Posted by SLS on January 2, 2005, at 10:06:21
In reply to Re: Dysthymia versus Bipolar type 2 SLS, posted by D minor on January 1, 2005, at 16:52:16
> > Hi Scott.
> >
> > It sounds to me as if you might have "double-depression", wherin major depressive episodes are superimposed upon a chronic dysthymia. Both aspects of this mixed condition are capable of producing irritability as a symptom. Dysthymia tends to be stubborn to treatment. You might want to look into trying amisulpride or perhaps even Abilify. If you use Abilify, be prepared to experience some anxiety or irritability initially.
> >
> > I don't think you have bipolar disorder. You really have to express a hypomanic episode to be eligible for this diagnosis. Episodes can last for as few as 5 days, though. Doctors seem to be quite fond of this diagnosis lately.
> >
> >
> > - Scott
> >
>
>
> Hi to both Scotts!
>
> Mr. Scott, I know how you feel about being confussed about diagnosis. I was initially diagnosed with unipolar psychotic depression. But a new doc recently diagnosed me with BP. I don't know if I believe him.
>
> The main reason for my doubt is this: I have never been "hypomanic" for more than a day at a time. I felt really "high" for a day, then really depressed for a few days with a few normal days in between for about two weeks. When I started Depakote that all stoped. So my question to SLS is, can you be hypomanic for just one day? I know the DSM says 5 days. Or does duration not matter when you're rapid cycling?
>
> Thanks,
> dm
>Some of the quantitative diagnostic criteria of the DSM are arbitrary, but are usually based on statistics. For instance, if one were to have three dramatic bipolar mood episodes per year every year, does this make him any less a rapid cycler than someone who has four? I don't know. Perhaps six is a better number. For some people with bipolar disorder, rapid cycling might only be a temporary change in the course of the illness that is perhaps limited to a phase lasting a few years.
There is an inherent contradiction between the observed and accepted existence of "ultra-rapid cyclicity" and "ultradian cyclicity" in which one can alternate between mood states every few days or even every few hours and the DMS requirement that a manic or hypomanic episode last a minimum of 4-7 days. How, then, could your mood state lasting only 24 hours disqualify you from one of these rapid cycling presentations? It can't. Be cognicant, however, that an episode is defined by some investigators as being a period of cyclicity that lasts for at least two weeks. It is this single period a rapid-cycle persists and not the cycles themselves. In other words, if you have been ultra rapid cycling for a period of time lasting more than two weeks, than you will qualify for rapid cycling if you experience more than four of these episodes per year. You can see how there is yet some confusion in the psychiatric field as to what constitutes rapid cycling.
Can you be more detailed and specific in the description of your "manic" days?
Do your manic episodes during these days reach the threshold of mania and not hypomania? Do you become psychotic or lose your ability to function at work or at home or around friends?
- Scott
poster:SLS
thread:435630
URL: http://www.dr-bob.org/babble/20041228/msgs/436739.html