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Is it actually atypical, treatment-resistant MDD/GAD, or is it Bipolar Spectrum Disorder?


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Hey guys, long time lurker here, and I'd really like your input on something.  I'm a bit stuck when it comes to treatment, and I'd like to hear some peoples' opinions, as I wont be able to see my doctor to talk about it for a little while.

I’m currently diagnosed as having GAD and MDD, but I’m starting to think I have a bipolar spectrum disorder.   Here are some points:

  • Failed multiple antidepressants (Zoloft, Lexapro, Prozac, Viibryd, Pristiq).  Failed and/or had too many side effects
  • Had side effects on every serotogenic antidepressant, even while augmenting (Wellbutrin, Buspar) like sexual dysfunction and extreme fatigue
  • Atypical depression — BP Depression has excessive sleeping with a lot of daytime fatigue and an increased appetite, opposite of MDD
  • Very anxious — BP much more likely to be accompanied by stronger anxiety symptoms
  • The fact that “If all the treatments don’t work, maybe you’re treating the wrong thing”
  • Excessive nighttime eating (seen in BP Depression vs unipolar)
  • Racing thoughts
  • Earliness of first depressive episode (age 19 at the LATEST), and research shows it’s very likely to be bipolar disorder if before the age of 18/20/25 (experts disagree on the age)
  • My anxiety symptoms could actually equate to mixed state
  • Losing and regaining interest in hobbies (I’ll enjoy my “typical” hobbies one day and then later, zero interest / motivation)
  • Cousin has BPII (I know immediate relatives are the key, but still, a data point)
  • Online shopping addiction (computer, iPad, something new in the mail every day)

 

  • The fact that Bipolar Spectrum Disorder doesn’t require mania/hypomania, just multiple non-manic markers of bipolar (see links below for source)
  • The odds that I have treatment-resistant depression coupled with very prominent anxiety, and considering my episodes of depression aren’t THAT bad that they would be so hard to treat

So, what do you guys think?  For me, it would be a big relief to get a diagnosis as somewhere on the bipolar spectrum, as I've tried so many meds already, and I just wanna feel better :(  If anyone is curious as to my regiment and past meds, I'd be happy to post that as well.

Thank you all so much for taking the time to read and respond!  It means a lot!

some sources:

http://psycheducation.org/diagnosis/
https://www.healthyplace.com/bipolar-disorder/bipolar-depression/differences-between-unipolar-depression-bipolar-depression/

Edited by lapinjapan
added a quick sentence at the end
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It doesn't sound like bipolar disorder to me. Bipolar is very much an illness with drives - food, sex, sleep, activity - as well as mood and potentially psychosis and problems with reality. Feeling lousy, having bad anxiety, shopping too much on a regular basis, and not responding to meds would not equate to bipolar disorder IMO. Especially with the meds - the side effects you describe are typical of general population that has side effects. For example, I didn't have sexual dysfunction or fatigue - on lower doses of ADs I had the opposite of fatigue and was on a constant hypomanic cycle followed by hard crashes, and on a high dose I went nuts, like hang yourself from the rafters in the garage, seduce your boss, crawl around on the floor to hide from serial killers nuts. My depression is laying in a bed filled with dirty dishes, unable to get out of the bathtub wishing I was dead - and the increased eating - I would stand in front of the fridge entirely unable to feed myself. I couldn't process how to select a food or eat anything. Night time eating - never done it. I would be cautious about trying to find items like those overeating statements to try and justify a diagnosis. I understand really wanting a diagnosis so you can get appropriate treatment, although I wouldn't wish this diagnosis on anyone.  Has anyone assessed your anxiety as an anxiety disorder with some accompanying depression? Anxiety can make you pretty fucking miserable and depressed. Maybe you have disordered eating. Your shopping issues could be an actual addiction that isn't an indication of a bipolar upswing, which is usually visible through a group of out of control (or approaching pretty dysfunctional) behaviors and drives that appear together and escalate at once, rather than an isolated thing that you do all of the time. Like, I don't have a shopping problem, but when escalating I would spend $1000 out of the blue on things I never really valued before. And also wanting to have sex with every person I see, take on three jobs at once, volunteer for tons of shit, stay up all night working on projects, etc. And then I would go back to normal, as would my other behaviors and drives, and not be spending huge sums of money. And not to mention the continuum of psychosis that occurs with a lot of people. Have you been evaluated for personality disorders? Maybe you just have some serious shit, like shopping and food addictions, anxiety, etc that make you feel like shit and need to be addressed. Maybe that's why meds haven't worked. I would be careful trying to think your issues into a specific diagnosis and if you don't have a severe mental illness then that is a good thing. I'm sorry you've tried so many things that haven't worked. It took 20 years for me to get an accurate diagnosis. It blows. And I also would suggest a second opinion. And I am hypomanic and have edited this post like 35 times so I am officially declaring that I'm done editing for now. Hang in there!

Edited by Renarde
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Since you've failed multiple antidepressants, it seems like a good idea to talk to your doctor about trying a different treatment tactic, regardless of whether your diagnosis stays MDD/GAD or changes. It also doesn't hurt to explicitly tell your doctor, "I've been wondering if I might actually have bipolar disorder because XYZ. What do you think?" Sometimes it's hard to cover all our symptoms and experiences in an appointment, so asking about it may help your doctor direct their questions to get a more accurate picture. Even if your doctor still thinks its MDD/GAD, I know a couple people in my personal life and have seen people on these boards who use mood stabilizers (most commonly lamictal) for treatment resistant depression, which can also be an option if your doctor is on the fence diagnosis-wise. 

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First of all, thanks so much to everyone who took the time to respond! I really appreciate it ^_^

On 8/30/2017 at 10:25 PM, thunder said:

Since you've failed multiple antidepressants, it seems like a good idea to talk to your doctor about trying a different treatment tactic, regardless of whether your diagnosis stays MDD/GAD or changes. It also doesn't hurt to explicitly tell your doctor, "I've been wondering if I might actually have bipolar disorder because XYZ. What do you think?" Sometimes it's hard to cover all our symptoms and experiences in an appointment, so asking about it may help your doctor direct their questions to get a more accurate picture. Even if your doctor still thinks its MDD/GAD, I know a couple people in my personal life and have seen people on these boards who use mood stabilizers (most commonly lamictal) for treatment resistant depression, which can also be an option if your doctor is on the fence diagnosis-wise. 

This is exactly what I plan on doing.  I have a really good feeling about Lamictal!  Fingers crossed I get it and it works :) it seems people have good luck with it.

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  • 1 month later...

Wow, this sounds just like me, lapinjapan.
I, too, am struggling with a MDD/GAD diagnosis after having tried Lithium for a stab at BP Mixed State diagnosis.

I've recently decided to swallow my fear of MAOIs and try EMSAM but it's too early to tell yet.
(Having tried Zoloft, Prozac, Wellbutrin, Zyprexa, Remeron, Abilify, Depakote, benzos, etc.)

Edited by Neuromancer
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Definitely talk to your pdoc since we can't diagnose. I do know my diagnosis was similar but I had episodes that in retrospect were hypomanic or manic, finally one was extreme enough to be diagnosed. But I never suspected it and in fact resisted such a high stigma diagnosis. I would have preferred the MDD diagnosis with meds that worked, but that was not to be. Whatever the diagnosis, it's getting the right treatment that's the important part, but I know sometimes that doesn't happen. I hope you can get on better meds, whatever the diagnosis. 

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It seems you don't work well with SSRIs or SNRIs.  Have you tried Mirtazapine/Remeron?  MAOIs?

None of what you wrote seems remotely bipolar:

  • Atypical depression — BP Depression has excessive sleeping with a lot of daytime fatigue and an increased appetite, opposite of MDD

This is a bad generalization.  Depression is characterized in many ways and is not easy to define under the umbrella of a diagnosis.

  • Excessive nighttime eating (seen in BP Depression vs unipolar)

Another generalization.

  • Earliness of first depressive episode (age 19 at the LATEST)

I never had a depressive episode before I became ill at 25.

A mixed state involves experiencing depressive symptoms at the same time as manic symptoms.  Anxiety alone will never qualify as a mixed state.

  • Losing and regaining interest in hobbies (I’ll enjoy my “typical” hobbies one day and then later, zero interest / motivation)

This is not a symptom.  

  • Online shopping addiction

Seriously?

  • Had side effects on every serotogenic antidepressant

Is this a scenario where you would take an antidepressant for a couple weeks and then quit it because of the side effects?

 

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