Posted by S.D. on January 5, 2001, at 17:30:24
In reply to Re: Bipolar type that cycles betw norm. and depressed? » S.D., posted by SLS on January 1, 2001, at 9:45:11
> 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.
>
>I suppose I'm dysphoric or mixed much of the time that I'm depressed. Only sometimes is it *pure* depression, but I may be splitting hairs. It is pure enough to be Dx'd that way by any pdoc (with a side of anxiety, but that is traditionally always considered separate, and in my case subsyndromal anyway).
It's rather like this quote the abstract Noa referenced:
( http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11121824&dopt=Abstract )
< blockquote >...depressive mixed states consisting of few hypomanic symptoms (i.e., racing thoughts, sexual arousal) during full-blown major depressive episodes - included in Kraepelin's schema of mixed states, but excluded by DSM-IV.
< /blockquote >> Why do you think you have a cycle between states?
Maybe 'cycle' is not the right word, although my pdoc told me yesterday that cycling even in classic bipolars does not have to be regular (constant period). I've never had shifts that were anything like yours or that had a constant period (unless a very long one so I haven't perceived it).
**
If cycle doesn't imply constant period, then anyone who has had more than one Major Depressive episode 'has a cycle between states'. I've not found any abstracts about trials showing 'mood stabilizers' (other than adjunctive lithium) are significant for people with this Dx/presentation. (That was my essential purpose in posting the query that started this thread.) But if not, I don't know what would be the point of broadening the idea of bipolar, or the "spectrum of bipolar", as sumarized in these words from the abstract Noa referenced:( http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11121824&dopt=Abstract )
< blockquote >'softer' clinical expressions of bipolarity situated between the extremes of full-blown bipolar disorder where the person has at least one manic episode (bipolar I) and strictly defined unipolar major depressive disorder without personal or family history for excited periods
< /blockquote >
**> Can you describe the details of your cycle and
> what you feel in both states?What I originally described was just Vanilla major depression as one state and either normal or dysthymic as the other. The paragraphs above, between the '**' marks, explains why someone like that would be bothering about all this.
In my case what I called almost normal I really feel is dysthymia. Which I guess is a way of saying "I hope this isn't really as good as it gets, because this is pretty lame. Whatever happiness is, I don't think I'm experiencing what normal people experience.")
To put it in more detail... since age 8 or earlier, maybe always, I think I've had dysthymia; and that since age 14 I've had what history-taking doctors have considered a few distinct major depressive episodes that have lasted around 3 months to 2 years.
( http://www.graylab.ac.uk/cgi-bin/omd?query=dysthymia )
I could elaborate to say I could maybe identify 5 'states' that don't necessarily corrospond to anything and may have different periods (probably no consistant period):
1) Major depressive episode, of the ho-hum DSM kind.
2) Mixed state of depression mostly as above, but also two or more of agitation, irritability, anxiety, racing thoughts. Similar to "depression with flight of ideas" first described by Kraepelin.
3) my normal dysthymic self. I can distinguish it from (1), above, because I don't spend as much time thinking about being better off dead. But fatigue and anhedonia and tendency toward anxiety remain.
4) disturbed sleep only - multi-week or multi-month stretches. Usually insomnia, but a long hypersomnia once and probably a few shortish ones.
5) What I'll call euthymic. Cured, if it would stay that way. I guess that doesn't have to be the same thing as 'happy', so I don't have to try to figure out what that feels like. This has probably happened a few times, for up to maybe several months. Most recently while on an AD.> 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.
>
My pdoc also said they (and not just lithium) are used this way. But I still can't find any trial results (e.g. valproate, carbamazepine, lamictal).> I guess all of this garbage is my feeble attempt to squeeze out any true rapid cyclicity ...
> ... or whether your illness is simply a recurrent unipolar depression that is best treated consistently and without "drug-holidays" indefinitely.
>
>Definitely no true rapid cyclicity. It can certainly be seen as simple recurrent unipolar depression, comorbid with an anxiety disorder ( I have other anxiety too, but 'subsyndromal' I guess since it doesn't seem to qualify as GAD ).
And it may not even be all that treatment-resistant if I can find an AD I can tolerate.
> No need to respond - just a few things to think about.*Now* you tell me.
>
> - ScottS.D.
poster:S.D.
thread:50592
URL: http://www.dr-bob.org/babble/20001231/msgs/50996.html