I have mania 100% of the time

Hello Doctor:
I've been diagnosed with Bipolar Type II for five years.  I have never had a depression cycle.  I'm severly manic 100% of the time.
My doctor tells me that I "must" be suffering some depression.  That these episodes (mixed) may be subtle but that NO ONE has mania 100% of the time.
Hmm...  I had great relief from the brain racing with a single daily dose, 12.5 mg, of Topamax for the first three years.  For reference, a 100 mg dose made me catatonic.  I am VERY sensitive to Topamax.  I am now on Lithium, 900 mg, which maintains a level of .7 in my blood stream.  I feel very good on Lithium.
Is there such a thing as hyper-mania?  Is it possible that I only get mania, with no depression?  Since I only go one way, is there a diagnosis for "Polar?"  That was a joke.
Seriously, since there is a diagnosis for the other end of the spectrum (depression) why isn't there one for people like me that suffer from CONSTANT mania?

[heyjude1]

Hi, I don't think doctors monitor this site, only support from other people suffering from the same dx.  I have read that manic episodes are not always followed by depression.

[ApRiLGeTsAngry77]

I am not a doctor but I do know that they are adding more diagnosis to the bipolar spectrum when the next DSM-V comes out. I think you could be having hypo mania. Medications can induce this.

[paranoid_cataclysm]

Doctors are on this site, but just not this specific forum.  Doctors are on the ask an expert forum.

[adel_ezz]

Hi
First of all bipolarity is not one thing or one set of symptoms (there is BP1, 2, 3, NOS). Again, for although and usually depression follows mania but in many situations one doesn't crash but rather lands smoothly. I read that many can have both poles but one suppressed a little, i.e. one pole manifests itself most of the time. This is why bipolarity takes years for pdocs to diagnose correctly. Again one finds people having the 2 poles during some periods of their life then only one and sometime they have euthemia feeling they don;t need to take the drugs anymore (here lies the danger, because if they relapse the dose must be increased). So whereas in periods lithium is suitable in others another MS etc... From what you describe lithium is the perfect drug.

As to mania/hypomania the difference is difficult to recognise. pdocs say if you don't need to be hospitalised then it's hupomania only. Others say mania comes with psychosis, etc... Also one shouldn't rely totally on pdocs information, they don't know everything

[ApRiLGeTsAngry77]

What kind of bipolar do you have? I have never heard of anyone landing smoothly.

Also, there are currently 5 types of bipolar in the current DSM-V.

There are also 3 different names of episodes between the depression and mania polar.

Pdocs are very limited in what they know.( as well as others)

[Shanna707]

Wow, I didn't realize there were 5 types of Bipolar in the DSM-V now and you mention 3 different names of episodes between the depression and mania polar.  Could you be more specific?  You seem very knowledgeable.

[adel_ezz]

No need for sarcasm pls.

As to whether there are 5 types. First of all, there is no clear consensus as to how many types of bipolar disorder exist. In DSM-IV-TR and ICD-10, bipolar disorder is conceptualized as a spectrum of disorders occurring on a continuum. The DSM-IV-TR lists four types of mood disorders which fit into the bipolar categories: Bipolar I, Bipolar II, Cyclothymia, and Bipolar Disorder NOS (Not Otherwise Specified) like I said, so I was in fact numerating the aknowledged types only, yet articles tell you there are even more than 5. Gerald Klerman classified six types. Akiskal put them to 9 types (1, 1.5, 2, 2.5, etc...).
see: http://www.psycom.net/depression.central.lieber.html

Even some articles, can't remember now where I read it, type 4 alone can be subdivided to 4.1 and 4.2 etc.. .

So I was mentioning the main ones only and the most dominant, where 1 is supposed worst in which psychosis is dominant and 2 depression is the issue and 3 or cyclothemia where antidepressants induced mania (AD are thought to trigger and prolong rapid cycling in general, yet some improved with AD's) and they still even didn't come to terms about cycloth.. according to Akiskal because once you have it under Ad you become liable to getting mania afterwards without AD.

Again it isn't important which one you have, because, can you tell me which mood stabilizer is taken for type 1 and which for 2 ?. If BP is so damn classified like you said why can't they specify a certain drug for each, it's the 2nd worst mental illness after schizo.. because the instability is due to the 2 poles so neither the AP's alone will resolve the issue neither the AD's alone. If they were classified so neatly why the AD I take doesn't suit you and instead it drives you manic. True as you said my knowledge is limited. Indeed. But also psychiatry has no answer to most of the questions. A group of psychopharmacologists + therapits + psychiatrists can't help one single individual.

Crucial said "My doctor tells me that I "must" be suffering some depression.  That these episodes (mixed) may be subtle but that NO ONE has mania 100% of the time" i.e. that his doc doesn't believe him. How can you explain this ?. Simply he doesn't know.

Again he said he is dx for BP2 for the last 5 years but has mania all the time, to my knowledge, he must be 1 and not 2. According to the DSM-IV-TR Bipolar I disorder, an individual has experienced one or more manic episodes with or WITHOUT major depressive episodes. So, one or more manic or mixed episodes are required. A depressive episode is NOT required for the diagnosis of Bipolar ,I but it frequently occurs. So if in 1 he must get depressed also, and he is not, then perhaps he is type 6 according to Klerman.

Has any pdoc told you that the drugs are all trial and error, do you know (of course you know) that what you take for years can stop being effective suddenly without any warning, can you explain why?

As to the eventual crash after mania, it depends on the antidepressant (i am speaking here of the cyclothemia type only not on the inherent type where you can become manic by yourself, so in this you are right). For example pdocs differ in what I have, some said 1, some said cycloth..a few 2 because this is the majority of the pts, and I have a job as engineer - I got a degree in electronics - so how come I can be 1, because the latter is usually associated with psychosis. But I confess I had delusions and hallucinations many times under my tricyclic AD in the past. You see drugs are our worst enemy, they help yes, but not only giving us side effects but also induced all sorts of symptoms.


have a nice day

[Crucial]

Wow.
First off, I want to say "Thank You" to all who replied.  I learned more reading this thread than most other resources.
I apologize as I did not know that this part oif the web site was "minimally" reviewed by Doctors.  Thanks for filling me in.
Again, I appreciated your feedback.
Crucial

[aga380]

I used to almost never get a depression ( at most tree days) after my first big mania atack ( a week in hospital) I was depressed for a year. I am on meds for five years know and I am a fairly happy person. I have some small mania symptoms one or two times a year but I do not get depressed after them. So I do belive you. If you are a yong man it is posible