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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 26. This is the beginning of the thread.
Posted by undopaminergic on December 2, 2019, at 9:39:39
Hi,
I suffered from depression since the end of 1999, and I thought it was unipolar.
But in the end of 2007 and start of 2008, I had a very intense "up" episode. The flight of ideas was so intense, fast, and/or overwhelming I did not have the time to write down an idea before the next one pushed it aside. Everything was better, not only *felt* better. For example, my motor function and timing were much better than normal. My emotions were back. My empathy was better. My ADHD was better, and I could do computer programming better. My memory was better. My decision-making was fast as lightning! If there were complaints, it's that the episode didn't last longer, the emotions were a little too intense at times, and my facial skin got greasier than usual. Also, at first it was too overwhelming, so I had to calm it down a bit. 5-hydroxytryptophan turned out to be the right choice; I tried oxazepam first, without effect. Sertraline 50 mg turned out too powerfully antimanic and almost spoilt my high. There were no adverse consequences of this episode.
After that, I've had a couple or few less intense "up" episodes, that all ended with hospitalisation.
My question is how to classify the episodes. By intensity the first episode was manic, not just hypomanic, and the less intense episodes were hypomanic. By consequences, the first episode was hypomanic and the other episodes we manic, because they ended in the hospital.
How would you classify them and why?
-undopaminergic
Posted by Lamdage22 on December 2, 2019, at 11:15:32
In reply to Classifying manias, posted by undopaminergic on December 2, 2019, at 9:39:39
Was this episode triggered by meds?
Posted by undopaminergic on December 2, 2019, at 12:32:13
In reply to Re: Classifying manias, posted by Lamdage22 on December 2, 2019, at 11:15:32
> Was this episode triggered by meds?
Possibly. In that context, the prime suspect is amantadine, in combination with methylphenidate withdrawal.
With time, I lean more and more to endogenous triggers.
-undopaminergic
Posted by linkadge on December 2, 2019, at 15:20:21
In reply to Re: Classifying manias » Lamdage22, posted by undopaminergic on December 2, 2019, at 12:32:13
I think the difference could be determined by a) the degree of disruption and b) the degree of loss of judgement.
For example, hypomanics are still generally 'in control' of the situation. Judgement might be impaired a little, but not to the point that it actually detracts from performance.
Full blown mania is often accompanied by delusions or distortions regarding ones own abilities that lead to more extreme disruptions to work or home life. The loss of judgement can be exacerbated by loss of sleep. Psychosis is more common (believing you have special powers or abilities).
In talking to somebody with hypomania, they could come across as relatively normal, just super excited / high energy. This can be infectious and the individual may just seem like a natural leader. However, talking to a full blown manic, it becomes obvious fairly quickly that something is off. This could manifest as extreme irritability, or goals that are way out of line with somebody's regular ability.
Linkadge
Posted by linkadge on December 2, 2019, at 15:23:08
In reply to Classifying manias, posted by undopaminergic on December 2, 2019, at 9:39:39
Its interesting that your mania responded to 5-htp and/or sertraline.
This would not be typical as these are not usually seen as antimanic agents.
I had one doctor classify my symptoms as 'hypervigilance' rather than mania.
If I am bipolar, I can fool everybody because it's never got to the point where I can't act normal.
Linkadge
Posted by beckett2 on December 2, 2019, at 20:22:49
In reply to Classifying manias, posted by undopaminergic on December 2, 2019, at 9:39:39
> Hi,
>
> I suffered from depression since the end of 1999, and I thought it was unipolar.
>
> But in the end of 2007 and start of 2008, I had a very intense "up" episode. The flight of ideas was so intense, fast, and/or overwhelming I did not have the time to write down an idea before the next one pushed it aside. Everything was better, not only *felt* better. For example, my motor function and timing were much better than normal. My emotions were back. My empathy was better. My ADHD was better, and I could do computer programming better. My memory was better. My decision-making was fast as lightning! If there were complaints, it's that the episode didn't last longer, the emotions were a little too intense at times, and my facial skin got greasier than usual. Also, at first it was too overwhelming, so I had to calm it down a bit. 5-hydroxytryptophan turned out to be the right choice; I tried oxazepam first, without effect. Sertraline 50 mg turned out too powerfully antimanic and almost spoilt my high. There were no adverse consequences of this episode.
>
> After that, I've had a couple or few less intense "up" episodes, that all ended with hospitalisation.
>
> My question is how to classify the episodes. By intensity the first episode was manic, not just hypomanic, and the less intense episodes were hypomanic. By consequences, the first episode was hypomanic and the other episodes we manic, because they ended in the hospital.
>
> How would you classify them and why?
>
> -undopaminergic
>
I didn't know hypomania could land someone in the hospital.
Posted by Christ_empowered on December 2, 2019, at 20:23:51
In reply to Classifying manias, posted by undopaminergic on December 2, 2019, at 9:39:39
hi. zoloft--aka 'soul-off' -- seems a popular choice in the moodier depressions, bipolar ii, etc. why? i dunno. maybe its the frontal lobe taming?
i read a short paper, long time ago, in which a shrink was writing that some bipolar ii people could be 'effectively managed with ssri monotherapy,' I'm guessing because of the emotional novocaine effect (?).
Posted by undopaminergic on December 3, 2019, at 12:22:08
In reply to Re: Classifying manias, posted by linkadge on December 2, 2019, at 15:20:21
> I think the difference could be determined by a) the degree of disruption and b) the degree of loss of judgement.
>
> For example, hypomanics are still generally 'in control' of the situation. Judgement might be impaired a little, but not to the point that it actually detracts from performance.
>
> Full blown mania is often accompanied by delusions or distortions regarding ones own abilities that lead to more extreme disruptions to work or home life. The loss of judgement can be exacerbated by loss of sleep. Psychosis is more common (believing you have special powers or abilities).
>
> In talking to somebody with hypomania, they could come across as relatively normal, just super excited / high energy. This can be infectious and the individual may just seem like a natural leader. However, talking to a full blown manic, it becomes obvious fairly quickly that something is off. This could manifest as extreme irritability, or goals that are way out of line with somebody's regular ability.
>
> LinkadgeAccording to that view, the later, less intense, episodes were definitely manic. I had a number of delusions, because of losing critical thinking, and instead thinking "impulsively", such as believing ideas without evidence.
-undopaminergic
Posted by Lamdage22 on December 3, 2019, at 13:00:31
In reply to Classifying manias, posted by undopaminergic on December 2, 2019, at 9:39:39
Does it make a difference in your treatment whether or not you were full blown manic or just hypomanic?
Posted by Lamdage22 on December 3, 2019, at 13:01:10
In reply to Re: Classifying manias, posted by Lamdage22 on December 3, 2019, at 13:00:31
Were you aware that you were manic or did you think you were perfectly fine at the time?
Posted by undopaminergic on December 4, 2019, at 9:25:19
In reply to Re: Classifying manias, posted by Lamdage22 on December 3, 2019, at 13:00:31
> Does it make a difference in your treatment whether or not you were full blown manic or just hypomanic?
>You mean what medications the (hypo)mania responds to? I have far too little experience to know that.
I'm not even sure I want to treat it (because it feels so good), unless it gets overwhelming.
-undopaminergic
Posted by undopaminergic on December 4, 2019, at 9:29:20
In reply to Re: Classifying manias, posted by Lamdage22 on December 3, 2019, at 13:01:10
> Were you aware that you were manic or did you think you were perfectly fine at the time?
>I thought I was *hypo*manic. At the same time, I thought that was just fine! Until I found myself in the mental hospital without a memory of how I got there, because I had taken 90+ tablets of 2 mg clonazepam.
I actually requested oxcarbazepine from the psychiatrist, but he prescribed clonazepam!
-undopaminergic
Posted by linkadge on December 4, 2019, at 18:49:24
In reply to Re: Classifying manias, posted by undopaminergic on December 3, 2019, at 12:22:08
I am still unsure as to whether I have ADHD, bipolar or simply unipolar depression. I have taken meds for all three and USUALLY antidepressants keep me the most well.
My depressions involve undersleeping (not by choice), lots of anxiety and pessimism. I always feel pessimistic about the future. ALWAYS. There is always something wrong. This doesn't fit bipolar exactly as there are usually periods of extreme optimism about the future.
That being said, I have some behavior characteristics that don't really match unipolar. I go through periods where I can be fast and fierce in arguments (I prefer to call it 'debating'). I go through periods where I can be 'witty' (joke wise) and people tell me I should do stand up comedy. I am a good actor. I can convince everybody that I am capable and confident. Nothing is further from the truth. If you asked people about me, they'd say I have it together. There are times where I am (seemingly) much faster than those around me at gathering and articulating ideas. But (when depressed) I go through periods where I simply can't speak (finding words is like climbing mount Everest). I also have periods of extreme irritability (not in public), but I will swear (hours on end - not around others), sometimes throw things etc (again never direct towards people). I.e. I get extremely pissed off at times, but I can control it and have never had it interfere with my work.
Again, I don't really know what's going on. I drink coffee (which could perhaps be masking the depression and turning it into a anxious energy).
But again, throughout all the different 'states' (whether it be bipolar or mood lability) I am hopeless about my future. Perhaps some of the mood lability is a response to this core belief, or perhaps it somehow contributes to my life decisions and hence hopelessness.
I have turned down so many job opportunities because I feel I couldn't handle the stress with them. Every time I do this, I just feel more depressed and hopeless.
Again, I simply don't fit into one category or another. I've done all mood stabilizers (i.e. therapeutic dose of lithium or divalproex, olanzapine etc) and my life just becomes more meaningless.
Linkadge
Posted by linkadge on December 4, 2019, at 18:51:29
In reply to Re: Classifying manias, posted by Lamdage22 on December 3, 2019, at 13:00:31
>Does it make a difference in your treatment whether >or not you were full blown manic or just hypomanic?
I think it can. For hypomania (i.e. that doesn't result in hospitalization) it may not make sense to take a regular mood stabilizer. An antipsychotic (as needed) may make more sense.
I couldn't see taking lithium monotherapy for BPII, but I suppose if it works, no harm no foul.
Linkadge
Posted by linkadge on December 4, 2019, at 18:57:24
In reply to Re: Classifying manias, posted by undopaminergic on December 4, 2019, at 9:29:20
Hi,
If it was a suicide attempt then this could be a mixed state. I could be wrong, but I don't know how many suicide attempts occur during a hypomanic episode (unless it was dysphoric mania or mixed mania).
I've read that mixed states can be particularly risky suicide wise.
Analyzing what happened there is REALLY important. It may not be possible for us to accurately diagnose this (pathology doesn't always recognize pathology).
Not sure what to say. If I had a good grasp on what was happening with me, I'd help you.
Yesterday, I stopped my lithium and slept better than I have in a LONG time (no nasty morning waking). So go figure.
Posted by phidippus on December 6, 2019, at 21:22:14
In reply to Classifying manias, posted by undopaminergic on December 2, 2019, at 9:39:39
Usually you get psychotic featured with mania. Your episodes sound more like hypomania.
Posted by undopaminergic on December 9, 2019, at 3:37:32
In reply to Re: Classifying manias » undopaminergic, posted by linkadge on December 4, 2019, at 18:49:24
> I am still unsure as to whether I have ADHD, bipolar or simply unipolar depression. I have taken meds for all three and USUALLY antidepressants keep me the most well.
>
> [...]
>
> Again, I simply don't fit into one category or another. I've done all mood stabilizers (i.e. therapeutic dose of lithium or divalproex, olanzapine etc) and my life just becomes more meaningless.
>
> LinkadgeI agree that you don't fit neatly into a category. Some of your states, which all fall short of "classic" (hypo)mania, seem like they might be bipolar mixed states. Eg. you're quick-witted but pessimistic, sounds like a typical mixed episode.
-undopaminergic
Posted by undopaminergic on December 9, 2019, at 3:55:27
In reply to Re: Classifying manias » Lamdage22, posted by linkadge on December 4, 2019, at 18:51:29
> >Does it make a difference in your treatment whether >or not you were full blown manic or just hypomanic?
> >
>
> I think it can. For hypomania (i.e. that doesn't result in hospitalization) it may not make sense to take a regular mood stabilizer. An antipsychotic (as needed) may make more sense.
>"As needed" is the key phrase when it comes to antipsychotics for (hypo)mania. In my view, they are merely antimanics and generally do nothing for depression, or even aggravate it due to the dopamine blockade. Mood stabilisers are a longer term solution (than acute antimanic effect), and they require time to start working, so augmentation with an antipsychotic in the beginning may be necessary.
Sometimes atypical antimanics may be preferable. Eg. serotonergics (like SSRIs) worked for me to dampen my mania. I have even found that stimulants can stabilise me in a state that is above "normal" but below hypomania. They do not induce a switch to (hypo)mania, but on the contrary, they work as stabilisers.
Memantine, however, can produce a state that resembles (hypo)mania, including the impulsiveness. As an example of impulsiveness, on a whim, I took a massive overdose of it, partly with a suicidal intent, and I ended up in intensive care, after which I was transferred to a psych ward.
-undopaminergic
Posted by undopaminergic on December 9, 2019, at 4:07:26
In reply to Re: Classifying manias » undopaminergic, posted by linkadge on December 4, 2019, at 18:57:24
> Hi,
>
> If it was a suicide attempt then this could be a mixed state. I could be wrong, but I don't know how many suicide attempts occur during a hypomanic episode (unless it was dysphoric mania or mixed mania).
>
> I've read that mixed states can be particularly risky suicide wise.
>That is absolutely true. The depressive aspects of a mixed state lead you to want to kill yourself, while the manic aspects give you the energy to do so.
In my case, it wasn't a suicide attempt. I merely wanted to sleep for a long time (maybe a few days), but instead I did stupid things and ended up in the hospital, with no memory from how I got there.
I wanted to sleep off my rage with the help of the clonazepam. I was angry for reasons to do with a delusion, and in my rage I vandalised my apartment, before I decided on a lengthy sleep.
> Analyzing what happened there is REALLY important. It may not be possible for us to accurately diagnose this (pathology doesn't always recognize pathology).
>There are difficulties diagnosing certain states while you're in them. Eg. a paranoid psychotic episode. With manias it is easier, but you tend not to understand that there is something wrong about it -- you feel so good, so how can anything be wrong?
> Yesterday, I stopped my lithium and slept better than I have in a LONG time (no nasty morning waking). So go figure.
>I would have thought that, if anything, lithium would be good for sleep.
-undopaminergic
Posted by undopaminergic on December 9, 2019, at 7:01:15
In reply to Re: Classifying manias, posted by phidippus on December 6, 2019, at 21:22:14
> Usually you get psychotic featured with mania. Your episodes sound more like hypomania.
>Except for the first episode, I got certain delusions (ie. an aspect of psychosis) that resulted from impulsive (uncritical) thinking.
-undopaminergic
Posted by linkadge on December 10, 2019, at 15:03:36
In reply to Re: Classifying manias » linkadge, posted by undopaminergic on December 9, 2019, at 4:07:26
>I would have thought that, if anything, lithium >would be good for sleep.
Lithium is strange for me. I've been off it for several days now and actually feel quite a bit more 'stable'.
Perhaps I was experiencing more akathisia (some antidopaminergic effect)? I'm not sure.
I've had this pattern before where it helps for weeks / months then bam I have very strange symptoms that only respond to discontinuation of lithium.
Linkadge
Posted by phidippus on December 10, 2019, at 16:11:34
In reply to Re: Classifying manias » phidippus, posted by undopaminergic on December 9, 2019, at 7:01:15
"uncritical" thinking?
Do you mean flight of ideas or intrusive thoughts?
Posted by undopaminergic on December 11, 2019, at 8:53:18
In reply to Re: Classifying manias » undopaminergic, posted by phidippus on December 10, 2019, at 16:11:34
> "uncritical" thinking?
>
> Do you mean flight of ideas or intrusive thoughts?
>I mean that you think impulsively, credulously, without judgement. That is, you don't think "soberly". You start believing in ideas on a whim, without having examined them rationally.
-undopaminergic
Posted by linkadge on December 17, 2019, at 17:41:36
In reply to Re: Classifying manias » linkadge, posted by undopaminergic on December 9, 2019, at 3:37:32
>I agree that you don't fit neatly into a category. >Some of your states, which all fall short of >"classic" (hypo)mania, seem like they might be >bipolar mixed states. Eg. you're quick-witted but >pessimistic, sounds like a typical mixed episode.
Thanks for the feedback. There are times where my vocabulary is excellent. I will dance circles around people in conversations. Then all of a sudden boom, I can barely string together a sentence. However, even when I'm outwardly 'optimistic' I feel its just a reaction to a deep seated feeling of hopelessness.
Linkadge
Posted by linkadge on December 17, 2019, at 17:43:31
In reply to Re: Classifying manias, posted by undopaminergic on December 9, 2019, at 3:55:27
>Sometimes atypical antimanics may be preferable. >Eg. serotonergics (like SSRIs) worked for me to >dampen my mania. I have even found that stimulants >can stabilise me in a state that is above "normal" >but below hypomania. They do not induce a switch to >(hypo)mania, but on the contrary, they work as >stabilisers.
Interesting. I'm the same way. Sometimes I can take Ritalin at night and it improves my sleep. Venlafaxine can be a mood stabilizer for me (sometimes leaving me more 'flat' than lithium).
Linkadge
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