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One of my pdocs told me that the way BP depression is created in the brain is different and feels different than MDD. This doesn't make sense to me, since I can be treated with AD drugs as a BP depressive. What do you guys think?

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One of my pdocs told me that the way BP depression is created in the brain is different and feels different than MDD. This doesn't make sense to me, since I can be treated with AD drugs as a BP depressive. What do you guys think?

Doesn't make sense to me either. I was diagnosed as having chronic MDD for 3 years before they figured out I was BP1. I'm still on two AD's in addition to my other crap.

Tommy

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A unipolar here with a side of dysthmia thrown in for good measure......

Loon-A-Tik, I'll agree with your pdoc that MDD and BP depression possibly occur in different areas of the brain, but I don't see how anyone can tell that they feel differently to the patient. After all, suicidal is still suicidal, and the bottom of the abyss is still a terrible place to be, no matter how you got there. Although I'm too lazy to provide any sources, the general rule of thumb is that depression is fatal 15% to 20% of the time, and as I recall that number is roughly the same whether you're looking at groups of people with BP or people with MDD.

The Amen Clinic is one place in the early stages of diagnosing what's wrong with your head and what will fix it by doing brain scans. Maybe a patient of theirs will chime in and let us know how it works for them, and if they still have to go through such a lot of trial and error to pin down the meds that will help them the most. I'm sure some of the big drug companies are also seeking a way to more exactly and effectively get the missing chemicals into the right brain synapses.

Assuming the two depressions are in different brain locations, eventually drugs could be developed that are very specialized for those separate locations, which would provide relief from symptoms of both MDD and BP depression, even if the symptoms are the same. If you've ever read any of your AD PI sheets you've come across that lovely phrase, "The mechanism of action is unknown." That of course translates to, "We know they work but we're making a wild-ass guess as to how!"

It will be a great day when they'll be able to do a quick blood test or a brain scan and then definitively prescribe meds accordingly. But in the meantime, depression still sucks no matter how you end up there.

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I have read that BP depression is more likely than unipolar depression to be the kind where you sleep too much and eat too much, and the kind where you are agitated. But that's "more likely," not "always."

That's interesting to me because although I have MDD, I have the atypical version which is defined as sleeping and eating too much, as opposed to the typical version where you start waking in the middle of the night and can't get back to sleep, etc.

However, since I've never evidenced even mild signs of hypomania, much less full-on mania, then I still get diagnosed with MDD and dysthymia. Wellbutrin is my good friend.

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I learnt in my psychotherapeutical readings that mania is a defence against the pain of depression....hence the bipolar highs and lows. Its a theory that makes sense to me as I try to negotiate my own recurrent depression (with PTSD and borderline and dissociative sprinklies...) that, I read, has a risk of hypomania thrown in.

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I learnt in my psychotherapeutical readings that mania is a defence against the pain of depression....hence the bipolar highs and lows. Its a theory that makes sense to me as I try to negotiate my own recurrent depression (with PTSD and borderline and dissociative sprinklies...) that, I read, has a risk of hypomania thrown in.

Nestling-

I always held to that theory, that my mania was a defence mechanism against depression. My pdoc looked at me like I was full of it, but I'm sticking to my guns on that one. It is good to hear some validation!

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Assuming mania is a defense mechanism:

- how do mixed states fit in? if mania is a way to cancel out depression, mixed states shouldn't happen. (maybe people who get mixed states regularly have defective defense mechanisms...)

- mania should usually follow depression, if it's a response. but that often doesn't happen - the more common pattern for bpI's at least is depression following mania. (I think it's the reverse for bpII.)

- why do a lot of people with depression not get hypo/manic at all? are they lacking the defense mechanism? (hearkening back to an earlier discussion, perhaps these are the depressed people who particularly want to be bp - the ones who see it as a defense mechanism or at least a break...)

- what is the use of having mania be a defense mechanism against depression? does it help you survive better? (especially since we've had a lot of people recently sharing how incredibly destructive manias can be.)

- perhaps depression could be a defense mechanism against mania?

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weeeellll my perspective, (which is a kind of Object Relations perspective) is that possibly when in a manic phase, one may somehow (through therapy/own insight/being told and hearing it)understand the reality of the situation, and be deeply disappointed and sad (assuming depression is a response to a loss of some kind....in the past, present, or anticipated in the future)..

sometimes people with *just* depression have other defence mechanisms, like dissociation for example....and also depression in itself can be seen as a defence mechanism on its own, which is very much the case with body psychotherapy theories (Lowen for one) a defence against excitement and life, against feeling flooded with life, because one isn't used to feeling that and fears feeling overwhelmed and out of control with it......the task in therapy then is gradually to feel safe with experiencing more and more life and feeling safe and secure in one's skin.

when we're in a defence mechanism it is usually unconscious, and developed early on, in my understanding, before rational thought processes developed....think of the analogy to dissociation as a defence, and it makes more sense then...I think...

this is what resonates for me anyway. I know its simply one perspective.... (and at 7.30 am at that....)

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I don't usually chime in on this type of stuff but thought I would this time. I am BPII and have spent most of the last 3 yrs in a major depressive episode with a couple rapid cyclings into brief hypomania. To me the hypomania is a relief from depression. Where the mind maybe says 'lets see if we can take a break here' or maybe a situation triggers some hypomanic behavior.

My pdoc talks alot about certain depressive behavior of mine being 'typical' of bipolar depression. He cites the tape running in my head that never shuts up and plays back all the bad, powerless, failure situations of my life. Also terribly rapid near hysterical descents into the pit of hell that can occur instantaneously and vanish in a few hours to leave the regular deep depression. There are a few other things he has talked about that I can't remember right now. I think the huge lack of motivation and extreme tiredness and hyposomnia are not just bipolar depression but are present in most depression although I wouldn't know for sure. I was diagnosed bipolar in my 40's and before that had been dx'ed with dysthimia (and spoiled brattiness) which I tend to blow off. He has said that for bipolar, the more untreated major depressive episodes one has the harder it is to treat the next one. I am extremely med resistant and have such a long learned behavior of depression it is nearly impossible for me to get myself going.

Susie

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