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Atypical hypo, mild hypo, or no hypo? Where do I fit?


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Hi All, I'm new here and I am so grateful for this space. 

I received a tentative BP II (I believe rapid cycling) dx a rather long time ago (over a decade), and have been on a mood stab. since then (lamictal). The thing is, I'm not certain if this fits me. I know you can't dx me, but I am hoping that maybe someone shares my experience, or can shed some light on what's going on for me. All of this is based on a fairly shaky memory of the time + my parents memory. 

Way back then, in my pre-teen days, I presented as having periods of being "stable," active and generally good. Very suddenly, I would go into extreme irritability and frustration with uncontrollable outbursts, typically triggered by something. I remember feeling, after these outbursts, that I had no control over them and would often be very apologetic and ashamed. As I got into my teens, I would more often rapidly spiral down into deep deep, inconsolable despair. 

The latter is pretty clearly depression, but does the former count as hypomania? Those period wouldn't last the requisite 4 days, they were just extremely fast shifts. There were times where I would get hyper focused on projects with a belief that, whatever I was doing it needed to be genius and the "best." The irritability and frustration would often be present as well. I don't recall ever having periods of euphoria and hyperactivity so often described as hypomania. I also don't know if I ever had grandiose ideas about myself, but I do know that I often believed myself to be different and wanted to be the "best" at everything. I wanted everyone to see me as super special and recognize my amazingness. Sometimes I would get into a cleaning frenzy with my room and have to reorganize everything, but I don't think those moods would last very long. I should mention that around the same time, I had developed a severe anxiety disorder with near-daily panic attacks. 

As an adult, I still have periods of crashing into deep depression, but for a while the periods in between have been longer (except recently they may be getting shorter again?). I don't know if I ever have what could be considered hypomania. I will have high energy periods where I want to be social and get frustrated if I don't have plans (but that could be normal). I will also get very focused and intense about work, and will commit myself to projects that I later lose interest in/can't follow through on due to the depression. A couple of different meds I have tried have triggered high high energy and pressured speech, but that's a med thing I believe. 

Anyways, apologies for this being long, I am finally in a stage of my life where I am trying to make sense of all of this and take charge of my treatment. I have been pretty passive about it for a while, but I have seen how it does severely impact my life. I just want to be able to hold down a job and advance in a career and have relationships without needing to bail!  

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Welcome to CB!

Sounds very frustrating what you are going through.

Have you seen a psychiatrist (pdoc)?  If so, this would be great questions to run by him/her.

Also, do you see a therapist (tdoc)?

I know you said you are on lamictal.  Have you tried any other meds?

I'm sorry for all the questions.  I just want to understand more of what you are going through and if you have help out there (aside from here at CB) or not.

Edited by melissaw72
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Thanks Melissa! 

I have been seeing a pdoc, he has said that because I have been medicated for so long that it is difficult to accurately diagnose, but that my "breakthrough" symptoms seem to be congruent with BP. I haven't shared with him my whole history, though, and he hasn't asked. He isn't terrible, but not great. I am looking for a new one.

I have seen tdocs off and on for years, and find them to be very helpful to address coping, and the deeper trauma-associated stuff. Or trauma-lite as I see it, because I can't fully accept that what has happened to me was all that bad, compared to others. I will be starting with a new tdoc soon. 

I haven't tried any other mood stabilizers, but I have been on a variety of ADs + other things. Right now, my other meds are Lexapro, Trazodone, Geodon, and Adderall. 

Thanks aura! I will check that out!

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1 hour ago, Omnishambles said:

Thanks Melissa! 

I have been seeing a pdoc, he has said that because I have been medicated for so long that it is difficult to accurately diagnose, but that my "breakthrough" symptoms seem to be congruent with BP. I haven't shared with him my whole history, though, and he hasn't asked. He isn't terrible, but not great. I am looking for a new one.

I have seen tdocs off and on for years, and find them to be very helpful to address coping, and the deeper trauma-associated stuff. Or trauma-lite as I see it, because I can't fully accept that what has happened to me was all that bad, compared to others. I will be starting with a new tdoc soon. 

I haven't tried any other mood stabilizers, but I have been on a variety of ADs + other things. Right now, my other meds are Lexapro, Trazodone, Geodon, and Adderall. 

Thanks aura! I will check that out!

Is your pdoc willing/open to try other meds?

 

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31 minutes ago, melissaw72 said:

Is your pdoc willing/open to try other meds?

I think it's more that I'm nervous about trying something new right now. I am not opposed to it, and I don't think he is either, but I have a newish job right now that I really want to maintain and I am worried that switching things up might make me lose it (both mentally, and thus the job). 

I have thought about doing a washout (under supervision of course) so that I can see where I'm really at.

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22 minutes ago, Omnishambles said:

I think it's more that I'm nervous about trying something new right now. I am not opposed to it, and I don't think he is either, but I have a newish job right now that I really want to maintain and I am worried that switching things up might make me lose it (both mentally, and thus the job). 

I have thought about doing a washout (under supervision of course) so that I can see where I'm really at.

(in bold) That is completely understandable.

About the washout, my thoughts on that are won't it take some time to go off the meds and deal with possible side effects of doing so, while at the same time going to work?  I think that tweaking the meds you are on wouldn't take as long as the washout.  You could do a little at a time.  But I can totally understand why you'd want to do a wash out, and like you said, supervised.

Also, I think that doing a washout of meds might be better done IP.  I know you want to maintain your job though so Idk if that is an option or not. 

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20 minutes ago, melissaw72 said:

About the washout, my thoughts on that are won't it take some time to go off the meds and deal with possible side effects of doing so, while at the same time going to work?

You're right, it would take time. Ideally, I would have some time I could take off work, but I'm not sure that could happen. Also, this job is a short-term position, it's set until mid-October. I am hoping it will lead to longer term opportunities in the field, and at the same time I sort of wish I could take a break in between this job and looking for the next one. Argh life!

20 minutes ago, melissaw72 said:

Also, I think that doing a washout of meds might be better done IP.

Yep, in a perfect scenario I would have time + good insurance + great pdoc who could facilitate a productive IP stint for this to happen. 

Can I ask what made you ask about my meds? Not offended or anything, just curious about what others' thoughts are on my situation. 

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Quote

Can I ask what made you ask about my meds? Not offended or anything, just curious about what others' thoughts are on my situation. 

I asked about your meds based on the following post you wrote (see below):

 

1 hour ago, Omnishambles said:

I think it's more that I'm nervous about trying something new right now. I am not opposed to it, and I don't think he is either, but I have a newish job right now that I really want to maintain and I am worried that switching things up might make me lose it (both mentally, and thus the job). 

I have thought about doing a washout (under supervision of course) so that I can see where I'm really at.

 

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So the whole spectrum concept is something that can be really helpful--keeping in mind that where on the spectrum you land isn't as critical as handling wherever that happens to be. 

For example, for a lengthy period of time, I "accepted" that I had BP 1, wrote it as my signature, discussed it on here, and yet in my head questioned whether it had applied because of not technically meeting the length of time for a manic period, because of a concern that certain symptoms may have been trauma or anxiety-related instead of psychosis-related, and because the only clear criteria was that I'd been hospitalized.  I've since learned very clearly that it's bipolar 1 and that I could have probably prepared better if I had known that.

I've always been scared by the possibility of a complete washout because to me it feels like setting yourself up to fall apart and to experience hell when you don't even know what that hell will be.  Also, because there are no guarantees that going back on medications would work again or how long you'd be in it, it just really seems messy.

I'd personally suggest to cautiously accept it could be either and learn about both, but I understand that can be really hard to do.   

Edited by dancesintherain
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6 minutes ago, Omnishambles said:

Of course, that makes sense! I actually meant this question: 

"I know you said you are on lamictal.  Have you tried any other meds?"

 

I think I was just wondering if you had tried other meds.  Out of curiosity.  Because there is so many other meds out there that if lamictal was the only one you tried there are more options out there.

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4 hours ago, dancesintherain said:

So the whole spectrum concept is something that can be really helpful--keeping in mind that where on the spectrum you land isn't as critical as handling wherever that happens to be.

This is really important, thanks! And to your point about a washout, you're right it could be counterproductive and hellish. It's strange, when I'm more up it's hard for me to remember how miserable the depression is. 

The acceptance bit has always been tricky, but I'm working on it! 

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