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how long does each 'episode' last.....


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#1 betcsu

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Posted 05 May 2006 - 09:08 PM

being diagnosed just in the last couple of months, im trying to reconstruct the adult years of my life looking for a pattern of some sort. my problem is, most of my life is a big blur and i dont remember much of it. i'm now looking at journal entries i started last fall to at least get a picture of the last 6 months and from there im working backwards as best i can.

i also know the beginning of when i know i first felt crazy. that was 20 years ago and i ended up in the hospital a couple of times. i dont have journal entries but i do have some writings covering about a year during that time, mostly poetry, which give me an idea of my state of mind during that period. and from this im trying to work forward as best i can.

i do know of specific times when i was without a doubt dpressed and i know of times looking back that i can say i was flying high as a kite but with some of these instances i cant quite put a beginning or an end to them.

i guess im just curious if there are supposed to be definitive starts and stops to episodes or do they sometimes just evolve. id also like to know what is an 'average' time for a period of mania and an average time for a period of depression. i know no two people or episodes are the same but for instance, can a manic period last a few months or only a few weeks or days?

im sure there are no real answers cuz like i said i know no people or epsiodes are the same but tell me for you guys, whats kind of sort of typical? just curious and thanks in advance.

Edited by betcsu, 05 May 2006 - 09:11 PM.

If I don't remember it,
it didn't happen!


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#2 ehygon

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Posted 06 May 2006 - 12:00 AM

Affective episodes are very different from person to person. Some people cycle in and out of an episode inside of a day, sometimes more than one. Sometimes your short (or long) cycle becomes something different (ie a 3 day mania suddenly as opposed to one which captures you for a month), which might help you to identify stressors in your life, and working to prevent them would definitely help.


The easiest way to get an idea of your mood cycle, is to chart. This also helps you to determine how well a medication is working, and might even provide clues to oncoming episodes, if yours are slow enough to register such differences. I started in february, and with just feb and march, i've got a pretty clear idea of how my cycle goes.

You can either do one on paper, which would be something akin to a graph (easy to find online), or there's a site, I believe it is www.moodtracker.com but I could easily be wrong, where you update online, like a journal.

#3 sepia

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Posted 06 May 2006 - 12:23 AM

I don't think that there is a "typical," especially with the move towards seeing bipolar as the "bipolar spectrum" instead of type 1 (very crazy) or type two (less crazy).

(I also don't see BPI or II as being "more" or "less" crazy. This is the interpretation I've picked up from various websites over the course of two years and the thoughts of non-BPs IRL. It is not my opinion.)

Basically, every permutation you mentioned in your post is possible. Mania can last months, even years in certain people and circumstances. Hypomania, too, can last for extended periods, as can depression of all levels and that mythical quarry of all BPs in treatment, euthymia. Some people are ultradian cyclers. (I don't think they are recognized by the DSM, owing to those minimum episode lengths given. These can be useful, as a lot of things look like hypomania for short periods which aren't, but are not universal set rules.) Others have long depressions and shorter hypomanias. There are all kinds of mixed-up crazy combinations.

I have had extended depressions over several months, and I have had extended hypomanias of up to two months. Hypomania ordinarily peters out within a week. Depression can be short-lived, but usually drags on for ages, though not for the years upon years experienced by some of my relatives. My moods are unstable enough and sufficiently circumstantially dependent for me to question my psychiatrist's opinion that they are solely due to bipolar, but I do believe bipolar is a major factor.

I had a point when I hit the "reply" button, but I seem to have lost it. One-thirty in the morning. Maybe I'll edit this into sensicality once I've had some sleep.

Informative as it can be to examine one's past for patterns, the best favor you could do for yourself would be to keep regular mood charts right NOW. There's no reason you can't do both, but drawing the face of your illness as it currently appears over time will help you recognize what's happening better than what has once happened and may never happen the same way again.

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If I can stop one heart from breaking, I shall not live in vain. --Emily Dickinson

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#4 Boz-pot

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Posted 06 May 2006 - 07:49 AM

For me, depression can last for weeks and mixed episodes for days (I'm having one at the moment). Hypomania has never lasted for more than a day and night, but it's entirely possibly for me to become manic at some point on several consecutive days. Originally, I thought my mania only lasted for a few hours or just a few minutes, however, in hind sight I think it can last for a good week, though at varying strengths throughout. Often I can go from manic, to depressed and back again within a few minutes. Sometimes this pattern continues all day - it's very tiring.

Edited by Boz-pot, 04 October 2006 - 05:32 AM.

Bipolar I
EDNOS
Mild Trichotillomania (eyelash variety)
Possible PTSD or some form of Anxiety Disorder
Chronic Imposter Syndrome


Previous Meds: Effexor, Citalopram, Prozac, Valium, Zyprexa
Current Meds: 600mg Lithium

#5 betcsu

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Posted 06 May 2006 - 09:02 AM

thanks for the replies so far. i gueess im trying to sort myself out cuz this week i will be seeing a real pdoc for the time in 10 years and then it was only to dole out pills. this time round this pdoc will be doing a real eval and trying to look at me dating back to my early hospitalizations to this last round of crazyness from last fall till now.

anyway, i just fear hes gonna ask me about stuff and all i'll have to say is 'i dont remember' or 'its all a blur' but i want to have better answers for him than that. and i guess id like to know if this or that qualifies as a manic or hypo period or not. i mean, ive had entire summers where i was non-stop everything and other times where it was only a few weeks to a month or so. ive even had times where i couldnt slow down that lasted six to nine months. i mean FLYING and i dared you to keep up - lost a ton of weight, too - i looked anorexic & i barely slept. anyway, so i was wondering, can a period of mania last THAT long?

also, ive had periods where i used a lot of alcohol & drugs, too. some were in an effort to try to slow myself down. some were used to speed me up. and yet others were used in an effort to try to keep up with myself. and now i dont even know what symtoms were drug induced and what were symtoms of something else. maybe im not bipolar or depressed but simply an addict.....

ok, im babbling now. im just nervous about my upcoming pdoc appt and like i said im afraid im gonna go in there and look like a dumb idiot who cant remember anything worth noting. besides, the meds im currently on (remeron and depakote) seems to have stabilized me pretty good so now im gonna go in there like aint nothing wrong! maybe it is/was all in my head! AAAACCCCKKKK!!!!!

If I don't remember it,
it didn't happen!


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dx: bp 1, sa, gad
current rx: am: lamictal 100mg, pm: celexa 20mg, hydroxyzine 25mg prn


#6 sepia

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Posted 06 May 2006 - 11:36 AM

Mania can last months, even years in certain people and circumstances.


For many people, mania has the built-in control of running their lives into the ground very quickly, making prolonged mania unsustainable. It becomes too obvious to miss, and eventually they are manipulated/forced into treatment, which tends to squash that mania but good. Other people have naturally shorter manic cycles. Nevertheless, it is still possible to be manic for years and evade all treatment.

I can't tell you if you were hypomanic or manic. Sometimes it's clear from someone's posts that they are describing one or the other, but in your case, it's not. I CAN tell you that episode length is not what marks the difference between one or the other. You can be manic for years. You can be hypomanic for years. They are distinguished by their severity and (officially) by the presence or absence of specific symptoms, like hallucinations, not by how long the episode lasted.



On another note, your wish to understand enough of your past history in order to be a productive participant in your psychiatric evaluation is admirable. I wish I'd had the clarity of mind to do so before my first official assessment. It might have saved me eight months of further undiagnosed misery and small personal calamities. Do your best to understand past episodes, but also do your best to not create patterns where the evidence isn't definitive. The human mind is made to make sense of things by detecting patterns all the time, but you will not be well served by inventing patterns in your illness where perhaps none exist. Learn as much as you can about the facts of your own past. Be wary of reinventing your history through solitary interpretation. It's best to work with someone "outside" for that. I hope your psychiatrist can be that someone.
If I can stop one heart from breaking, I shall not live in vain. --Emily Dickinson

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#7 Angelwhore

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Posted 06 May 2006 - 02:13 PM

My hypomanias tend to be short (days or a week or so) and my depressions long (months during my teenage years, before Ilearned to ask for help). My only mania was due to prozac, and lasted a couple of months.

In terms of mood charts, i started one a month or so ago that's different colours for different moods - seems more appropriate to me, graphs are too....clinical.

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We are
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DX: Bipolar (probably two, but that's never been specified); possible BPD
RX: 30mg Paroxetine daily; 25mg quetiapine at night, as needed

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#8 Loon-A-TiK

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Posted 06 May 2006 - 05:20 PM

I hope some of my experiences and advice can help you and other people. I'm 27 (almost 28) and have been DXed since I was 7. I went from childhood, through my puberty, and into adulthood with my disorder, and knowing I have it. I also watched my parents struggle with it, and my dad died from it. My sister spent a year in her teens institutionalized due to it.

For me personally, I have usually about 4 major moods per year. Usually I have a "nice mix" of depressions, manias, and mixed episodes thrown in there. I don't go hypo very often. Usually it is from "normal" to a little higher, and within a week I'm batshit crazy. I also have psychosis in my deep episodes, so that makes it all the more joyful.

I've noticed that even though I have major mood episodes, that doesn't mean other episodes don't sneak in and overlap kind of in a way. I can be in a depression but have a smack of mixed or mania get in there for a week or two, then it is depression again. The mixed or manic episode feels dark, so there is still depression, which is why I think those other episodes just superimpose on the underlying ones. Just my theory.

I usually have these mini-cycles about every month. It is like break-through menstral bleeding or something. Weird.

A lot of this is controllable for me by hormonal birth control. I think it can be related to PMDD. This theory comes from my childhood experience. When I was a kid, my episodes lasted for months and did not have these shorter/thinner ones over the major ones. I think these newer ones have got to be related to my adult body.
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#9 robotlove29

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Posted 07 May 2006 - 01:19 AM

As a rapid cycler, i'd say a mood lasts from a day to a few days. high on life, then down in the dumps....
been dx'ed as several things, major depressive disorder, anxiety disorder (dead on), bipolar II, shcizoaffective disorder depressive type, OCD.....but am sticking with MDD and GAD.

past meds; effexor, zoloft, prozac, seroquel, invega, rispirdal, haldol, lunesta, xanax
current meds; Lexapro, Lamictal, Klonopin

#10 Boz-pot

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Posted 10 May 2006 - 03:54 AM

I'd love to know why I have Bipolar II. I come from a naturally emotional family where all of us are prone to depression now and then, but nobody else has the same problems as me. Luckily I have been granted leave of absence from university as my life was becoming unbearable. For the last week I have had such a dreadful mixed episode that things begin to feel unreal and I get scared of inanimate objects like shop mannequins - not sure why - I know they're not alive or anything.
I have asked many people if they ever feel like I do - manic and depressed simultaneously - but they don't really understand. They can tell I'm distressed and uncomfortable and can sympathise but their 'normal' brains have never had to cope with the ambivalence I feel right now.

I did probably a very stupid thing yesterday, but I did give me a few hours respite. I was so desperate to feel somewhere near normal that I bought a couple of pep pills called 'love' which were meant to cause euphoria. Well, they didn't make me euphoric - I think I must have been too depressed to start with for that - but they made me feel calm and relaxed for the first time in weeks. I was still exhausted but it was in a pleasant restful way.

Later, of course, they wore off and I went back to my jittery state. I was meeting with friends for a last drink before I prematurely go home (yay!) on Friday. I became very high and giggly with them, which felt nice but then it turned back to a mixed state. They were really lovely to me and I'm going to miss them. I wandered round the shops to pass the time until my train came, during which time, the jittery paranoid feeling got worse. I felt like screaming or lying down in a corner of a shop (neither of which I did, luckily). It was so horrible. I've experienced all this many times before but this time it was especially bad. I think it may have been triggered off by saying goodbye to my friends as I felt lonely and lost.

I saw my GP on Monday and he was worried about me. I told him how I've been feeling recently and he thinks I need extra/different medication. I'm on 40mg of Prozac a day at the moment and even though I would be even more manic and/or jitterely depressed, I don't think it's enough. For the last few weeks it's felt like I haven't been on any medication at all. I hope my psychiatrist agrees with the GP as my illness is completely incapacitating at the moment. I'd rather be drugged up and feel capable of things than off meds and crazy.
Bipolar I
EDNOS
Mild Trichotillomania (eyelash variety)
Possible PTSD or some form of Anxiety Disorder
Chronic Imposter Syndrome


Previous Meds: Effexor, Citalopram, Prozac, Valium, Zyprexa
Current Meds: 600mg Lithium

#11 Anelize

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Posted 10 May 2006 - 06:20 AM

Like you, much of my life before diagnosis is a blur. Mostly because I'm a recovering alcoholic, and I drank my way through life since I was 11. Self-medicating my way through hypomanias mostly. I remember having some damn ugly depressions since puberty. Probably once or twice a year for a month or so at a time. I seemed to be hypomanic all the time. I went through nursing school working two 16 hour shifts and one 8 hours shift in 3 days plus going to school 5 days a week. I got about 4 hours of sleep a night, if that, after studying. Thinking back, I couldn't do that today. I remember just never needing to sleep much. Later on, when I was a nurse, I worked all kinds of extra shifts, doubling back (working 3-11, sleeping 11-7, coming back for the 7-3 shift) over and over again, and never being tired. The other nurses were ragged, and I'm just happy as a clam to be getting all that overtime, LOL.

Of course, in about 8 months, I'm taking a month off and crawling under a blanket wanting to die.

I highly recommend moodtracker.com (or whatever other method you want to use). This last year has been kind of rough on me. I seemed to start with a depression that developed around when my mother was hospitalized with side effects related to her cancer (she's doing great now), and it just sank into a full blown episode. I had a med change related to that. I've been having a fair amount of cycling ever since. I feel like it's the "kindling" effect (I'm 43). Most of my episodes are short lived (2-5 days) and I'm able to just power on through them. If they are any longer than that, I usually have enough presence of mind to get my ass to my pdoc, with my graphs.

I've only had true mania once. It diagnosed me. I switched on lexapro, while I was in the hospital for a suicidal ideation.

Good luck to you at your appointment. It sounds like you are really trying to dot your i's and cross all your t's.
"Be Here Now"
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DX:
Bipolar I, rapid cycling; GAD; Addiction (Sobriety Date: 2/4/2000); RNY Gastric Bypass 2007
Med-Go-Round: Seroquel 800mg; Effexor 300mg; Neurontin 1200mg; Topamax 300mg
Stuff that doesn't agree with me for one reason or another: Risperdal, Remeron, Zyprexa, Abilify, Geodon; SSRIs, Wellbutrin; Lamictal; Lithium; Benzos

#12 AirMarshall

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Posted 10 May 2006 - 10:42 AM

I agree that there is no standard length for them.

Do remember that studies have shown the on average Bipolars spend more time depressed than normal or elevated. And there is no way to predict what the next mood will be. Depressions don't have to follow mania, nor vice versa.

For me my hypomania/mania lasts no longer than about a week, sometimes only three days. Mixed episodes about the same. On the other hand I've most recently had depression that went on for months to several years, punctuated briefly with a higher mood.

Even a couple years before first seeking help, I had recognized a pattern of high moods about every 3 -4 months. I would be very frugal in between, then get elated and hyperfocus on buying things that I normally wouldn't buy.

A mood tracker can definitely be a help. Many people have riddled out their patterns. I'm not into minutiae and haven't been able to do a detailed one, and I'm just not that volatile a cycler to need it. But general notes on a calendar work for me.

Good luck,

a.m.

**My work is done.  Swimming for the nearest shore.**


#13 CuteButDumb

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Posted 11 May 2006 - 01:34 AM

Thanks for all the replies to this thread...I've been wondering about this a lot myself.
I was officially diagnosed nine months ago and have been rapid cycling the past year and a half and I have had manias that have lasted over a month and depressions that have been more like two weeks at a stretch. I also can go, as someone else said, from pretty much normal to batshit crazy in a matter of a week (or less) and then I'm in it with full-on delusions and when I come out of it, I too can't remember a lot of it.

The not remembering good stretches of life...that really, really sucks. I talked to my pdoc about that very thing this week, though, and she said she believes it's a defense mechanism of the brain because the realities of manias and depressions can be just too much for us to take.

#14 NARS

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Posted 11 May 2006 - 12:52 PM

Hey, Boz-pot? Get thyself to a pdoc if at all humanly possible. It seems pretty clear that if anything the prozac is just winding you up. Read the pinned posts at the top of the forum, print out your post on this thread, and hand it to the next medical provider you see. You don't have to be incapacitated.

Betcsu, have you seen the pdoc yet? My experience is that the pdoc won't ask how long you've been this or that except to establish that your moods have lasted more than a week or two. It sounds like the answer to that is pretty much absolutely.

Also, I caution you to be honest with him. Don't make believe you're something that you're not; don't minimize your episodes. He needs to know exactly how you are, right down to your inability to remember a lot of what happened.

As for how my episodes have been, well, it's been all over the place. It can be months of slowly winding up from depression through hypomania all the way to psychosis, or it can be from zero to a hundred in 6.5 seconds. Because I spend so much time in mixed states it can last forever. Depression used to linger on for months after a crash; now it generally morphs back into a hypo or mania pretty quickly.

I agree with everyone; focus on the present. Get a mood chart. Here's the one I use, a quick-and-dirty form I spend 5 minutes on every night before bed. Mass General mood chart Your pdoc will be more interested in how your moods respond to medication right now than how you would have responded years ago. Past symptoms are important, but he doesn't need a complete blow-by-blow of the past 20 years, just the highlights or lowlights.
Dx: BP II; Psychmeds: lamictal 300mg, wellbutrin xl 300mg, ambien CR (5mg), provigil 100.


You don't have to believe everything you think

#15 ncc1701

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Posted 12 May 2006 - 11:36 PM

Heya betscsu,

What they all are saying.

It's generally thrown around by the psychs that BPII, for example, spend 37 weeks depressed to every one week manic.

Which might be one reason why it's so hard to tell unipolar from bipolar.

And especially with the current ideas of mood spectrum, there can be any variation at all.

For me?

The first two mixeds I knew *for sure* lasted (1) about a week or ten days and (2) roughly a month. Mostly otherwise I've been I think dysthymic most of the time (mild depression -- that was normal for me -- a nice break from depressed or mixed) and major depressed eps roughly a few months at a time.

Alcohol always made it worse, which I see now, and when I look back I think I see shorter manias/mixed made worse when I tried to make it better with alcohol.

Now, with mood charting, there have been a couple of times (notably 3-4 days without sleep, too much socializing, taking abtibiotics that wrecked my meds) when I ramped up and up, but could *see it* in such concrete form that I could at least try to slow it down.

So.

Anyways.

I think for most people there's not a *bingbingbing* moment when we switch from manic to depressed to stable to whatever, but cycling in subtle but ominous ways, if that makes any sense.

Be up-front with your psych and help him figure it out with you.

In fact, I think (from this and your other posts) that you're well on your way to having a decent therapeutic alliance here which is great.

--ncc--
--ncc1701--

Dx: BPI with mixed episodes, social anxiety

Rx: Lamictal 300 @ 1830. Seroquel 25 @hs

Therapy: Went to the beach in a polkadot bathing suit. Once.

"Dammit, Jim, I'm a doctor, not a psychiatrist!" (ST:TOS:The City on the Edge of Forever)

#16 Boz-pot

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Posted 30 May 2006 - 03:05 PM

Hey, Boz-pot? Get thyself to a pdoc if at all humanly possible. It seems pretty clear that if anything the prozac is just winding you up. Read the pinned posts at the top of the forum, print out your post on this thread, and hand it to the next medical provider you see. You don't have to be incapacitated.

Thanks, NARS. Don't worry, I'm going on Thursday.
Bipolar I
EDNOS
Mild Trichotillomania (eyelash variety)
Possible PTSD or some form of Anxiety Disorder
Chronic Imposter Syndrome


Previous Meds: Effexor, Citalopram, Prozac, Valium, Zyprexa
Current Meds: 600mg Lithium

#17 pacanuck

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Posted 02 June 2006 - 09:58 PM

I going into a month of being hypomanic..and it's really getting to me. Thank God I see pdoc on Wed. Something has to be done - life is slowly going down the toilet. It's getting very tiring to keep my hands on these reins. And they slip from time to time. I don't want to add another med - I'm almost off the effexor (which I'm sure was making me manic) and there is no improvement. Things are just as screwed up.
sigh
Anyway -
sticking to the thread - I'm just agreeing with everyone that everything has it's own ebb and tide.
Just try to keep from drowning - now that's the trick!

RELAX...EVERYTHING IS OUT OF CONTROL......




I write down everything I want to remember. That way, instead of spending a lot of time trying to remember what it is I wrote down, I spend the time looking for the paper I wrote it down on. - Anonymous





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