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Tyri0n
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19 Feb 2013, 4:28 am

I definitely have an up and down cycle but was diagnosed with Major Depressive Disorder, recurring, not bipolar. I was wondering if you could have bipolar that isn't exactly symmetrical, with manic episodes that are mild and depressive episodes that are fairly severe. When I am in my "high" mood, I tend to be energetic and sleep less (but still make myself sleep some), also have high self-confidence, and a generally good mood. I also develop a slightly irrationally high opinion of myself, which recently caused me to break up with the girl I started dating during a depressive episode because I felt during my "manic" episode (which lasted a month) that I could do better. I've never done anything crazy like breaking the law, unprotected sex, or buying things I couldn't afford, though. I also get pretty generally angry and hostile at the world when I'm in the "up" state while, in the depressive state, I just want to be nice to everyone and wish that everyone would like me. The depressive episodes last about 2 months while the manic episodes last about a month. This has been happening since I went off SSRI's last year all the sudden without tapering off.

I have a family member with bipolar disorder, but his manic episodes are a lot more extreme. So is it possible I have some sort of bipolar disorder, or is all this consistent with recurring depressive disorder?

I don't want to get evaluated by a professional because this would involve the possibility of getting a diagnosis, which I would have to disclose to the State Bar, which could destroy my career.



Sarah81
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19 Feb 2013, 6:37 am

There are many types of bipolar disorder and what you are describing sounds like type two. In type two bipolar people experience a lot of severe depression but do not have full-blown mania. Instead they have hypomania, which is probably what you are referring to when you say mild mania.

I have type one bipolar which means I do get the full blown manias but don't perhaps spend as much time depressed. I still experience hypomania as a kind of prelude to a full blown manic episode.

I have managed my bipolar quite well these last two years and have done a lot of things, like get married and take an overseas trip. I have endured quite stressful situations which I won't go into right now just by following my management plan including sticking to my meds.

However recently I've been having difficulty coping with any kind of stress, and have been having other symptoms which are 'warning signs' an episode is coming. I thought it might be a depression. Today I had an acute assessment and they think I am in a mixed episode, with aspects of hypomania and moderate depression. They allowed me to come home only because I have a huge amount of insight and understanding about my disorder. When I first started to become ill several years ago, they wouldn't have let me come home in this state in case I did something dangerous to myself. However over the years me and my family have learned a lot about how to manage bipolar.

So, they tweaked my meds and gave me strict instructions to avoid stress and I have another outpatient appointment next week to monitor those meds.

The point I am trying to make here is, that at first I didn't realise that I was having hypomanic symptoms until they brought it up (I was talking really fast, as one example). Hypomania can be difficult to spot in yourself or even in another person, because it looks like you are just doing really well and you're really confident. You can accomplish a lot. It can be really frustrating, because other people suddenly become really stupid, and you can even get angry when it seems like they're not listening to your genius. And what you don't realise is that your judgement can be right out.

It takes a long time to get a diagnosis of bipolar disorder, they won't make the call until they actually observe you being manic or hypomanic and they're sure that that's what it is. There is a lot of overlap between the different symptoms. And if you're not aware of your hypomania, which is usually the case, you won't report it to them.

Most people with bipolar disorder can not safely take antidepressants alone without a mood stabiliser. Antidepressants can induce a manic episode. In me they actually caused an awful episode of psychosis with mixed mood features.

So, if this sounds like you then bring it up with your psychiatrist. I'm a layperson in this area so can't really diagnose you.



Sarah81
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19 Feb 2013, 6:49 am

Tyri0n wrote:

I don't want to get evaluated by a professional because this would involve the possibility of getting a diagnosis, which I would have to disclose to the State Bar, which could destroy my career.


There are many successful people with bipolar disorder. Some of these practice medicine, law.. pretty much anything goes. bipolar disorder can be managed quite successfully, but it's not easy, and you do have to consider how much stress you are going to put yourself under.

I'm not planning to return to my profession of speech pathology, but I could if I wanted to. I'm going to focus on my family life and I want to have kids. Yes I know it's genetic. So are a lot of things... but I digress. The point is I can do anything I want to but not EVERYTHING I want to.

When you say the State Bar, I assume you're going into law? Good for you. Whatever you do, try to avoid too much stress and pressure, make sure you have a good routine, and check your meds with the psychiatrist regularly. Stigma is strong in some of the more perfectionistic professions. But I can assure you that everyone has something to hide. Bipolar doesn't make you any worse at your job.

You'll have to weigh up whether you want a diagnosis or not and what realistically is the effect that will have on your career. But what I can say for sure is that UNTREATED bipolar disorder is the fastest ticket to destroying not only your career, but your finances, your reputation and standing, your friends, and any romantic prospects. I know. It happened to me. Four years of pure hell and loss after loss. However I have been able to rebuild my life again so far.

Best of luck.



Sarah81
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19 Feb 2013, 7:10 am

Disclaimer: If I'm coming across as arrogant, opinionated, over-confident, patronising... well that happens during hypomania. Cause right now, I'm on FIRE baby :)



Tyri0n
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19 Feb 2013, 12:04 pm

No, you're fine, and helpful. I'm wondering, though, how would one distinguish Bipolar II from Major Depressive Disorder, Recurring? Particularly if the manic symptoms are mild enough, and as you say they could pass for "normal" vs. depressed, what would be different about it?



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19 Feb 2013, 12:42 pm

Tyri0n wrote:
I'm wondering, though, how would one distinguish Bipolar II from Major Depressive Disorder, Recurring? Particularly if the manic symptoms are mild enough, and as you say they could pass for "normal" vs. depressed, what would be different about it?

And therein lies the problem. :wink: This is a big reason why people who think they have unipolar depression (whether they haven't recognized their hypomania periods as such, or if their first episode is a depressive one) are prescribed an SSRI and then become (hypo)manic.


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Tyri0n
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19 Feb 2013, 12:56 pm

OddDuckNash99 wrote:
Tyri0n wrote:
I'm wondering, though, how would one distinguish Bipolar II from Major Depressive Disorder, Recurring? Particularly if the manic symptoms are mild enough, and as you say they could pass for "normal" vs. depressed, what would be different about it?

And therein lies the problem. :wink: This is a big reason why people who think they have unipolar depression (whether they haven't recognized their hypomania periods as such, or if their first episode is a depressive one) are prescribed an SSRI and then become (hypo)manic.


Oh, so can SSRI's cause bipolar to develop even if one gets off them? I heard that quitting Zoloft suddenly can be "dangerous" but did it anyway about 11 months ago. I wonder if this could have caused bipolar disorder to develop.

I do feel like deliberately pissing people off, and I deliberately sabotaged my last two romantic relationships while in this non-depressed/manic mode, or whatever it is, or another interpretation is I got into a relationship with someone who wasn't suitable both times JUST because I was depressed and then became more sensible later on and fixed things. The anger I feel when in a manic mode could just be my normal that goes dormant when I'm depressed and not a manic state at all. I have no idea. I think blind rage is a natural reaction to extreme NVLD when everything that moves seems like a threat, everyone seems hostile to me even if they aren't, and my peripheral vision narrows when I'm around people, so I feel trapped and suffocated. It seems natural to react to this with anger when not depressed. Does that make it a manic episode?

How are these things ever diagnosed -- because "normal" and "manic" are both sufficiently removed from "depressed" that they could be confused with each other. Why not just define hypomanic as normal and depressed as abnormal?

Does one have to have problems sleeping during a true manic mode? If I can still sleep 7 hours or so (though it's lighter sleep for sure), is it a true manic mode?

Finally, is it possible for bipolar II to be misdiagnosed as Asperger's IF one is evaluated during the depressive stage AND one had serious social and communication diffulties in childhood for whatever reason?



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19 Feb 2013, 4:30 pm

The first question my shrink asks is" are you sleeping?"
If you are getting regular sleep you don't have mania.
There is a milder form called cyclothymia,it's milder than bi-polar II.
If you have true mania,you don't sleep much, not for days or weeks,maybe only an hour or two.Cycles vary from person to person.


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19 Feb 2013, 6:17 pm

Misslizard wrote:
The first question my shrink asks is" are you sleeping?"
If you are getting regular sleep you don't have mania.
There is a milder form called cyclothymia,it's milder than bi-polar II.
If you have true mania,you don't sleep much, not for days or weeks,maybe only an hour or two.Cycles vary from person to person.


I concur. I have cyclothymia as well as Aspergers. The opening post in this thread could easily have been written by me. Most of the time I keep off medication, but if the mood swings become too severe I take some mood stabilisers.

When I'm up I tend to either be a workoholic and/or chatty and confident, don't feel very hungry, I'm dynamic and full of fun and jokes, don't sleep well, mind racing, and often get out of bed and go work some more on my computer. When I'm down I'm withdrawn, don't communicate much, don't get much done, lack concentration, have varying degrees of pessimism and depression and eat lots. Occasionally the depressive phases plunge into full blown suicidal depression; but thankfully they are fairly rare; though suicide ideation is never far away.

One of the things that differentiates cyclothymia from bipolar is that cyclothymia often doesn't include certain key symptoms found in bipolar such as paranoia and so called "magical thinking" or hallucinations.

I'm in an up phase at the moment. I bet my posts on WP reflect the up / down phases too.

It is hard to say what triggers a switch between the up / down phases. Sometimes it seems to be circumstance driven e.g. some bad news but at other times the mood just changes for no apparent reason.

Each phase tends to last several days or even weeks. There is also a form of cyclothymia called rapid cycling where mood changes can occur several times a day in an unpredictable manner.

Cyclothymia can develop into full blown bipolar with age; but I'm hoping this doesn't happen as it is more serious and really does require medication.


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Tyri0n
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19 Feb 2013, 7:09 pm

Quote:
Each phase tends to last several days or even weeks. There is also a form of cyclothymia called rapid cycling where mood changes can occur several times a day in an unpredictable manner.


I have experienced both the weeks and months, as well as the multiple switches within a day. Once, I felt on top of the world and then 5 minutes later, I could not hold back the tears.

Your description actually sounds just like me, and it was triggered by withdrawing from 100 mg Zoloft suddenly. Do you think this could have caused brain damage triggering cyclothymia/pre-bipolar? And is there any possibility that Vitamin D deficiency could cause something like this (I didn't get sun for years, and Zoloft supposedly depletes Vitamin D on top of this)? And, if so, is there any possibility that my taking nootropic drugs (noopept) and Vitamin D would stop this disorder from occurring by repairing the damage that was done by the evil SSRI?



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19 Feb 2013, 7:57 pm

You should never abruptly stop an SSRI,taper off gradually.
The discontinuation syndrome is a b***h.It could possibly trigger some mood swings.
You can make a daily mood chart,this will help you track your highs and lows.
Make notes of anything that's you think triggers them.
It's ok to feel bad if you have a lousy day at woke or to feel joyful when good things happen.
I have no idea about the vit D,have you been tested to see if it's low?My doc checks this yearly.


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Tyri0n
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19 Feb 2013, 8:02 pm

Misslizard wrote:
You should never abruptly stop an SSRI,taper off gradually.
The discontinuation syndrome is a b***h.It could possibly trigger some mood swings.
You can make a daily mood chart,this will help you track your highs and lows.
Make notes of anything that's you think triggers them.
It's ok to feel bad if you have a lousy day at woke or to feel joyful when good things happen.
I have no idea about the vit D,have you been tested to see if it's low?My doc checks this yearly.


1. I had violent thoughts, and thoughts of harming others, so I had to stop suddenly.

2. This was 11 months ago. So this could be scary if it actually brought on pre bipolar lasting this long.

3. Yes, Vit D levels were very low. It is unlikely that they are still low, as I've been taking it for several months.



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19 Feb 2013, 8:45 pm

I hope that your doc was aware that you stopped suddenly.
Dr.Redfield's books are your best source of info on bi-polar disorder.Your local library most likely has some of her books.She is also bi-polar.


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Tyri0n
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19 Feb 2013, 10:45 pm

Misslizard wrote:
I hope that your doc was aware that you stopped suddenly.
Dr.Redfield's books are your best source of info on bi-polar disorder.Your local library most likely has some of her books.She is also bi-polar.


Yes, told me to taper, but I knew better. I really was afraid of what I was becoming. I had some strong violent urges that freaked me out.



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20 Feb 2013, 5:23 am

My only episode(perhaps -s, only one recorded) of mild hypomania (as in they weren't sure it was even hypomania, but they wound up calling it that) happened due to SSRI's. It's still bipolar disorder according to my psychiatrist, even though I seem to have no risk of hypomania as long as I'm not on antidepressives; it's been a few years since I quit them, and since then I haven't had any episodes other than depression. I'm now only taking Lamictal, and haven't had anything worse than mild depressions since I started taking it.

So yes, mild mania/hypomania is possible with bipolar disorder, and apparently (at least here) you automatically get a bipolar diagnosis if you had an episode; I asked if it wouldn't be unipolar disorder when hypomania was triggered by antidepressives, but no. Not that I bother, I can't drive a taxi or fly a plane, but then I never wanted to, anyways. The countries who don't let bipolar people immigrate (due to possible health expenses) don't let aspies immigrate either, so I'm screwed in any case. But then I wouldn't want to immigrate to a country with that kind of attitude anyways, either. I'll let some other country get my tax money instead :-)



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21 Feb 2013, 1:15 am

Pdoc treated my hypomania by increasing my lithium. The effect is as though I have run at full speed into a brick wall. I think the hypomania has stopped at least, and that I'll recover soon enough, and hopefully that will be all I'll need.