Posted by Blue Cheer 1 on February 14, 2002, at 12:20:55
In reply to Re: Puzzle » Blue Cheer 1, posted by Elizabeth on February 13, 2002, at 23:56:15
> > 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.
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> 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 know. I've never known anyone who was diagnosed as bipolar II. I know that in the lithium clinic where I was treated for 7 years, we were just plain "bipolar." I assumed everyone had at least one manic episode, but then I never asked. All these numbers after the diagnosis don't seem justified. Two helpful links: http://www.mhsource.com/bipolar/insight0128gha.html http://www.mhsource.com/bipolar/insight0126gha.html
> 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?)
You mean the time? LOL.. Yeah, you're lucky what you experienced didn't happen in the 70's or earlier. Your "agitation" might've been treated with antipsychotics.
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> > 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).
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> 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. :-}
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> > The thing to do is to treat the bipolar disorder primary, and the other disorders as they appear.
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> 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.)Yeah, that's what I meant to say -- "priority" - mood stabilization is prioritized.
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> > Comorbid conditions are associated with worsening of course (i.e., rapid cycling, severe episodes, early onset and duration).
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> 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?I was never "mixed" until I had serial high-dose trials of Prozac, Zoloft, Luvox, Paxil, Effexor, Parnate, Deprenyl, etc. - for about 4 years straight (with lithium). Then, when there was no response, the headcase psychiatrist decided to take me off lithium (after 20+ years and no consultation with my primary psychiatrist who'd been prescribing it!). Well, you know the rest of the story... anyway, that's how I became mixed. My present psychiatrist tries to tell me I'm a rapid cycler, too, but I guess he hasn't seen it defined in the DSM yet. :) Actually, he wrote it up in an admissions note when I was going to have ECT (along with about a dozen other lies - all designed to justify me *having* ECT and relieving him of liability in case things went, ahem, "wrong." I'll never forgive him for making up these lies. (He had my wife walk me over to the inpatient unit, and we stopped at the cafeteria where we both read the note. (I never would've bothered except for a parting remark he made: "Of course, if you try to sign out, they'll commit you." That was uncalled for since it was a voluntary admission, and not the kind of send-off one would expect!! He *even included* an e-mail I'd sent him the night before, in which I said I wanted ECT. From the initial consideration and discussion of ECT through the hospitalization (18 days), it was one lie after another. Finally, I refused to sign the informed consent and walked out.
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> > 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.
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> Some people think that going on and off ADs frequently can be destabilizing. Do you think this is an issue?I think so. I've taken every AD ever marketed in the U.S. and some abroad (with the exception of Serzone), and they just weird me out and agitate me. I can't tolerate them at all now. Not until I read this board did I see that I wasn't the only bipolar who'd never responded. The psychiatrist who dragged me through all the AD trials used to say that I "got side effects no one else gets," and that "you get the same ones with every drug." He made it sound as though it were *my* fault I was a non-responder. I'd like to try Dexedrine with Lamictal and Trileptal - if I get in a bad depression again. I just d/cd lithium last night (started on 1/23) because it was somehow making me depressed again. I only wanted it for its neuroprotective/neurotrophic properties, but not at the expense of worsening depression. Plus, it was causing some dyskinesias.
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> > Using anticonvulsants for sub-baseline episodes is optimal because they're effective as stabilizers too. (For example, Lamictal.)
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> 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.That's strange you had a seizure. I read about that here, I think, but it's vague. I'm concerned about their affect on cognition, and maybe the liver.
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> > 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.
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> 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.Yeah, I side with the "splitters." You're right: just as it was lithium in the 70's that uncovered so many "bipolars" (many of whom dropped out of treatment, I *know*, after discovering that they weren't really bipolar), now I think another generation is getting the BD diagnosis, in part, due to the advent of AEDs. Many psychiatrists "see" what they want to see, especially if they have a lucrative practice treating mood-disordered patients. I've been hospitalized with some people who had no depression or mood elevation, or even a history of mood problems, but when they were assigned to psychiatrists who specialized in mood disorders, they were asked all kinds of questions about mood. Even when they said that's not me, you know, they were pressed.
At least most people with bipolar disorder aren't being misdiagnosed with schizophrenia - like in the 70's and before that. I was depressed on and on for 10 years before getting a bipolar diagnosis. It's not fun going into a VA hospital for 8 months, in a severe depression, and getting dx'd as schizophrenic (sometimes by FMG's who did their residencies in OB-GYN at Bombay U. or somewhere); then getting bombarded with high-dose antipsychotics - which actually *did* make you appear to be withdrawn and schizophrenic. I spent about 3 years, off and on, in a VA hospital, misdiagnosed until a Senior Attending psychiatrist from a real psychiatric hospital happened to come to the VA as head of a university/VA hospital teaching program, and then he saw me get admitted a few times in different mood phases. It was 7 years before I was even treated with an AD - and that was when my *mother* called the treating psychiatrist, and actually had to tell her that she saw me as depressed.
Back then, in retrospect, I think you wouldn't get a manic-depressive dx unless you were maybe an ultra rapid cycler, or had clear-cut manias. I remember only one guy dx'd as manic-depressive (before lithium). You'd see him out on open ward one day, talking a mile-a-minute and multiplying 3-digit numbers in his head, super-personable, and then the next morning you'd wonder where he was -- and he was back on the locked end so bad off he had to be spoon-fed.
Blue
> -elizabeth
poster:Blue Cheer 1
thread:92727
URL: http://www.dr-bob.org/babble/20020208/msgs/94126.html