Posted by Tony P on January 17, 2012, at 13:13:14
In reply to Aggitated Depression + Bipolar Different Or Same?, posted by Phillipa on January 6, 2012, at 12:00:07
I believe there's a difference, based on my experience, which can affect treatment choice. But this area of medicine is in flux and meds are pretty much trial and error so far as I can see.
My mood can swing completely in a day or even an hour from "retarded" depression to anxious, agitated depression, or even hypomania. A few years ago, my pdoc (who was strong on bipolar spectrum), decided to try me on Lamictal (mood stabiliser with moderate AD effect) at a high dose; it worked reasonably well, but not as well as other meds.
An old term for what I experience is "cyclothymia", although one (older) pdoc assured me the term is still a good one. After reading a couple of descriptions on the web, I've concluded a more up-to-date diagnosis is "atypical depression", which turns out not to be atypical at all, but the _commonest_ type when you include moderately depressed/functional people. The significant thing for me is that a minor external event, or just ruminating, can throw me into despair or rapture; I don't have any obvious cycle.
The pattern that drives me agitated that I've identified lately is that I have an outside commitment, it doesn't matter what; I'm depressed, so I have trouble getting ready - showering etc. So I try short acting meds - coffee or stimulants plus benzos - or distract myself by reading or playing on the computer. Then I start feeling guilty and anxious because I'm not preparing to go out. If I'm not coping well, I respond to the anxiety by further meds & distractions & procrastination, making me feel even more guilty and anxious as the deadline approaches, spiralling into something close to a panic attack, but still depressed underneath it.
As I say, Lamictal helped a bit, but not nearly enough. I am now on Cymbalta, Buspar & Valium plus Alertec prn; I think the medication is doing as much for me as can be expected, and it's up to me to break the pattern. I've learned, but am still having trouble putting it into practice, that the most important things are to catch the cycle _early_ before I'm a basket case, and to take baby steps -- have a shower, put my shoes on without worrying whether I'll actually make it out the door, etc.
I don't know if your friend has a similar pattern, but I'm sure if it's not an "ultra-rapid-cycling-bipolar swing" that there is one, and the same principles can apply.
In summary, although some classic bipolar people do by all accounts occasionally get into a "mixed" state, irritable & agitated, I don't really believe in "ultra-rapid-cycling-bipolar". My hunch is that most of us who experience that are "atypical" depressive; an SNRI like Cymbalta can help, but only so far. After that it's insight and behaviour modification (cognitive-behavioural counselling has helped me).
Just my 2 bits worth!
TP> Was wondering if there is a difference between aggitated depression and bipolar? Or is anxiety with depression different from a bipolar spectrum with aggitation? Asking as an old babbler is experiencing this and plus I am totally confused. Thanks Phillipa
poster:Tony P
thread:1006506
URL: http://www.dr-bob.org/babble/20120108/msgs/1007578.html