Does my response to Trileptal mean I really have BPII?

[malachite]

I've done a lot of digging, and cannot find anywhere that Trileptal is effective for unipolar depression. I take it in conjunction with tricyclics. I have felt more stable on it in the last few months than for a very long time. Does this mean I may have BPII instead? I know no one can diagnose, but I am curious if anyone knows of it being used for unipolar depression. If I have had hypomanic episodes, they must have been very, very, hypo. Thanks in advance for any help you can provide.

[Velvet Elvis]

When we speak of "depression" we're actually speaking of about 20 different kinds of brain abnormalities that present with the same symptoms.  When we speak of "bipolar" we're most like talking about a hell of a lot more.  It only makes sense that there are cases that straddle the two.

 

Don't box yourself in with DSM codes.  They are useful for billing insurance and not much else.

 

Right now it sounds like the most exact diagnosis that can be given to you is "a brain with an abnormality that responds favorably to trileptal."    Treat the symptoms with whatever helps and don't worry about what it's called.  

 

I'm most likely somewhere in the grey area between BP and recursive depression and really don't worry about what it's called.  IMHO the DSM-IV is barely accurate about anything.  While the DSM-V makes some progress, it still leaves a LOT to be desired.  

[koa]

You don't treat a diagnosis, you treat symptoms... so as long as your symptoms are being treated, that's the most important thing.  As VE said a diagnosis is something that's useful for describing a cluster of symptoms and for billing/insurance, but isn't the be-all end-all.  I can't diagnose you, but it doesn't really sound like you have bipolar symptoms from what you're describing.  

[malachite]

Thank you VE, your knowledge of MI is very helpful. And thank you, koa, for your response as well. I know that treating symptoms are the important thing; I guess I just want the right word for what I experience. Although a label will never convey the fullness of an MI.

[tryp]

I used to wonder if I actually had BP, because antidepressants don't work for me (I get super agitated but not really truly hypomanic) on them and mood stabilizers seem to.  One psychiatrist actually told me that I DID have BPNOS, which led to a lot of confusion for me.  So you'll get mixed opinions even from the medical community on what actually should be called "bipolar".

 

What I actually have is a narrow window of tolerance secondary to trauma and mood instability, also secondary to trauma.  But I do think that the UP/BP thing is probably more of a spectrum than a binary.

 

Worth talking over with your doctor.

[malachite]

Thanks, tryp. Things being on a spectrum makes a hell of a lot more sense to me than anything being binary. My brother was just diagnosed with "something between depression and bipolar." The tricyclics I am on seem to pair well for me with the Trileptal. SSRIs never really worked for me, but I am reading a lot about them not working for a lot of people.

[CeremonyNewOrder]

I've seen on the Internet people who take a mood stabilizer but are still MDD.

[Mirazh]

I'm BP-NOS, with noticeable dysphoric hypomanic episodes, and still went an estimated ten-ish years between the BP kicking in and my eventual BP diagnosis (from a pdoc who specializes in mood disorders.)

Just before my Dx, I came across this link in one of the stickied threads over in our BP forum:

http://www.psycheducation.org/

And it was a lot of stuff I read on there as well as here on CB that helped me be ready to accept the BP Dx as soon as I got it. That's me though; for you I brought up the site due to this link:

http://www.psycheducation.org/depression/02_diagnosis.html#Anchor-What-60973

That's a long page, but I specifically set the link to the stuff specifically talking about the concept of mood disorders existing on a spectrum. I know it's just a repetition/rewording of stuff that others have said here in-thread, but thought you might like even more info on the spectrum concept.

[Mirazh]

... actually that whole page (second link) is, IMHO, *really* good. That specific page and a whole lot of awesome folks here on CB helped kick-start my insight into my illness.

I can understand the search for a label. I like labels and categories, I also find them useful tools, but I greatly enjoy labels and categories and sorting. With words, anyway. But VE's dead-on about accuracy of the DSM in general. Honestly on a different site the other day I referred to the categories in the DSM as 'useful, and in healthcare systems that use it, necessary - but it reflects diagnostic/treatment trends and POLITICS far more than literal reality so should not be confused with the latter.'

But, as you can see, I hang on to my little labels all the same. I like them, I use them, and sometimes I need them; need to know how to use them. Just don't allow yourself to be trapped by them: we create the labels and definitions, the labels do not create and define us.

... the linked site has its problems. Even at that link. But overall I think it is by far one of the better resources on mood disorders.

Edited September 28, 2014 by Mirazh

[malachite]

Mirazh,

My God. I read this. I felt like my experience was being described for the first time. I am...stunned. I am saddened, that perhaps I could have been properly medicated over 20 years ago when I was diagnosed at age 14. Maybe I could have avoided some of the horrors I have been through. Maybe not, who knows? I am angry. I want my life back. But, most of all, I want to thank you for this. I am going to keep combing through it all. I know how little is really known about all this MI stuff, how much less was known 20 years ago, but I feel cheated. I know that will pass. Thank you.

[Mirazh]

Oh geez malachite, I didn't realize I was talking with YOU, damn can't wait to refill my Dex this week. My attention is shyte right now.

I'm glad the link was helpful. Seriously it was like that for me too, reading that link. The part further down where he describes 'bipolar variations' and I actually do every single one of those to some degree, gah. My life on the page. I hadn't experienced that regarding mental health since I spotted my ADHD years before and started researching it hardcore.

A good friend of mine is in a very similar place right now; she's been fending off the episodic depression beast with medical help and antidepressants since her mid-teens at least, she's past 30 now, and I believe now carries a Dx of cyclothymia. Or something. And she's on mood stabilizers, which were never tried with her until last year either.

[malachite]

Hahaha! What would you have said differently if you knew you were talking with me?

 

I think I have 5 of those markers for being on the spectrum. I did try Lithium (in conjunction with an AD) and was "okay" for a couple years. I mean, I did almost nothing during that time, but I could work some. I tried Lamictal and that did nothing for me. I found it interesting that the author doesn't put much stock in Trileptal. But, it's working pretty well for me atm. Who knows how long, but I've been semi-okay for four months and that's a long time for me.

[Mirazh]

Nothing different, I think. It just suddenly hit me that I know you, and I know some of your history and all that. Maybe if I'd have said anything differently, it'd have been a variation on 'why the hell didn't I think of this either?' Not that it's my PLACE of course, just. Gah.

Yeah the author of the site has some, ah... well there's issues with the site. But I do like his advocation of reading multiple sides to debates and checking out other sources.

I've only got two mood stabilizers I've tried, and Lamictal was only for three weeks - we didn't even titrate me up past the dose I started on. I respond in a way to Depakote that is great for me but is opposite the 'typical' stuff I first read about it anyway. That is, it's supposedly a great antimanic but not known to usually do much for depression, whereas I have no idea if it helps my hypomania or not but DAMN it sure kicks my depression's and even a lot of my anhedonia's asses. Sooo. Meds are "fun!"

I'm glad the Trileptal has been working pretty well. I hope it continues to do so. We've had to bump up my Depakote the one time after I'd already found an effective dose, so I went from 750 to 1000, and here I have stayed for a year now. May your experience with Trileptal be as simple.

[malachite]

Mirazh,

 

I'm at 600mg. of Trileptal, so I think there is room to go up if necessary. I sent that site to my mom to read, to see what she thinks, since she has so much knowledge and first hand experience with my MI.

[jt07]

Anticonvulsants and antipsychotics tend to work for me, but antidepressants don't (except maybe for anxiety). I don't know what that says about me other than I'm lucky to have found some classes of meds that do work. I, personally, am not interested in pursuing a diagnosis of BP because nothing would change regarding my treatment.

 

I have an interesting anecdote as to how I found out that Tegretol worked for me. I was in grad school and went to the doctor because of my depression and saw a GP. After going through my laundry list of meds with him, he wrote a prescription for Tegretol and said, "Take this. My sister takes this and it helps her." When I got home I looked it up on the internet and found out that it was an anticonvulsant. I cursed that doctor because I didn't think it would help. Then one day, I got so depressed that I took one of the chewable pills out of desperation. Within 30 minutes, I was feeling better and not nearly as desperate. So that's how I discovered that anticonvulsants help.

[Motoko]

I'm BP-NOS, with noticeable dysphoric hypomanic episodes, and still went an estimated ten-ish years between the BP kicking in and my eventual BP diagnosis (from a pdoc who specializes in mood disorders.)

Just before my Dx, I came across this link in one of the stickied threads over in our BP forum:

http://www.psycheducation.org/

And it was a lot of stuff I read on there as well as here on CB that helped me be ready to accept the BP Dx as soon as I got it. That's me though; for you I brought up the site due to this link:

http://www.psycheducation.org/depression/02_diagnosis.html#Anchor-What-60973

That's a long page, but I specifically set the link to the stuff specifically talking about the concept of mood disorders existing on a spectrum. I know it's just a repetition/rewording of stuff that others have said here in-thread, but thought you might like even more info on the spectrum concept.

 

OMG, thank you so much for posting that website and the article.  That was SO HELPFUL in describing how I feel sometimes.  I found yet another article on the site describing bipolar mood shifts as different waves operating at different speeds so you wind up with a whole spectrum of mood states rather than just up, down, normal.  I sent the article above to my shrink in case he's not familiar.  Again, thank you!

[Mirazh]

No problem. It's actually one of many links posted in a sticky thread in the Bipolar forum, I forget who put it up initially. But reading it was a big deal for me so I try to pass that around.