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Mental Health  (Expert Forum)
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Just Diagnosed Bipolar II
Answered by
Roger Gould, M.D. - Mental Health, Wellness
Questions posted in the Mental Health forum are being answered by Dr. Roger L. Gould, author of the Mastering Stress and Depression program and affiliated with the UCLA. Department of Psychiatry. Topics covered include anger, attention deficit disorder (ADD), bipolar disorder, dementia, electroconvulsive therapy (ECT), learning disabilities, memory, obsessive compulsive disorder (OCD), panic, personality disorders, phobias, post-traumatic stress disorder (PTSD), schizophrenia, stress, transitions, and work problems.
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MedHelp Member's Question

Just Diagnosed Bipolar II

by Strategery, Feb 06, 2006 12:00AM
I've had at least 3 episodes of major depression with GAD in my lifetime. I sought help about 5 years ago and was put on Effexor 225 mg. It worked wonderfully for both anxiety and depression. About a year and a half later, I felt it had stopped working. I was then put on Paxil, and it didn't feel nearly as effective as Effexor. About a year later, my doctor tried Lexapro with even less success than Paxil. I stopped taking Lexapro because it felt completely useless (still felt dysthymic and anxious), and a few months later I fell into a pretty bad depression. My new doctor put me back back on Effexor, and within about a month it lifted me out of my deep depression. However, I didn't really feel "right" as I did the first time on Effexor. I was very keyed up, agitated, anxious, irritable, my mind raced, and I couldn't concentrate on anything because I'd get distracted so easily. However, I was NOT euphoric or grandiose. Therefore, the thought of mania or hypomania never crossed my mind. I am probably more in a mixed state/ rapid cycling, but I didn't know there was such a distinction at the time. My doctor said I was hypomanic and gave me a startup kit of Lamictal. On my next visit, he diagnosed me as bipolar II. In two days, I will be up to 100 mg Lamictal, and my Effexor dose has been reduced down to 150 mg for the time being.



At the time these symptoms first came to light about 2 months ago, I had no idea what was happening. The most obvious symptom then was the distractability and inability to concentrate at work. I thought I was just experiencing bad anxiety with a new twist--that of inability to concentrate. I thought I had suddenly acquired ADHD. I agree with my doctor's assessment, but it came out of left field. I was shocked. I had never thought that I could be bipolar because I can't remember any hint of hypomania in my life.



I've been experiencing doubts as to whether I am truly bipolar II. I'm 27 years old and have never experienced these symptoms before now. I've been taking Effexor, so I keep thinking that these symptoms are merely med induced (although Effexor didn't do this to me the first time I took it) and that I'm really not bipolar. If anything, I would think that I am somewhere on the bipolar spectrum, but not bipolar II. Am I in denial or just being logical? The DSM states that med induced hypomania cannot qualify as BPII, but rather BPIII. I don't want to split hairs over the diagnosis, and I realize that the most important thing is that the mood stabilizer strategy works, but I still need answers.



So did Effexor cause my hypomania/ mixed state, or did it just bring to light an underlying bipolar disorder? What came first, the chicken or the egg? I realize that this is probably a controversy in the psychiatric community. If indeed I am bipolar and it is just emerging at the age of 27, I can't help but think that it will only get worse. Is it hard to say what my condition really is, or is it clear-cut?
Doctor's Answer

by Roger Gould, M.D., Feb 09, 2006 12:00AM
These are the right questions, and you are right to pursue them until you get an answer that makes sense,but first of all, if in fact that is the diagnosis, it does not mean that you will get worse as you get older.



It sounds like you are in good hands and the mood stabilizer is right for now, but if you really want to get some solid information, talk to your doctor about getting you stabilized, then trying to get off the Effexor, and after that off the mood stabilizing drug to see what happens...If it was the Effexor that caused the excitability, which it can, then you will know that by this experiment.  Go slowly with this, better to be safe.
Member Comments (20)

by Marie/ Canada, Feb 06, 2006 12:00AM
Hi Chancey,



I have bipolar 1 diagnosed when i was 28, my shrink says probably because of my antidepressents.  They do cause hypomania and mania in some people but it's not common.  For years i think i may have had bipolar 2 since i was 20 until one day 8 years after i started taking antidepressents i went into a mania that would last for 2 months and i stayed in hospital for the whole time.  I would feel happy that your doc did diagnose you will bipolar 2.  I hope this means that it won't progress to bipolar 1.



Marie

by BonnieH, Feb 07, 2006 12:00AM
To: Chauncy
Hi, I hope you're feeling better, I too take effexor, and was weaned off, because of surgery, and now I'm gradually getting back to my regular dose. Patiently waited for it to kick in again because of depression and anxiety. Maybe you only need your dosage ajusted. My doc told me, since I had to go off for 6 weeks, that I'd probably have to up it a little, at least for a while. I think switching around medications sometimes just makes it worse. It seems like if it helped all along your body may need a little more. I 'd stick with the effexor for now. Good Luck, and try and stay positive, I know it's hell.  Bonnie

by Strategery, Feb 07, 2006 12:00AM
Hi Bonnie,



My doctor had me lower my dose from 225 mg to 150 mg and I'm actually starting to feel better. In the past, 225 mg was a good dosage for me, but this time it caused me to have this alleged hypomania. It helped my depression, but then it caused me to be wired, anxious, have really bad insomnia, racing thoughts, etc. So if anything, my dose was too high.



Right now I'm trying to figure out if I'm really bipolar II or if this episode was just a bad reaction to Effexor.

by Strategery, Feb 07, 2006 12:00AM
Marie,



So do you think that if meds induce mania or hypomania that one is truly bipolar?

by Marie/ Canada, Feb 07, 2006 12:00AM
I have thought of that myself too all i know is i had a ton of symtoms more then some who 'are truly bipolar' so i have experienced it and now when i come off my meds (my doc has tried this) i still get mania/hypomania.  So my shrink says i will need my lithium the rest of my life and apparently lithium does not usually work if you don't have bipolar.  All i know is i'm happy and i'm well.  Hope you will feel this way soon too.  Sorry you are going through this.

by love4mom, Feb 08, 2006 12:00AM
my mom has not yet been diagnosed with anything. She shows signs of bipolar, not quite sure which one. she has not been herself for 7 months now. She was initially prescribed lexapro and klonopin. She previously had been taking valium daily for the last 15 to 20 years for stress. I think the valium just stopped working and she also experienced several life changes 7 months ago. She was convinced shortly after starting the lexapro that she had had a stroke in her sleep. She said she had this tingling feeling up the back of her head and neck and down her leg that lasted over an hour. That was the start of many self diagnosed illnesses that through 2 mri's, a cat scan, and many doctors visits and test were proven to be false. Of cource no one ever gave her an exceptable explanation for the very real to her feelings. Unfortunately her psych doc did not insist on a set meds schedule so she went on and off the meds and ended up having what I think were withdrawals (she hates the word withdrawal) but she thought they were life threatening illnesses or conditions. We ended up comiting her for 30 days in a mental hospital. She was paranoid, suicidal, she paced contanstantly, was convinced she was "shutting down", and screamed help and shut-up all day. The hospital took her the lexapro and klonopin within a few days and put her on risperdol, remeron, ceroquil, valium, and a heart med. She was sedated and severly depressed. They offered no counseling because they said it wouldn't help till her meds started working. After three weeks they met with us and said the meds were not working like they wanted and preposed shock therapy, we said no!! I asked if it was possible that she was bipolar and having a reaction to the anti depressants and recomended lithium. They said coincidently that was their next med to try if we refused shock therapy. So instead of taking her off some of the meds expecially the anti-depressants they just added lithium to the drug cocktail. They released her and she slept for a month only getting up to eat. Recently we have taken her off all the meds and she is still about the same as she was when we addmitted her to the hospital. From what we could tell she is no better on the meds than off. I think they had her on to many and they were fighting one another and some were just not right at all for her. She is going through withdrawals now but thinks it is toxisity and that her left lung has collapsed because she was taking so many meds together. She no longer wants to live and has given up hope of getting better and the doctors can offer no hope only to commit her again. The medical community has FAILED my mom, it sickens me that they call themselves doctors, they really don't care. All the doctors do is medicate they never talk to her or try to find out what is really wrong with her. At this point we are just day to day. Has anyone out there been through this?? Help I could really use some advice and a little hope wouldn't hurt.

by emt987, Feb 08, 2006 12:00AM
hello all, I was diagnosed with bipolar with rapid cycling. I have had OCD in the past now it seems to be social aniexty is this chemical in nature? I cannot afford any new medicine i am on 3 already. I hate it so much I am lonely all the time because i can't talk to people. I have attacks if i go plcaes myself so Iam depressed because I am so dependent on others.(mywife) I hate my life what can I do. I am mean to my children sometimes I wonder if they are better of without me.

by Strategery, Feb 09, 2006 12:00AM
Am I going to receive a response? I just noticed that people who posted after me have received responses, so I was just curious.

by DonaldB, Feb 10, 2006 12:00AM
Hello Everyone..I was just recently diagnosed with BipolarII disorder and I am having a hard time dealing with it, I am giving people close to me a rough time and finding myself up and down. I feel like I have nobody to talk to and go thru periods of lonelyness quite bit lately. I really need some friends to talk to. I don't get on the internet too often these days but if anyone can talk to me my e-mail address is ***@**** or my phone number is 254-640-9339. I know this might seem desperate but unfortunately  I am.Please somebody write or call me. I would like to know more about this.

Donald

by dfox, Feb 19, 2006 12:00AM
Hello love 4 mom, my heart goes out to you hon.

Your mom is so lucky to have you as a child.

I didn't look to see if you signed your name or not , so i don't know if you are female or male.

Anyway i just thought that i would re-enforce the fact , that your mom no doughtedly is going through withdrawel's.

If she was on these drug's for more then a month.

I wonder what her origanal problem was to start with?

I really feel for you.

I sure am glad you refused shock treatment for her.

I was diagnoised with bipolar in 1999, i had so many problem's it was horrible.

If you could just get your mom to the right phychiatrist, to try the right med for her, she would feel so much better, if it is mentally.Tey must try many different med's , till they find the one that work's for her.

I know you said she had test, i just wonder if they have missed anything.

I know you have had her extencively checked.

So the odd's are she is mentally disabled.

This can be a real problem.

Especially for those that have no experience at drug addiction(withdrawel) mental health.

These are such complicated subject's.

How long has she been depressed.

Write me via email and we can try and get to the bottom of it.

I am willing to try and help you.

I know a lot about both subject's mental health and drug addiction