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Bipolar "without" mania/hypomania?


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Hi, I'm pretty new to the bipolar world and curious about what others experience, especially beyond the "textbook" symptoms.

 

A little about my history... I've had depression for about 8 years, and was diagnosed with ADHD around the same time (mostly inattentive form). I take Adderall for ADHD and it's a godsend for SOME of the symptoms; although mostly giving me a little more motivation/energy and helping my mood a bit--not sure it does much for the "self regulation" issues.

 

Pretty much nothing has worked for depression; maybe about 10 different antidepressants, therapy, etc. Depression also got markedly worse after the birth of my daughter and has never improved (20 months ago). After the typical AD's did nothing at all, my doctor tried lamictal. It's the only med that's helped to an extent--it works GREAT for irritability, and that's about it. I'm still severely depressed, but find if I don't take even a single dose, I get extremely moody, reactive and irritable.

 

Every doctor/therapist I've had the last 8 years has always immediately evaluated for bipolar symptoms and just as quickly ruled it out, and I never suspected it either as I didn't think I had ANY symptoms of the mania side.

 

I saw a new GP yesterday and he was very thorough in assessing my symptoms... I was very surprised when he immediately suggested bipolar I or cyclothymia. When I asked about the manic symptoms, he listed my severe impulsivity (spending sprees mostly), irritability/anger, and that some (or even all) of my "ADHD" symptoms may be bipolar symptoms. A few other tip offs to him--my depression/mood being so much more severe after having my baby, and the fact that 1) NO antidepressants helped and 2) although it doesn't control all my symptoms, the only thing that DID help was a mood stabilizer (lamictal).

 

So not really asking for a diagnosis, just curious from those with more experience if "manic" symptoms can look like that? I wouldn't say I really ever have any "high" or elevated mood periods, no danger-seeking/grandiosity, reduced need for sleep (I do have trouble getting to bed but not sleeping and I'm ALWAYS tired). Racing thoughts, talkativeness, yes... All of the symptoms I have are also constant, I don't notice much up and down.

 

Doc prescribed a small dose of seroquel (12.5mg) to augment the lamictal; I'll try anything at this point! He probably has a good point about mood stabilizers, and since nothing has helped up til now maybe he's on to something. 

 

So anyone else had manic symptoms that were all more "negative"?

 

Thanks!

 

P.S. Sorry for the length, I think I'm incapable of brevity...

 

 

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Oops, apologies... I just found this in another thread: http://www.psycheducation.org/depression/02_diagnosis.html very interesting! Does seem to fit a lot of what I've experienced and what the doctor said...

 

Still, would love to hear how this has manifested in others :)

 

Although I imagine it may be (if I'm lucky) a diagnosis-by-treatment situation.

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Absolutely possible that your symptoms could be assessed a BP.    I used to get happy hypomania as a teen but now

the Hypo bit only presents as irritability, impulsiveness, agitation, anxiety and distracability ... no elevated mood at all

just miserable jumpiness and grumpiness. 

 Your new GP could have insight into your especial misery that the previous docs lacked and this could lead to

significantly improved meds.   I do hope so!

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Thanks everyone, this is all pretty interesting new information! I have another question... it does look like all forms of bipolar have cycles--even for cyclothymia, rapid cycling, etc., they talk about "episodes" of depression (and not necessarily associated with life events), and I don't think I've EVER had this that I know of. I can't think of any time in the last 8 years I told myself "I don't feel depressed anymore." That said, I have plenty of times when I'm happy, sort of, but generally it's kind of superficial... I'm usually okay at work, I can watch a movie and laugh at it, whatever, but as soon as the "distraction" ends, I'm back to feeling depressed. I might have been a little better when I was pregnant, or when my relationship with my husband was good... but even then I don't remember ever thinking the depression "went away"

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You would be surprised. The mania that the common man associates with Bipolar Disorder, is not as common as you would think. I got in a discussion about this with my pdoc. The pure Euphoria doesn't happen over and over and over as much as the layman would think.

 

I get the ( happy) hypomania but haven't had it in a really, really, really long time. In general  when I am under extreme stress (i.e. recently, death of a friend, loss of a marriage and house, severe financial problems) I will spin into a mixed state - a combination of a mania (dysphoric) and depression. I rapid cycle.  My most recent mixed state lasted about 4 months. People talked too slow. My brain moved too fast. Everything was annoying, I was irritable, I threw things. I felt suicidal and wanted to choke or strangle people.  I was suicidal and had plans. I couldn't sleep.  So much energy. negative energy. I hit my head against walls to try and make it stop.  It's just awful, awful.  Adding another mood stabilizer - Depakote - helped get me out of that one. What a relief it was.

 

 

 

My current mood lately has been mildly depressed. I'll go back in to my pdoc in a couple of weeks and see what we move around. But at least it isn't mixed and at least I am not suicidal.

 

Continue to educate yourself.  It does manifest itself just slightly different in everyone and you can learn a lot.

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We can't really diagnose here, but there is a sub-type of bipolar called bipolar NOS.. More depression and mixed states. Generally bipolar is classified as having one manic episode, but that's bipolar type 1.

 

Lamictal is a good mood stabilizer, one of the best, and bipolar or not, it can really help. 

 

And I have negative manic symptoms. I call it "dysphoric mania"

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Yeah, not looking for a diagnosis exactly, just curious about what people "really" experience as opposed to the DSM examples. Ha, I've spent 8 years reading everything about depression, anxiety and ADHD... I'm amazingly ignorant on the bipolar spectrum!

 

Still skeptical about finding a good therapist/pdoc, though... seeing a new NP/therapist next week but it was mostly for therapy, but now I'll ask about bipolar. I was really surprised a GP would suggest it... and having had a million doctors, I got the impression (from his thorough questions mostly) he was pretty educated/experienced with it... he was quick to suggest it, but not in a "Oh that's probably depression, here's some prozac, come back in a month" kind of way; more like it all clicked for him.

 

Thanks everyone for the insight, I have a lot to learn now!

 

A side note... so far this seroquel is giving me awful insomnia :( Since I never had trouble sleeping in the first place that's a little frustrating... hope it goes away!

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The type of episode I have these days is dysphoric mania. My pdoc kept being out of town when I got episodes, so the covering pdocs always told him I had had mixed episodes, or irritable hypomania, because they didn't know me. When I finally saw him *during* an episode, he said, "You're manic!" with surprise. They have all been dysphoric. Before his actually seeing me during an episode, my diagnosis was BP NOS; last summer it was switched to BP 1. I have been treated for BP since 1988, so that has been quite a long trajectory.

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There is a lot more to mania than euphoria. I do get very euphoric, but even then, I do get the negative symptoms as well, and I always have severe suicidal ideations in mania, even if I get euphoric. It doesn't sound like it makes a lot of sense, but it's very hard to stay euphoric if the world around wont collaborate with you. For me, the most dominant symptoms in mania are decreased need for sleep, hypersexuality, anger and irritability, pressured speech and racing thoughts, if it gets really bad some psychotic symptoms as well. I was misdiagnosed as psychotic/developing schizophrenia initially, and it took a long time for me to get diagnosed correctly and in hindsight notice the manic episodes I've had for years. Sometimes it's also hard to notice the garden variety euphoria because for me the episodes start euphoric (and it feels like the world is finally like it should be), but as it goes on, the negative symptoms take over very quickly and looking back, they are all that sticks in memory because they are so painful.

 

Have you looked around for a pdoc?

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I had one happy hypomania, it was a pain. I think it was med induced but I read an 350 page book in four hours (great book, but realy?) was doing yoga at 4am and could not sit still. I was also ready to spend spend spend. But this was out of charactor for me so I put the CC's away.

 

Otherwise my hypo's are crankyniss, anger, frustration, and some racing thoughts(not like Belmont or the Kentucky Derby, but cant get them to shut up). I was misdiagnosed with depression at first and then with the cyciling it bumped it to BP its either NOS or II. I personaly think its NOS.

 

But make sure you get a pdoc as soon as possible

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I've had happy manias, but usually it manifests as a strong desire to punch people for the smallest things, like breathing in a certain way, making odd noises, letting music leak out of their headphones. I will become positive that people can just look at me and tell that I'm crazy, and that they are all talking about me and staring at me when my back is turned. I'll get enraged by idiotic comments on websites and write incredibly long and detailed rants, and then call my boyfriend and monologue about this stuff for literally hours. And it will seem that everyone except me is too stupid and slow-witted to understand how important and awful all of this is, which means I started feeling compelled to let everyone know why all of this is so wrong, over and over and over again.

 

When I'm like that, living inside my head is a terrible thing. It's like being forced to live inside the 'It's a Small World' ride at Disneyland forever, with no down-time. But I had the same issue you had, where I didn't realize that I was suffering from hypomanic and even manic/psychotic episodes because I wasn't happy and I thought hypomania and mania meant feeling carefree, not turning into a troll under a bridge. 

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Sounds to me like a mixed state - have you read about those? Where you have symtpoms of both depression or mania, or a little bit of both tilting to one side or the other. I had a mixed state once. It was the most awful thing I'd ever been through. I was hyper, full of anger and rage, irritible, but reallly depressed and down, and my sleep was normal. Not too much, not too little.

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Sometimes I get those irritable hypomanias, like everyone is going too slow and pissing me off with their stupidity. Usually the higher I go, the less irritable I get. But the mixed moods are common (at least around here).

 

This is what I experience too. More irritability that things are slow or stupid. And the higher I go, the higher I go! I think I've been in a mixed state though. But it may have been an agitated depression. Who knows!

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The DSM is a textbook, we are not textbooks and our BP experiences are different.

Anyways, yes, (hypo)mania can be very irritable, anger, etc. It's not all sunshine and roses for a lot of ppl. Even when I was manic for over a year I wasn't sleeping good, and I was freaking tired, which is the opposite of the DSM manic symptoms.

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