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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by jumpy on January 30, 2003, at 21:22:22
Hey Everyone,
After 7 years of depression and panic attacks, I still (and my docs) can't agree upon whether I have bipolar spectrum or plain depression. Anyone know any good ways to tell the difference?
Thanks
Jumpy
Posted by Ritch on January 31, 2003, at 0:25:36
In reply to Anyone hear have the bipolar II/depression mixup, posted by jumpy on January 30, 2003, at 21:22:22
> Hey Everyone,
>
> After 7 years of depression and panic attacks, I still (and my docs) can't agree upon whether I have bipolar spectrum or plain depression. Anyone know any good ways to tell the difference?
>
> Thanks
>
> Jumpy
Hypomanic/manic response to antidepressants (not just one here and there but pretty much any of them at some dosage level).
Posted by catmint on January 31, 2003, at 2:08:28
In reply to Re: Anyone hear have the bipolar II/depression mixup » jumpy, posted by Ritch on January 31, 2003, at 0:25:36
My understanding is that all depressive symptoms are commonly shared among bipolars and unipolars, but I read somewhere that bipolar depressives sleep and eat a lot! I've also heard that bipolar depression is especially deep and prolonged but I know plenty of unipolar depressed people who have it just as bad.
It is also well documented, as Ritch said in the previous post, that standard antidepressants are not effective as monotherapy for bipolars because of the risk of inducing mania.
So, if you have responded to SSRIs or Wellbutrin without becoming unglued then you probably have unipolar depression.
Posted by jumpy on January 31, 2003, at 6:00:08
In reply to Re: Anyone hear have the bipolar II/depression mixup » jumpy, posted by Ritch on January 31, 2003, at 0:25:36
> > Hey Everyone,
> >
> > After 7 years of depression and panic attacks, I still (and my docs) can't agree upon whether I have bipolar spectrum or plain depression. Anyone know any good ways to tell the difference?
> >
> > Thanks
> >What if you get worsing anxiety with antidepressants .... is that dysphoric hypomania? Desimipramine and impramine and prozac made my anxiety worse.
Thanks,
J
> > Jumpy
>
>
> Hypomanic/manic response to antidepressants (not just one here and there but pretty much any of them at some dosage level).
>
Posted by Ritch on January 31, 2003, at 9:41:54
In reply to Re: Anyone hear have the bipolar II/depression mixup » Ritch, posted by jumpy on January 31, 2003, at 6:00:08
> > > Hey Everyone,
> > >
> > > After 7 years of depression and panic attacks, I still (and my docs) can't agree upon whether I have bipolar spectrum or plain depression. Anyone know any good ways to tell the difference?
> > >
> > > Thanks
> > >
>
> What if you get worsing anxiety with antidepressants .... is that dysphoric hypomania? Desimipramine and impramine and prozac made my anxiety worse.
>
> Thanks,
>
> JProzac made me pretty wired up as well. You may just be med sensitive (watch your doses). Desipramine can be agitating to some people. You might try a sedative TCA or a sedative SSRI and see what happens, amitriptyline or Paxil. Dysphoric hypomania isn't just anxiety, it often has a lot of motor agitation/restlessness involved and often interspersed with anger/hostility episodes and angry rumination. Kind of like a feeling of "I've just had it with everything!". Instead of a bubbly happy hypomania where people are friendlier towards you and you are effecting their mood positively, people are *getting away* from you. ;)
Posted by JohnL on January 31, 2003, at 16:56:50
In reply to Anyone hear have the bipolar II/depression mixup, posted by jumpy on January 30, 2003, at 21:22:22
Though doctors are trained to draw boundary lines between symptom clusters and to give them names, and then to match certain drugs to those symptom names, from what I have seen over the years that provides limited benefit in actually getting the patient well. It provides a starting point, but that's about it. Often what happens is that a drug not really intended for the symptoms worked better than anything. We see that for example with Zyprexa as an antidepressant instead of its intended use as an antipsychotic.
After someone has already tried several meds, I think it makes a lot of sense to venture outside the immediate class of drugs and do some short term trials from other classes. For example, someone with resistant depression and anxiety might end up with a small amount of an SSRI and a small amount of Zyprexa. Or some other AP.
We know something is wrong in the brain. But we don't know what. Did SSRIs help? No? They made things numb? Then obviously boosting serotonin was not the desired tweeking. They did help, but just a little? Then maybe it will be part of a combo. The serotonin component is only part of it, there's more. Keep exploring for clues.
One patient who suffered anxiety their whole life had given up on all drugs. As a last resort, there was only one thing left, and it was lithium. The patient was totally cured in less than 24 hours with small dose lithium. Another similar case with Depakote. And Neurontin.
When treatment isn't working, and when the diagnosis is tricky, it makes sense I think to do some exploring to gather clues and find out what class of medication to spend time on. Way too often the appropriate drugs for the symptoms don't work, while other drugs do work, and so the effort at trying to label those symptoms with names is tricky and not always useful.
JohnL
> Hey Everyone,
>
> After 7 years of depression and panic attacks, I still (and my docs) can't agree upon whether I have bipolar spectrum or plain depression. Anyone know any good ways to tell the difference?
>
> Thanks
>
> Jumpy
Posted by jumpy on January 31, 2003, at 19:55:59
In reply to Re: Anyone hear have the bipolar II/depression mixup » jumpy, posted by Ritch on January 31, 2003, at 9:41:54
> Prozac made me pretty wired up as well. You may just be med sensitive (watch your doses). Desipramine can be agitating to some people. You might try a sedative TCA or a sedative SSRI and see what happens, amitriptyline or Paxil. Dysphoric hypomania isn't just anxiety, it often has a lot of motor agitation/restlessness involved and often interspersed with anger/hostility episodes and angry rumination. Kind of like a feeling of "I've just had it with everything!". Instead of a bubbly happy hypomania where people are friendlier towards you and you are effecting their mood positively, people are *getting away* from you. ;)
Hey Ritch,
Okay ... that doesn't sound like me. I just get more anxious and nervous. Thanks.
J
Posted by jumpy on January 31, 2003, at 20:11:30
In reply to Re: Anyone hear have the bipolar II/depression mixup, posted by JohnL on January 31, 2003, at 16:56:50
> When treatment isn't working, and when the diagnosis is tricky, it makes sense I think to do some exploring to gather clues and find out what class of medication to spend time on. Way too often the appropriate drugs for the symptoms don't work, while other drugs do work, and so the effort at trying to label those symptoms with names is tricky and not always useful.
>Well, this is what I have tried so far ...
Klonopin
Prozac and Klonopin
Imipramine and Klonopin
Effexor and Klonopin and Trazodon
Imipramine and Lithium and Klonopin
Nardil and Klonopin
Desipramine and Klonopin
Zoloft and Klonopin
Zoloft and Klonopin and Buspar
Zoloft and Klonopin and Desipramine
Pamelor and Klonopin
Lamictal and Klonopin
Lamictal and Nardil and Klonopin
Nardil and Klonopin and Dexadrine
Lithium and Klonopin
Depakote and Klonopin
Zoloft and Zyprexa and Klonopin
Neurontin and Klonopin
Neurontin and Selegiline and Klonopin
Neurontin and Selegiline and Klonopin and Provigil
Parnate and Klonopin
Parnate and Klonopin and Lithium
Celexa and Neurontin.... and finally ECT 2 months ago
Only the nardil, imipramine/Lithium and ECT has worked for me .... all else failed
Any Ideas???? thanks
Jumpy
Posted by CindyLou on January 31, 2003, at 20:33:54
In reply to My list of med trials » JohnL, posted by jumpy on January 31, 2003, at 20:11:30
Hi Jumpy,
I have also tried a litany of meds and med combos, and I am also confused as to whether I am bipolar or simply have unipolar depression + anxiety.All this to say, for the past few months I have had good results from Lexapro (5 mg. at night). I am normally extremely med sensitive and can't tolerate most meds that I've tried. I also take 0.5 mg. Klonapin at night to sleep, and sometimes I take 0.25 mg. during the day if I am especially anxious. The Lexapro has helped the anxiety and the depression, although I still suffer from fatigue. But I am okay with the fatigue now that my mood is so much better.
My best to you. I know it's a difficult road, and sometimes feels hopeless, but it's not -- there is so much out there. Maybe Lexapro is worth a try?
Hang in there,
-cindy
>
> Well, this is what I have tried so far ...
>
> Klonopin
> Prozac and Klonopin
> Imipramine and Klonopin
> Effexor and Klonopin and Trazodon
> Imipramine and Lithium and Klonopin
> Nardil and Klonopin
> Desipramine and Klonopin
> Zoloft and Klonopin
> Zoloft and Klonopin and Buspar
> Zoloft and Klonopin and Desipramine
> Pamelor and Klonopin
> Lamictal and Klonopin
> Lamictal and Nardil and Klonopin
> Nardil and Klonopin and Dexadrine
> Lithium and Klonopin
> Depakote and Klonopin
> Zoloft and Zyprexa and Klonopin
> Neurontin and Klonopin
> Neurontin and Selegiline and Klonopin
> Neurontin and Selegiline and Klonopin and Provigil
> Parnate and Klonopin
> Parnate and Klonopin and Lithium
> Celexa and Neurontin
>
> .... and finally ECT 2 months ago
>
> Only the nardil, imipramine/Lithium and ECT has worked for me .... all else failed
>
> Any Ideas???? thanks
>
> Jumpy
Posted by viridis on February 1, 2003, at 5:42:18
In reply to Re: Anyone hear have the bipolar II/depression mixup, posted by JohnL on January 31, 2003, at 16:56:50
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.
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.
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.
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.
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.
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.
>
> 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.
>
> 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.
>
> 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.
>
> 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.
Posted by cybercafe on February 2, 2003, at 22:09:23
In reply to Is bipolar II just a diagnosis of convenience?, posted by viridis on February 1, 2003, at 5:42:18
i strongly suspected i was bipolar in 1997
i finally convinced a doc i was bipolar in 2000i flew across the world with no planning and virtually no cash
and my doc still wouldn't diagnose me bipolar
... like, duh....ummm... i sought treatment because i mistook ADD as being an ultra-rapid cycler
took me another 2 years to get an ADD diagnosis (+bipolar II)
i have seen 6 pdocs in 6 years, and have consistently found it very hard to get diagnoses other than anxiety and depression
Posted by lostsailor on February 3, 2003, at 22:34:55
In reply to Re: Is bipolar II just a diagnosis of convenience?, posted by cybercafe on February 2, 2003, at 22:09:23
I have had only one pdoc and he too was hard pressed to diag bi-polar disorder despite my stories I had told him of my behaviors. Three years later he changed my diag from mag dep, reccurent to bpII = panic, gad and the rest.
Seems the the key factor is his visually seeing you in a manic episode. I can ask next week and see if you post to remind me. peace, ~tony
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