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Not quite sure if it's major depression or bipolar

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OK, this is one of probably a few thousand "here's my symptoms what do you guys think" topics on this forum.  Sorry, I just keep thinking about this too much and would like to see what people with first hand experience think.

My current diagnosis is major depressive disorder, and the depression is indeed major.  No doubt.  Started at age 15 and lasted on and off for about 7-8 years, then oddly went away for about 12 years.  It came back a year and a half ago (at age 37) with a vengence.  Like I was hit by a truck.  In two months I went from loving life to abusing drugs daily to relieve the mental pain (I had never even tried an illicit drug before then) and had decided to end my life.  My suicide was all planned but I started having suicidal impulses I couldn't control and was able to finally get help (this is the first time I had ever sought treatment for mental health).

In the last year and a half meds and therapy have been working well.  During the last few months I have had fairly regular cycles of depression.  I'll be "normal" for about three weeks and then have about a week of depression.  It's nice knowing that when it hits, it will likely be gone in a week.

Here's what got interesting.  About two months ago, I was day three into a depression cycle and it was probably the worst day of depression EVER.  I wrote a suicide note and decided that night I was going to do it.  But at about 4pm, over the course of about an hour, I went from that to a very heightened elated state.  Just like that.  The heightened state was nothing like I had ever experienced.  I felt amped up, like having constant adrenaline.  I loved on my family more and did all sorts of projects and built things.  I was on top of the world, and it felt great!  It lasted for four days, and then I went back to "normal."  Bummer.  A few weeks later, it happened again for five days, but it wasn't as pronounced.  But I could definitely tell when it hit.  Hard to describe, something between anxiousness and adrenaline.  It wasn't too extreme, but very distinct.  Both times I felt it immediately when it came.  Both times it ended when I woke up the next day and the feeling was gone.

I did not have trouble sleeping at all (but I am on a med that makes me sleepy).  I figeted a lot (moved my fingers, bounced my legs, etc.).  I talked maybe a little more than normal.  I did go on a spending spree the second time, but I was due for new clothes anyway (maybe not the $300 boots though...).  I just think that outwardly I didn't seem that off, but my wife did notice a difference the first time it happened.  I read stories about hypomania, and I wonder if that's really what happended to me.  I didn't experience symptoms as extreme as most people seem to experience.

Also note:  meds are wellbutrin, remeron, and depakote (started two weeks before the first "up" episode).

So the million dollar question is... bipolar II?  I'm seeing my pdoc in a couple weeks.  I just don't want to go in all self-diagnosed and look like a fool.  My wife thinks I'm overreacting a bit.  I don't want to be bipolar... well, I don't want to be manic.  If what I had was hypomania, I'm fine with that.  It was great!  My concern is that if I'm bipolar, I need to know so I get proper treatment to prevent a manic episode in the future.  Maybe the two "up" periods are all I will ever have.  Or maybe they weren't really up at all, and were just good moods.

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Sounds like a textbook case of "just worry about giving the doc the whole picture and let him make the Dx" there can be some grey area there...it's so much better to treat the symptoms and let the Dx fall into place. That said there is something called BP NOS- or even MOOD D/o NOS- which opens up more options treatment wise without pigeonholing too much 

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Seconding @Iceberg

lay it all out. Have the pdoc treat the symptoms. Labels are just loose associations. Tons of grey areas in psychiatry 

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I actually think you may be on to something with the BP 2 question.  If  you're depressed and then clearly switching almost instantly to elated with energy, even if you're anxious, that's a big clue.  To simplify things, I call depression being "down" and anything else being "up" due to the distinct change in energy level.  You definitely sound like you're making a quick switch from down to up and that's indicating something for sure.  Mania is a loose label that you'll have really research yourself if you want to understand it at all.  Hypomania is like mania-lite and usually, but not always, feels pretty good. 

The recent switch to Depakote coinciding with your new experiences is another clue.  New or change in meds can cause a flip in bipolar people.  Though I didn't even know I was bipolar then, I went full-blown hypomanic in early 2015 coinciding exactly with a switch from Lexapro to Zoloft.  It was totally euphoric and lasted just over a month.  I never went full manic, thankfully, but the feeling was overwhelming and just awesome until it finally fizzled out.  I recall experiencing at least 2 more similar, but shorter and less intense episodes like that early that summer.  My "ups" lately have been definitely on the hypomanic/ manic side with lots of energy but not so much euphoria.  Again, psych terms are often loose labels as the other poster pointed out.  It really is crucial to understand these things yourself. 

And your doctors may or may not make the correct call based on your description.  I had that experience with 2 different pdocs and, as a result, needlessly suffered 2 more years not understanding I was actually bipolar.  I described, in good detail, that CLASSIC episode of hypomania in 2015 to both of them and they completely missed it.  They both said the same thing: "I don't know but wouldn't it be great to feel like that all the time?"  Yeah, no shit!  It would be great.  But it's not normal and yet it went right over their heads.  My last pdoc completely missed that I was experiencing sometimes very intense mixed states even though I clearly described them to her. 

Doctors are not nearly as smart as we, and they, think they are most times.  We have to be informed ourselves which means we have to learn to navigate all the info on the web and wade through the b.s. to get to the correct information.  It takes time but it's possible.  I found out one of the best places to get knowledge on MI's is these types of online forums.  Everybody is so different, so you have to read a lot of experiences.  But you'll start to see lots of similarities in some and that will help lead you in the right direction.

Apologies for the long post.  I do that.  I'm also hypomanic right now, for the last 3 weeks or so.

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Thanks for the post, Distorted Me.  I went to my pdoc and he said it was likely hypomania.  He also said, "it feels great and we all wish we could be like that."  Yeah, true, it feels great.  But the first time it happened after a few days my body just about gave out from all the physical going and doing.  He said I have what he would call, "atypical depression," since my cycles and swings are a bit unusual.  I asked him if I was BP2, and he said that he usually stays away from labels and considers it to be a spectrum, with BP1 on one end and just depression on the other.  He said that based on the common definition of BP2 I would fit that diagnosis.  He said that some researcher has tried to break bipolar down into 27 types, which is ridiculous.  So he is ok with the label of "bipolar" for those who experience true mania, and for others he just says you are on the spectrum.

I asked if there was a risk of me developing full blown mania, and he said it's highly unlikely since it rarely first presents itself this late in life (age 38).

I told him the Depakote didn't do anything and it is horse pills I didn't like taking.  He suggested Lamictal, so I've started on that.  He also mentioned that not having a mood stabilizer with my antidepressant might trigger hypomania.  I won't lie, after taking Depakote for two months and it not doing anything (both times I went hypo I was on it), I stopped in hopes that I would be hypo again.  People with MI have all sorts of crazy rationalizations for stopping meds from time to time.

The last several weeks have been amazing.  I've been "normal," not up or down.  I feel good.  It's a bit scary because I typically have regular cycles of depression and I'm way overdue.  But then again, I'm on a new med and the weather is great.

Oh, and this is from a fellow Tennessean.  Go Tigers.

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Patents, I glad to hear you're doing well on this mix of meds. That's very good news.  It can take so long for some people to find a combo that works for them.  I'm disappointed your pdoc didn't have the nads to come out and say yeah you are probably BP2 and start treating you as such.  Your meds he has you on now are the same as for BP 2.  And your description of that first experience is like textbook.  I felt the same way in 2015 which is why I remember it so clearly.  It was like I had the super happy, I love everyone and everything, awesome energy drug directly into my veins for a month.  Fucking unreal! 

It even sounds like you were very close to hitting mania, but thankfully you didn't, another reason to be confident in BP 2 and not BP 1.  When you say you felt worn out from expending all of that energy, and if you didn't hallucinate or start calling yourself Jesus, you capped out, if you will, in the hypomanic range.  In that 2015 big time hypomanic episode, I was dangerously close to entering the mania realm. I'm sure I was extremely close but I capped out almost exactly the same way.  I'm not sure if your pdoc was even listening to what you were saying.  Goddamn those fucking docs make me so mad sometimes!

I just noticed you're on 150 mg of Bupropion and now starting Lamictal.  I'm at 100 mg Lamictal and it's been good for me, the best of any of the 6 meds I've tried so far.  I can't wait to get to full dosage to see what it's really like.  I just stopped taking the Bupropion though because it's clearly activating in me.  My temper has always been noticeably worse when I'm on it even though I have 10x more motivation. But that could very well be what's keeping you from being so depressed actually.  I definitely get depressed less often on it, and I really noticed that this time around (I've taken it off and on for 8 years).  I also suspect it's kept me 'up' a lot longer than normal - like not quite hypomanic, but very close and clearly jumping just over the line every few days.  Bupropion definitely amps me up a little bit.  If it weren't for the temper issue, which is already bad in me, I'd take it forever.  And I've done a few things to try to get hypo again myself.  Not smart but I'd kill to get that euphoria back.  It's actually helped me get sober and stay off drugs for good.  I know there's no drug out there that even comes close to some good old fashioned hypomania.  Not even close. I've read Sam-e can do that and have considered it but I think I should just stay away.

Listen man, if you ever start feeling you're getting anywhere near as depressed as you were before, PLEASE reach out for help.  Suicide is no answer.  We've all thought about it many times but you're going to hurt so many people.   You don't want to do that, I know you don't.  It's the chemicals in your brain making you feel that way - they're evil and it's not real so don't make it real by doing anything stupid.  You have a million reasons to live and now you know first-hand how effective medication can be.  If you ever, ever feel that way again, call someone right away or just go to bed and think about it in the morning.  Please. If you can't get yourself to call anyone or do anything else, drive your butt to the ER in your area.  Don't think about it, just do it.  They will be happy to help you.  Or do what I did. Just take it off the table - remove it as a possibility in your life and stop thinking about it completely.  Hell you can even start researching for better ways to purposely get hypo, then share them with us.  You know how good hypomania can be.  I love it so much I'm actually glad I'm BP.  That's sick right?  Oh well, I'm a fucked up individual anyway. 

Go Tigers, eh?  You must be out in Memphis. Awesome.  I'm kind of new to Tennessee but I absolutely love it here.  I can breathe here and the people are just different in a very good way. 

 

 

 

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It's been a bit hard to accept a BP2 diagnosis, but not in the usual sense.  I have no problems being labeled bipolar.  It's because my pdoc didn't just come out and say, "I'm diagnosing you with BP2."  My wife has also been wondering if I want to be labeled bipolar just for sake of having the label.  It's strange, but there is a sense of belonging.  But the more I think about it and the more I read about it, it makes sense.  The episodes of hypomania definitely makes it clear, but I had been starting to wonder if I really had major depressive disorder since my experiences weren't the same as most.  Most people I talk to have rather persistent depression, like they are always down to some degree.  I'm either depressed or I'm not.  Sometimes it's more severe than other times.  Since getting treatment and being on meds, I'll have cycles of depression lasting 1-3 weeks between cycles of "normal" lasting 3-5 weeks.  I'm actually on about the 8th week of normal now.  And there were the two cycles of hypomania too.  I just get the impression that cycling like that isn't common with MDD, but it is with BP2.  While I don't remember any past episodes of hypomania before the most recent two, my wife said that she remembers me being like that years ago.

I also think about how fast things happened when all this started a year and a half ago.  I went from fine and normal to almost suicide and drug addicted in only 8 weeks.

Bupropion is my lifesaver.  It is the first med I tried.  Two weeks after starting I felt a world of difference.  For a few days I felt "cured."  Of course the depression would ebb and flow.  Bupropion was giving me insomnia, though.  So he put me on trazodone at night for sleep.  It worked.  But after a few weeks things went south.  I was getting agitated, confused, and having tremors.  Then one night my wife went to bed and I swear I thought I heard her say as she walked out of the living room that she was going to leave me.  That's not what she said of course, but that's what I heard in my state of confusion.  I spent the next 20 minutes pacing from one end of the room to the other, rubbing my hands together and mumbling to myself.  My legs got tired and I sat on the couch.  Wondering where I was, my wife came back in and found me sitting in a dark room, rocking back and forth, and mumbling "they are going to take me away, they are going to take me away."  I thought I had gone bat shit crazy and I was destined for a group home where I would be for the rest of my life.  She was able to calm me down and get me to bed.  She called my pdoc first thing the next morning.

He took me off both meds and started me on celexa.  It worked fine, but over time I couldn't handle the side effects.  Then he tried mirtazipine which left me feeling like a zombie for several weeks until I got used to it.  But it wasn't really cutting the depression.  So we started back on bupropion and kept the mirtazipine at night to counteract the insomnia of bupropion.  Later when I described my cycling, he tried me on depakote.  Wasn't doing anything so now I'm on lamictal.

I'm on fairly low doses of everything.  I have a natural low tolerance to medications.  That wasn't such a good thing when I got myself addicted to opiods (that's how I coped with my depression before I got treatment), because it meant that my supply would last a long time.  I tried 300mg of bupropion on my own and after a couple weeks I felt a bit shaky and my hands started trembling so I dropped it back down.

Thanks for the encouragement and advice about seeking help.  I thought I had been doing everything right - meds, treatment, supportive community, recovery meetings - but yet when I found myself in crisis I didn't do what was right.  Thank God I flipped to hypomania that afternoon, cause I was planning to attempt that night.  I realized that a gap in my treatment was not having a crisis plan.  So I reached out to some friends, many who have personal experience, and let them know they are on my list to call if I'm in crisis again.  I fell a little embarrassed I let that happen.  I do some public speaking about depression and suicide and have a web site about my journey.  Sometimes I give myself pressure to keep up with this image of being strong so I can help others.  But I know and freely admit that I am not cured, I will have ups and downs, and that I have to look out for myself first.  It's ok to not be ok.

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Posted (edited)
On 6/3/2018 at 6:59 AM, Distorted Me said:

 

Doctors are not nearly as smart as we, and they, think they are most times. 

This is not very helpful and simply untrue. How long would you survive 8 years of medical school ? Not very long I think. You have made a vast generalization based on seeing 3 doc's, wow I am impressed with your thoroughness. 

Edited by notloki

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7 minutes ago, notloki said:

This is not very helpful and simply untrue. How long would you survive 8 years of medical school ? Not very long I think. You have made a vast generalization based on seeing 3 doc's, wow I am impressed with your thoroughness. 

I don't think he was saying that doctors aren't smart.  Of course they have to be smart to get to where they are now.  But I think what Distorted was getting at was that the general public regards doctors as having such high knowledge and experience that they are infallible and always have the right answer.  They are human, and they are increasing having to deal with more and more patients and insurance company demands.  While we should rely on their expertise, it's ok to have reasonable doubt and seek a second opinion and advice.   A doctor sees you for just a few minutes, but you have an unlimited amount of time to think about your condition.

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1 hour ago, patents said:

I don't think he was saying that doctors aren't smart.  Of course they have to be smart to get to where they are now.  But I think what Distorted was getting at was that the general public regards doctors as having such high knowledge and experience that they are infallible and always have the right answer.  They are human, and they are increasing having to deal with more and more patients and insurance company demands.  While we should rely on their expertise, it's ok to have reasonable doubt and seek a second opinion and advice.   A doctor sees you for just a few minutes, but you have an unlimited amount of time to think about your condition.

Thank you very much, patent.  You put it far more eloquently than I can and I appreciate that.  I tend to be way too blunt sometimes and as a result my words don't come across as I originally intended them to. 

We have to trust our health care professionals, of course.  I don't want anyone not to.  But we really need to be as informed as possible about our conditions and our treatments.  Nobody knows us better than we know ourselves.  Blindly following any diagnosis or course of treatment is not a recipe for success.  Doctors will be able to provide us with far better care when we're more engaged in our treatment and that means sometimes questioning the doctors and nurses in what they're telling us.  Way too many people are afraid to trust their own judgement and it's kind of scary to think about that.

As you mentioned, psychiatrists especially are more overworked today than ever before.  We all know how difficult it can be to just make an appointment.  And how many pdocs aren't even taking new patients?  There's some serious job security in this field right now.  But this means we get a sliver of their attention and our treatment can suffer as a result.  We need to be informed now more than ever.  That's all I'm trying to say.  Unfortunately, I can be an arrogant a-hole sometimes and that definitely comes through in my posts, I'll admit that.  I do not want to mislead anyone, ever. 

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2 hours ago, notloki said:

This is not very helpful and simply untrue. How long would you survive 8 years of medical school ? Not very long I think. You have made a vast generalization based on seeing 3 doc's, wow I am impressed with your thoroughness. 

Notloki, thank you for pointing this out  I shoot from the hip too much sometimes and don't always choose my words as carefully as I should, especially in a setting such as this.  But also I am basing my opinion on a hell of a lot more than just "3 doc's".  I'm not going to get into it with you though.  It's not worth it.

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