![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 34. This is the beginning of the thread.
Posted by spike4848 on February 3, 2002, at 15:39:13
How can you tell the difference between severe anxiety disorder and dysphoric mania? Both have irritablity, moodiness, depression, racing thoughts. Both have increased anxiety/irritablity when starting an antidepressant. Both improve with a benzo/neurontin/depakote.
Any ideas ...
Spike
Posted by IsoM on February 3, 2002, at 17:49:43
In reply to Solve this Puzzle, posted by spike4848 on February 3, 2002, at 15:39:13
Spike, despite all the talk about soft bipolar II, unless something new comes up, I think mine is just ADHD & depression (plus little extras, but we won't go there now). I'm mentioning this because I don't *think* I know what it's like to feel dysphoric mania but I do know what you call severe anxiety disorder with depression. I never figured it was anxiety though, not the way I felt.
Link to this web-site & review the symptoms, this woman lists: http://home.att.net/~mercurial-mind/dysphoria.html
Now I'll compare how I feel myself when I'm in "severe anxiety disorder" phase.Mood - I feel exactly as she mentions
Social - again, exactly like this. I KNOW 99% of the world are idiots.
Self-Image - not so much. I get very arrogant & while I know I'm being an arrogant idiot & don't like myself acting this way, I believe I richly deserve to feel arrogant because I AM better than others.
Concentration - I can't do much. I'm just too, too distracted & agitated. I accomplish little.
Energy - my energy level is low. I feel so agitated & restless, but seem also very tired. What energy I have is powered by rage like hers, but I'm not sure my rage is her level. I can still control my rage, but it does feel much more than just anger.
Sexuality - completely unlike hers. Mine's just dead, dead, DEAD. Anyone trying to touch me then would have me blow up.
Goals - when I get feeling like this, I do nothing but waste energy here & there & nowhere. Again, unlike hers.
Food - I can't eat like this. I nibble, nothing tastes good. I lose all interest in food when depressed.
When I feel good, I sound more like someone who's slightly manic but I still don't think I'm bipolar. I do need lots of sleep still & I alwasy remember what my limits are.
Don't know if this is any help at all. Like I said, I'd have to know that I was bipolar to know what the dysphoric mania was. One more thought though, if you were dysphoric manic, wouldn't you have had to cycle to that point from euphoric mania first? Did you?
Posted by Dinah on February 3, 2002, at 18:34:55
In reply to Solve this Puzzle, posted by spike4848 on February 3, 2002, at 15:39:13
My experience is with dysphoric hypomania not mania, what I call my "little episodes". All I can tell you is that if you are in one you know it. It is the most unpleasant feeling in the world. I don't get irritable so much, except towards myself (I self injure in this mood.) I can't even begin to describe the crawling out of your skin feeling, the insomnia, the agitation, the distorted thinking, the overstimulation....
I know anxiety as well. I easily fit into a severe anxiety disorder, and have had severe anxiety all my life, I think. The hypomania didn't start until I was put on antidepressants, although stopping the antidepressants didn't stop the hypomania. Anxiety, no matter how strong, doesn't feel the same. It's terribly unpleasant as well, but in a different way.
And remember too the cycling aspect of a bipolar spectrum disorder.
Just my own experience with both.
Dinah
Posted by Dinah on February 3, 2002, at 18:38:59
In reply to I Hate Puzzles Sometime » spike4848, posted by IsoM on February 3, 2002, at 17:49:43
>
> Don't know if this is any help at all. Like I said, I'd have to know that I was bipolar to know what the dysphoric mania was. One more thought though, if you were dysphoric manic, wouldn't you have had to cycle to that point from euphoric mania first? Did you?Hi IsoM
My understanding is that it's not necessary to experience euphoria in order to be bipolar. In some people, mania is always dysphoric. I'm no expert or anything, I just think I remember reading that somewhere.
Dinah
Posted by spike4848 on February 3, 2002, at 19:56:59
In reply to I Hate Puzzles Sometime » spike4848, posted by IsoM on February 3, 2002, at 17:49:43
>One more thought though, if you were dysphoric manic, wouldn't you have had to cycle to that point from euphoric mania first? Did you?
Never manic, never hypomanic that I can recall. My Brother is bipolar ... so I always have wondered if my panic/depression is some form of bipolar disorder. The 2 pdocs that have treated me say they have never suspected bipolar illness in me, but I have read many pdoc's misdiagnose bipolar and unipolar depression. I think I have been reading Dr Phelp's Web Site too much (www.psycheducation.org). He scares me alittle. He says up to 40% of depressed patient are really bipolar .....
Spike
Posted by jazzdog on February 4, 2002, at 12:40:17
In reply to 40% of Depressed Patient's Really Bipolar? » IsoM, posted by spike4848 on February 3, 2002, at 19:56:59
For me, the difference is grandiosity. When I've been manic, or even hypomanic, I feel very powerful. Don't know if this helps -
- Jane
Posted by JohnX2 on February 4, 2002, at 21:04:35
In reply to Solve this Puzzle, posted by spike4848 on February 3, 2002, at 15:39:13
I just saw this post....need to think a bit.For starters I would say lets get away
from "labeling" people and just give them
the medicine that works. You listed the medicine
that works so the puzzle is already is solved.-John
> How can you tell the difference between severe anxiety disorder and dysphoric mania? Both have irritablity, moodiness, depression, racing thoughts. Both have increased anxiety/irritablity when starting an antidepressant. Both improve with a benzo/neurontin/depakote.
>
> Any ideas ...
>
> Spike
Posted by Jackster on February 6, 2002, at 3:35:36
In reply to Solve this Puzzle, posted by spike4848 on February 3, 2002, at 15:39:13
> How can you tell the difference between severe anxiety disorder and dysphoric mania? Both have irritablity, moodiness, depression, racing thoughts. Both have increased anxiety/irritablity when starting an antidepressant. Both improve with a benzo/neurontin/depakote.
>
> Any ideas ...Interesting - my PDoc has just prescribed
Tegretol to augment the Paxil I'm on. (For Panic Disorder) He thinks I could be slightly bi-polar - and that they think that bipolar and panic disorder could be linked.I know (when I'm not on antidepressants) that I have higher highs, and lower lows than the average person, and that I have a volcanic temper - but I've never considered myself bipolar. I've never had manic episodes either. I do have extreme anxiety when starting activating SSRI's (ie. prozac, zoloft). And I had terrible irritability starting clomipramine.
Is it possible to be slightly bipolar? Kind of strikes me as being slightly pregnant! (ie. impossible). Is it possible that tegretol will help my panic disorder?
Thanks
Jackie>
>
Posted by Ritch on February 6, 2002, at 9:55:47
In reply to Re: Solve this Puzzle » spike4848, posted by Jackster on February 6, 2002, at 3:35:36
> > How can you tell the difference between severe anxiety disorder and dysphoric mania? Both have irritablity, moodiness, depression, racing thoughts. Both have increased anxiety/irritablity when starting an antidepressant. Both improve with a benzo/neurontin/depakote.
> >
> > Any ideas ...
>
> Interesting - my PDoc has just prescribed
> Tegretol to augment the Paxil I'm on. (For Panic Disorder) He thinks I could be slightly bi-polar - and that they think that bipolar and panic disorder could be linked.
>
> I know (when I'm not on antidepressants) that I have higher highs, and lower lows than the average person, and that I have a volcanic temper - but I've never considered myself bipolar. I've never had manic episodes either. I do have extreme anxiety when starting activating SSRI's (ie. prozac, zoloft). And I had terrible irritability starting clomipramine.
>
> Is it possible to be slightly bipolar? Kind of strikes me as being slightly pregnant! (ie. impossible). Is it possible that tegretol will help my panic disorder?
>
> Thanks
> Jackie
>
> >
> >
Hi Jackie,I guess it depends on whether the *theory* that bipolar disorder is caused by seizures or "seizure-like" phenomena. There are some that believe that panic is caused by seizures or "seizure-like" phenomena (or just simply neuronal instability). Benzos have anti-convulsant properties, so some may be led to believe in the connection (between panic disorder and bipolar disorde). I have biplolar disorder and have had panic attacks. I don't have any problems with that connection at all. I must say however, that when I have a mild "mixed" affective state I don't really feel panicky (autonomic-wise..racing heartbeat, etc.), just a feeling that I am pacing around the edge of a big black pit. The panic tends to arise out of stressful situations where I have to perform perfectly or where I fear that something I have done (lose my temper) will be met with some sort of disaster. That's my connection between the bipolar and the panic. I may lose my temper and go off at someone in a hypomanic state (not depressed though-mind you), and then the anger subsides and then I worry about the consequences of what I have done-that is when the panic creeps in. Usually, my temper episodes tend to be a response to certain antidepressants, so I have to be really careful.
Mitch
Posted by Elizabeth on February 8, 2002, at 0:32:52
In reply to Solve this Puzzle, posted by spike4848 on February 3, 2002, at 15:39:13
In mania, you might see a lot of impulsivity, rage (not just irritability, but serious anger and aggression, maybe violence), delusional thoughts, psychomotor agitation (not being able to sit still, that kind of thing), feeling like you have lots of energy and can do anything, etc. Anxiety might include things like excessive worrying, jitters, and avoidance behavior.
But really, what's the difference, as long as the meds work?
-elizabeth
Posted by spike4848 on February 8, 2002, at 1:13:02
In reply to Re: puzzle??? » spike4848, posted by Elizabeth on February 8, 2002, at 0:32:52
> In mania, you might see a lot of impulsivity, rage (not just irritability, but serious anger and aggression, maybe violence), delusional thoughts, psychomotor agitation (not being able to sit still, that kind of thing), feeling like you have lots of energy and can do anything, etc. Anxiety might include things like excessive worrying, jitters, and avoidance behavior.
>
> But really, what's the difference, as long as the meds work?
>
> -elizabethCause if you give a patient an SSRI who you think has severe anxiety and it turns out they really are bipolar .... things get ulgy fast .... mania, depression, cycling, suicide, etc. It would be nice to know the difference before.
Spike
Posted by Elizabeth on February 9, 2002, at 0:18:57
In reply to Yes Puzzle! » Elizabeth, posted by spike4848 on February 8, 2002, at 1:13:02
> Cause if you give a patient an SSRI who you think has severe anxiety and it turns out they really are bipolar .... things get ulgy fast .... mania, depression, cycling, suicide, etc. It would be nice to know the difference before.
I think you should be cautious with SSRIs (and TCAs too) if you're very anxious *or* if you're bipolar. SSRIs tend to make anxiety worse (at least, at first). This is especially true in panic disorder, but also somewhat for other anxious people. Starting at a really low dose (about 5 mg of Prozac or equivalent) is safest.
-e
Posted by Blue Cheer 1 on February 10, 2002, at 0:20:02
In reply to Yes Puzzle! » Elizabeth, posted by spike4848 on February 8, 2002, at 1:13:02
> > In mania, you might see a lot of impulsivity, rage (not just irritability, but serious anger and aggression, maybe violence), delusional thoughts, psychomotor agitation (not being able to sit still, that kind of thing), feeling like you have lots of energy and can do anything, etc. Anxiety might include things like excessive worrying, jitters, and avoidance behavior.
> >
> > But really, what's the difference, as long as the meds work?
> >
> > -elizabeth
>
> Cause if you give a patient an SSRI who you think has severe anxiety and it turns out they really are bipolar .... things get ulgy fast .... mania, depression, cycling, suicide, etc. It would be nice to know the difference before.
>
> Spike
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 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). The thing to do is to treat the bipolar disorder primary, and the other disorders as they appear. Comorbid conditions are associated with worsening of course (i.e., rapid cycling, severe episodes, early onset and duration). 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. Using anticonvulsants for sub-baseline episodes is optimal because they're effective as stabilizers too. (For example, Lamictal.)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.
Blue
Posted by judy1 on February 10, 2002, at 15:37:07
In reply to Re: Yes Puzzle!, posted by Blue Cheer 1 on February 10, 2002, at 0:20:02
I have comorbid bipolar/panic and cannot take SSRI's or any AD without shooting into a manic episode even with a mood stabilizer in place. (Even got manic on lamictal) I do agree with you that a shrink should be able to distinguish bipolar and anxiety in a familiar patient. take care- judy
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
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.
>
> 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.
>
> > 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.)Yeah, that's what I meant to say -- "priority" - mood stabilization is prioritized.
>
> > 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?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.
>
> > 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?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.
>
> > 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.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.
>
> > 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.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
Posted by Mr. Scott on February 14, 2002, at 19:59:18
In reply to Re: Puzzle » Blue Cheer 1, posted by Elizabeth on February 13, 2002, at 23:56:15
"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"
What did it turn out to be if I may ask?
Scott
Posted by Blue Cheer 1 on February 16, 2002, at 7:05:23
In reply to Re: Yes Puzzle! » Blue Cheer 1, posted by anniebananie on February 15, 2002, at 23:36:35
>
> > 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.
>
> Did you read about this somewhere & if so where? I'm particularly interested in the coming-and-going aspect of these other disorders. Do you know if ADD may be one of those conditions?
>
> Annie
Well, in an effort to figure out what the heck happened to me, I read about OCD for two years or so after being diagnosed as having it (hospitalized, too), following Valium d/c. Prior to that, I'd been diagnosed as bipolar (for 20 years). The only OCD symptoms I had prior to Valium d/c (which I thought were due to lithium or psychological tension) were some transient sterotyped compulsive movements and plate scraping while eating -- like rubbing the edge of the plate with the utensil). I was trying to understand how I got from bipolar I to OCD. Then I had a manic episode, and *then* I found some articles about the comorbidity of BD and OCD. Although the literature was scant at the time (1995), I found some excellent articles (especially by Stephanie Kruger, M.D.) about comorbid bipolar and OCD, and unipolar and OCD, and that it was quite common (as high as 35% incidence in one study). If you do a PubMed Medline search for "anxiety disorders bipolar" or "bipolar comorbidity" or "comorbidity bipolar ocd", you'll find a number of articles. According to one psychiatrist I know, this is the "age of comorbidity." Mauricio Tohen, M.D. wrote a book a few years ago called Comorbidity of Affective Disorders. I see a few articles in Medline and searching Google about ADHD and bipolar, but mostly in children. I really don't know much about ADD, but I've been told that bipolar disorder can be comorbid with just about anything. Given their multi-factorial etiology, I guess the same can be said about most other psychiatric disorders.Blue
Posted by Elizabeth on February 15, 2002, at 8:56:59
In reply to Elizabeth what do you mean? » Elizabeth, posted by Mr. Scott on February 14, 2002, at 19:59:18
> "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"
>
> What did it turn out to be if I may ask?In my case, it was an agitated depression associated with Nardil poop-out. I've never had a true manic episode. Does that answer your question?
-elizabeth
Posted by Elizabeth on February 15, 2002, at 10:36:09
In reply to Re: Puzzle » Elizabeth, posted by Blue Cheer 1 on February 14, 2002, at 12:20:55
> I've never known anyone who was diagnosed as bipolar II.
That's surprising -- they're really easy to find (hard to avoid, I'd say :-} ).
> 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.
Did you get to know the other patients? Or did you all just take lithium? ("Lithium clinic" -- what a weird concept.)
> All these numbers after the diagnosis don't seem justified.
Well, I think the reason for them is to diagnose a whole lot of people who don't have manias with bipolar disorder (and therefore, to give them Depakote).
> Two helpful links: http://www.mhsource.com/bipolar/insight0128gha.html http://www.mhsource.com/bipolar/insight0126gha.html
The problem is, as Ghaemi says, that nobody knows just what counts as "hypomania." And some clinicians and researchers think that a lot of the things he classifies as bipolar NOS or "soft signs" should count as bipolar II. I'm rather at a loss to see how, e.g., atypical depression with no history of mania or hypomania (which isn't all that uncommon) could be considered bipolar.
> > (The docs never seem to care much about that aspect of mood disorders, do they?)
>
> You mean the time?Yes, the lost 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.
In fact, I did have shrinks trying to give me Zyprexa and Risperdal, not just Depakote and Lamictal. (The Risperdal, in particular, sucked.) Oh, and I once got prescribed Mellaril for insomnia. (!)
> Yeah, that's what I meant to say -- "priority" - mood stabilization is prioritized.
That makes sense, I guess, although in severe mixed states I'd wonder if perhaps eliminating suicidal ideas should fall higher on the list. Is this something that would happen naturally with "mood stabilization," do you think?
> 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).
This strikes me as paradoxical, that mixed states frequently seem to occur in response to antidepressants. Is that why there are no tricyclics on your list? TCAs seem to have a reputation for causing mixed/dysphoric mania more often than MAOIs.
> 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!).
Uh-oh.
> 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. :)
Uh, how does he justify this diagnosis?
> 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."
Well, if people weren't constantly sueing each other left and right, doctors probably wouldn't be so paranoid. But yeah, medical records always seem to be full of mistakes and/or lies. I once read a note which said "sertraline" instead of "selegiline;" imagine what problems this could cause if someone happened to take it seriously.
> 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!!
That sort of threat is an abuse of the law, IMHO. Yet doctors do it routinely.
> 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.
Did you change your mind about the ECT? Or just didn't want to entrust your life to this doctor who kept making things up about you? (Or something else?) I know how you feel; some of the things that hospital doctors do and say are just unconscionable.
> 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.
Really? *All* the tricyclics??? (What a waste.)
> 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.
They do that a lot. Really helpful, huh?
> I'd like to try Dexedrine with Lamictal and Trileptal - if I get in a bad depression again.
Hopefully you won't have to. The stimulant-anticonvulsant combo is a weird one, though; how'd you come up with that?
> I just d/cd lithium last night (started on 1/23) because it was somehow making me depressed again.
Again: uh-oh!
> I only wanted it for its neuroprotective/neurotrophic properties, but not at the expense of worsening depression. Plus, it was causing some dyskinesias.
That sucks. I've been lucky enough to avoid that (well, I've also made a point of staying away from the typical antipsychotics, except for that one time I tried using Mellaril).
> 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.
I'm not sure that the AEDs had anything to do with it, but it's one thing that could have contributed. On the other hand, I had at least one seizure when I was taking desipramine (which I wasn't metabolizing normally or something, so my serum level was on the high side).
Trileptal is ****ing expensive. I've been thinking that maybe I should switch to Tegretol. I don't know. Waffle, waffle.
> 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.
Tegretol was always here (well, it's old enough, anyway), but now the AEDs have the power of drug ads behind them.
> 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.
They didn't have any mood problems? That's kind of weird; what were they in the hospital for? Most psych disorders have *some* effect on mood, at least.
> At least most people with bipolar disorder aren't being misdiagnosed with schizophrenia - like in the 70's and before that.
I've heard it said that schizophrenia was the wastebasket diagnosis not too long ago, yeah.
> 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.
They don't help much with the depression, either. Some people say that *low*-dose antipsychotics help (even the typicals), but I didn't get much out of the DA antagonists I tried (up to 10 mg of Zyprexa).
> 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.
Really blatant and clear-cut, in other words. Whereas now, there doesn't have to be any evidence of anything resembling mania! As usual, the truth probably lies somewhere in between.
-e
Posted by Mr. Scott on February 15, 2002, at 18:50:47
In reply to putative mania » Mr. Scott, posted by Elizabeth on February 15, 2002, at 8:56:59
Yes. It answers my question, but also begs another.
Regardless of the name of the illness, do you you use Mood stabilizers to treat it?
Scott
Posted by anniebananie on February 15, 2002, at 23:36:35
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.Did you read about this somewhere & if so where? I'm particularly interested in the coming-and-going aspect of these other disorders. Do you know if ADD may be one of those conditions?
Annie
Posted by Ritch on February 16, 2002, at 0:39:30
In reply to Re: Puzzle » Elizabeth, posted by Blue Cheer 1 on February 14, 2002, at 12:20:55
> 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.
Blue,
I have been dx'ed BP since 1979 and I didn't see the differentiation on my charts until the last five years.
> 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.
My 2nd pdoc in 1980 suggested 10mg Valium 3x daily (with my lithium). At the time there was all this furor about benzodiazepines being BAD, and I *refused* it, and wound up a year later taking Thorazine 25mg once daily instead-which was a big mistake.
> 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.
Jeez, what a mess! If it wasn't for antidepressants (too high a dose or the wrong one, etc.) I never would have had a serious mixed episode.
> 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.Adderall and Neurontin whipped my seasonal bipolar depressions with small dosages. I just got uptight and panicky on the Adderall. Would like to try Neurontin+Provigil instead. Or who knows? Neurontin+Focalin (dexmethylphenidate).
> 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
My grandmother got *misdiagnosed* with paranoid schizophrenia in the mid-60's and was given ECT. She was manic-depressive just like her father (who was a travelling preacher).Thanks for those personal insights,
Mitch
Posted by Blue Cheer 1 on February 16, 2002, at 7:05:23
In reply to Re: Yes Puzzle! » Blue Cheer 1, posted by anniebananie on February 15, 2002, at 23:36:35
>
> > 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.
>
> Did you read about this somewhere & if so where? I'm particularly interested in the coming-and-going aspect of these other disorders. Do you know if ADD may be one of those conditions?
>
> Annie
Well, in an effort to figure out what the heck happened to me, I read about OCD for two years or so after being diagnosed as having it (hospitalized, too), following Valium d/c. Prior to that, I'd been diagnosed as bipolar (for 20 years). The only OCD symptoms I had prior to Valium d/c (which I thought were due to lithium or psychological tension) were some transient sterotyped compulsive movements and plate scraping while eating -- like rubbing the edge of the plate with the utensil). I was trying to understand how I got from bipolar I to OCD. Then I had a manic episode, and *then* I found some articles about the comorbidity of BD and OCD. Although the literature was scant at the time (1995), I found some excellent articles (especially by Stephanie Kruger, M.D.) about comorbid bipolar and OCD, and unipolar and OCD, and that it was quite common (as high as 35% incidence in one study). If you do a PubMed Medline search for "anxiety disorders bipolar" or "bipolar comorbidity" or "comorbidity bipolar ocd", you'll find a number of articles. According to one psychiatrist I know, this is the "age of comorbidity." Mauricio Tohen, M.D. wrote a book a few years ago called Comorbidity of Affective Disorders. I see a few articles in Medline and searching Google about ADHD and bipolar, but mostly in children. I really don't know much about ADD, but I've been told that bipolar disorder can be comorbid with just about anything. Given their multi-factorial etiology, I guess the same can be said about most other psychiatric disorders.Blue
Posted by Blue Cheer 1 on February 16, 2002, at 8:15:14
In reply to Re: Puzzle » Blue Cheer 1, posted by Ritch on February 16, 2002, at 0:39:30
> > 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.
>
> Blue,
>
> I have been dx'ed BP since 1979 and I didn't see the differentiation on my charts until the last five years.Hehe, maybe your psychiatrist was anticipating a full-blown episode to happen sooner or later. >
>
> > 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.
>
>
> My 2nd pdoc in 1980 suggested 10mg Valium 3x daily (with my lithium). At the time there was all this furor about benzodiazepines being BAD, and I *refused* it, and wound up a year later taking Thorazine 25mg once daily instead-which was a big mistake.Yeah, I'm hooked on Valium, and I have doubts that I'll ever get off it. Once I did (for about 3 months in 1990), but I was in a sertraline study for depressed lithium patients, and it was unavailable at the end of the 8 weeks. So, I switched to Prozac and made the mistake of resuming Valium when I got Prozac-induced anxiety. I don't like being on it, but it's he** getting off it. I was using 20 mg/day for the past year or so; went down to 15/d two months ago; now down to 12.5 mg/day for one week -- and I feel it.
>
>
> > 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.
>
>
> Jeez, what a mess! If it wasn't for antidepressants (too high a dose or the wrong one, etc.) I never would have had a serious mixed episode.This "mixed" dx bothers me because I think I really only had one protracted mixed episode. You're in real bad shape, according to strict DSM criteria, if you're mixed. In my case, one doctor sees me as mixed, and the other as depressed - or sometimes a little mixed.
>
>
> > 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.
>
> Adderall and Neurontin whipped my seasonal bipolar depressions with small dosages. I just got uptight and panicky on the Adderall. Would like to try Neurontin+Provigil instead. Or who knows? Neurontin+Focalin (dexmethylphenidate).Me, too. I've made up my mind. The next drug I'm taking if my depression worsens is a psychostimulant. I don't know how I'll feel using it with two AEDs and Valium, but I'm going to find out. One after another if I have to. I'd never heard of Focalin until I saw it mentioned here not long ago. I used Ritalin in 1975 (with lithium and doxepin - maybe Valium, I forget), and under the counter Dexedrine, methedrine in divided doses - both with lithium and Valium (oh, and beer). :) But I'm off lithium now, and don't drink, so I'll have to see. I don't want plain Ritalin, though (what the VA is willing to give).
>
> > 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
>
>
> My grandmother got *misdiagnosed* with paranoid schizophrenia in the mid-60's and was given ECT. She was manic-depressive just like her father (who was a travelling preacher).That's sad. I hope it helped anyway, if she had it while depressed. A manic travelling preacher sounds interesting. I think hyperthymia, at the least, is a prerequisite for that kind of work. :)
>
> Thanks for those personal insights,
>
> MitchThanks to you, too.
Blue
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