Posted by Ritch on February 1, 2003, at 10:25:54
In reply to Is bipolar II just a diagnosis of convenience?, posted by viridis on February 1, 2003, at 5:42:18
> I'm a bit skeptical about the whole "bipolar II" thing. I've known two people who are BP I (classic "manic depressive") and that's definitely for real -- drastic mood shifts from the depths of depression to periods of hyperactivity, bizarre grandiosity, etc. But from what I've seen at least, BP II seems much more loosely defined, and many people could fit this category (or spectrum), especially if one of the main criteria is a negative response to ADs that involves some degree of activation and/or dysphoria. So it seems to me that BP II is either really quite common, or else it's the latest catch-all for a variety of disorders that don't respond well to standard (or maybe just newer) ADs.
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> Certainly my symptoms could get me labelled as some flavor of bipolar -- alternating anxiety, severe depression that involves inability to eat or sleep, and periods of somewhat elevated mood that could possibly qualify as hypomania (although never full-blown mania). Plus, I react badly to SSRIs and Wellbutrin; the reactions include agitation and with some, irritability and anger. One therapist did suggest that I might be bipolar.
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> But my current psychiatrist hasn't labelled me as bipolar, although he did question me quite a lot about mood swings, and suggested early on that I seemed a bit hypomanic. At first he seemed to be leaning toward mood stabilizers such as Depakote, and I did agree to take Neurontin, which he considers an extremely mild mood stabilizer. I think he realized, once I got more comfortable with him, that my initial "pressured speech" etc. was mainly the result of anxiety, and now that I'm more accustomed to him (and benzos have calmed my anxiety) our visits are quite relaxed and even enjoyable.
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> I guess my point is that "bipolar" has the risk of becoming an easy diagnosis that shunts people toward mood stabilizers which (as I understand it) usually work more on the manic side of things. If my periods of slightly elevated mood are "hypomania", so what -- they don't do me any harm, I'm very productive, I'm not irrational, and I'm happy.
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> I agree with JohnL that pdocs should keep an open mind and try a range of meds to see what works best. Poor response to newer ADs isn't an automatic diagnosis of bipolarity. I do very well with Klonopin and Adderall (plus the Neurontin, although I don't think it's doing anything). I doubt that, if I'd been designated "bipolar" (as I suspect I could easily have been with a different doctor), stimulants would have been an option. It's not that being bipolar is necessarily a terrible thing, but I do think that a casual diagnosis of BP may limit a person's treatment options unnecessarily, and it seems like an awful lot of people are being diagnosed as BP II these days.You have some very good points. Your symptoms seem to fall in that "newer" category that you hear about lately (BP-III) or cyclothymia. When you are getting different docs with different diagnosis, then I would likely be skeptical of the BP dx as well. Mixed anxiety/depression can look very similar to a developing bipolar *mixed state*. When I first saw a psych over 20 years ago I was experiencing mixed anxiety/depression and it was intensifying to the point where I was becoming paranoid and was sleeping only 1 or 2 hrs every night. I don't know (without treatment) whether it would have crossed into a psychotic depression with delusions or a full blown bipolar mixed state or not. I have known one person that was a "classic" BP-I and it was so strange that he could take no meds (at all) for months (and have no psych symptoms to speak of) and then would just totally wigout and occasionally be hospitalized. The stuff I have is the chronic, rapid-cycling thing and I wonder if it really is a quite different illness altogether. I like the hypomanias too ;). I don't like the temperamental variant of those, however. Klonopin is often used instead of antipsychotics to bring down people that are manic (and it works quite well-at higher doses of course). I definitely agree that "what works" is more desirable than taking a med based on what the label is. Of course, the argument here is that if you don't treat it "properly" you will have "kindling" ocurring and you will be lots worse in the future. OTOH, if "what works" now is really *working*, then there shouldn't be any "kindling" happening, anyway.
poster:Ritch
thread:138453
URL: http://www.dr-bob.org/babble/20030130/msgs/138722.html