Posted by Elizabeth on February 13, 2002, at 23:56:15
In reply to Re: Yes Puzzle!, posted by Blue Cheer 1 on February 10, 2002, at 0:20:02
> Comorbid bipolar disorder and anxiety disorders (OCD, agoraphobia/panic attacks, social phobia, etc.) are quite common, and they come and go during the course of bipolar illness.
I would imagine that's what makes bipolar d/o so tricky. It seems like it *should* be easy to identify it, based on the DSM criteria, but I suppose that the other stuff could complicate things a great deal. I still think that bipolar II is probably overdiagnosed, though. I never have a clear idea what people mean when they say, "I have bipolar II disorder." The definition has become vague, the boundaries blurred. Even bipolar I gets confusing when you're talking about mixed episodes, rapid-cycling, comorbid disorders, etc. I'm sure you've noticed how the concept of bipolar disorder has become diluted in recent years.
I once got (mis)diagnosed as bipolar when I had an episode of agitated depression. Various mood stabilizers didn't help, and nobody wanted to give me ADs. (I had been on Nardil when it started and the assumption was that the "mixed episode" was triggered by it. This may have been true, but I never had any agitation or mania on any AD besides Nardil before or since then.) Eventually the agitated depression resolved on its own...after I'd lost a lot of time. (The docs never seem to care much about that aspect of mood disorders, do they?)
> I had several limited-symptom panic attacks in the mid-80's (probably a result of genes and the stress associated with raising two children every day (well, until 6:00 P.M. or so - when the changing of the guard took place), and OCD symptoms developed in 1981 (birth of first child).
Having kids is stressful; I'm not surprised that it would trigger an anxiety disorder. Maybe "being a parent" should be classified as a mental disorder. :-}
> The thing to do is to treat the bipolar disorder primary, and the other disorders as they appear.
Even if another disorder manifests first, you'd consider the bipolar to be primary? Or do you just mean give it priority in treatment? (This also doesn't deal with the question of how to diagnose bipolar when there are a bunch of comorbid conditions clouding the picture.)
> Comorbid conditions are associated with worsening of course (i.e., rapid cycling, severe episodes, early onset and duration).
I think that mixed episodes (or episodes with mixed features) are among the most serious ones. But they're probably also very hard to treat, no?
> Anxiety and agitation can be features of all phases of bipolar disorder (e.g., the anxiety you feel when you're in a manic frenzy or dysphoric mania). Treatment with SSRIs and other ADs for depressive phases is alright, as long as you discontinue them within two months or so following the resolution of the depression.
Some people think that going on and off ADs frequently can be destabilizing. Do you think this is an issue?
> Using anticonvulsants for sub-baseline episodes is optimal because they're effective as stabilizers too. (For example, Lamictal.)
Agreed, if it's definitely bipolar. I think that taking anticonvulsants may have bad consequences that we don't necessarily know about (I never had a seizure before I took them...), and they're less effective for depression and anxiety than ADs/benzos.
> I can't see how a psychiatrist would have difficulty distinguishing between bipolar disorder and anxiety/agitation if he's seen the patient for any length of time, though.
Me neither, but there are all these in-betweens that are getting labelled "bipolar" these days. I think it's the anticonvulsants; they seem to help with a variety of problems in addition to bipolar cycling. It's also possible that there are phenocopies, conditions that present as dysphoric or rapid-cycling mania but that are better classified as depression or anxiety. I know I'm not the only person who's been treated for putative mania which turned out not to be indicative of bipolar d/o. I'm sure you know how harmful it can be for depression to go untreated.
-elizabeth
poster:Elizabeth
thread:92727
URL: http://www.dr-bob.org/babble/20020208/msgs/94088.html