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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by samantha28 on April 17, 2009, at 22:16:41
Hi, while DSM states you can only have a mixed episode in bipolar I and not in bipolar II many clinicians seem to diagnose people with bipolar II - mixed state.
Yet many MH professionals say you can have mixed state in bipolar II as well:
Bipolar I - mixed state looks like this:
"A dysphoric mania consists of a manic episode with depressive symptoms. Increased energy and some form of anger, from irritability to full blown rage, are the most common symptoms (MMDT). Symptoms may also include auditory hallucinations, confusion, insomnia, persecutory delusions, racing thoughts, restlessness, and suicidal ideation."
Bipolar II - mixed state looks like this:
"An agitated depression is a "major depressive [episode] with superimposed hypomanic symptoms" (Benazzi, 2000). Mixed episodes in which major depression is the primary state, concurrent with atypical manic features were described in two studies (Benazzi & Akiskal, 2001; Perugi et al., 2001). A study by Goodwin and Ghaemi (2003) reported manic symptoms in two-thirds of patients with agitated depression, which they suggest calling "mixed-state agitated depression".
This sounds like hair splitting splitting. Agitated depression sounds like dysphoric mania to me.
I have the following symptoms: intense suicidal urges, irritability, high sex drive, feeling fat but energized with nervous energy, depressed mood but I can change to euphoria for brief moments, tired at the same time as being energized, racing thoughts, lack of ability to concentrate and I feel like I need to be moving all the time despite feeling fatigued, negative remunerations, sometimes I can feel like I can do anything and other times I feel hopeless and pensive and empty.
I have been dx as bipolar I mixed state by one doctor and bipolar II mixed state by another - which is the more correct dx?
Finally are the treatments the same in both mixed states?
cheers
Samantha
Posted by Phillipa on April 17, 2009, at 23:24:42
In reply to Mixed state bipolar I or II, posted by samantha28 on April 17, 2009, at 22:16:41
Samantha you didn't mention delusions or hallucinations so I vote for bipolar 11. Mood stabalizer, calming agent maybe klonopin or atypical antipsychotic? What meds are you currently taking? Love Phillipa
Posted by samantha28 on April 17, 2009, at 23:40:28
In reply to Re: Mixed state bipolar I or II » samantha28, posted by Phillipa on April 17, 2009, at 23:24:42
Hi Phillipa,
Thanks for your vote, I think it is bp II. There was a time when I thought that if I killed myself with enough publicity I might raise awareness of a particular mental illness. I don't know whether that qualifies as psychotic or just plain stupid.
I am on abilify and it worked wonders for me for about 5 weeks then I started to go down hill again.
Have you ever been in a mixed state and if so what was your experience?
Sam xx
Posted by samantha28 on April 18, 2009, at 0:02:25
In reply to Re: Mixed state bipolar I or II » samantha28, posted by Phillipa on April 17, 2009, at 23:24:42
Hi Phillipa,
Thanks for your vote, I think it is bp II. There was a time when I thought that if I killed myself with enough publicity I might raise awareness of a particular mental illness. I don't know whether that qualifies as psychotic or just plain stupid.
I am on abilify and it worked wonders for me for about 5 weeks then I started to go down hill again.
Have you ever been in a mixed state and if so what was your experience?
Sam xx
Posted by linkadge on April 18, 2009, at 7:54:36
In reply to Re: Mixed state bipolar I or II, posted by samantha28 on April 17, 2009, at 23:40:28
Thats the thing, in some cases an antidepressant is enough to get everything under control. Nowadays though, you'd be more likley to get a BP diagnosis wich would land you on a mood stabilizer.
Linkadge
Posted by Zana on April 18, 2009, at 10:25:19
In reply to Re: Mixed state bipolar I or II, posted by linkadge on April 18, 2009, at 7:54:36
My vote would definitely be for a mood stabilizer in addition to an AD although other atypicals may be more helpful eg geodon, seroquel, respiradal.
What really strikes me though is the intense suicidaly urges. How are you managing with those? Do you feel safe? Do you need to be in a more containing environment like the hospital?
Let us know.
Zana
Posted by samantha28 on April 18, 2009, at 15:42:52
In reply to Re: Mixed state bipolar I or II, posted by Zana on April 18, 2009, at 10:25:19
> My vote would definitely be for a mood stabilizer in addition to an AD although other atypicals may be more helpful eg geodon, seroquel, respiradal.
>
> What really strikes me though is the intense suicidaly urges. How are you managing with those? Do you feel safe? Do you need to be in a more containing environment like the hospital?
>
> Let us know.
>
> ZanaDear Zana, I have had several suicide attempts in the recent past. I was initially dx with a personality disorder and sent straight home after being on life support with no follow up care. It is a long and unbelievable story what happened to me. I was supposed to have died. I can't talk about this as I am currently seeking legal advice.
Thank you so much for your concern. I would like to put the message out there that mixed states of bipolar are a very dangerous and distressing stage.
I am currently on an anti-psychotic and much better though I am haunted about what happened to me.
Posted by samantha28 on April 18, 2009, at 15:47:06
In reply to Re: Mixed state bipolar I or II, posted by linkadge on April 18, 2009, at 7:54:36
> Thats the thing, in some cases an antidepressant is enough to get everything under control. Nowadays though, you'd be more likley to get a BP diagnosis wich would land you on a mood stabilizer.
>
> LinkadgeTrue, though my GP put me on an anti-depressant and my anxiety shot right up. I didn't do very well and made my mixed state worse. I am doing much better on a mood stabilizer now. I still don't know if I am bipolar I or II.
Posted by linkadge on April 18, 2009, at 19:48:23
In reply to Re: Mixed state bipolar I or II, posted by samantha28 on April 18, 2009, at 15:47:06
>True, though my GP put me on an anti-depressant >and my anxiety shot right up. I didn't do very >well and made my mixed state worse. I am doing >much better on a mood stabilizer now. I still >don't know if I am bipolar I or II.
Which antidepressant?
To confuse the matter, SSRI's can cause significant start up anxiety, insomnia and akathesia. This could definately make the agitation aspect of agitated depression worse.
I think there is some research that agitated depression does better on a TCA such as doxapin or amitryptaline.
The hypothesis remains to be tested though that if the depressive components of agitated depression were to be selectively (and sucessfully) treated whether the agitated components would resolve too.
Linkadge
Posted by Phillipa on April 18, 2009, at 21:27:48
In reply to Re: Mixed state bipolar I or II, posted by samantha28 on April 18, 2009, at 15:42:52
Wish you could let us know what happened as used to be a psych nurse. I loved my job. Love Phillipa ps ditto for the mood stabalizer lamictal is pretty tolerable as well as trileptal. No don't think bipolar but who knows. That's me.
Posted by Zana on April 19, 2009, at 11:06:39
In reply to Re: Mixed state bipolar I or II » samantha28, posted by Phillipa on April 18, 2009, at 21:27:48
Lamictal sent me through the roof. Depakote downed me out. Do you have someone you are working with on your meds now? And what about therapy? Wouldn't some support help?
Take care of yourself.Zana
Posted by samantha28 on April 19, 2009, at 16:47:54
In reply to Re: Mixed state bipolar I or II, posted by Zana on April 19, 2009, at 11:06:39
Hi Zana,
I tried Depakote but it just sent me to sleep. I find Abilify helpful for my motivation, giving me energy and stopping my racing thoughts. I am back in a state of depression though but it has helped in the other areas I described. I am sure my depression would be worse without it but I suspect it has a lot to do with the trauma I suffered when I was never dx properly.
I have a lovely pdoc, but he doesn't talk much and I feel like I am talking to a brick wall sometimes. I don't think I will ever recover from my attempts.
Posted by B2chica on April 20, 2009, at 12:51:42
In reply to Re: Mixed state bipolar I or II, posted by samantha28 on April 19, 2009, at 16:47:54
i've been told i'm Bipolar II, had some incidents of slight auditory hallucinations and severe delusional thinking/actions but never been dx with BP1, i think they were then settling on psychotic depression...(with manic tendencies of course)..
Also i VERY clearly have full manic reactions to some SSRI's, and have had history of hypomanic symptoms. so who knows.at this point in my life now, i finally give up on dx. i focus on my symptoms and what works.
even though i've had the bipolar dx, moodstabilizers always seem to make me worse with cycling. i think that's why they were leaning toward Psydep.
my main saving grace during my worst suicidal, psychotic, whatever episodes ALWAYS seems to be zyprexa.Especially with severe and intense suicidal intentions.
********************
although i've been on it off and on, its mostly been on.
and the first two times i went on it i actually didn't gain any weight (the second time maybe 5 lbs) but the next time i gained lots...though i think i blame zoloft for that as well.but to me. a few pounds is well worth it to not be in those scary positions again.
no need for me to get into detail, but i'm very lucky zyprexa was used to intervene at the times it was.
also it usually helps pretty quickly, like within 48 hours.i think i would maybe look into this as an option for you.
reasons i've stuck with it in the past.
1. it really helped me with rage
2. ALWAYS helps with suicidal intentions
3. helps greatly with depression
4. subsided any 'strange' thinkingbest wishes.
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