Wellbutrion and Bipolar(if too long read last paragraph only)
I've long suspected I was bipolar for since I began middle school. I was nearly at the top of my class in elementary school. I was scoring at the top and understanding all the material before anyone else could or did. Then in middle school I became extremely depressed and studying or doing work was absolutely the last thing on my mind. This wasn't mild depression that you would expect children to suffer but full blown depression where I was afflicted constantly by fatigue, apathy, lack of desire, thoughts of suicide, hopelessness, etc. I felt all this for the three years I was in middle school.
When highschool started, I once again was at the top again. I made up for lost time in middle school, studied hard and did so many things in high school. I had a 4.0 GPA(I purposely chose the hardest classes that my high school had to offer). I was in several academic teams and I was also participating in school sports(which I also excelled at and was near the top). After school, I also was weight training, boxing, and reading several advanced economic textbooks (and books like Keynes, Hayek, Friedman, etc) for pleasure. I slept very little. I often literally went 48 hours without sleep and every night I actually did sleep. I only needed 3-5 hours of sleep and I woke up refreshed rather than exhausted as one would expect.
I think the ending of this "manic episode" was marked by the day I came to school drunk. I thought myself to be the greatest person in the world. I wanted to pass an exam while I was drunk just to prove that opinion. I did pass the exam with a %100 but I also passed out where they had to call paramedics and I almost died that day according to my parents because my blood pressure dropped to below 10. But I was all ready accepted to a good college based on how well I did before it all ended.
Once college started, I started failing all my classes. I was exhausted even if I slept 10 hours the night before. It was the hardest thing for me to concentrate. I had no motivation to show up for quizzes, take exams or turn in home work. Often times, I told myself "I don't care, I'm not going to take that final. I'm too tired." I failed or received D's in classes I would have otherwise received an A in.
At one point I was so depressed I burst out in tears for no reason apparent to me. I sought the help of my university psychiatrists. They diagnosed me with major depression and gave me wellbutrin to help. The wellbutrin sent me into what seemed like a mixed state. My depression was so much worse. I became obsessed with suicide, even more hopeless and gloomy. I began to research methods of suicide: nitrogen poisoning, carbon monoxide poisoning, a gunshot wound to my brainstem, eating a cup of apple seeds, barbiturates. the point was that i knew so many methods that no normal person should have known. I also did risky things like taking a vacation to another state,spending large sums of money in said stateand acquring a state issued ID in order to purchase a firearm because I felt like I just didn't care and I was really intent on ending my own life(all this the week before finals). I had absolutely no need for sleep during this period and I spent two days literally wandering the city throughout day and night.
All of this I told my psychiatrists. However they won't diagnose me as having bipolar because I don't have "racing thoughts. I have nearly every symptom except racing thoughts so they won't diagnose me. " I find it baffling. Out of all the different medications, only lithium carbonate has been one that has had a good effect. Yet they still tell me I have major depression. They act as if it is a terminal illness and they do not want to diagnose anybody with it. I feel as if they are making an error by doing this though. What are your thoughts? Are they right in saying that I only have major depression?
I'm sorry for writing this giant essay. Reading the last paragraph should be sufficient enough if you don't have time.
I have all of those symptoms aswell, and for monthss the friends and family around me suggested bipolar for me. I was indenial, and later on got diagnosed with bipolar. But during a manic episode racy thoughts should have happened, coz thats what also adds manic behaviour on top of what you have. I didnt start with racy thoughts to begin with but they were faster than usual. You will experience racy thoughts as your illness gets worse, and when you do, tell yoir doctor to complete your diagnosis. Racy thoughts run at like 95 mph in your mind and it is very distracting so if you do experience it, tell your doctor.
I forgot to say that wellbutrin gave me some of the wildest mood swings of my life. I went from extreme apathy to extreme sadness to extreme apathy again. But I think what stood out most was how angry it made me. Every little thing people did irritated to me no end, which is not normal for me at all.
Wellbutrin did the same to me - royally screwed me up. I am surprised they would have you on lithium and not diagnose you with bipolar disorder.
There is a category of diagnosis that is called bipolar NOS (not otherwise specified) it is where you fit enough of the diagnosis but not all of it to be considered bipolar. Without the racing thoughts you may fit in there?
As for diagnosis. Some pdocs won't diagnose BP until they see you in each of the states. It wasn't until I was clearly hypomanic that I was officially diagnosed, even though I was already on BP meds. Before that it was ADHD and Generalized Anxiety Disorder
I am assuming here that you go to the university clinic because you don't have independant coverage. If you are still on your parent's insurance I'd get a second opinion.
If you are getting the medication that is helping you, I wouldn't worry too much about the diagnosis. It will come in time. If the meds aren't working or they suggest going on an SSRI without a mood stabilizer then I would seek out other help immediately. (SSRI + Bipolar = crazy)
The book "The Bipolar Disorder Survival Guide 2nd Edition" by Miklowitz is a really comprehensive look at bipolar disorder and gives you some wonderful coping tips, and indepth look at causes and medications. Just a really good overal book for newbies (and us old timers who need a refresher course)
Ok this'll be long too. Psychiatrists...blech...can't live with 'em...can't live (well) without 'em.
While I probably had symptoms earlier, I started in my early 20s with major depression and was put on a series of ADs to find the right one. In those days it was mostly TCAs although Prozac was also round then.
Guess what...nortryptaline, amatryptaline, imipramine, and clomipramine...all put me into a mixed state. Desipramine made me hypomanic.
I had no idea what any of this was, and when I reported my symptoms to my shrinks they all said that it was just anxiety...guess that's why they make the big bucks.
Then one of them put me on Depakote...note Depakote is not an AD, and even though I responded well (except the side effects) to it, they still said I had depression...and they say it's the patients who are in denial.
Then it was Wellbutrin which helped with the depression and didn't precipitate any type of mania. Then going med free, I was ok for many years. My moods were still more extreme than most people's, but none were high or low enough to seek help again.
Then depression crept back in over a couple years. I thought is was chronic fatigue, because subconsciously I was probably "done" with psychiatry. Anyway, after my GP found no problems, and acupuncture did nothing, I started self-medicating with St. John's Wort, and guess what...mixed mania, hypomania, then my first full blown mania with delusional thinking, then crashing back into a mixed state.
I went back to my GP for routine blood work, something set me off at reception, and there was a bit of a scene. Anyway, my GP put a lot of pieces of the puzzle together and got a rush psych eval. My current NP diagnosed bipolar...although I'm not sure of the details...probably BP II...since the full mania was pretty late in the game.
I deescalated with Seroquel, which I almost never take anymore, and I've responded very well to the max dose of Lamical...except some of the depression. My NP is very wary of giving ADs to bipolar patients, but I talked her into low dose of Wellbutrin. It has helped and not precipitated any mania. The depression came back this winter and I convinced her to upping the Wellbutrin just the other day. She thinks it's just winter and wants to lower the dose when spring comes.
We'll see. We'll see if it triggers any mixed states or mania. We'll see if I can lower the dose in spring.
Anyway...I think bipolar is spectrum...it manifests in many ways...and it likely progresses over time. So it's silly for the DR to be hung up on the lack of one symptom. The proof should be with the lithium, just like the Depakote was the proof (which the DRs denied) for me back in the day.
.All of the behaviors and feelings you described are associated with unipolar and bipolar depression (BP). A lot of people don't realize that major depression (MDD) has a wide range of symptoms. I’m very sorry that you had to suffer for so long at such a young age. I’m glad you’re able to get the treatment you need and feel better now.
Lithium makes everyone feel better. It's a mineral salt present in ground water, and some communities have more in their water than others. The ones who have the most have the lowest rates of depression and suicide and highest rates of overall happiness. It's an old drug first used to treat depression (1886) and even now the best drug available for lowering the risk of suicide.
Many psych drugs, and non-psych drugs for that matter are used off-label, and rarely does a drug have the exact same effect on all people. You didn’t mention ever having tried other mood stabilizers. As far as your post goes though, I guess it really doesn’t matter. Making a diagnosis based on the efficacy of a medication is like diagnosing a brain tumor because Tylenol didn’t make your headache go away. There are lots of more likely reasons for that. You might actually have a brain tumor, but Tylenol can’t help make that diagnosis.
Your pdoc might not think you have BP regardless of just one missing symptom, because maybe he’s observing something that you’re unaware of. Maybe he’s using the missing symptom to keep his observations off the table for now. He might be questioning your authenticity. Pdocs are required to use their personal judgment to make a diagnosis. It’s not as simple as just matching a list of symptoms with the DSM. We wouldn’t need pdocs if it was.
That said, you could have BP and your pdoc may be refusing to diagnose it because he’s not convinced yet and he’s waiting for more information. Maybe he’s being cautious because BP is considered an overly-used diagnosis right now. Just like ADHD two decades ago, the public perceives that too many people are being diagnosed with BP simply because it’s become fashionable to have it.
The insurance companies are paying attention, too, and starting to question every BP diagnosis. Being questioned slows productivity and increases costs for pdocs ultimately affecting their income. That’s likely why they’re treating it like a terminal illness and don’t seem to want to make the diagnosis.
I don’t mean to be unsupportive, not at all. I know how frustrating and angering it can be trying to get a correct diagnosis. I’m trying to be objective, look at the facts of your situation and stay emotionally detached, so I can provide another perspective. The next pdoc may give you a BP diagnosis, especially if you let it be known that you want one. However, agreeing with you doesn’t make the new doc right. It’s a judgment call.
Why do you so desperately want to be diagnosed with BP? If you can get the treatment you need, does it really matter what your diagnosis is? If you’re feeling better and treatment is working, having no diagnosis wouldn’t even matter, would it? Except in very, very few life circumstances, the label/diagnosis could be anything, and it just wouldn’t make any difference.
If you’re interested in a correct diagnosis, don’t tell the next doc what you think. Just answer his questions and see what he or she says. That’ll be very interesting, and don’t you want to know? You can always share your thoughts later.
It’s funny, because I rarely admit that I have BP, and when I have to answer the question I often put MDD instead. I don’t want to have BP; I just want effective treatment for my particular cluster of symptoms. People make blanket assumptions based on labels, and BP is not an attractive label to have. Those who think it is are giving the label and the illness it represents even more negative attention by publicly using the illness as an excuse for unacceptable behavior. They’re burning a picture of insanity into the public’s mind. It’s hurtful and ridiculous!!
I regularly have to divulge what medications I take because of my occupation. Many people know, or assume they know what my meds are for and automatically question my sanity. If that’s not bad enough, hearing or thinking the words “Bipolar Disorder” just adds insult to injury in the U.S. right now. I’m a professional and would like to be thought of that way. It’s illegal to discriminate on the basis of disability, but in the real world laws don’t matter, you just don’t get the job because you might go postal like Charlie.
Getting this diagnosis can have a very negative effect on your life. The label can be much more devastating than the illness itself because of society’s sustained ignorance. Your pdoc knows this, and he might be trying to protect you from something you can’t even imagine right now.
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