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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by D minor on April 22, 2005, at 23:16:06
I know I asked this question a while back, but things have changed a little since then. Sorry. I'm just really curious about what type of bipolar I might have. I don't think my pdoc will tell me, though I'll ask him (again) when I see him next thursday.
I looked at the mood charts I've been keeping for the past six months and came up with several patterns. About a week before a serious depression hits me, I begin to hallucinate. Then comes the terrible low, along with the hallucinations.
This time I took Cymbalta and went up, up, up. I don't think I quite hit mania, but my pdoc said "it seems like you're bearly hanging on." And that's exactly how I felt. I felt like I was loosing control. Starting to climb walls and things. Almost went to the hospital. The hallucinations stopped though.
So, what do you make of this mess? Do you think that without the increase to 600mg Seroquel and the starting Topamax I would have kept going up into full mania? Hard to tell huh? Even with the meds I've still had some bouncing around.
dm
Posted by HappyGirl on April 23, 2005, at 0:14:41
In reply to I know I've asked before but... what type Bipolar?, posted by D minor on April 22, 2005, at 23:16:06
Hi:
It's VERY HARD to say which/what type of Bipolar you have. However, if the med. combo. has a GOOD effect on your condition, ... then you have Bipolar.Besides this fact, it takes 'time' to get/feel better even on the RIGHT med. combo. In my 'own' analyzation on this, ... probably our 'whole' chemical system in the brain needs 'time' to adjust any 'foreign substances'/psycho. meds. In my case, it takes almost three to four years to get 'fully' effect. It's quite a 'long' time, ... but this is 'common' fact among Bper's. You can read others' experience which has 'similar' characteristics to yours. Unless a very milder form of Bipolar without any complications, it takes at least a year to get 'full' effect even on a right med. combo. Rapid cycler and mixed state are both regarded one of 'serious' form of Bipolar. Included Bipolar with psychotic feature.
Then, in my suggestion through the experience along with the reading/hearing, you need a 'GOOD' patience along with 'faith' on your own med. regimen rx'ed by your pdoc.
H.G.
Posted by Larry Hoover on April 23, 2005, at 9:20:21
In reply to I know I've asked before but... what type Bipolar?, posted by D minor on April 22, 2005, at 23:16:06
> I know I asked this question a while back, but things have changed a little since then. Sorry. I'm just really curious about what type of bipolar I might have. I don't think my pdoc will tell me, though I'll ask him (again) when I see him next thursday.
>
> I looked at the mood charts I've been keeping for the past six months and came up with several patterns. About a week before a serious depression hits me, I begin to hallucinate. Then comes the terrible low, along with the hallucinations.
>
> This time I took Cymbalta and went up, up, up. I don't think I quite hit mania, but my pdoc said "it seems like you're bearly hanging on." And that's exactly how I felt. I felt like I was loosing control. Starting to climb walls and things. Almost went to the hospital. The hallucinations stopped though.
>
> So, what do you make of this mess? Do you think that without the increase to 600mg Seroquel and the starting Topamax I would have kept going up into full mania? Hard to tell huh? Even with the meds I've still had some bouncing around.
>
> dmHow about "Bipolar Spectrum Disorder"?
Giving an antidepressant to a bipolar patient without a mood stabilizer to block induced mania is on the verge of medical malpractise, unless of course, the doctor doesn't think you're bipolar.
Being "switched" into mania by an antidepressant is part of the differential diagnosis for bipolar disorder. What that means is that a medication-induced manic (or hypomanic) incident cannot count towards a bipolar diagnosis. In fact, it's an exclusionary factor. Only if you have been seen to display hypomania or mania, absent any drugs, can the bipolar diagnosis be made (according to the current DSM).
There is a growing concensus, though, that the current DSM is too restrictive, and that your exact description of induced mania falls into a broader category of bipolar, which some call "Bipolar Spectrum Disorder(s)". In that new diagnostic paradigm, there are six different kinds of bipolar, not the two that exist now. And you clearly fall into at least one of those six bipolar diagnoses.
Anyway, your mood charts are a superb tool. Way to go, keeping those up.
What you described sounds a lot like psychotic depression, except the typical presentation is depression first, then psychosis.
Whatever you call what you have, it looks very much like successful treatment is going to be based on a mood stabilizer. If you're otherwise not afflicted with serious depression (at this time), getting used to a mood stabilizer is probably the best thing, and then you take a wait-and-see attitude about the need for other medications, if and when symptoms arise.
That's this guy's opinion, anyway.
Lar
Posted by Ritch on April 23, 2005, at 11:42:41
In reply to I know I've asked before but... what type Bipolar?, posted by D minor on April 22, 2005, at 23:16:06
> I know I asked this question a while back, but things have changed a little since then. Sorry. I'm just really curious about what type of bipolar I might have. I don't think my pdoc will tell me, though I'll ask him (again) when I see him next thursday.
>
> I looked at the mood charts I've been keeping for the past six months and came up with several patterns. About a week before a serious depression hits me, I begin to hallucinate. Then comes the terrible low, along with the hallucinations.
>
> This time I took Cymbalta and went up, up, up. I don't think I quite hit mania, but my pdoc said "it seems like you're bearly hanging on." And that's exactly how I felt. I felt like I was loosing control. Starting to climb walls and things. Almost went to the hospital. The hallucinations stopped though.
>
> So, what do you make of this mess? Do you think that without the increase to 600mg Seroquel and the starting Topamax I would have kept going up into full mania? Hard to tell huh? Even with the meds I've still had some bouncing around.
>
> dmIt sounds like what you've described before.. bipolar with psychotic features. That's interesting that the hallucinations only happen just before and during the depressive phases. It's kind of like you've got rapid-cycling psychotic depression with clearly drug-induced hypomania-manic symptoms. (Maybe drug-induced rapid cycling?) It sounds like Seroquel was a good pick by your doc.. overall you seem to be in a lot better shape despite the recent Cymbalta meltdown. If you can get your cycling to settle down.. then your hallucinations and depression should abate too. It would be interesting to see if the Topamax settles the cycling down. I hope things get straightened out for you. It sounds like your pdoc is getting a handle on things.-- Mitch
Posted by D minor on April 25, 2005, at 11:48:24
In reply to Re: I know I've asked before but... what type Bipolar? » D minor, posted by Larry Hoover on April 23, 2005, at 9:20:21
> How about "Bipolar Spectrum Disorder"?
>
> Giving an antidepressant to a bipolar patient without a mood stabilizer to block induced mania is on the verge of medical malpractise, unless of course, the doctor doesn't think you're bipolar.
>
> Being "switched" into mania by an antidepressant is part of the differential diagnosis for bipolar disorder. What that means is that a medication-induced manic (or hypomanic) incident cannot count towards a bipolar diagnosis. In fact, it's an exclusionary factor. Only if you have been seen to display hypomania or mania, absent any drugs, can the bipolar diagnosis be made (according to the current DSM).Ok, now I'm not sure. I did do a bit of what seemed like rapid cycling when I came of of Topamax for a while. But I was first diagnosed with major depression. Because of my migrains I was put on Topamax, so any manic symptoms may have been masked. So I really don't know what would have happened to me in the absence of any medication.
When I was put on Cymbalta I wasn't on any mood stabilizer. And my pdoc does think I'm bipolar. Is that wrong of him? It's just that I was so depressed.Thanks so much,
dm
Posted by gromit on April 27, 2005, at 2:18:21
In reply to I know I've asked before but... what type Bipolar?, posted by D minor on April 22, 2005, at 23:16:06
> I know I asked this question a while back, but things have changed a little since then. Sorry. I'm just really curious about what type of bipolar I might have. I don't think my pdoc will tell me, though I'll ask him (again) when I see him next thursday.
Are you in the US? If so you absolutely have the right to see what is in your medical records. I'm pretty sure this was part of HIPAA if it wasn't required already.
Rick
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