Posted by SLS on January 1, 2001, at 9:45:11
In reply to Bipolar type that cycles betw norm. and depressed?, posted by S.D. on December 30, 2000, at 18:05:32
> For as long as I've believed I had a predominantly chemically/genetically -based mood disorder, I've thought it was Major Depression or Dysthymia (or both, a/k/a double depression).
Someone asked me about Bipolar and I said I didn't know too much about it but that I didn't think there was anything that was recognized as being a type of Bipolar (meaning in practice, I suppose, that it responds to the typical treatments for Bipolar), having the feature that the cycles are only between 'normal' (or almost normal) and depressed - no mania or even hypomania.> But I promised I'd investigate, so I'm asking.
> If there *is* recognized such a thing, how is it distinguished from plain old major depression that comes and goes? (response to classes of meds, maybe?)
Hi S.D.Yes, there are bipolar and "soft" bipolar (not meeting strict diagnostic criteria for bipolar disorder) presentations that exhibit a cycling between depressed and normothymic states. I personally experienced a period of two years in which I was an ultra-rapid cycler, switching between severe depression and nearly normal (mild depressive) states regularly with a period of 11 days. 3 days up and 8 days down. Like clockwork. Damned biological clocks. Upon my first trial of lithium, rapid cyclicity ceased and left me chronically depressed thereafter.
At no time during my rapid-cycling period did mania or hypomania appear. In fact, the only time they do now is when a medication precipitates it. My manic states during these events have been either mixed or dysphoric. Depressions that include antidepressant-induced manias (but no spontaneous manias) has been proposed as bipolar type III (contradictory to the work cited by Noa) to be included in the DSM diagnostic manual for over a decade. Several years ago, someone on another site posted a diagnotic parsing that included five types of bipolar presentations.
Why do you think you have a cycle between states?
Can you describe the details of your cycle and what you feel in both states?
Personally, I feel that mood-stabilizer medications are a good idea in situations like this to help prevent the condition from evolving into a more severe and treatment-resistant course.
I agree in many ways with Noa regarding diagnosis based upon response or non-response to mood-stabilizers, especially when they seem to be helpful in cases currently thought to be unipolar. However, I think there is a place for charting the responses to various drugs as to be considered in a multimodal assessment.
A good starting point for you might be to throw away labels and conclusions and diagnostic terms and simply list in detail what you experience.
Examples:
1. How you feel now - both mentally and physically
2. Recall at what age you suffered your first unequivocal depressive episode.
3. Describe your baseline depression - how you felt and functioned before taking any psychotropic medications.
4. Describe the course of your mood states with regard to time:
- length of time for a complete cycle (beginning of depressive episode to the beginning of next depressive episode)
- cycling, length of time between depressive states
- the consistency or regularity of this cycling
- any seasonality; a tendency for changes in mood states to be associated with different times of the year.5. Describe what medications have been helpful, and how they helped.
I guess all of this garbage is my feeble attempt to squeeze out any true rapid cyclicity that might be indicative of a bipolar-spectrum disorder, or whether your illness is simply a recurrent unipolar depression that is best treated consistently and without "drug-holidays" indefinitely.No need to respond - just a few things to think about.
- Scott
poster:SLS
thread:50592
URL: http://www.dr-bob.org/babble/20001231/msgs/50669.html