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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 detroitpistons on January 31, 2009, at 8:52:39
Hi all,
I've been struggling with the idea of a Bipolar II diagnosis for a couple years now. I have NEVER experienced any kind of euphoria, grandiosity, spending sprees, etc.
I have, however, experienced irritability, anger, and negative energy. During these times, I am more likely to experience things like road rage and I tend to speak my mind more freely (it was very difficult to keep my composure on the phone with AT&T this week!) I think the idea that hypomanias are not always pleasant has emerged in the past few years. Still, I think there are doctors out there who think that mania and hypomania need to be "fun" in order to carry that designation.
About 3 years ago, I was in a deep depression. I got out of it with a 225 mg dose of Effexor XR. Then, I started getting this negative internal energy, anxiety, irritability, a tight feeling in my chest, and a general feeling of discomfort. I was put on Lamictal, and eventually, things got better. Since then, things haven't always been rosy, but I think the Lamictal has succeeded in preventing major depressions.
I think I also have a generalized anxiety disorder which could be sort of distinct from my depression. During depressions, I have anxiety, but I also have some anxiety when not depressed. A lot of times it's situational. My mom's main problem has always been generalized anxiety with some OCD-like tendencies. She doesn't really ever get depressed or hypomanic, at least not that I can tell.
Currently, I'm still mostly OK on Lamictal and Effexor, but I've had a lot of life changes recently. I've had difficulty staying asleep lately and I think I'm feeling a touch of irritability and a little generalized anxiety. I'm going in to see the psych, right now, in fact.
One idea I'm kicking around right now is, if I am indeed bipolar II, perhaps I never experience euphoria because of my natural tendency to be anxious.
Thoughts? Anybody feel like this applies to them?
Posted by SLS on January 31, 2009, at 9:19:31
In reply to Bipolar II + Anxiety = dysphoric hypomanias?, posted by detroitpistons on January 31, 2009, at 8:52:39
Do you have racing thoughts?
Do you have a flight of ideas where one leads to another which leads to another to where it has nothing to do with the original thought?
Do you start a bunch of tasks and never get any of them done?
I think there is a possibility that your irritability and anxiety are due to unresolved depression. Perhaps 225mg is too low a dosage for Effexor. I would consider going up to 300mg.
- Scott
Posted by Phillipa on January 31, 2009, at 12:05:48
In reply to Re: Bipolar II + Anxiety = dysphoric hypomanias? » detroitpistons, posted by SLS on January 31, 2009, at 9:19:31
Well I'm not bipolar for sure. Just high anxiety which leads to some OCD to try and keep anxiety under control. Agree with Scott or maybe a different med? Love Phillipa
Posted by SLS on January 31, 2009, at 12:40:55
In reply to Re: Bipolar II + Anxiety = dysphoric hypomanias? » SLS, posted by Phillipa on January 31, 2009, at 12:05:48
> Well I'm not bipolar for sure. Just high anxiety which leads to some OCD to try and keep anxiety under control. Agree with Scott or maybe a different med? Love Phillipa
Has your doctor ever considered using a tricyclic in combination with Luvox? Elavil (amitriptyline) and Sinequan (doxepin) can be sedating and anxiolytic.
- Scott
Posted by Garnet71 on January 31, 2009, at 13:40:28
In reply to Bipolar II + Anxiety = dysphoric hypomanias?, posted by detroitpistons on January 31, 2009, at 8:52:39
Hey Detroit.
I have/had a similar situation with the depression and anxiety; laced with the irritability or impatience.
I quit taking SSRIs about 10 days or 2 weeks ago; the irritabilty has diminshed and I have not felt better in many months. Starting to feel more like myself moodwise; my inner 'sparkle' is coming back - but the anxiety has also returned; my symptoms are mostly physical though. I don't feel mental anxiety, if that makes any sense (I am not saying this isn't derived from my brain, it's just that I don't notice the anxiety until I get the breathing problems/hypoxia symptoms - then I am aware I have anxiety).
Sometimes I think I had too much seratonin in my brain - from the SSRIs (was taking Zoloft but also started Wellbutrin) - as the cause or irritability. I know Wellbutrin causes irritability in some - but it did not seem to make these symptoms worse from when on just the Zoloft. I only can guess though.
Only a month ago or so, I went to a new PDoc who prescribed me Lamictal. I can only assume he suspects I am bipolar II. He seemed to jump to a conclusion right away when I mentioned my family history (grandmother with schitzophrenia; bipolar sister; abusive father; ill brother). I can tell a lot from observing a person's body language, eyes, etc., that when speaking of the family history, he seemed to make his mind up; of course I do not know for sure..I did not know his thoughts about my treatment, despite my asking many questions, until I got home and looked into Lamictal and found out what it was prescribed for. I never got the script filled or went back to him.
In the past, I've never experienced mania either. Never had a diagnosis of Bipolar before; only suspect new PDoc thinks I have it. Of course I realize this is only 'discovered' after people have been treated for say, depression, for a number of years.
What I want to say though, aside from telling you my experience, is that if you read about Bipolar II - it seems anyone in the entire population has it. I question the diagnosis itself. Technically, you could say I am experiencing hypomania right now. Just yesterday I was thinking about this while in class. When I was joking with friends, and talking about going out and other things (things I didn't feel inclined to do just 2 weeks ago while under the influence of SSRI & Wellbutrin) - I realized my mood and behavior was just like theirs. Normal peoples'. Everything I was doing was so normal; I feel so much more like myslef. Loving music again,blasting the radio in my care- when I wasn't the least bit interested in listening to music for months on end. Irritability is diminshing too. So - a doc might say my behavior is 'hypomania' - but I say it is just being NORMAL. I compared my relapsed confidence with others', my mood, well-everything, and I think I is more 'normal' now then when not 'hypomanic'. But because I have been entangled in the mental health system - I could be said to have Bipolar II. Am I making any sense?
As for the irritabilty and impatience I have experienced in the past - when not under meds, I was under a lot of heavy, chronic stress at the time. Wouldn't that be normal? I also was rather type A- very ambitious and was accomplishing a lot at the same time. I'm not so sure that is part of an 'illness'. Of course, years of chronic stress has caused major problems - but I look back and see my reaction as normal, rather than part of "bipolar II"
Sometimes it even sounds like astrology. Look at any sun sign personality description(I am Scorpio) - and it is so easy to say "that sounds like me". That's what I think sometimes of psychiatric diagnoses - the DSM.
So-I question people being diagnosed as Bipolar II, rather than having other underlying issues or just a personality no more or less unique than any other's.
Effexor ruined my sleep quality. It also ruined my sex life at the time more than any other AD; I would never take it again, although I hear it helps some who aren't helped by other meds.
I think in general, those of us with anxiety and depression tendencies are difficult to treat. About the Bipolar II, I'm not so sure I would trust that diagnosis w/o further insight and experimentation. I think once you are seen through the psychiatry lens, rational, common sense conclusions can be missed.
Posted by SLS on January 31, 2009, at 16:52:05
In reply to Re: Bipolar II + Anxiety = dysphoric hypomanias? » detroitpistons, posted by Garnet71 on January 31, 2009, at 13:40:28
Along the bipolar spectrum lies a subtype which presents as depression only.
Mine is a form of bipolar disorder where mania occurs only as the result of drug intervention. Otherwise, I remain depressed without respite for decades.
Knowing when you are dealing with bipolar depression helps to develop treatments appropriate for that disorder. SSRIs seem to be of little use. Parnate and Wellbutrin are better choices. Effexor is ok, too.
- Scott
Posted by garnet71 on January 31, 2009, at 17:15:09
In reply to Re: Bipolar II + Anxiety = dysphoric hypomanias? » Garnet71, posted by SLS on January 31, 2009, at 16:52:05
Well thanks for the information. It would be nice if my doctor told me that rather than hand me a script and say "call me if you get a rash", despite asking numerous questions - on the initial visit (script-writing session). The same medication as shown on all the pens, calendars, and brochures in his office. Maybe the mentally ill should be seen and not heard. Or better yet, maybe we are destined to Google ourselves to death - until we die of suicide if not from the effects of the illness itself.
Posted by detroitpistons on January 31, 2009, at 20:56:27
In reply to Re: Bipolar II + Anxiety = dysphoric hypomanias? » detroitpistons, posted by SLS on January 31, 2009, at 9:19:31
I had all of those symptoms a couple years ago after starting Effexor, but not since then. I've been relatively stable on Lamictal.
> Do you have racing thoughts?
>
> Do you have a flight of ideas where one leads to another which leads to another to where it has nothing to do with the original thought?
>
> Do you start a bunch of tasks and never get any of them done?
>
> I think there is a possibility that your irritability and anxiety are due to unresolved depression. Perhaps 225mg is too low a dosage for Effexor. I would consider going up to 300mg.
>
>
> - Scott
Posted by detroitpistons on January 31, 2009, at 21:28:16
In reply to Re: Bipolar II + Anxiety = dysphoric hypomanias? » detroitpistons, posted by Garnet71 on January 31, 2009, at 13:40:28
What you are saying makes sense. Doctors don't know what our personality traits are, and it doesn't seem like they care to know. If you are naturally a fast talker, they might automatically think "mania." I sort of feel like impatience, for example, is just part of who I am...Also, could be ADD/ ADHD, but that's another thing that I'm struggling to figure out.
With my situation specifically, I did have a bad reaction after starting Effexor. There was no doubt that something was wrong. Something had to be done. My doctor treated my symptoms. He didn't slap a label on me. It looked like hypomania and he treated it that way. I actually think he handled the situation pretty well.
The question in my mind is this: Could what happened to me simply just be a bad reaction to Effexor or does it necessarily mean that I have a bipolar disorder? This is a question that is up to debate. One of the prominent researchers, can't remember his name, is of the opinion that, if antidepressants make you hypomanic or manic, then you definitely have some kind of bipolar disorder. I'm not sure what the consensus is though.
BTW, as far as too much serotonin/ anxiety, I understand Wellbutrin is a very activating drug and is probably not good for people who are prone to anxiety.
I just don't know. I go back and forth. I go from extremes of overidentifying with my condition to underidentifying with it, and so on. Sometimes I think the doctors are good, and sometimes I think they are full of sh*t. I probably overanalyze everything. Being prone to anxiety definitely complicates things.
Just to keep things in perspective, sometimes the doctors are right. Sometimes they see something in us that we don't.
Taking drugs sucks and thinking that there's something "wrong" with you also sucks. It pisses me off that I can't just have a stable life like other people I know, but I guess I just have to deal with it and make the best out of it. I had been in denial for a long time, but with each year that goes by, I get more and more convinced that I have mood disorder(s). I think I'm tired and probably just rambling now, so.....goodnight.
> Hey Detroit.
>
> I have/had a similar situation with the depression and anxiety; laced with the irritability or impatience.
>
> I quit taking SSRIs about 10 days or 2 weeks ago; the irritabilty has diminshed and I have not felt better in many months. Starting to feel more like myself moodwise; my inner 'sparkle' is coming back - but the anxiety has also returned; my symptoms are mostly physical though. I don't feel mental anxiety, if that makes any sense (I am not saying this isn't derived from my brain, it's just that I don't notice the anxiety until I get the breathing problems/hypoxia symptoms - then I am aware I have anxiety).
>
> Sometimes I think I had too much seratonin in my brain - from the SSRIs (was taking Zoloft but also started Wellbutrin) - as the cause or irritability. I know Wellbutrin causes irritability in some - but it did not seem to make these symptoms worse from when on just the Zoloft. I only can guess though.
>
> Only a month ago or so, I went to a new PDoc who prescribed me Lamictal. I can only assume he suspects I am bipolar II. He seemed to jump to a conclusion right away when I mentioned my family history (grandmother with schitzophrenia; bipolar sister; abusive father; ill brother). I can tell a lot from observing a person's body language, eyes, etc., that when speaking of the family history, he seemed to make his mind up; of course I do not know for sure..I did not know his thoughts about my treatment, despite my asking many questions, until I got home and looked into Lamictal and found out what it was prescribed for. I never got the script filled or went back to him.
>
> In the past, I've never experienced mania either. Never had a diagnosis of Bipolar before; only suspect new PDoc thinks I have it. Of course I realize this is only 'discovered' after people have been treated for say, depression, for a number of years.
>
> What I want to say though, aside from telling you my experience, is that if you read about Bipolar II - it seems anyone in the entire population has it. I question the diagnosis itself. Technically, you could say I am experiencing hypomania right now. Just yesterday I was thinking about this while in class. When I was joking with friends, and talking about going out and other things (things I didn't feel inclined to do just 2 weeks ago while under the influence of SSRI & Wellbutrin) - I realized my mood and behavior was just like theirs. Normal peoples'. Everything I was doing was so normal; I feel so much more like myslef. Loving music again,blasting the radio in my care- when I wasn't the least bit interested in listening to music for months on end. Irritability is diminshing too. So - a doc might say my behavior is 'hypomania' - but I say it is just being NORMAL. I compared my relapsed confidence with others', my mood, well-everything, and I think I is more 'normal' now then when not 'hypomanic'. But because I have been entangled in the mental health system - I could be said to have Bipolar II. Am I making any sense?
>
> As for the irritabilty and impatience I have experienced in the past - when not under meds, I was under a lot of heavy, chronic stress at the time. Wouldn't that be normal? I also was rather type A- very ambitious and was accomplishing a lot at the same time. I'm not so sure that is part of an 'illness'. Of course, years of chronic stress has caused major problems - but I look back and see my reaction as normal, rather than part of "bipolar II"
>
> Sometimes it even sounds like astrology. Look at any sun sign personality description(I am Scorpio) - and it is so easy to say "that sounds like me". That's what I think sometimes of psychiatric diagnoses - the DSM.
>
> So-I question people being diagnosed as Bipolar II, rather than having other underlying issues or just a personality no more or less unique than any other's.
>
> Effexor ruined my sleep quality. It also ruined my sex life at the time more than any other AD; I would never take it again, although I hear it helps some who aren't helped by other meds.
>
> I think in general, those of us with anxiety and depression tendencies are difficult to treat. About the Bipolar II, I'm not so sure I would trust that diagnosis w/o further insight and experimentation. I think once you are seen through the psychiatry lens, rational, common sense conclusions can be missed.
Posted by detroitpistons on January 31, 2009, at 21:35:57
In reply to Re: Bipolar II + Anxiety = dysphoric hypomanias? » SLS, posted by garnet71 on January 31, 2009, at 17:15:09
I saw a doctor for the first time today at the county mental health place (because I'm broke). He asked me if I knew the date, who the president was, the date of my birth, etc. I thought, "Well I've never been asked that, but OK." He asked me a few questions about my medication history, and asked me how much medication I had left. I told him one month. He said, we'll schedule you to come in in about a month and proceeded to try and shuffle me out. I said, "But wait, I was going to tell you about a problem." I told him I was having trouble sleeping, so he quickly wrote me a prescription for 30 x 15 mg of generic Remeron (which cost $56 at CVS - did I get ripped off?) and saw me out the door.
Oh how I long for the days when I had a job and medical insurance....
> Well thanks for the information. It would be nice if my doctor told me that rather than hand me a script and say "call me if you get a rash", despite asking numerous questions - on the initial visit (script-writing session). The same medication as shown on all the pens, calendars, and brochures in his office. Maybe the mentally ill should be seen and not heard. Or better yet, maybe we are destined to Google ourselves to death - until we die of suicide if not from the effects of the illness itself.
>
Posted by Garnet71 on January 31, 2009, at 23:55:31
In reply to Re: Bipolar II + Anxiety = dysphoric hypomanias? » garnet71, posted by detroitpistons on January 31, 2009, at 21:35:57
Hey - I want you to know that having insurance does not make for better doctors. I went 10 years w/o health insurance, and as a single mom, yes it sucked...but I've seen 4 pdocs over the years - with insurance - and they are no better. The last one I had sounds just as bad as the one you saw, from the information you provided.
The best doctors I ever had were the military doctors (gasp! government run healthcare!). That is because health care is not treated like a commodity in the military. They take the time to work with you and listen, and listen again, and actually think about the underlying cause and have no desire or need to push you out the door. I only had the opportunity to see them while on active duty away from home here. I wish I could make them my permanent doctors.
Well, if the doctor would have taken a few minutes to talk to you about your sleep problem, or I should say listen to you, you may have been able to find a medication that's on the $4 list at CVS and other stores. Grocery stores, Walmart, and some pharmacies have a list of medications for $4-all generics of course, but look at the lists online for sleep scripts. Your PDoc should have known this, working at a place for the low-income community. He should be ashamed of himself.
I am migrating over to the 'alternative' board where I belong..lol...but just wanted to tell you about the scripts.
By the way, I have an issue with calling treatment methods that don't include chemicals/ pharmaceuticals "alternative". Think about how incredibly stupid that is. Although I understand the lack of regulating the quality of supplements, etc., not the entire base of treatment but an element (although generic medications that are FDA regulated are not required to be 100% effective), I think it is an extreme disservice to mental health patients to seperate the two courses of treatment - and one of the main underlying reason for the source of the problems for many of us.
Good luck!! Come find me over at the alternative board if you want to chat in the future.
Posted by SLS on February 1, 2009, at 7:43:32
In reply to Re: Bipolar II + Anxiety = dysphoric hypomanias? » SLS, posted by detroitpistons on January 31, 2009, at 20:56:27
> I had all of those symptoms a couple years ago after starting Effexor, but not since then. I've been relatively stable on Lamictal.
It is possible that you experienced a drug-induced hypomanic episode after starting Effexor. Some would classify this as bipolar III, a relatively new diagnostic type that will be placed in the new DSM V when it is published. How was your sex-drive during this episode?Have you lost interest in previously pleasurable activities?
Is your ability to concentrate on reading impaired?
Are you fatigued or is your energy level low compared to before you were sick or when compared to the people around you?
Are you indecisive?
Do you sigh a lot?
- Scott
Posted by Phillipa on February 1, 2009, at 19:34:07
In reply to Re: Bipolar II + Anxiety = dysphoric hypomanias? » detroitpistons, posted by SLS on February 1, 2009, at 7:43:32
One week of wellbutrin at 150mg ended me up in the hospital very activating. No Overspendsing none of classic symptoms of bipolar. Took me off the med and away this high energy went. Primary diagnosis Gad new one for me. So no wonder wellbutrin is much to stimulating for me. Phillipa
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