Has anyone been diagnosed with bi-polar w/o mania?

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hopefulmigrainer
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   Posted 10/31/2006 6:39 PM (GMT -7)   
Hi everyone, I usually post on the depression and anxiety forum but thought I'd take a peek over here.  I can be extremely depressed, crying nearly hysterically and then be calm the next day, maybe even hopeful.  I don't have extreme highs and lows but my Mom wonders why I get better and then go down again.  I told her that this is just the nature of depression and I have not been diagnosed with bi-polar.  So, I was just curious what your experience has been.
Talk2Kel 
DX: chronic migraine, cervical degeneration, depression/anxiety 
RX: Wellbutrin, Lexapro, Soma, Immitrex 
"You don't find out that God is all you've got until God is all you've got."


Nestchick
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   Posted 10/31/2006 8:07 PM (GMT -7)   
Nope, you have to have had a manic episode in order to have bipolar dx.

hopefulmigrainer
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   Posted 10/31/2006 8:18 PM (GMT -7)   
What is a manic episode? What comes to mind to me are the extremes like sexual promiscuity, spending sprees, hyper - Superman feelings and driving a motorcycle recklessly. I don't have those type of highs but I'm not always sensible when it comes to soothing myself. I think that is normal for depression. Thanks for the input. Anybody else?
Talk2Kel 
DX: chronic migraine, cervical degeneration, depression/anxiety 
RX: Wellbutrin, Lexapro, Soma, Immitrex 
"You don't find out that God is all you've got until God is all you've got."


Green Lantern
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   Posted 11/1/2006 10:41 AM (GMT -7)   
My understanding is that you can be diagnosed as bipolar mixed without having manic episodes.  I was diagnosed with this at one point and have never had any manic episodes.  I'm not sure the diagnosis was correct as now it has changed to depression and GAD.  I just know I'm a messed up guy who doesn't respond to any medications the way pdocs think I will.
Generalized Anxiety Disorder, Depression


hopefulmigrainer
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   Posted 11/1/2006 12:09 PM (GMT -7)   
Hi Green, I am now being treated for depression and GAD too.  Have you tried all of the different combos of meds?  Are you working with a psychiatrist?  Have you gotten a 2nd opinion about your treatment/meds?  I hear a loss of hope in your voice and that concerns me.  I am so glad that you are reaching out here on HW.  Take care.
Talk2Kel 
DX: chronic migraine, cervical degeneration, depression/anxiety 
RX: Wellbutrin, Lexapro, Soma, Immitrex 
"You don't find out that God is all you've got until God is all you've got."


CounterClockwise
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   Posted 11/1/2006 5:00 PM (GMT -7)   

Hi Hopeful,

The wisdom these days is that you cannot be diagnosed for bp without a manic or hypomanic episode -- basically because without the manic end of the spectrum the condition is (unipolar) depression rather than manic depression / bipolar.

A couple of good pages you could check out for more information on manic / hypomanic episodes are:

http://www.psychnet-uk.com/dsm_iv/bipolar_disorder.htm

http://www.mdf.org.uk/?o=1620

I think the way you describe not being sensible when it comes to soothing yourself is very common for depression -- especially when linked to anxiety. I am very much like that myself -- and I am a unipolar depression with anxiety gal (on this board because of my ex's bipolar). It sometimes takes a while to find the right meds for that too -- as well I know lol -- but I have eventually managed it with the help of a patient and thorough doc. Always worth pushing for more investigation into the meds side of things. :)

Rosie x


********************

People are not like fish: they do not work well battered.

When I'm not in my right mind, my left mind gets pretty crowded...

********************

 
Moderator, Bipolar Forum


Crissi
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Date Joined Feb 2006
Total Posts : 27
   Posted 11/1/2006 5:41 PM (GMT -7)   
You could have soft bipolar or bipolar II. It is often hard to detect hypomania. For anyone who questions this they should read Dr. Phelps book, Why am I still depressed? I just read this book and it was fabulous. As he describes it , some hypomanics episodes can feel like you are normal and have joined the land of the living. Dr. Phelps also has a site at psycheducation.org. I don't know if we're allowed to link in here but he really is an expert at bipolar disorder and his site gives loads of info about bipolar II and soft bipolar.

Some of us with bipolar II have great difficulty getting diagnosed because we have no obvious mania or hypomania. Also or Hypomania's can be dysphoric which means we can be extremely irritable, agitated, anxious, etc.

Good luck and I hope everything works out for you.

Crissi

CapninHapnin
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Date Joined Sep 2006
Total Posts : 285
   Posted 11/1/2006 8:19 PM (GMT -7)   
Hey hope

I was diagnosed with BP2 with rapid cycles. I suspect some of my behavior as a youth could be classified as a mania. What I suffer from most is hypomania. And in my case, some of these hypomanias are worse than the depressives. the bad hypo's start with not having the need to sleep, then I start thinking of things very rapidly until I begin hallucinating. I am aware that I am hallucinating and the things I see and hear are not real. My hallucinations range from beautiful to horrific. But I can still somewhat function at first. I can drive, talk, work until it escalates becoming unbearable. At that time, I begin drinking, and after that fix subsides I start looking to other alternatives which are never acceptible.

On the good side, I can now receive treatment when the old noggin goes into a tail spin. Overall, with my treatment, I have only suffered three of these episodes in the last two years. Woo Hoo!

Take good care of yourself

Cap
I want "I wish I had one more day to spend at the office" on my tombstone.


manicmama
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Date Joined Oct 2006
Total Posts : 22
   Posted 11/1/2006 11:22 PM (GMT -7)   
Hi!  I am recently diagnosed as Bipolar NOS with rapid cycles. ( on top of social anxiety disorder, general anxiety disorder, and blah blah blah, I'm tired of it all...)  What that means, I guess I understand, I am still trying to digest all this.  My bipolarness is more like Crissi's response.  Esp. the dysphoric hypomanic states, and really it is a scarey state for me and my loved ones.  I am violent, angry, argumentitive and vicious.  As well as hysterical and most times I truely belive I am right to be so enraged.  My thoughts are racing so fast, they make sense until I try to say them, then it's chaos that comes out.  This can last for hours or maybe up to 2 weeks.  The episodes are what can get me in alot of trouble. Yesterday, was my 3rd wedding anniversary, and my 3 and 2 yr old sons were home as well as my husband.  Long story short, during an argument, I flipped the solid oak table over twice, knoked off all the stuff on it, pushed, pulled, and threatened to hit my husband several times even after he choked me, and severely bruised my arm, saying if I hit hit he'd break it.  I still would not let him leave...ahhhhh!  Needless to say we are both out of control.  I am horrified by what I have allowed my sons to see, and live through in such a short time. I am now trying to get the help I need to be able to raise my sons in a healthy and nurturing home, which is what I am like when I am normal...whatever that is.  I am in cognitive behavioural therapy, and on meds. And really reaching out to anyone I can, who will listen and not judge me.  So far that is not very many people, they dont get it, that is where this forum comes in.  I dont have much time, and I only have dial up so mostly I just read the threads, and fell connected to other people.  Safely!
Good luck! 
Shady
 
DX:BP NOS, SAD, GAD, PTSD,PD,AGORAPHOBIA, recovering heroin addict (7yrs.),recovering methadone addict (4yrs),hypertension
 
RX:DEPAKOTE, Kolonopin,Toporol xl
 
Surgeries:Reconstructive shoulder surgery, breast reduction, tonsilectomy, and spinal meningitis all in the same 2 yrs.  1993/94
Twin pregnancy in 2002, gave birth 5 wks early, got pregnant 2 months later and gave birth exactly 12 months after having my twins.


hopefulmigrainer
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Date Joined Oct 2006
Total Posts : 902
   Posted 11/2/2006 1:35 AM (GMT -7)   
Hi everyone, thank you so much taking the time to post a reply. I really do appreciate it. I think I've ruled out Bipolar but I have a deeper compassion for what you BP's go through. I'm glad that we all have a safe place like Healing Well. Take good care.
Talk2Kel 
DX: chronic migraine, cervical degeneration, depression/anxiety 
RX: Wellbutrin, Lexapro, Soma, Immitrex 
"You don't find out that God is all you've got until God is all you've got."


CounterClockwise
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Date Joined Jul 2006
Total Posts : 1529
   Posted 11/2/2006 2:28 AM (GMT -7)   
Thanks for those lovely words Hopeful. -- Bp may not have been something for you to worry about, but look what it has achieved! -- Any deeper understanding of what bp sufferers from those of us who don't have this condition is a great achievement.

From one d/a-p to another, *good luck to you*!! :)

Rosie x
********************

People are not like fish: they do not work well battered.

When I'm not in my right mind, my left mind gets pretty crowded...

********************

 
Moderator, Bipolar Forum


Green Lantern
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Date Joined Apr 2006
Total Posts : 105
   Posted 11/3/2006 1:11 PM (GMT -7)   
Hopeful,
 
In the past 10 months I have been on Zoloft, Wellbutrin, Paxil, Geodon, Lexapro, Lamactil, Lithium and Xanax.  I have been working with a Pdoc the whole time and I either have the opposite reaction or no reaction to the meds he thinks will work (except Xanax, that works).  He asked me the other day "Do I look stumped?"  I said yes.  He said "Well that's because I am."  He referred me to a Pdoc that does what they call an rEEG.  It is used for people that have difficulty finding the right medication.  It basically maps your brain and compares it to a database of brain maps to find ones similar to yours and then the types of medication that have worked on those brains.  Problem is, you have to be off all meds to get the test done.  At the time I was on 2mg Xanax 3x day, 40 mg Lexapro, 600 mg Lithium, 666 mg Campral, and 6 mg Lunesta.  The guy said he wouldn't do it because I was on such high doses and different meds that he didn't think it was a good idea for me to go off the meds.  My original Pdoc and I called BS and I'm in the process of getting of the meds, Xanax first (not fun).
 
Crissi,
 
What you describe could be me.
Generalized Anxiety Disorder, Depression


hopefulmigrainer
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Date Joined Oct 2006
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   Posted 11/3/2006 7:45 PM (GMT -7)   
Green, that sounds very challenging. Hang in there.
Talk2Kel 
DX: chronic migraine, cervical degeneration, depression/anxiety 
RX: Wellbutrin, Lexapro, Soma, Immitrex 
"You don't find out that God is all you've got until God is all you've got."


Green Lantern
Regular Member


Date Joined Apr 2006
Total Posts : 105
   Posted 11/8/2006 11:38 AM (GMT -7)   
hopeful,
 
I have done a lot of research on bipolar mixed the last couple of days in advance of my pdoc appointment this morning.  Here is a definition I found:  "Symptoms of mania and depression are present at the same time.  the symptom picture frequently includes agitation, trouble sleeping, significant changes in appetite, psychosis and suicidal thinking.  Depressed mood accompanies manic activation."  I also found this:  "Antidepressants can cause mixed states/  Remember, bipolar disorder is not like the north and south pole; hypo/manic symptoms can occur while depressed symptoms are also present.  In a way, this is the same as #2 above, except that instead of switching from one state to another, you have both at the same time.  Usually this looks like agigtation or anxiety, or irritability, difficulty sleeping and depression all at the same time."  This also "These findings suggest that depressed patients with atypical bipolar features that resemble anxiety or agitation may suffer from mixed states.  This has treatment implications for the diagnosis of bipolarity in patients previously thought to be unipolar, for antidepressant use (which may worsen such states), and for the selection of mood stabilizers (i.e., lithium vs. anticonvulsants) in know bipolar patients.  Patients with treatment resistant unipolar depression should be evaluated for symptoms that might suggest rediagnosis and alternative treatment with combinations of mood stabilizers, rather than antidepressants." 
 
So, basically, many times bipolar mixed is diagnosed as unipolar depression or unipolar depression with GAD (as in my case).  Antidepressants make it worse and lithium is a poor mood stabilizer for mixed states.  I took it a step further and analyzed what combination of mood stabilizers would be good for a mixed state.  I chose Depakote, an anticonvulsant (this class is recommended for mixed states) ("...if sleep problems and anxiety are prominent, Depakote may be a better starting place...", and Seroquel (an atypical antipsychotic) ("for sleep and agitation").  I presented all this to my pdoc this morning and he agreed, even down to the med combination.  So I am tapering off of Lexapro and Xanax and starting on Depakote and Seroquel.  I'll let you know how it goes.  Zyprexa was another med that was mentioned in many of the articles I researched but I have taken it in the past and it didn't help.  Lamactil is another med that is suggested if depression is prominent, but I tried that and only got to 1/6 of the therapeutic dose and couldn't sleep for days on end.  Hope this helps someone.
Bipolar Mixed


hopefulmigrainer
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Date Joined Oct 2006
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   Posted 11/8/2006 11:47 AM (GMT -7)   
Hi Green, I really appreciate your taking the time to reply. I will read again this afternoon when I'm awake. Do you have "situational" anxiety and depression or do you just have it all of the time? I think that I had an emotional breakdown after my husband walked out. I was already disabled with migraines and after only 4 short months of marriage, I was in complete and utter shock. I think I experienced something like PTSD. I cried intensely for 4 1/2 months - everyday. The grief was intense - not in proportion to what happened. I lost my old self completely, I hid out and poorly managed money and just avoided what was coming - some really big deadlines #1 - Move #2 - disability is going to end #3 - go back to work (even w/ depression & migraine) because I have nobody to stay with. I haven't been able to get back on my feet. I can barely handle stress. I am blessed with friends who call me frequently but I don't even have the energy to talk. I feel bad because my mind gets like ADD (which I don't think I have because I'm pretty darn organized and my understanding of ADD is that they are incapable of organizing). Anyway, I would love for you to keep me posted on your progress with these meds. I am seeing a psychiatrist too. Everyone seems to think that resolution of these major life changes is going to be the answer. I hope so but in the meantime, if I do have Bipolar mixed, I would like to be treated effectively as life is difficult and I need help coping. Again, thanks & please keep me posted.
Talk2Kel 
DX: chronic migraine, cervical degeneration, depression/anxiety 
RX: Wellbutrin, Lexapro, Soma, Immitrex 
"You don't find out that God is all you've got until God is all you've got."


hopefulmigrainer
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Date Joined Oct 2006
Total Posts : 902
   Posted 11/8/2006 12:04 PM (GMT -7)   
Green, I took a little quiz from the link provided above

http://www.mdf.org.uk/?o=1620

I scored "low probability" but my score was the highest before "moderate probability."

I don't experience the high energy and agitation. I just have days/hours where I'm normal and then something will happen and I'll lose it. Usually it is situational.

Anybody else on here experience this with Bipolar?
Talk2Kel 
DX: chronic migraine, cervical degeneration, depression/anxiety 
RX: Wellbutrin, Lexapro, Soma, Immitrex 
"You don't find out that God is all you've got until God is all you've got."


Green Lantern
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Date Joined Apr 2006
Total Posts : 105
   Posted 11/8/2006 12:16 PM (GMT -7)   
hopeful,
 
What you describe was another of the descriptions of bipolar mixed that I found.  Your manic symptoms are not extreme highs, but "you feel like you have joined the land of the living."  I never even came close on the bipolar tests I took.  They all focus on major manic symptoms.  Seems like it might be worth talking to your pdoc about it if nothing else is working.  Good luck. 


Bipolar Mixed


D_J
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Date Joined Nov 2006
Total Posts : 30
   Posted 11/14/2006 12:45 AM (GMT -7)   
BPII is more like unipolar depression without major manic episodes. As some of you have mentioned, Bipolar disorder is much easier to diagnose in Mixed rapid cycling states and as BP I with major! manic episodes. However, despite possibly an incorrect diagnosis, putting someone on a mood stabilizer and an antidepressant could be useful for people with BP and unipolar depression. If antidepressants make you feel worse, try a mood stabilizer as well. I don't see how it could make unipolar depression any worse, atleast Lamictal works for depression as well.

D

Green Lantern
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Date Joined Apr 2006
Total Posts : 105
   Posted 11/14/2006 8:09 AM (GMT -7)   

hopeful,

Things are going much better since the med change.  No more depression, the Depakote takes away the anxiety, so I don't feel like using Xanax (which I'm tapering off of now), and the Seroquel+Depakote makes me sleep like a baby without the Lunesta.  Mine was just an all the time feeling, like my brain wanted to jump out of my skull.  All this started happening after I got sober 11+ months ago.  I guess those 23 years of self medicating finally wore off.

 


Bipolar Mixed


hopefulmigrainer
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Date Joined Oct 2006
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   Posted 11/14/2006 12:32 PM (GMT -7)   
Congratulations, Green Lantern. This is GREAT news. I am feeling better too. Congratulations too on your sobriety. You are on the road to a very bright future. What class of drug is Depakote? I could not take Seroquel (instead of Xanax) because I felt like a zombie all day long. She prescribed it in lieu of xanax for when I was crying hysterically or panicking. I still prefer xanax but am off of it too. I really am happy for you. You should post a "good news" thread. :)
Talk2Kel 
DX: chronic migraine, cervical degeneration, depression/anxiety 
RX: Wellbutrin, Lexapro, Soma, Immitrex 
"You don't find out that God is all you've got until God is all you've got."


Green Lantern
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Date Joined Apr 2006
Total Posts : 105
   Posted 11/16/2006 9:52 AM (GMT -7)   
Depakote is an anti-convulsant.  At first when I took it during the day it made me drowsy, but now I take 250mg morning and afternoon and 1000mg at night and its not a problem.  It has had an obvious benefit in tapering off the Xanax by reducing my anxiety level.  I take 100mg seroquel at night and I'm out like a light.  I can't imagine taking that during the day.

Bipolar Mixed


hopefulmigrainer
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Date Joined Oct 2006
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   Posted 12/13/2006 12:32 AM (GMT -7)   
I'm really moody. My psych says that my mood has never been stable but she does not say I'm bi-polar. She says that she thinks that my depression is environmental (situational). Sometimes the depression is so bad, I can't stop crying, my heart aches and aches and I can't stand the feeling. I was taking wellbutrin and Lexapro but wasn't taken off of Lexapro (cold turkey) and I have been in deep depression ever since. I can't take Lexapro b/c I take a lot of meds for migraine and they antagonize each other. I have been so depressed as to think about going to a hospital b/c I don't know what to do. I HATE depression and today I had a migraine through the roof.

How did you people discover that you had bi-polar? Were any of you the types who would have bouts of depression? When I look back, I wonder if the depression came before the bad things or the bad things and then the depression. I do know that I have never been as bad as this last year and a half in which nearly everything that could go wrong has gone wrong.

I was looking at a brochure for a drug called Lamictal and it showed a line with dips and then you go up to the straight line. Could that be bi-polar? I think my psyche is worthless and I have to find a new one.
"God grant me the serenity to accept the things I cannot change, to change the things I can and the wisdom to know the difference. Amen."
 
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Green Lantern
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Date Joined Apr 2006
Total Posts : 105
   Posted 12/14/2006 4:34 PM (GMT -7)   
Hi hopeful,
 
Lamictal is supposed to be a good anti-depressant/mood stabilizer (not sure which one) for people with bp.  It can also help with irritiability, etc. and won't throw you into a manic phase.  Lamictal is pretty new, for this use, but it would be worth asking about
Bipolar Mixed


hopefulmigrainer
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Date Joined Oct 2006
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   Posted 12/16/2006 12:07 AM (GMT -7)   
Hi Green,
Thank you for your reply.  I am like a baseline that dips below at varying degrees and then comes back up to the baseline. 
 
I think this article explains it best:

Where Unipolar Depression and Bipolar Depression Converge

With these difficult to treat depressions the circle closes, as we begin to see traits that have something in common with bipolar disorder, not enough to suggest a bipolar diagnosis, perhaps, at least not right now. Should a future DSM, however, adopt softer criteria, we may well see bipolar disorder broken down not only into I and II - as it has been since the 1980s - but also bipolar III, IV, and maybe even V. Here, truly we are talking about a multipolar phenomenon.
Dr Akiskal has been the main proponent of an expanded definition of bipolar disorder, one that would incorporate a good deal of the current unipolar population. Dr Akiskal has pointed out that many patients with so-called unipolar depression exhibit certain hypomanic (mild mania) symptoms. Though these symptoms may not add up to an actual hypomanic episode, Dr Akiskal maintains they constitute sufficient evidence of bipolarity, and thus has urged that this population be diagnosed accordingly.
In an article in the July 2004 AJP, Ellen Frank PhD of the University of Pittsburgh et al take the argument one step farther by proposing there is a strong relationship between hypomanic or manic symptoms and the number and severity of depressive episodes.
 

 


"God grant me the serenity to accept the things I cannot change, to change the things I can and the wisdom to know the difference. Amen."
 
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Green Lantern
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Date Joined Apr 2006
Total Posts : 105
   Posted 12/19/2006 1:05 PM (GMT -7)   
That article pretty much sums up how I've come to look at bp in the last few months based on my own research.  I'm not saying I'm right but based on the pdocs and even gps i've talked to, in addition to internet research, they all have differing opinions on what constitutes bp and a lot of them leave open the possibility, as i see it, of a continuum of bp that has varying degrees of depression and mania.  The more i read and deal with pdocs, the more i am amazed at how little we know about mental disorders and how to treat them.  Keep trying hopeful and don't be afraid to bring up things like that article with your pdoc and see if they think it may apply to you.
Bipolar Mixed

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