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Sometimes when I'm hypomanic, caffeine actually helps bring me down a little. WTF? Does this happen to anyone else, or am I just a freak?

Me too. When Im on my way up, I start *craving* caffeine like nobody's business, and it does help settle me down a bit.

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I'm the same. When I'm hypomanic I instinctively reach for the coffee, can easily drink 7-8 cups a day, and feel like it settles me down, quiets some of the mind chatter. Actually makes me fall asleep easier. And they taste sooo good! Everything tastes so good when I'm hypomanic. And music, wow. And the beautiful, beautiful colors... I'm digressing.

Now that I'm in normal mood, I'm happy with 2 cups a day and they don't have quite as strong an effect, although they still make me more mellow than wired up.

I really don't think I'm ADD/ADHD though.

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I tell ya. Caffeine is wierd for me, too. If its in the morning or early afternoon, it fires me up big time. In general, I can drink it at night and it tends to put me to sleep. The other night I couldn't sleep so I made a pot of coffee and was off to sleep in no time. Now, the effect of caffeine in coffee works that way for me but chocolate will keep me up for days.

I don't get it either. ;)

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This is an ADD hallmark.

There's supposed to be some kind of link between ADD and bipolar.

Maybe you're not being hypo so much as just being hyper. Dunno. Look into it.

[link=http://psychcentral.com/quizzes/adultadd.htm"'>http://psychcentral.com/quizzes/adultadd.htm" target="_blank]http://psychcentral.com/quizzes/adultadd.htm[/link]

Nah, totally not me. Interesting thought, though. I think I've read something about that too - a lot of ADHD kids going on to have bipolar later, IIRC? (I never had anything like ADHD as a kid, always had great concentration and was pretty tame.)

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ADD-ADHD, Bipolar, Tourettes & Autism are all "attention-Different spectrum" wiring (disorders). All share co-morbidities. Depending on which ones you share in common with ADD-ADHD, I bet that would identify/explain your caffeine response.

It'd be a pretty revealing experiment to get a bunch of bipolars divided by type & co-morbidity to document their experience with caffeine use during hypo or mild mania, full blown mania even. I bet we'd find some similarities initially but then distinctions would emerge depending on the co-morbidity and BP types.

For myself, as a rapid cycler BPII, caffeine taken in substantial quantity during the initial rise into hypomania will kick me up to a nearly fully manic state. The crash always triggers the depression end of my cycle or a mixed-state moment, like bouncing off the pavement a few times after hitting it from a great height. Equally, I've found that caffeine in sufficient quantities can help me avoid the very bottom of the depression trough in my cycle, but it's a HUGE amount and since I ingest it via coffee, the acidity component pretty much thrashes my entire system something fierce. I have Tourette's so I share some comorbidites like OCD and impulsivity (the latter to a lesser extent than the OCD). But my son, who has ADHD, has a completely different experience with caffeine than I do. What shoots me "upward," calms him. If I had more co-morbidity with ADHD, I bet I'd experience the same. My daughter who is COBPD experiences caffeine similarly to me, only more pronounced and immediate (makes sense; smaller body, age, etc.). She has learned to use a small amount on certain mornings depending on where she is in her cycling to avoid the trough. But if we aren't paying attention to details, we miss and she ends up in a mixed state or manic in short order... the caffeine isn't a calming agent like it would be for an ADD-ADHD person.

Do the experimentation on yourself and document your type and comorbitities, and your med regime (which will influence things certainly), and mood chart through a 2-3 week trial. Could be big fun. or not.

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This is an ADD hallmark.

There's supposed to be some kind of link between ADD and bipolar.

Maybe you're not being hypo so much as just being hyper. Dunno. Look into it.

[link=http://psychcentral.com/quizzes/adultadd.htm"'>http://psychcentral.com/quizzes/adultadd.htm" target="_blank]http://psychcentral.com/quizzes/adultadd.htm[/link]

Nah, totally not me. Interesting thought, though. I think I've read something about that too - a lot of ADHD kids going on to have bipolar later, IIRC? (I never had anything like ADHD as a kid, always had great concentration and was pretty tame.)

BP-NOS and ADHD are often confused by clinicians for each other, especially in kids. IOW, it's not that the kids actually had ADHD then developed BP (a genetic impossibility), it's that they had BP as kids but were misdxd as ADHD, then got a better dx when they were adults. Happens all the time. Try finding a clinician that can properly dx COBPD let alone treat a BP kid... knowledgable practitioners are like one in a billion for BP kids. It's hell on earth, and almost always they're off the insurance grid so it's 100% out of pocket. A misdx for a kid is a nightmare on every level.

If you've noticed on dx criteria that your definitely falling into the BP camp more than the ADHD camp, you're dx for BP-NOS is probably accurate. I'm betting you've just got some comorbidity somewhere with ADD-ADHD and that's where the stim-calm response to caffeine is coming from. It's a matter of doing the work and gathering data and seeing what is revealed by the evidence.

Someone posted the DSMIV dx criteria for BP types recently and I guess I need to go find it to answer my own question but... since you have BP-NOS, it's easier just to ask a real person: does NOS experience mixed states like other BP types?

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Bollocks...I did that quiz...it says it's me...oh ARSE! :);)

But, assuming my results aren't bollocks (which they could well be), it's only occurred in the last few years when, interestingly, my BP has got so much worse...hmmmmm

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lwing, did you do the long test or the short one? The short one is full of holes... depending on how you read the question the answer could be different. It's craptasms like that short test that many clinicians recklessly use to produce crapified dx results for unsuspecting people.

I wonder if the long test was better written or not.

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lwing, did you do the long test or the short one? The short one is full of holes... depending on how you read the question the answer could be different. It's craptasms like that short test that many clinicians recklessly use to produce crapified dx results for unsuspecting people.

I wonder if the long test was better written or not.

Ah, I did the short test. I'll give the long one a go later when I'm less busy at work. Thanks for pointing that out! ;)

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Ah, I did the short test. I'll give the long one a go later when I'm less busy at work. Thanks for pointing that out! :)

Just did the long test...same result...oh bum! ;) I need that on top of rapid cycling BP like a hole in the head. Gah! Some of it really made sense especially the irritability and inability to concentrate and get jobs actually finished, but then that could also be an aspect of my BP...if anything, I'm just more confused! Ah well :)

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If its in the morning or early afternoon, it fires me up big time. In general, I can drink it at night and it tends to put me to sleep. The other night I couldn't sleep so I made a pot of coffee and was off to sleep in no time.

The effect seems to vary a lot with timing for me too. Morning coffee almost always wakes me up. Afternoon coffee sometimes gives me a lift, but sometimes calms calms me down. It's a real wild card.

since you have BP-NOS, it's easier just to ask a real person: does NOS experience mixed states like other BP types?

Oh yes indeed. And they totally suck. In a mild mixed state, you'll find me thinking, "I'm too tired to go running, but I have to go running, because I have too much energy." And that's when it's mild. Also, FWIW, the first pdoc (actually a pRN) I went to who dxed bipolar put me in the BP II camp; the pdoc I'm seeing now said that to be technical, we'd have to call it BP NOS, because the DSM definition of BP II requires at least 4 continuous days of hypomania, and my cycling is a lot faster than that. (Interestingly, she also mentioned that the next DSM - due out ~2012??? - may have more categories or sub-categories of bipolar, since obviously there are a LOT of variations out there that are NOS - ie, obviously bipolar, but don't quite match the cut-and-dried DSM definitions.)

I just pulled this up on wikipedia:

The most common symptoms[25][26] of ADHD are:

Impulsiveness: acting before thinking of consequences, jumping from one activity to another, disorganization, tendency to interrupt during conversations.[25]

Hyperactivity: restlessness, often characterized by an inability to sit still, fidgeting, squirminess, climbing on things, restless sleep.[25]

Inattention: easily distracted, zoning out, not finishing work, difficulty listening.[25]

This is about as far as you can possibly get from what I was like as a kid (and what I'm like when I'm not cycling). There's some overlap with what hypomania is like for me now (restlessness, distraction), but I do think the BP dx makes a lot more sense for me.

Anyway, JackBQuick, the stuff you wrote about comorbidity was really interesting! I think I read somewhere (can't remember where) that some people tend to abuse stimulants (meth, coke, etc) more when in manic states - again, it seems to fit into the picture of stimulants putting on the brakes for some people.

Does it seem like awareness of the potential for misdiagnosing BP/ADHD in kids is growing at all? Oh, and here's another question - do ADHD symptoms cycle, or are they pretty constant? I hope that within our lifetimes they'll figure out more about how the brain works and exactly how it's all connected. There are just so many unanswered questions. (Another thing I wonder about sometimes is migraines-epilepsy-bipolar --- anticonvulsants work for all of them; why?[/rambling])

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BP-NOS and ADHD are often confused by clinicians for each other, especially in kids. IOW, it's not that the kids actually had ADHD then developed BP (a genetic impossibility), it's that they had BP as kids but were misdxd as ADHD, then got a better dx when they were adults. Happens all the time. Try finding a clinician that can properly dx COBPD let alone treat a BP kid... knowledgable practitioners are like one in a billion for BP kids. It's hell on earth, and almost always they're off the insurance grid so it's 100% out of pocket. A misdx for a kid is a nightmare on every level.

Um. Plenty of people have ADD as kids and go on to have both BP and ADD as adults. There's no genetic impossibility to it.

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Does it seem like awareness of the potential for misdiagnosing BP/ADHD in kids is growing at all? Oh, and here's another question - do ADHD symptoms cycle, or are they pretty constant? I hope that within our lifetimes they'll figure out more about how the brain works and exactly how it's all connected.

ADD is consistent. I'm somewhat regretting bringing it up.

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BP-NOS and ADHD are often confused by clinicians for each other, especially in kids. IOW, it's not that the kids actually had ADHD then developed BP (a genetic impossibility), it's that they had BP as kids but were misdxd as ADHD, then got a better dx when they were adults. Happens all the time. Try finding a clinician that can properly dx COBPD let alone treat a BP kid... knowledgable practitioners are like one in a billion for BP kids. It's hell on earth, and almost always they're off the insurance grid so it's 100% out of pocket. A misdx for a kid is a nightmare on every level.

Um. Plenty of people have ADD as kids and go on to have both BP and ADD as adults. There's no genetic impossibility to it.

But that's substantially different--"ADD as kids and go on to have both BP and ADD as adults"-- than being ADHD as a kid then [exclusively] BP [and not ADHD] as adults. That's what I was trying to point out in my unnuanced parenthetical. ;)

When one thing "turns into another" it's more often the case that it didn't happen and it was really a misdx. When things along the Attn-Diff spectrum add-on, that's different and entirely genetically possible (depends on what's being expressed and what allele is being activated by which ecological pressure, and when, etc.).

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Anyway, JackBQuick, the stuff you wrote about comorbidity was really interesting! I think I read somewhere (can't remember where) that some people tend to abuse stimulants (meth, coke, etc) more when in manic states - again, it seems to fit into the picture of stimulants putting on the brakes for some people.

Indeed, the person is merely trying to medicate their mania. The impact of those other compounds (meth, coke, etc.) on the body and a given wiring often means the self-medicating executed is uncontrolled and creates more problems. Kind of like when tdocs play cocktail party with us... granted they're trying to get it right too and are supposed to have a science background to implement that well, but I've had my fair share of cocktail parties that were as disastrous as my self-medicating "experiments" that went horribly wrong. Once I found a tdoc who played the cocktail party game in a focused and disciplined manner (evidence based) I stuck to him because things didn't go south like they tended to before.

Does it seem like awareness of the potential for misdiagnosing BP/ADHD in kids is growing at all? Oh, and here's another question - do ADHD symptoms cycle, or are they pretty constant? I hope that within our lifetimes they'll figure out more about how the brain works and exactly how it's all connected. There are just so many unanswered questions. (Another thing I wonder about sometimes is migraines-epilepsy-bipolar --- anticonvulsants work for all of them; why?[/rambling])

I don't see any evidence that misdx in kids is improving. In fact with the health care system crashing going on, I see more misdx and fewer practitioners all the time. Most so-cal mental health is getting shifted to the county sheriff and the corrections (penal) system and US Behavioral Health is a giant MSW factory trying to pretend MI can be "treated" with group therapy 10 times a year. It's dangerous.

Getting my kid help is a royal PIA and nearly a FT job. After four years of paying the local expert tdoc who is off the insurance grid, who's raised his rates and shortened his appt times for med-management twice in the past year to the point where paying for treatment is financially crippling us, we just found another for med-mgmnt tdoc who has been gaining ground in reputation for evidence based treatment and he's on our plan. We'll see. We've been through so many pdocs who claim they can treat BP kids then after a couple of visits you realize, 'hey, I know more about BP than this hack, WTF?!' This week we've been interviewing five pdocs for our daughter's non-med treatment. Some know a little, some really don't know what they're talking about at all. Anyway, that's just my own craptasm to deal with.

The confusion between the attributes of ADHD and BP mania in kids is pretty tough unless you know from personal experience which is what. My son and I can look the same when he's off his Concerta and I'm hypomanic, but the behavior is coming from two totally different places and that matters greatly in terms of how one treats the symptoms. It's even harder to explain that to a teacher or principal who just doesn't get it but has totally drunk the kool-aid that ADD-ADHD is a myth.

I explain it to my kids this way (warning here's numerous detail oriented flaws... keep in mind this is how I explained it to a bunch of fifth graders so they could grasp what was going on generally): "normals" have a 1/2 inch pipe, they take in and process the same load all the time at both ends. ADHD is like having a funnel with the wide part inside the brain and the narrow part on the outside. The ADHD person knows there's more happening out there and has to go pry open the narrow end (be impulsive, stimulate themselves, however) to settle down.

A BP person has the funnel going the other way; wide part on the outside, narrow end on the inside and that narrow end is moving all over the place activating different parts of the brain depending on the content coming down the funnel. All that broadband intake hurts like hell and we freak out accordingly: we're either triggered to hunker down (depression) or to leap over the crevasse to safety (mania) depending on where the narrow, focused, high-pressure content coming through the narrow pat of the funnel is being targeted on our brain.

When mania is active, we behave similarly to the ADHD. But if you try to smack us up with too much stim--the way an ADHD brain needs in order to pry open the narrow end of the funnel outside their head--the BP in out the crazy end and fries because now we have this massive 8" pipe (wide at both ends) hammering our brain on all 156 bands at full volume. Plus we have the oh-so-exciting experience of the mixed state which looks like ADHD on crack until you figure out, oh, if I give the mixed state Bipolar too much stim they'll shoot out manic, too much antidepressant (or an AD at all if we're BPII) and we go manic or heighten the mixed state. That's why we need mood stabilizers and an ADHD person doesn't.

Research is turning up some seriously cool shit all the time. A really good source online is Dr. Jim Phelps. Look for his stuff on biology and BP, I think he covers the co-morbidity aspect as well. He's a big evidence based treatment tdoc. Plus he's got good tools to use when you go see your tdoc and pdoc to help get through the noise and to the issue at hand.

Okay, that's all too much typing... can you tell where I am in my cycle today? In a moment I'll feel paranoid too probably. Oh, no wonder, it's med time. Later ;)

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