Bipolar II to Bipolar I?

Yesterday, I dropped in for an emergency appointment at my school's mental health office to discuss my increasingly serious suicidal ideation and what seems to be rapid cycling induced by an anti-depressant. The doctor was concerned enough that she made a full length follow-up for this morning. During this meeting, I gave her a detailed history of my mood disturbances, symptoms, and episodes, and she suggested that I definitely have a bipolar disorder, and that I have "more than bipolar II" (ie. BP I). This surprised me, although several of the mixed episodes that I have experienced since I last saw a psychiatrist (October 2009 or so) have been absolute, out-of-control hell, with distinct and crippling paranoia. One led to an overdose and a consequent hospitalization. I'm still on the fence about it, but we're meeting two more times in the next few days to complete the evaluation, and hopefully things will begin to make sense.

Anyway, my questions are: (a) has anyone experienced a change of their illness from BP II/ BP NOS to BP I, or cyclothymia to BP I/II, etc.?
(b) does anyone out there question their diagnosis, and why? Have you had conflicting diagnoses from pdocs?

The treatment is essentially the same, that is, medications to manage whatever particular symptoms one struggles with. I know the diagnoses are really just "labels", but with the label comes a sense of hope, sometimes.

[Athena_M]

Were you in the hospital for mania?

If you end up being hosptialized for a severe manic episode then it is usually Bipolar 1.  I have bipolar 1 and have been hospitalized for extreme manic episodes with psychosis.  I can go years and years (4-5) without a manic episode unless I go off my meds.  I have had periods of depression usually after my manic episodes that have left me feeling suicidal.  

Usually in bipolar 2 the mania comes but not as extreme.  Some people cycle from depression to hypomania almost daily.  

Personally I'm glad I have bipolar 1 because the cycles are more spread apart.  My friends with bipolar 2 have a hard time with medication because one day they can be manic and the next day depressed.  The bad part about having bipolar 1 is the hospitalizations are long.  My 5 have been at least 3 weeks.  If I would have stayed on my meds then I wouldn't have had the hosptializations.  

Whatever your diagnosis there are alot of people here to help you and you will feel better once you get a clear diagnosis.  I know it gets overwhelming and confusing. Keep me posted on how things are and what the docs determine.

[hell1971]

I am Bipolar II and this means that I suffer more from depression/hypomania than mania, when I am manic it is hypomanic which is less extreme than pure mania, I have however had an extreme manic episode but my diagnosis was kept at BP II because the mania was triggerred by an anti depressant, really as long as you are getting the right treatment the lable doesnt matter. I have had many periods of denial since being diagnosed a year ago but I am just learning to accept the diagnosis for good and make sure I dont get as sick as I did last year. This site has seen me through some really tough times and im almost addicted to it but the support you get is outstanding, I have learnt alot by reading and contributing to posts on here. Good luck with your assesment and I hope you get the treatment you need.

[adel_ezz]

your post is interesting in how to differentiate between BP1 and BP2. I agree with you that like all the sites that say in 1 you get mania whereas in 2 just hypomania. Further they say in mania you have psychosis and in hypomania you don't except that many said they still do

I have been in this disorder years and still i can't tell the difference between a mania and a hypomania. If you see my profile it says "can anyone guess" and actually this tortures me in a way because although i know all the meds their doses and many things about this disorder but still i can't decide to what type i belong, neither the pdocs. this doesn't mean i am NOS. I was even thinking to post this question so as the folks in this forum ask me a set of questions and let them decide.

One of the pdocs said i am BP1.5 (incidentally don't laugh i read it more than often) why he said that is because i didn't enter the hospital. In Mania he said i must be hospitalized. But this can be a family decision. For example in one of the episodes, I tried to commit suicide my mother was abroad with my sister and i was left alone with my father. I tried to jump from the window and he was preventing me and we had a fierce fight and i injured him in the face many times and we continued fighting for a period until i was exhausted and the man too. It was one of my mixed states. Now something like this shouldn't have passed smoothly i believe the hospital is a MUST. Likewise many other incidences occured (not committing suicide, but hurting others) occurred and i was never hospitalized. Perhaps the reason was that my family never trust hospitals fearing they will put me on some drugs or narcotics or the like to keep me exploited later sort of blackmail. So really i can be 1. But again depression is my main concern and unless i take an AD i stop functioning. I am under the impression that my mania is due only to the AD i take, so if i can find a way to stop depression without an AD (lamictal i didn't tolerate it, didn't try abilify) then my problem is solved and i could even be BP3.

Again the meds are the same really, unless lithium is for 1 not for 2, but i have seen 2 taking it, etc...

coming to your post, it's really enlightening when you said

"My friends with bipolar 2 have a hard time with medication because one day they can be manic and the next day depressed. Usually in bipolar 2 the mania comes but not as extreme.  Some people cycle from depression to hypomania almost daily."

Do i understand that in BP1 there is no rapid cycling. If this is so then i am BP2, because i cycle and my main concern is depression and i graduated from a university, i.e. less probability of frequent psychosis. Again when do you call a mania "extreme" I really can't tell

finally as to whether when unmedicated 2 turns into 1 i also read it, but this is illogic too either you are genetically 1 or 2.

at last don't neglect the phenomenon of "kindling" i.e. more frequency and worsening rather than the metamorphosis from 2 onto 1

have a good day

  

[thornis]

Conflicting diagnosis are common. It is really hard to know what is going on in someones head.
As Athena said there is this 1.5 category. As my doctor said in BP 1 usually the person loses almost complete control in a manic state.
Im just coming down from a 3 to 4 week mixed manic attack. The attack that resulted in me joining this site and a lot like what you described.
I'm in school too. One thing I did that seemed to help was... well first I had to stop going to classes, I could not function properly or even sit down for more then an hour... but I got into this schedule of doing half an hour of work then taking a walk, then half an hour of work, then walk, ect. ect. It was hard at first, but after a while I got into the routine and it helped a lot. Just do everything a little bit at a time. Also I have some pretty good room mates who put up with my increasingly erratic behavior (like closing all the blinds in the house in a bought of paranoia)
Also remember, it wont last forever. Good luck!

[adel_ezz]

>>>I could not function properly or even sit down for more then an hour..but I got into this schedule of doing half an hour of work then taking a walk, then half an hour of work, then walk, ect. ect.

you are describing me. All bipolars do this. The problem with me is that my patience became narrower and narrower, so reading less no of paragraphs, sit less ammount of time, restlessness. This is an authentic BP behaviour LOL

[Athena_M]

Hi Adel_ezz,

Based on what you wrote I would "guess" you have Bipolar 2.  

In bipolar 1 the problem is usually with the manic episodes being so extreme that hospitalization is usually forced by court order or the police come to take you into the hospital.  There is usually no option for family deciding to not hospitalize.  Also the mania from lack of sleeping for weeks turns into psychosis.  Where the person hallucinates and has delusions and false beliefs.  I once thought I was MARY the mother of Jesus and then one time I thought I was Michael Jackson's mother. LOL.
In mania the speech is extremely fast.  The thoughts and ideas are for inventions and all types of strange ideas.  The person will be singing in a theatrical way.  (Which is why I was put in the isolation room, I kept singing really loud when all the other patients were sleeping).  What's funny about that is that I did take Theater singing before I was diagnosed.  The person stops sleeping maybe getting one hour a night and it could be that way for weeks.  The person becomes a danger to themself and others.  Once I was so manic I started dancing in the middle of the street with cars honking at me.  I thought I was an angel-everyone thought I was gonna prove it by jumping off a building. So, I was hospitalized. I had my keys and credit cards taken away from me by my husband.  I almost lost my job.  

In bipolar 1 there is usually no cycling.  The medication is to control the mania from occuring.  The medicine can lead to depression.  

Whereas in bipolar 2 the medication is to control the depression and can cause hypomania. Hypomania is just like mania only less severe and does not normally require hospitalization.  

I'm so glad your father stopped you from jumping out of the window.  That must have been a horrible time for you.  

If you get your medical reports I am sure there is something written down that says whether you have bipolar 1 or bipolar 2.  

I have seen too that the meds for both are somewhat the same.  

There are things you could do to help lighten the depression that I have done.

Sleep at night - if we stay up late our brains don't make enough serotonin
Get sunlight for 30 minutes before noon.
Eat bread - it has something in it that helps make serotonin
Eat one or two pieces of dark chocolate 60-70%
Try Omega 3 with Fish oil capsules
Take a dance class- Dancing is so good for us that have "mental illnesses" or watch dancing

Good luck Adel.  

I think it would be a good post for people to guess which bipolar you have.

Take care

[starbunny]

Yes it is interesting how people distinguish between BP 1 and 2. I assumed that I was 1 because of how extreme the manic periods were with psychosis. I hear now how one should be hospitalised for bp1 so I am not sure, perhaps it is bp2, although like adel I have done such dangerous and erratic things due to psychotic behaviour during the last episode that I probably ought to have been.
When I asked the pdoc what my diagnosis was he told me that the bipolar spectrum is large and said mild mood swings on one side moderate in the middle and severe at the other end. He said I was toward the severe end, but again I am none the wiser.
It seems that he does not want to differentiate between 1 and 2 here and just treat the symptoms. Perhaps it is just a sliding scale with an imaginary cut off point rather than BBP1/2 being two seperate distinguishable conditions? What do you think?

[Athena_M]

Here is a definition of the difference between mania in Bipolar 1 and hypmania in Bipolar 2.  It's a little hard to differenciate the two, but I found this information interesting from Wikepedia.

Manic episode
Main article: Mania
Mania is generally characterized by a distinct period of an elevated, expansive, or irritable mood state. People commonly experience an increase in energy and a decreased need for sleep. A person's speech may be pressured, with thoughts experienced as racing. Attention span is low and a person in a manic state may be easily distracted. Judgment may become impaired; sufferers may go on spending sprees or engage in behavior that is quite abnormal for them. They may indulge in substance abuse, particularly alcohol or other depressants, cocaine or other stimulants, or sleeping pills. Their behavior may become aggressive, intolerant or intrusive. People may feel out of control or unstoppable. People may feel they have been "chosen," are "on a special mission," or other grandiose or delusional ideas. Sexual drive may increase. At more extreme phases of bipolar I, a person in a manic state can begin to experience psychosis, or a break with reality, where thinking is affected along with mood.[8] Many people in a manic state experience severe anxiety and are very irritable (to the point of rage), while others are euphoric and grandiose.

In order to be diagnosed with mania according to the Diagnostic and Statistical Manual of Mental Disorders (commonly referred to as the DSM) a person must experience this state of elevated or irritable mood, as well as other symptoms, for at least one week, less if hospitalization is required. According to the National Institute of Mental Health, "A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present."[9]

Hypomanic episode
Main article: Hypomanic episode
Hypomania is generally a mild to moderate level of mania, characterized by optimism, pressure of speech and activity, and decreased need for sleep. Some people have increased creativity while others demonstrate poor judgment and irritability. Many people experience signature hypersexuality. These persons generally have increased energy and tend to become more active than usual. They do not, however, have delusions or hallucinations. Hypomania can be difficult to diagnose because it may masquerade as mere happiness, though it carries the same risks as mania.

Hypomania may feel good to the person who experiences it. Thus, even when family and friends learn to recognize the mood swings, the individual often will deny that anything is wrong.[10] Mind you, what might be called a "hypomanic event", if it not accompanied by complementary depressive episodes ("downs", etcetera), is not typically deemed as problematic whatsoever. The "problem" arises when mood changes are uncontrollable and, more importantly, volatile or "mercurial". If unaccompanied by depressive counterpart episodes or otherwise general irritability, this behavior is typically called hyperthymia, or happiness, which is of course perfectly normal. Indeed, the most elementary definition of bipolar disorder is an often "violent" or "jarring" state of essentially uncontrollable oscillation between hyperthymia and dysthymia.


I think the main difference is the person with hypomania Bipolar 2 does not experience delusions or hallucinations.  

[thornis]

There are other classification systems too that aren't used as much. There is the ICD (ICD-10) and Young and Klerman. It is possible your doctors each come from different schools of thought so it actually maybe less contradictory then it seems.

http://bipolar.about.com/cs/faqs/f/faq_classifybp.htm

[bpchrisb]

Type 2 Bipolar is basically a spectrum disorder that covers some of the more rare BP symptoms such as rapid cycling and mixed episodes. With some folks, it just means that they are mildly BP; they simply cycle a little more than BP1 people do.

BP1 is more predictable; the changes in mood generally come on gradually and the swings last longer. I have been told that a 'true' BP1 person cycles once or twice a year and that it normally flows with the seasons. But, that's all relative; I have a friend that rode a manic episode for almost a year.

I had the same issues with an AD; it made me cycle hard; several times throughout a day when things got really out of hand. But, I had very few full blown manic episodes, I cycled between hypomania, depression and a stable mood. I also had a lot of nasty mixed episodes tossed in there; mania and depression occurring at the same time; it was miserable.

I am actually thankful that I am a rapid cycle BP person because I was never hypomanic or manic enough to truly enjoy it. And, I was never crushed with long lasting bouts of depression. Plus, it's easy to tell when things are getting dicey because my mood changes quickly; I don't move into mood changes slowly.

[Seph1212]

For what it's worth, my shrink has told me that bipolar is a progressive disorder. That is, the duration and severity of depressed and manic episodes increases over time. In this light, I think it probable that cyclothymia may progress to BP II and BP II may progress to BP I.

I've been diagnosed BP II since 1995...mostly depressive and mixed states with hypomania. I always have more rapid speech than most, but in the past year I was not sleeping for a week at a time and thinking/speaking so fast I was like a hurricane. I had what I'd call my first full-blown mania, as I don't think flying around the country, partying (dancing, singing, alcohol), and spending many thousands of dollars along with having the delusion that I was a rock star and could manipulate space and time with my mind is the hallmark of hypomania. No hospitalization was required though. After about 2.5 months of this I crashed. So was that hypomania or mania?

[Athena_M]

That's wonderful you are thankful for having rapid cycle BP.

I feel the same way about having Bipolar 1.  I'm glad I have this form because I can go long periods without feeling any bipolar symptoms.  The downside is the long hospitalizations for mania if I go off my meds and the depressions that follow are long too.  

Yes, there is some cycling that can occur during the year.  For example in the Spring time I usually have to change my medicine because we lose an hour of sleep here in CA and I feel the mania coming on.  Sometimes I have had to ask my pdoc for pills to help me sleep or I have to up my Seroquel until I get used to lack of sleep and extra sunlight.  

In the winter if I get depressed I usually call my pdoc for Wellbutrin that I take for a few months until I feel OK without it.  

I've had the illness for so long now 15 years that I have learned what medicines work and when I need to change my dosages.  It's been almost 6 years since I have gone completely manic and about 8 years since I have had a major bout of depression.  

[adel_ezz]

funny i am a rapid cycler but i don't consider myself lucky. what's lucky about cycling. my main concern is depression, but an AD sends me off manic. I think i am BP2 like Athena says.

i began to think that this disorder goes with the person steadily versus insanity. I wonder if we can be told the story of the old veterans who retired left this forum. Are there anyone to tell us hi/her swtory of survival. I have the feeling that all of us are a few decades only in it so where are the ancient. I was very happy when pdocs tell me i am taking very small doses of AP's meaning my case is very mild. There was this chap from australia who kept telling me your pdoc is wrong he is giving you sedatives and it's a severe illness, until my situation is getting worse and now my parents and the pdoc will put me on lithium.

[Athena_M]

Lithium is supposed to be a really good medication for Bipolar 2 and Biplar 1.  The research shows it gets rid of depression and suicidal thoughts and aggresion (aggression). One of my friends was on it and she able to work and enjoy life.

I took it for a year and it actually had the opposite effect for me.  I was more suicidal and depressed.  So my psychiatrist switched me to Seroquel.  

We all react to medications differently what works for one person may not work for another.  

I'll keep my fingers crossed for you.  I hope the lithium works well for you.  

[Athena_M]

Wow, it does sound like you had a manic episode with psychosis BP1 rather than just a hypomanic episode.  

The money spending and the delusions sound like a manic episode.  Sometimes though it can be sparked by drugs and alcohol.  The alcohol probably kept you out of the hospital for mania because it probably made you sleep.  

What did your pdoc say about this episode.  Do you have a Dual Diagnosis?  Meaning have you been diagnosed with bipolar and drug/alcohol addiction?  

Hope you are feeling better.  

[bpchrisb]

I do agree that the disease progresses; I went from clinical depression/GAD to BP2 over the space of a year. But, I have also found that medications have a huge impact on all of it; especially if shrinks are messing with doses and changing things.

For example, I spent the entire month of May playing the human guinea pig. I was placed on all kinds of different medications and every single one of them agitated me. I knew it was akathesia but my shrink felt that my disorder was progressing and getting worse. But, it wasn't mania; I was just really restless and agitated while on these meds.

The funny thing was, there was a simple triggering factor to the whole thing; we had been tinkering around with Neurontin. I am given 1600mgs a day (4x400mgs) with the last dose being optional; for sleep. I had been taking the 1600mgs religiously, always taking the last one to sleep, but I found that I melatonin was enough and didn't need the last 400mg pill. I had given up chewing and found that I was sleeping much better.I got through the nicotine withdrawals just fine, didn't take the last pill and then started having bad depressive episodes. It was a big mistake; I went through withdrawals and paid for it.

So, she started me on various medications, I couldn't sleep, so she told me I could take up to 2000mgs a day if needed. I would get through the insomnia phase, drop back down to 1200-1600mgs a day and begin withdawing AGAIN.

Finally, I got sick of it and decided to just get back on the normal med cocktail I was taking (full 1600mgs a day of Neurontin, 250mg of Lamictal, and 1.5 of Klonopin) and evened out completely. I was crashing with the sun; even if I had seven solid days of good weather, I would crash as soon as it became overcast. I could set a clock by my cycle just by looking at the weather forecast. Since resuming my normal med routine, I haven't a swing in mood in over two weeks and the weather has been TERRIBLE.

The disease can progress naturally, but, in my case, tinkering around with medications can have a bad impact. It's especially true for those BP folks that are still being prescribed various ADs; they make everything unpredictable.

[cornflkgrl]

I'm new to this board.  I've been diagnosed for 12 years.  In that time I think it's gone from BP II to BP I back to BP II.  

My question is:  What are you if you only experience paranoia, delusions and psychosis during depressive episodes??

I don't seem to ever cycle into full mania, but rather terrible mixed states of high energy, but very depressed thinking (bad combo), which tends to come with repetative thoughts, visual disturbances, and paranoid delusions.  I have been hospitalized numerous times for these things -- once by court order.  It was not "mania" though.  It was depression (in my mind anyway).  I certainly was not feeling happy or good or inflated in my self esteem.  I was not on any kind of grand ride that I wish to visit.

I also have a problem with meds where I have to keep switching every couple years because they don't work after taking them for periods of time (anywhere from a few months to a few years and they stop working)
I am down to having taken everything and now I'm on 300mg Wellbutrin and it does nothing for me.

So, anyway, what am I?  BP I, BP II?  Not BP at all?  Just curious.  My doctors (and I've had many) have always given me varying diagnoses.

[Athena_M]

Psychotic Major Depression or PMD sounds like what you have described.  The delusions are during the depression instead of the mania.  People with bipolar can have PMD also.  

I think you could have Bipolar 2 with PMD, but I'm not sure.

The treatment for PMD will get better as there is now new research going on for better treatments.

If the Wellbutrin is not helping then all your pdoc for another change in medicine.  

I like your screen name, now I want cornflakes. : )

[Seph1212]

The alcohol didn't make me sleep. My pattern is to spontaneously crash after a hypomania. Only this time the mania was more severe and of greater duration. Also in the past, a hypomania has been preceded by a mixed state and followed up by a depression. This time, it was preceded and followed by a mixed state.

I wouldn't think I have an alcohol addiction (I haven't used drugs in many years) because I infrequently drink when depressed or baseline. It's when I switch to hypomania that I become pleasure seeking and have lowered impulse control.

I know that alcohol is a depressant (in the long term), but in the short term it is very much a stimulant for me. And it's a viscous circle. The more stimulated I become, the more pleasure I seek and the less impulse control I have.

Actually I've bounced back from this episode pretty quickly. I reported to my family doctor for a routine monitoring of my lipids and blood sugar, and after tearing into the receptionist for asking me to verify my address, he sent me back to my shrink. She temporarily re-added Seorquel and upped my Lamictal, which I confess I had become spotty in taking. I'd say I'm baseline again.

[Seph1212]

PS...alcohol hasn't always been a result of my pleasure seeking. It has variously been sex, eating, lavish projects, shopping, reckless sports, etc. This time it happened to be partying in Hollywood, and elsewhere. After all, I was going to be a rock star.