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Re: BP Disorder II and Irritability Smilez

Posted by ramsea on November 25, 2003, at 4:16:11

In reply to Re: BP Disorder II and Irritability tried them all, posted by Smilez on November 24, 2003, at 8:27:25

Topamax is a godsend for some people but I have read a lot of clinical reports that are clearly ambiguous. For example, there is not enough agreement among doctors that Topamax is useful for treating bipolar for it to be approved as a bipolar medication, so it will remain off-label. At the same time, Lamictal was approved for treating Bipolar depression. Perhaps you've read the Topamax threads already. Some people find it increases their bad temper, and the dumbing-down SEs are too much for them.

It can cause weight loss, and I think therein lies its biggest appeal. If you find you are feeling generally worse, it could be the Topamax doesn't agree with you. Try something else, like Lamictal, which is often weight neutral. Or Trileptal, and others. Wellbutrin is another drug that can definitely increase anxiety and agitation. Maybe it won't do this to you. But if you find you are feeling worse, urgently tell your doctor. There are many other options to try. I can't take Wellbutrin--it makes me quite definitely hypomanic/manic in a dysphoric way. This is not an infrequent side effect. It is best used with patients who are lethargic and slow. Your doctor may be hoping to improve the ADD with it. But do be aware that it commonly enough worsens or causes agitation, anxiety, "all wired up" feeling, irritability and distress.

A little response to your comments about "fun" manic states--I know you were kidding. But to relieve your mind, I can get manic, clinically speaking, and it is not fun. Oh, at the time there is a sense of super-normal powerefulness, perhaps,but ruining your family, community reputation, and career is not fun, and even at the time there's something in the back of my mind that is aware that something is less than okay--spiralling out of control. Basically, it's a bit of tragedy. So anytime you envy the so-called euphoric manic high, don't bother. It's usually the case that I don't properly recall events anyway, even if they were wonderful, so what is the good of that? A moment of euphoria which I can't even remember.

One way to see these matters, I think, is that irritability on its own isn't hypo/manic. In order to qualify as hypomanic or manic it must be quite extreme, and matched with attributes of so-called euphoric hypo/mania. So it isn't really a different category of mood state if it is at bipolar level (and even bipolars will have ordinary irritability too)---it's just a deeply unpleasant overexcited state. The key word might be overexcitement.

When we are irritable, for a long period of time (could be over a week), and hyper or overexcited, with racing thoughts, flight of ideas, etc., it may well be a hypomania discharging itself through irritability. If we are in a bad temper but pretty cool, pretty in control and "normal" for us, we may just be needing an attitude adjustment. For it to be bipolar I would imagine it would need some aspect of hyper/overcitement and "spiralling out of control", and "all wired-up about to snap", to qualify. Just a thought.

A Mixed State to be a diagnosis must have a certain number of criteria met from Major Depression and Mania. It is then considered to be "true" mania, and if someone suffers a Mixed Episode they will apparently be diagnosed Bipolar 1. Perhaps the equivalent exists with Bipolar 11, only the criteria might be Major Depression and Hypomania.

The main thing of course is that the actual suffering is dealt with, whatever it is called. Please don't give up with the first try. It takes time, usually, to get the right mix.


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poster:ramsea thread:281626
URL: http://www.dr-bob.org/babble/20031121/msgs/283512.html