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I don't think you can according to the DSM.  You can only go the other way, AFAIK.  That's because you never know whether another hypomanic episode is right around the corner. 

Whether a bpII can permanently stop having hypomanic episodes entirely of their own accord...I don't know.

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I'm not sure if what I'm about to say has anything to do with what you're asking, but for whatever it's worth, here it is. When I read your Q, I thought of something I'd read here: http://www.psycheducation.org/bipolar/frameset.html (more on the full passage later). In the passage I remembered, first the author Jim Phelps, M.D. listed 11 "Soft signs" of bipolarity; then he said:

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There is a very radical idea buried in these 11 items, which we should look at before going on, but you should be aware that this idea is somewhat uncommon even among bipolar experts, and likely to be dismissed with a "hmmmph" by many if not nearly all practicing psychiatrists.  The idea is this: there might be a version of "bipolar disorder" that does not have any mania at all, not even hypomania.  Ghaemi et al call it "bipolar spectrum disorder".  Akiskal called it "bipolar outcome in the course of depressive illness", and later termed this "soft bipolar".  It is also implicitly recognized in a new (2005 update) bipolar diagnostic system in use at Harvard.

This is strange, you are saying to yourself.  "I thought bipolar disorder was distinguished from 'unipolar' depression by the presence of some degree of hypomania; don't you have to have some hypomania in order to be bipolar?  How could it be 'bi' - polar if there is no other pole!?"

But Dr. Ghaemi and colleagues assert that there are versions of depression that end up acting more like bipolar disorder, even though there is no hypomania at all that we can detect (or, as in item #9, only when an antidepressant has been used). These conditions do not respond well, in the long run, to antidepressant medications (which "poop out" or actually start making things worse).  They respond better to  "mood stabilizers".  And there is very often a family history which looks more like bipolar than unipolar. 

By this account, there are people whose depression looks so much like unipolar that even a "fine-toothed comb" approach to looking for hypomania will not identify it as part of the "bipolar spectrum", yet who actually should be regarded as "bipolar", in a sense, because of the way they will end up responding to treatment. 

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If you want to read it in its entirety, go to http://www.psycheducation.org/bipolar/frameset.html -- click on "Diagnosis" in the left menu. It's all worth reading; however, if you just want to read the reference I mentioned, click on "Soft signs" of bipolarity in the list at the top of the Diagnosis page.

Hope I wasn't to far afield of what you were asking. ;) I know what you were asking implied a movement from BPII to true unipolar depression -- but because to this new way of looking at BP spectrum disorder, BP can look like unipolar depression, I do think this relates.

Best,

revlow

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I think it can change for a number of reasons.

1) it's a trendy dx

2) alot of other dx's can look like bp and be co-morbid with the depression. e.g. bpd, adhd, etc.

3) anxiety sometimes passes for hypomania but it could turn out to be just a co-morbidity of anxiety and depression.

4) the dsm is pretty slilppery and one pdoc's assessment may not be accepted by the next one.

5) ad's pooping out is iffy grounds for a bp dx.

i suppose one could go on dreaming up reasons...

Ultimately, it's about what works. Is it working? Don't worry about labels.

7

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Well, she keeps adjusting my medicine, so I don't know if it's "working." Sometimes I can tell it definitely is, but there are other times, where it's like, uhm, what the hell, why isn't this doing anything.

I've had periods of hypomania, which might be why I was diagnosed with bipolar two, because the depression is very apparent.

The article was real interesting. What's real amusing, is that I read it two night ago. The whole damn webpage. I'm not sure exactly how I feel about it.

I'm not entirely sure what co-morbid means? Is that meaning that I could be both bipolar and have depression? Is that common? Well, I guess, is that even a possibility?

I'm on clonazepam for anxiety. So I dont know if it's that?  I still have moments of hypomania. So I'm not entirely sure if it's just anxiety and depression, entirely possible. But if that's the case, would they still put me on a mood stabilizer? Why not just go on an anti-anxiety medicine and something to treat depression?

I just had never heard of going from bipolar to depression.

I'm not trying to be obnoxious, I have a bad habit of playing devil's advocate, especially when I don't know or can't figure something out.

I'm not so much stressing the labels, I'm just concerned that I could get the wrong treatment if that's not what I have.

(Oh- random, I went to three different pdoc's, and they all dx-ed me with bipolar type two, so that's what I guess really threw me off.)

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Well, she keeps adjusting my medicine, so I don't know if it's "working." Sometimes I can tell it definitely is, but there are other times, where it's like, uhm, what the hell, why isn't this doing anything.

meds take time; sometimes a very long time to figure out what they can do for you at what doses. Also, meds can help alot but is best combined with therapy.

I'm not entirely sure what co-morbid means? Is that meaning that I could be both bipolar and have depression? Is that common? Well, I guess, is that even a possibility?
co-morbid means coexisting disorders. e.g borderline and depression.

bipolar subsumes depression.

So I'm not entirely sure if it's just anxiety and depression, entirely possible. But if that's the case, would they still put me on a mood stabilizer? Why not just go on an anti-anxiety medicine and something to treat depression?

not a front-line med for this scenario but not unheard of. It's all about clinical response, individual chemistries.

I just had never heard of going from bipolar to depression.
Dx changes happen.

(Oh- random, I went to three different pdoc's, and they all dx-ed me with bipolar type two, so that's what I guess really threw me off.)

<{POST_SNAPBACK}>

You state you have hypomania and depression. You know the bipolar II drill. If this is what you tell pdocs, that's the dx you'll get. Perhaps you are leading the witness, including yourself? I am just throwing out some ideas to help you. I don't know, of course, how these pdocs diagnosed you.

good luck,

7

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I'll just tell you a bit about myself, because you sound kind of like me. I've been struggling with depression forever.  I'm 43 years old.  In my 20's, I crashed and became completely disabled by it and was in and out of hospitals for 5 years.  After that, I could function, but I just dealt with a whole lot.  Mostly mood swings from depression (functional) and a lot of anxiety, irritability and crabbiness. 

Up until this past year, I could deal with it, but then the stress of real life became too much for me to handle and I was sliding fast into dark territory.  I was very depressed (still functional; have a family to take care of now), very anxious, very irritable and crabby and very irrational.

Started therapy last spring and was initially treated for unipolar depression.  I became much better, but my moods were still unpredictable.  Sometimes I'd be wonderful and then I'd wake up and it would all come crashing down; for no apparent reason.  Through all this, the edginess and anxiousness still persisted.

Then comes the possibility of BP II and mood stabilizers (lamictal) -- BINGO!  I've never felt better and more stable in my whole life.  I don't know if I'm truly bipolar type II or not (probably am), but if treatment works, that is fine with me.

I have no idea if this helps or not, but I thought it might.

Good luck!

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I've wondered about the comorbidity of bipolar and depression.  It seems possible that in addition to our going-to-happen-anyway bipolar depressions, we could get mostly-situational depression in response to bad circumstances.  If you look at unipolar depression as ranging along a continuum from going-to-happen-no-matter-what to overresponsiveness-to-bad-situations, it seems possible that depression and bipolar could be comorbid.

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I've had periods of hypomania, which might be why I was diagnosed with bipolar two, because the depression is very apparent.

Per the DSM definition, one incident is all thats required for dx.  Actually I've only had one true hypomanic incident, but I can see the general tendencies and some periodicity in me.

I'm not entirely sure what co-morbid means? o
Comorbid is a coexisting illness.

Is that meaning that I could be both bipolar and have depression? Is that common? Well, I guess, is that even a possibility?

Umm, no.  By definition the opposite pole from mania/hypomania IS depression.  Keep noodling around on Dr. Phelps site (or I can dig out the citations from Pubmed) and you will see that BPII'ers spend an average of 53% of the time depressed, a bit less for BPI's.    So we can expect to be depressed about half the time (untreated).

I'm on clonazepam for anxiety. So I dont know if it's that?
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Seven- I have a hard time with patience, though I am doing better. It's never been my strong suit. I actually am trying to dot he therpy thing now as well.

But i'm moving January 2nd, so I have to go through the whole pdoc/tdoc process again if my insurance decides to be obnoxious (I have military insurance, and I'm moving back near base). I'm MORE than willing to drive the 3 hours to see my pdoc/tdocs. I really do like them that much.

I do get the hypomania, like the other day. I had to go clean the kitchen. And tonight, when I decided now was a great time to put a coat of primer in our kitchen, did I mention that we have vaulted ceilings...yeah, that was special. But usually I'm real depressed and just lack motivation/creativity, don't want to leave the house, but don't really want to be alone. All I want to do is sleep, especially since eating is out of the question because I have no appettite.

Revlov- I don't understand unipolar depression. I mean, I've looked it up, I've read the definition, but I just don't get it. It makes me feel stupid admitting that too.

Pissing people off can be fun, especially when they're shitheads.

Annie- I love my Lamictal. I almost think I was better off when I was just taking that and the damn Ambien (for sleep). I might actually talk to my pdoc about that next time I see her. She'll probably think I'm being a pain, but we'll see.

*Oh someone please explain the differences in depressions to me! I don't get them. (ANd yes, I have read the depression board, a lot, and I still don't understand it.)*

Air Marshall- I very much agree that I'm bipolar type two. I get hypomanic but I also get real depressed. (Way more depressed than hypomanic/manic...and Zoloft and Paxil make me puke nonstop for HOURS.)

I would adore it if you found the quote for me. I can't even figure out the quotes thing here on the boards, let alone search for something...most of the technological things I manage happen on accident or sheer dumb luck.

Being depressed about half of the time sounds right (untreated of course). I mean, it sounds really accurate. I remember being absolutely miserable and not wanting to leave the house awful, even to go visit with people.

I understand the use of mood stabilizers (yeah for Lamictal), but is it possible that clonazepam can make you more depressed? (The other benzo's didn't work for me- I can't do Valium because of a previous addiction to them, the Xanax didn't do anything, though, I've never been on avitan now that I think about it. I'll have to write that one down and ask her.) I almost feel as if it's treating the short term problem, but making it worse long term. (I'm not sure if that makes sense.)

Unfortunately I do really really badly with AP's...I start hallucinating. And then I talk to the man in the purple velour suit kneeling on my floor with a box over his head. Not really questioning why he's there, because it seems like a perfectly normal thing. Or the half of the girl (torso up) on my bed talkuig to me, and me responding, just having a good old time together. No AP's for me...I keep getting strange new friends the more I try new ones. (There was one time I had midget trolls on my desk walking around- not dwarves- but midget trolls...no more AP's.)

As far as AD's go...well, Wellbutrin XL is the only one I've tried so far. And in the three days I've been taking it, it's done nothing but make me hypomanic for two of them. Granted, I know it takes at least two weeks for it to kick in...but I"m hoping that's going to stop, soon, please! (Is that something worth calling the pdoc about?)

I think I'm a pretty much "by the book" bipolar. Which is probably how the three made their assessments, I dunno. But at least they all agreed and there wasn't a lot of doubt or anything.

I have always been a worrier. I worry about everything. I worry about all the things I have absolutely no control over. And then I freak out about them, because I have no control over them. (Get the idea that I'm a slight control freak yet? Or that I have trust issues?)

I really really try to not worry sometimes. My dh is very laid back and he's like "everythign will have a way of working itself out." Which is really cool, but he's in freaking Iraq right now, and isn't here to remind me of that.

But I really appreciate all the concern and help everyone's been. It's really cool to have such a good support group (even if it is online). But like they say, you can't pick your family (my very annoying, not at al supportive, except sometimes dh when it suits him), but you can pick your friends (my rl friends that I can tolerate and trust as well as my internet buddies here...you guys!).

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Revlov- I don't understand unipolar depression. I mean, I've looked it up, I've read the definition, but I just don't get it. It makes me feel stupid admitting that too.

<{POST_SNAPBACK}>

Please don't feel stupid. We've all been learning as we go along, you know. Unipolar depression is just straight depression. That's it, no bipolar part to it. "Unipolar" meaning only one end or "pole", and bipolar meaning two poles...the two being opposite: depression on one side, mania or hypomania on the other end of it. So people with just plain unipolar depression never experience the hypomania or mania end of it.

*Oh someone please explain the differences in depressions to me! I don't get them. (ANd yes, I have read the depression board, a lot, and I still don't understand it.)*

<{POST_SNAPBACK}>

There are a lot of subtypes of depression, both subtypes of unipolar depression and subtypes of bipolar depression. Too many to go into here, and really more than is helpful to what you're going through now. Seriously.
Air Marshall- I very much agree that I'm bipolar type two. I get hypomanic but I also get real depressed. (Way more depressed than hypomanic/manic...

<{POST_SNAPBACK}>

As Air Marshall was saying, there's usually more depression experienced by BPIIs than hypomania. But just because you experience more depression doesn't mean you are not BPII, if you are. To quote Dr. Phelps "...the 'unipolar' extreme represents straightforward depression with no complications." That doesn't sound like what you're describing. You do seem to have hypomania, right? So, to my limited knowlege, as well as the dx of your 3 pdocs, it sure sounds like BPII.

Being depressed about half of the time sounds right (untreated of course). I mean, it sounds really accurate. I remember being absolutely miserable and not wanting to leave the house awful, even to go visit with people.

<{POST_SNAPBACK}>

Still doesn't mean you are not BPII. In fact it fits right in with the description of BPII.

I understand the use of mood stabilizers (yeah for Lamictal), but is it possible that clonazepam can make you more depressed?

<{POST_SNAPBACK}>

Yes. Here are the possible side effects listed in the patient information for clonazepam:

* Some common side effects reported with this medicine include:

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Ok, I officially understand the definition of unipolar depression. Thank you!

I do agree that I'm bpII, lots of hypomania and even more depression.

I'm going to talk to my pdoc on the 29th about all this mess. (Their office is closed until the 26th, and they have no voicemail except to tell me if it's an emergencey to call 911 or to call back during regular business hours.)

Does anyone know if pms can literally worsen your condition. I swear I get extremely more depressed the week before I'm about to start my period (sorry, this might be tmi). I mean to the point where I feel like I"m not even taking medicine for the depression, or that I was ever on it.

Rev- I appreciate the mom in you! I only wish my own mother was that supportive...maybe in time. It would be meddling if I wasn't already asking for help and/or advice.

And truthfully, I don't mind the bpII "label," I like knowing what's going on with my body. That way I can get better, or at least not make things worse. ;)

I just worry too much about all the little things in life. Can worrying about all sorts of things be associated to bp? social phobias? Or is it just me worrying about things? I can't seem to stop, no matter how much I know I'm not in control, and can't change them. (Oh, and yes, I am a control freak and a perfectionist- it gets worse when I'm hypomanic, but that's not a huge surprise.)

And Rev- you're not coming across too harsh at all! I really like that you post and keep me informed, or find thigns I wouldn't ever find. (Have I mentioned how computer illiterate I am? No matter how much I try, google is NOT my friend, and not from lack of trying.) Sometimes I need a dose of reality or reassurance to be like hey, this isn't right, call your damn doctor.

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Does anyone know if pms can literally worsen your condition. I swear I get extremely more depressed the week before I'm about to start my period (sorry, this might be tmi). I mean to the point where I feel like I"m not even taking medicine for the depression, or that I was ever on it.

<{POST_SNAPBACK}>

Yes. Absolutely! You should talk with your docs about this. For some women, prescribing an OCP can help, for some women switching to a different OCP can help. Or adjusting your other meds during that week.

I just worry too much about all the little things in life. Can worrying about all sorts of things be associated to bp? social phobias? Or is it just me worrying about things? I can't seem to stop, no matter how much I know I'm not in control, and can't change them. (Oh, and yes, I am a control freak and a perfectionist- it gets worse when I'm hypomanic, but that's not a huge surprise.)

<{POST_SNAPBACK}>

From what I've read, yes. Here's one excerpt from Dr. Phelps' site, under Diagnosis Details: http://www.psycheducation.org/bipolar/frameset.html

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GAD or BPII?

In my experience it is very clear that some people who are experiencing anxiety, who often have been diagnosed with GAD, respond to the mood stabilizer approaches described below. Could they have had a form of bipolar disorder?

In my experience two symptoms best identify people who are going to respond well to mood stabilizers: profound insomnia and difficulty concentrating. These are two of the GAD symptoms; I

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Ok, once again, as usual...I don't quite understand the chart. I've read it like four times. It's not the organization, which is really pretty. I'm just confused. I"ll have to spend some time tomorrow rereading that man's webapage more in depth.

I think what I don't understand is that there are such slight differences between being bipolar and GAD, how can you tell the difference? Or am I reading that wrong to? Can it be a comorbid thing? Something else I need to bring up to my pdoc, because mine looks like both, unless I'm reading it wrong.

I don't understand what you mean about the two things in brackets though. I get that you put them in brackets, but why? Are those the big signifying differences? (I am a certified insomniac unless I take medication.)

I don't know if I"ve posted this somewhere, but the px's I'm on are: 200mg Lamictal, 150 Wellbtutrin XL, 2mg Clonazepam (or as needed), and 5-10mg of Ambien.

Crap, my mind is lost at the moment. I'm going to reread this tomorrow and not have a damn clue of what it means.

Ok, off to bed with me...please respond...much confusion in my head.

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Guest luli2545

I don't have the science to get all this. But it seems circular logic, or sort of chicken/egg sort of question: Because people respond to mood stabilizers, they must be bi-polar nos or something. (of course, adding in a retrospective look at family history of bp, and my impression of past dx's of bipolar covered a wide range of cycling and who knows who had what kinds of behavior)

Seems I don't quite put my stock in some of the logic of determining what is bipolar and what is not.

I've heard of depression on depression, like an axis one, major depressive disorder, with a secondary axis one dx of dysthymia...so a person has depression, no mania, and cycles down into more severe depression. Of course, with anxiety...This condition has been called a form of bipolar too...so I don't get it.

So, if someone doesn't respond well to AD's, or they poop out so go on mood stabilizers, then they are bipolar? Further, since the chemistry of a lot of the meds is sort of black box, idiosyncratic, yer mileage may vary etc...how can this be definitive?

I've seen patients go nutso on ad's and yeah, real clear bipolar...

I've seen patients have almost the same symptoms...but the depressed type insomnia doesn't look like vanilla flavored bipolar, up three nights cleaning & feeling fine kind of thing (patients in spring time who are just fine & flying high, then crash into many of the sx of major depression. the sleep problems of depressants seem to be early insomnia, interrupted sleep, early morning awakening...but the patients are tired as heck and wanting to have good sleep, instead of staying up and doing stuff, and feeling just fine getting no sleep, or three hours of sleep per night.

And why, incidentally, can't the one end of the "pole" be depression, and the other end of it be, sense of normalcy? Whats up with all this?

...the idea is this: there might be a version of "bipolar disorder" that does not have any mania at all, not even hypomania.  Ghaemi et al call it "bipolar spectrum disorder".  Akiskal called it "bipolar outcome in the course of depressive illness", and later termed this "soft bipolar".  It is also implicitly recognized in a new (2005 update) bipolar diagnostic system in use at Harvard.

there are versions of depression that end up acting more like bipolar disorder, even though there is no hypomania at all that we can detect (or, as in item #9, only when an antidepressant has been used).

These conditions do not respond well, in the long run, to antidepressant medications (which "poop out" or actually start making things worse).  They respond better to  "mood stabilizers".

By this account, there are people whose depression looks so much like unipolar that even a "fine-toothed comb" approach to looking for hypomania will not identify it as part of the "bipolar spectrum", yet who actually should be regarded as "bipolar", in a sense, because of the way they will end up responding to treatment. 

-----this new way of looking at BP spectrum disorder, BP can look like unipolar depression...

Best,

revlow 

<{POST_SNAPBACK}>

Maybe it's just confusing...but I'm obviously not getting why it is such a big deal?

Sorry if I'm off topic

Luli

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berelain326:

You may not be as confused as you think you are...

I think what I don't understand is that there are such slight differences between being bipolar and GAD, how can you tell the difference? Or am I reading that wrong to? ... mine looks like both...

<{POST_SNAPBACK}>

That's exactly Dr. Phelp's point -- that they are extremely similar, the real difference being the type of medication that works best. "In my experience it is very clear that some people who are experiencing anxiety, who often have been diagnosed with GAD, respond to the mood stabilizer approaches..."

I don't understand what you mean about the two things in brackets though. I get that you put them in brackets, but why? Are those the big signifying differences? (I am a certified insomniac unless I take medication.)

<{POST_SNAPBACK}>

Those were Dr. Phelps' brackets. He explains them by saying: "In my experience two symptoms best identify people who are going to respond well to mood stabilizers: profound insomnia and difficulty concentrating. These are two of the GAD symptoms; I
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luli2545:

I may not be the best person to explain this; maybe someone else can explain the science behind it better. My ability to articulate this is no doubt highly influenced by the long, sordid story of my own diagnosis. (Here is a brief version of it, should you be interested: http://www.crazyboards.org/index.php?showt...dpost&p=91258.)

Another article I'd bookmarked was from the March 2002 of the Canadian Journal of Psychiatry; as I remember it goes into more scientific detail: "Cade's Disease" and Beyond: Misdiagnosis, Antidepressant Use, and a Proposed Definition for Bipolar Spectrum Disorder. It's geared more toward the psychiatric community, whereas Dr. Phelps' site is written more for primary care physicians and the general public. (Unfortunately as I write this, it appears the Canadian Journal of Psychiatry's website is down; hopefully it will be back up soon.)

If I can find some better articles I'll post them, or maybe someone else has some recommendations? There are a ton of articles around re: the different types of depression, and the different types of BP disorder. Again, maybe someone knows some particularly good articles. In the meantime, if you wish to read about these, some articles I have bookmarked are:

Types of Depression - Has links for more detail in each section.

What is Bipolar Disorder - The page on the different types of BP Disorder, from the same site as above.

The High Prevalence of "Soft" Bipolar (II) Features in Atypical Depression - From the same website as above. For more information on these "soft signs" of bipolarity, both Dr. Phelps' site and the Canadian Journal of Psychiatry article include detailed lists.

Again, personally I think Dr. Phelps' site http://www.psycheducation.org/start/BPIntro.htm is the best place to start to learn about BPII in particular.

Hope this helps,

revlow

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