Posted by detroitpistons on March 16, 2006, at 12:33:52
In reply to Re: Never thought I'd hear this..... » detroitpistons, posted by SLS on March 14, 2006, at 13:00:10
Scott/ Link,
As you (Scott) mentioned, early onset (before the age of 25) of episodes is pretty widely accepted as a soft sign of bipolar. This was the case with me. I've read that cyclothymic and dysthymic temperament early on is also suggestive of bipolar predisposition. This describes me during my adolescence, with major depression occurring a bit later on (early twenties). Also, I've read that most bipolar II patients with early onset had several episodes of depression before ever becoming hypomanic. This also describes me. I'm not saying that I'm yet completely convinced that I have bipolar II. I found the following interesting:
BP-H AA refers to antidepressant associated hypomania.
"LIMITATION: Naturalistic study, where treatment was uncontrolled."
"BP-H AA emerges as a disorder with depressive temperamental instability, manifesting hypomania later in life (and, by definition, during pharmacotherapy only). By the standards of clinicians who have taken care of these patients for long periods of time, BP-H AA appears as no less bipolar than those with prototypical BP-II. We submit that familial bipolarity ('genotypic' bipolarity) strongly favors their inclusion within the realm of bipolar II spectrum, as a prognostically less favorable depression-prone phenotype of this disorder, and which is susceptible to destabilization under antidepressant treatment. These considerations argue for revisions of DSM-IV and ICD-10 conventions. BP-HAA may represent a genetically less penetrant expression of BP-II; phenotypically; it might provisionally be categorized as bipolar III." [Abstract]
For me, I think the most important part of this is, "By the standards of clinicians who have taken care of these patients for long periods of time, BP-H AA appears as no less bipolar than those with prototypical BP-II."
Personally, I put more stock into clinician experience, expecially when it is over long periods of time with the same patients.
Here's the abstract in it's entirety"
Akiskal HS, Hantouche EG, Allilaire JF, Sechter D, Bourgeois ML, Azorin JM, Chatenet-Duchene L, Lancrenon S.
Validating antidepressant-associated hypomania (bipolar III): a systematic comparison with spontaneous hypomania (bipolar II).
J Affect Disord. 2003 Jan;73(1-2):65-74."BACKGROUND: According to DSM-IV and ICD-10, hypomania which occurs solely during antidepressant treatment does not belong to the category of bipolar II (BP-II). METHODS: As part of the EPIDEP National Multisite French Study of 493 consecutive DSM-IV major depressive patients evaluated in at least two semi-structured interviews 1 month apart, 144 (29.2%) fulfilled the criteria for bipolar II with spontaneous hypomania (BP-II Sp), and 52 (10.5%) had hypomania associated solely with antidepressants (BP-H AA). RESULTS: BP-II Sp group had earlier age at onset, more hypomanic episodes, and higher ratings on cyclothymic and hyperthymic temperaments, and abused alcohol more often. The two groups were indistinguishable on the hypomania checklist score (12.2+/-4.0 vs. 11.4+/-4.4, respectively, P=0.25) and on rates of familial bipolarity (14.1% vs. 11.8%, respectively, P=0.68). But BP-H AA had significantly more family history of suicide, had higher ratings on depressive temperament, with greater chronicity of depression, were more likely to be admitted to the hospital for suicidal depressions, and were more likely to have psychotic features; finally, clinicians were more likely to treat them with ECT, lithium and mood stabilizing anticonvulsants. LIMITATION: Naturalistic study, where treatment was uncontrolled. CONCLUSION: BP-H AA emerges as a disorder with depressive temperamental instability, manifesting hypomania later in life (and, by definition, during pharmacotherapy only). By the standards of clinicians who have taken care of these patients for long periods of time, BP-H AA appears as no less bipolar than those with prototypical BP-II. We submit that familial bipolarity ('genotypic' bipolarity) strongly favors their inclusion within the realm of bipolar II spectrum, as a prognostically less favorable depression-prone phenotype of this disorder, and which is susceptible to destabilization under antidepressant treatment. These considerations argue for revisions of DSM-IV and ICD-10 conventions. BP-HAA may represent a genetically less penetrant expression of BP-II; phenotypically; it might provisionally be categorized as bipolar III." [Abstract]
> > > I guess you'll know soon what psychological issues remain after the depression goes into remission. Sometimes, depression leaves a real mess in its wake. Therapy can help clean it up after the depression is gone. Sometimes, "issues" mysteriously vanish once the depression is gone. I guess your doctor would like to see you biologically healthy before assessing your psychological health.
> > >
> > > With depression, things generally are not that simple. I don't think there are very many blanket statements that can be made that covers every person who suffers from it. Let's hope the Lamictal does the trick.
> > >
> > > Are you bipolar? What other drugs, if any, are you currently taking.
> > >
> > > Good luck.
> > >
> > >
> > > - Scott
> > >
> >
> > I was recently diagnosed as bipolar II after being on Effexor 225mg. I had an irritable hypomania with a lot of agitation, irritability, racing thoughts, excess energy, etc. I was sort of rapid cycling and a kind of mixed state.
> >
> > I went down to 150mg of Effexor and started the Lamictal (just went up to 200mg today). The doc wants to wait till I'm fully stabilized to think about taking me off of Effexor.
> >
> > To be honest, I'm not really sure I'm really bipolar because this hypomanic episode happened while on Effexor. But I did take Effexor once before with awesome results (maybe even some euphoric hypomania, but I can't really remember)and then it pooped out. I then tried Paxil and then Lexapro, with diminishing results.
> >
> > Late last summer, I started becoming depressed again, and saw the doc but by that time I was really spiralling down. The Effexor succeeded in pulling me up, but then a couple months later the hypomania hit me hard. I guess the fact that my depression is recurring along with the fact that SSRI's don't work for me are soft signs of bipolar, but I'm still not completely convinced of the BPII dx.
>
> I, too, have experienced mania only while taking antidepressants. That seems to be enough to qualify one as having a bipolar-spectrum disorder. For the most part, I would agree with this diagnosis.
>
> 200mg seems to be the "sweet spot" for Lamictal when it is used to treat bipolar depression. For me, Lamictal by itself is not sufficient to treat depression. It does seem to be used more often as an augmenting agent than as monotherapy. However, there have been a few postings here on Psycho-Babble by people for whom Lamictal was sufficient to bring them into remission. Interindividual biologies are so varied as to produce many different responses to the same medication. It is still difficult to predict how any one person will react to any one treatment.
>
> I am not one who believes that psychotherapy is necessary simply because one describes themselves as being depressed, especially if the depression is part of a bipolar diathesis. Some perfectly healthy people are struck with brain disorders in the absence of psychopathology.
>
> I suspect that you have been in psychotherapy long enough to have identified specific issues that need attention - if any do indeed exist. For me, I have used psychotherapy from time to time to help me deal with the effects that bipolar depression has had on my life. It has helped provide me with some tools to "undo" the damage that the biological depression has caused and continues to inflict. I seem to have very few issues that are independent of bipolar disorder. For these, I have used pschotherapy as a precision tool. However, I do believe that issues can be resolved, and not be vortices of perpetual therapeutic need. It has been my experience that during times of remission, I have not had a need for psychotherapy. I pretty much just get up, brush myself off, and start walking and talking. I have fun.
>
> It might be interesting for you to identify your psychological issues and describe them to your doctor. Perhaps he will conclude that you should go for psychotherapy. Perhaps not. Either way, you will have provided him with detail that he didn't have before from which to draw more informed conclusions as to how to approach your recovery from depression and maintenance of mental hygeine.
>
> If I were a doctor, I would never resolve to never tell anyone that they don't need psychotherapy. Some people don't.
>
> :-)
>
>
> - Scott
>
poster:detroitpistons
thread:620137
URL: http://www.dr-bob.org/babble/20060315/msgs/620942.html