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Diagnosed Years Ago w/MDD - New Pdoc Leaning Towards BP II


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I know I have seen this subject discussed here before, but didn't have any luck locating it...

About 10 years ago (I'm 49), I was diagnosed with MDD and dysthymia. I have had five episodes of depression beginning in my mid-twenties. The most recent one ended a little over a year ago and lasted for two years. I saw a new pdoc this week because I've moved, and he suggested I might actually have BP II. The only problem with that is that I don't recall any hypomania.

I am on 450 mg of Wellbutrin (generic), and he just augmented it with Lamactil. I have been on Wellbutrin for years, and it has helped a lot. He was also suggesting lithium as a possible augmentation, but decided on the Lamactil instead. The pdoc said that because I have had five episodes, there is a cycle going on and that a med usually used in BP may be helpful to me.

Besides moving and needing a new pdoc, I have also recently felt myself getting closer than I care to be to the edge of the abyss and am terrified of falling back in. I don't really care what the diagnosis is, I just want to be well.

Has anyone else had a similar experience? And in looking back, how would I know if I ever had experienced hypomania?

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um, i'm not the bp expert, but i believe it's considered 'possible' to be bp w/o having mania. i guess the criteria is the regularity of the cycling? i had a tdoc explain that some (few) people cycle down-normal-down-normal-down-normal ad nauseum. (there can even be up-normal-up-normal) i also know that often mood stabilizers are used for depression, especially in hard to treat cases.

i can see how your doc is thinking...mood stabilzers have been shown to work for some folks w/MDD, you have had several episodes which shows you have a problem staying stable, and maybe there is a cycle under there.

so i can't tell you how to look for hypomania but i'm saying that may not be necessary. it's all about whatever works, really.

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I don't know how widely accepted it is, but there is a theory out there that you can have bipolar without ever having hypomania. Some people think of it as a spectrum with unipolar depression at one end and bipolar disorder at the other, and it can be really hard to tell where one ends and the other begins. I've found Jim Phelps' book and website really interesting & useful. (I do experience hypomania, though not as strongly as some other people do.)

OTOH, it could just be unipolar depression. One pdoc told me that once you have one episode of depression, you have a 50% chance of having another; once you have two, you have (something like) an 80% chance of having another; and it just keeps going up. Each episode predisposes you to have more. So maybe recurrence doesn't necessarily signal bipolar in and of itself.

As far as how to treat it: ditto reddog, Lamictal is sometimes used for unipolar depression (I think as an add-on to conventional ADs, but I'm not sure). Also, what do you have to lose by trying it? ADs can make bipolar worse, but mood stabilizers (at least the more antidepressant-side ones) don't make depression worse. Worst case, it simply won't work. It won't mess you up even more. So anyway, even if it's not bipolar and you still treat it as bipolar, the consequences shouldn't be terrible.

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I believe you have to experience at least one episode of mania or hypomania in your lifetime to be diagnosed BP. However, your "up" phase may not be apparent to you right now. Just because your depression waxes and wanes does not necessarily mean you have something other than unipolar depression. In general, most BP patients get pretty manic/agitated/freaked out when given SSRI's by themselves.

What I do know is lithium has been used for years to augment antidepressants in people with unipolar depression. I don't know that the research has bore out lamictal on treating unipolar depression.

Try the meds and see if it helps. If it does, great! But further explore your moods and don't let a medication be a diagnosis, ok?

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What my tdoc told me last week when I asked him this is, the mood cycles I have even when I'm not in a marathon mode of MDD, could possibly indicate BPII. I have a new pdoc appt. on Tuesday. I'll let you know what kind of feedback I get on the matter. I've been dx'ed forever with MDD and have a serious episode every couple of years. And the episodes themselves can last for years. My last one did--two years. I almost didn't make it back from that one.

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For me the most important part of having a BP diagnosis is that doctors (hopefully) will be very cautious about putting me on antidepressants than they would other people who present with depression. That in itself could save me a lot of nightmarish insanity.
See, this is why I have always eventually come back to accepting that I'm just moody MDD. SSRIs and SSNRIs have always been very, very effective for me. I've never flipped my shit, not once due to SSRIs, and I've been on them since Prozac was first introduced. But when I say effective, I mean not suicidal and it's only been in the last few years that I've come to expect more from *effective* in the way of medication.
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Disclaimer: I'm not any type of professional.

From what I've read, there's a lot of consideration that cyclical agitated depression may be a form of bipolar. Agitation is like anxiety except it has energy to it and generally is not fear based. It just is part of the depression. Phelps cited above has a write up that can help some make the distinction.

If your depression has had no agitation, my guess is that your pdoc is stretching the definition of bipolar. That's a guess. As said, I'm not a professional!

As for treatment, really, all that matters is what works. Some bipolar meds are effective in treating unipolar depression. For example, Lithium has been used for decades to augment ADs. Lamictal also is used for unipolar depression as well. Obviously, these meds are also used to treat bipolar, too. They also are used to treat schizoaffective disorder as well.

The label on your illness is only a label. When it gets down to it, the only utility it really has is as an insurance billing code. One pdoc may consider the cyclical nature of your depression as indicating bipolar. Another may consider the same symptoms and think of it as cyclical depression. It sounds like you fall into the grey area. In some ways that tough because it's nice to have a diagnosis that lays it out and is as you feel. In reality, that doesn't always happen.

Good luck with Lamictal. It is a good med.

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