That doesn't sound like mania to me. It sounds more like a common cluster of SRI withdrawal symptoms plus a return of emotions that might have been blunted for those years you took the drug. From everything I have read of your experiences with your illness, I never saw anything that jumped out at me as demonstrating bipolarity.
>
>
> - Scott
Posted by SLS on March 21, 2006, at 9:44:47
In reply to Re: Never thought I'd hear this..... » SLS, posted by detroitpistons on March 21, 2006, at 8:58:01
Referring to your post:
http://www.dr-bob.org/babble/20060310/msgs/620191.html
> I was recently diagnosed as bipolar II after being on Effexor 225mg. I had an irritable hypomania with a lot of agitation, irritability, racing thoughts, excess energy, etc. I was sort of rapid cycling and a kind of mixed state.
You labelled what you experienced as hypomania. Why?
You seemed to convey in your description that this state was somehow different from the other states you have experienced. Taking into consideration that it emerged while taking Effexor and that you describe excess energy and racing thoughts does seem to indicate a hypomanic episode.
Can you perhaps describe in more detail what you experienced during this possibly hypomanic period?
Is there any history in your family of mental illness? What type?
- Scott
Posted by SLS on March 21, 2006, at 9:58:46
In reply to Re: Never thought I'd hear this..... » SLS, posted by corafree on March 21, 2006, at 8:29:10
> Scott: You thought it might be ok for me going though this high anxiety period, right?
Are things getting any better with the Abilify? You can, of course, take an anti-anxiety drug temporarily while your body is getting used to the Abilify. It shouldn't be for any longer than two weeks. I am reluctant to comment any further without knowing more about your illness and its history. I am not advocating that Abilify is the right drug for you, but the beginning can be very rough. Do you have anything lying around that you can use for anxiety? Perhaps a call to your doctor?
- Scott
Posted by detroitpistons on March 21, 2006, at 10:10:08
In reply to Re: Never thought I'd hear this..... » detroitpistons, posted by SLS on March 21, 2006, at 9:44:47
> > I was recently diagnosed as bipolar II after being on Effexor 225mg. I had an irritable hypomania with a lot of agitation, irritability, racing thoughts, excess energy, etc. I was sort of rapid cycling and a kind of mixed state.
>
> You labelled what you experienced as hypomania. Why?
>That's just what the doctor said.
> You seemed to convey in your description that this state was somehow different from the other states you have experienced. Taking into consideration that it emerged while taking Effexor and that you describe excess energy and racing thoughts does seem to indicate a hypomanic episode.
>
> Can you perhaps describe in more detail what you experienced during this possibly hypomanic period?
>Here's what I said in a prior post:
> Can you describe your manic reaction in more detail?
Well, I started taking the Effexor and was no longer depressed after about 6 weeks, but I still didn't feel "right." I still felt anxious. Over the course of the next couple of months, it became worse. I started noticing that I couldn't concentrate on anything at work (at the time I thought I had suddenly developed ADD). I was easily distracted and I couldn't focus on one thing at a time. My thoughts were racing. I became extremely agitated, nervous, and anxious. I had much less patience and I was easily irritated. I felt like I could blow up on someone at any time, as I had done to one of my bosses in the past (while on Paxil) and nearly got fired. I just felt more impulsive, angry, and aggressive. I had way too much energy. I actually did some cleaning (I normally have a very difficult time cleaning--I wait till something is covered in dust to clean it). None of this was pleasant, however, and at the time, I had thought that mania/ hypomania was supposed to feel good. My doctor explained that this wasn't necessarily the case. I've learned a lot since then. I should also add that I was seeing things out of the corners of my eyes, hearing quick sounds, and feeling sensations in my legs like my phone was going off when it wasn't, for instance. These were relatively mild hallucinations.
> Is there any history in your family of mental illness? What type?
>Not that I know of, but my mom has bad anxiety and has had depression, although I don't think she really gets it anymore because her lifestyle and routines are extremely stable, so she doesn't really experience any triggers. I suspect that other people in my family may have had mood or personality disorders, but none would have been formerly diangnosed. Nobody in my family would ever acknowledge, admit, or seek help for any mental problems.
Posted by SLS on March 21, 2006, at 10:41:50
In reply to Re: Never thought I'd hear this..... » SLS, posted by detroitpistons on March 21, 2006, at 10:10:08
Sorry that I didn't recall seeing this post. I remember now.
:-)
It is difficult to say for sure from your description whether it was a mixed-state hypomania or a partial relapse into depression. Partial relapses often involve anxiety and irritability. Even racing thoughts can be part of certain depressions.
However, the following passage might be revealing:
> I had way too much energy.
In what way?
> I actually did some cleaning (I normally have a very difficult time cleaning--I wait till something is covered in dust to clean it).
Did you pace yourself or did you race from one task to another? Did you find that you were not completing all the tasks you began? Were you organized or disorganized? How many hours of sleep did you get? Increased libido? Did you find yourself driving too fast? Did you find that other people were too slow and that you were quicker and smarter?
Those are just a few things that are often associated with hypomania.
> I should also add that I was seeing things out of the corners of my eyes, hearing quick sounds, and feeling sensations in my legs like my phone was going off when it wasn't, for instance
I'm not entirely sure what these things demonstrate, but they seem to indicate an altered state.
- Scott
Posted by corafree on March 21, 2006, at 14:30:35
In reply to Re: Never thought I'd hear this..... » SLS, posted by detroitpistons on March 14, 2006, at 12:00:46
Detroit Pistons:
I first started Effexor when it only came in house shaped tabs and it was fairly effective for a few years. No bad side effects, was stabilizing, I handled my responsibilities, was working.
When Effexor-XR came out, I thought it would be convenient.
I began it and never, ever, had I experienced such a really high .. high. I was out of control w/ excitability and blabbery humor. I knew this was too crazy and d.c.'d it. (After seeing your post, I thought I'd share this.)
I thought to myself, then, and still, this must be the way a person who is bipolar 'manic' feels.
I stopped the Effexor-XR in about a month.
Some time later, I tried it again and there were none of the above side effects. It was so odd. Same drug. Same me (maybe).
Crises occurred and it would bottom out for a while. Then I'd go off. Then I'd go back on for awhile to numb myself. So, in all, I've prob' been on it from beginning to end, maybe five times.
I stopped it after a nervous breakdown last year, finally realizing (Duh; it was about time!) that every time on it, I'd experienced no 'real true human feelings'.
I'll never go there again and I mean it wholeheartedly.
What a tricky drug it has been for me.
I'd say 'nothing' has ever caused me to feel that 'way too tremendous high' in my life like Effexor-XR did just that once.
I started Abilify last eve and awoke w/ aching, coughing, a little shortness of breath, swelling in my hands, eyes burning. Called for emerg appt; unsuccessful. Told by another P to cut in half (I have smallest dose.) and take until mid next month when appt w/ my P.
After hearing this, I called a nurse line. In talking, realized it was more than a side effect; more an allergic reaction. I'm discontinuing it.
I had the same type reaction to Trileptal.
And, to Lamictal, I had very severe headaches.
None of these anti-psychotics (right?) have agreed w/ me.
Is it always anti-psychotics that are used to treat bipolar? Or, is it anti-psychotics and mood stabilizers?
My dx, if must be one, two, or some, feels like GAD, PTSD, and some Borderline traits (I used to be very outgoing, friendly, and caring for others' feelings. Now I have a lot of difficulty in relationships, politically incorrect and hurt others/myself, and am brutally honest.)
I've often had people who are bipolar, want to diagnosis me the same. I see from this link that there's this theory we are all somewhat bipolar.
When you're in the middle of a big change in your life, that's kind of the last thing you need to hear.
So far anything used to treat bipolarity has some properties that I cannot tolerate.
Anyway, if you see some similarities here, maybe you could share your treatment plan.
tks, cf
Posted by corafree on March 21, 2006, at 14:45:55
In reply to Re: Never thought I'd hear this..... » corafree, posted by SLS on March 21, 2006, at 9:58:46
Scott:
I just posted to Detroit Pistons. Pretty much explained 'me'.
Since the nervous breakdown, I'm on Valium 10mg 3x a day, so I'm okay.
Seems again I'm anti-psychotic intolerable.
I gave Trileptal more than a week and my eyes still burned (even treating them w/ plain saline solution) constantly.
I wanted to see a P asap but they shut the door in my face.
An idea .. tricyclics, maybe. Am awaiting to hear back from one of our friends here.
I think I tried Elavil in the past and had a mild initial adverse reaction (was working .. had to be at my desk at 5:45a), and didn't give it even a week.
Checked Net and looks as if Pamelor may be an option.
All these newer ADs .. I just don't trust them I guess. Especially after the ongoing frustration with Effexor-XR.
I'm really happy to have met you here. Don't think we've communicated in past.
My memory isn't all that great. I have a busted back and am on a narcotic 3x a day.
It's cool how comfortable I feel when I'm posting here. I almost forget about the way this 'county system' is really dropping the ball. Maybe this is their way of letting you know right up front that you are a lesser person!
But like I said, just typing how I feel and sharing it w/ so many people that care is the best therapy I have, until I find someone to help guide me, and I think I need to go back. I've never had that kind of therapy. I believe I've hidden from uncomfortable feelings for many years. This isn't traditional therapy anymore. Not a lot of Ts prob' even do it. I'm not even sure what to call it. I do know that the T they staffed me w/ out here is not a good match.
While online, my cell has been right beside me here. I have still not gotten a return call from 'the system' .. and that's to my 9 or 10 messages left.
What are they saying to me???
Oh Racer ... it was you that shared your life in the 'system'. I tried to call my medicare advantage plan insurance earlier re: Ts. My phone line is being changed. I'll call them in a.m. I'm afraid it looks like it will be $30 a visit. I receive $895 a month in SSD. But, I do have $2,000 in savings. Probably would be worth it. Sure would have liked to do something other than pay med or psych bills w/ that tho.
bestwishesandtksagain, cf
Posted by linkadge on March 21, 2006, at 15:53:28
In reply to Re: Never thought I'd hear this..... » SLS, posted by detroitpistons on March 21, 2006, at 10:10:08
Btw, I tried effexor twice, and it sent my anxiety through the roof both times.
Constantly elevated heart rate, always jumpy.
Anyhow, the doctor finally pulled me off it and put me back on an SSRI which didn't work but also didn't have those side effects.
Linkadge
Posted by linkadge on March 21, 2006, at 16:01:46
In reply to Re: Never thought I'd hear this..... » SLS, posted by corafree on March 21, 2006, at 14:45:55
Effexor was first marketed as prozac with a punch. Even before I started effexor, I heard from a mother's friend to be carefull since it can be stimulating.
I am really sensitive to meds that have effect on the norepinephrine pump. SSRI's did absolutely zip for me, but the TCA's and effexor all effected me in strange ways.
I have heard a lot of accounts of it increasing anxiety.
Linkadge
Posted by SLS on March 21, 2006, at 16:08:37
In reply to Re: Never thought I'd hear this..... » detroitpistons, posted by linkadge on March 21, 2006, at 15:53:28
Hi Link.
> Btw, I tried effexor twice, and it sent my anxiety through the roof both times.
>
> Constantly elevated heart rate, always jumpy.How did you react to MAOIs?
- Scott
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