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psychosis & bipolar depression?


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i know that psychosis can be pretty common during manic episodes, but does anyone ever experience psychosis during depressive episodes? could it be a sign of mixed episodes? or, could psychosis be present during any and/or all of the above? i'm trying to figure out if i might be having mixed episodes, and if i should bring any of this up at my next appointment with pdoc...

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Psychosis can be present in any kind of mood episode. Psychotic symptoms are absolutely something you need to tell your pdoc about. Really, if you're having psychotic symptoms, you need to call your pdoc for an earlier appointment. This stuff will only get worse the longer you wait to address it.

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I am not BP, but I did once have a psychotic episode during my depression back in 2007. This was one of the worst phases of my illness, having to deal with both symptoms at the same time. Stupid me never did anything about it and now I see how bad an idea that was. During this time I started cutting myself because of the combination of the depression, the thought control, and my hallucinations. I also, convinced I was being followed, had to leave the area I was living in at the time.

It sucked!

And I would say to get help and go back to your pdoc about this one.

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my pdoc is already aware of my psychotic symptoms during depressive episodes, and it's just been worse lately because trileptal was actually making my depression worse. so, i'm tapering off of that and dealing with fun lithium nausea again until the trileptal is gone and i can start lamictal.

i guess i'm more worried about mixed episodes, because when i think of the times when i've felt the worst, it sounds more like a mixed episode. in fact, when i read over the symptoms, that's almost exactly how i was feeling the last time i got hospitalized. so, it's probably something i should ask my pdoc about (i've already talked to my tdoc about it)... but if any of you have mixed episodes, how do you know, and how do you deal with it?

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yeah, i get rage-y too... and i'll have racing thoughts and feel energetic, but i'm still depressed mood-wise.

but yeah, i see tdoc every week and pdoc only does meds, because of the ethics laws in my state or something. we haven't even found a mood stabilizer that works yet, and she's reluctant to start me on an atypical, probably because i'm not on a mood stabilizer that's helping yet. and she keeps mentioning how expensive some of the drugs are...

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a couple of times i let my depressive episodes escalate without treatment, they have turned psychotic. the psychosis i experience in depression is very different from my manic psychosis. in depression i feel like my body is rotting and i get visual, auditory and tactile hallucinations. i've never been catatonic, but gotten close to it. i have also experienced paranoia, but nothing like manic paranoia. i have also had very very intense feelings of derealization and depersonalization. for me psychosis during depressions does not automatically mean it's a mixed episode. i think that notion is wrong, because psychosis is different from the activation of mania or hypomania; as in, the difference between agitation and hallucination. the two can go together but one does not signify the other.

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I've noticed that some people with "bipolar II" experience psychosis during depression. Why wouldn't they be BPI? Also for BP2's who get mixed states. I thought a mixed episode was all that was needed to diagnose BP1?

As I understand it, and please feel free to correct me if I'm wrong, one of the primary differences between BPI and BPII is the severity of the manic episodes.

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I've noticed that some people with "bipolar II" experience psychosis during depression. Why wouldn't they be BPI? Also for BP2's who get mixed states. I thought a mixed episode was all that was needed to diagnose BP1?

As I understand it, and please feel free to correct me if I'm wrong, one of the primary differences between BPI and BPII is the severity of the manic episodes.

yep... what i've read says that psychosis needs to be present during mania for a bp1 diagnosis... my pdoc made it sound more like how much the manic episode interferes with your daily life and ability to function determines the diagnosis (basically, whether it's hypomania or mania). she said that, while it can be no fun for some people (but really fun for some!) hypomania doesn't usually affect your ability to function and get through the day/complete tasks/etc.

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I've noticed that some people with "bipolar II" experience psychosis during depression. Why wouldn't they be BPI? Also for BP2's who get mixed states. I thought a mixed episode was all that was needed to diagnose BP1?

As I understand it, and please feel free to correct me if I'm wrong, one of the primary differences between BPI and BPII is the severity of the manic episodes.

yep... what i've read says that psychosis needs to be present during mania for a bp1 diagnosis... my pdoc made it sound more like how much the manic episode interferes with your daily life and ability to function determines the diagnosis (basically, whether it's hypomania or mania). she said that, while it can be no fun for some people (but really fun for some!) hypomania doesn't usually affect your ability to function and get through the day/complete tasks/etc.

If psychosis is present during hypo/mania, it is classed as mania and given a BPI diagnosis. This is not the only way to be diagnosed BPI. It is possible to become so speeded up that you can't work and might not make the most sense, become ragey to the point of potential harm, or lose your self-awareness such that you spend $110,000 on cotton candy. Those can occur without psychosis but would still be classed as BPI. IIRC, mixed states work similarly. Essentially, the difference between BPI and BPII is the degree of manic/mixed functional impairment. Depression can be simply horrid with pscyhosis while the person is diagnosed BPII. This holds for mixed, too, if the "energy side" is not causing significant functional impairment or psychosis. That's not to say BPII mixed can't be pretty damn debilitating. It's just to say the mania is somewhat manageable. Okay, so that's my effort to make the distinction. It's probably not perfect.

ETA:

Mixed states applying to BPII will be officially recognized in the upcoming DSM-V, the diagnostic manual for pdocs. Right now, it isn't formally accepted, but many (most?) pdocs recognize it anyway.

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a couple of times i let my depressive episodes escalate without treatment, they have turned psychotic. the psychosis i experience in depression is very different from my manic psychosis. in depression i feel like my body is rotting and i get visual, auditory and tactile hallucinations. i've never been catatonic, but gotten close to it. i have also experienced paranoia, but nothing like manic paranoia. i have also had very very intense feelings of derealization and depersonalization. for me psychosis during depressions does not automatically mean it's a mixed episode. i think that notion is wrong, because psychosis is different from the activation of mania or hypomania; as in, the difference between agitation and hallucination. the two can go together but one does not signify the other.

that makes sense. it just seems like there's a lot of emphasis placed on psychosis during manic episodes, but less so with other types of episodes. so i wasn't totally sure if psychotic symptoms could also happen during depressive episodes. people talk about psychosis happening with severe depression (like with mdd), but i wasn't sure if the same rules applied for people with bipolar, which is why i was asking if it could be an indication of a mixed episode... as in, looking at psychosis as a symptom of mania, so therefore it's a mixed episode, instead of thinking about it as a potential symptom of any type of episode. all of this can be quite confusing!

sorry, i'm still kind of new to treating my bipolar... i got diagnosed as bipolar ii three years ago but chose to ignore it, and somehow avoided dealing with it for all that time, and now..... i'm still figuring it out.

p.s. sorry for any bad spelling/grammar/incoherence, i've been awake for over 24 hours!

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I've noticed that some people with "bipolar II" experience psychosis during depression. Why wouldn't they be BPI? Also for BP2's who get mixed states. I thought a mixed episode was all that was needed to diagnose BP1?

As I understand it, and please feel free to correct me if I'm wrong, one of the primary differences between BPI and BPII is the severity of the manic episodes.

yep... what i've read says that psychosis needs to be present during mania for a bp1 diagnosis... my pdoc made it sound more like how much the manic episode interferes with your daily life and ability to function determines the diagnosis (basically, whether it's hypomania or mania). she said that, while it can be no fun for some people (but really fun for some!) hypomania doesn't usually affect your ability to function and get through the day/complete tasks/etc.

Psychosis does not have to be present for an episode to be manic, rather than hypomanic.

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ETA:

Mixed states applying to BPII will be officially recognized in the upcoming DSM-V, the diagnostic manual for pdocs. Right now, it isn't formally accepted, but many (most?) pdocs recognize it anyway.

Is it wrong to say "yay" about this? Because when I started having mixed states, my diagnosis was changed from BP II to BP NOS. I don't know why going back to a BP II diagnosis makes me happy, but what the hell. I guess I just think it sounds more precise, which is pretty laughable.

ETA: Edited for bizarre use of prepositions.

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ETA:

Mixed states applying to BPII will be officially recognized in the upcoming DSM-V, the diagnostic manual for pdocs. Right now, it isn't formally accepted, but many (most?) pdocs recognize it anyway.

Is it wrong to say "yay" about this? Because when I started having mixed states, my diagnosis was changed from BP II to BP NOS. I don't know why going back to a BP II diagnosis makes me happy, but what the hell. I guess I just think it sounds more precise, which is pretty laughable.

ETA: Edited for bizarre use of prepositions.

And I totally miss the good old days of being BP NOS, instead of BP I, for absolutely no reasonable sort of a reason I can come up with.

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