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I have Bipolar 1 Disorder. I can identify my classic manic episodes and my classic depressive episodes, but there are some mood states I have that don't fall neatly into those two categories. One is something I often have as I am transitioning from the euphoric high of mania into the blank immobilization of depression. In between those two states I often have a period of a mixture of both. I have the racing thoughts, insomnia, restlessness, and delusional thought processes, but the content of those racing thoughts is not euphoric at all, but intensely negative, pessimistic, and depressing. It is basically torture. I had it once for two weeks straight. I didn't sleep a wink and was tortured by those progressively negative thoughts day and night until I finally fell into the depression where I basically can barely move or gather a thought, but it is a blessing compared to that terrible in between place. Is this a mixed episode? or is it a dysphoric manic episode? The second one I am confused about, and I am not certain if it counts as one episode or many jammed up into a short period of time, is a time recently where I rocketed abruptly into euphoric mania for three days and then plummeted suddenly into a deep depression for three days. This happened about four times in a row. Two times I had a normal mood day in between cycles. Also, in between the mania and depression, I had one day just like I described above, with the mania and depression combined together. So, this series of short full cycles, one right after the other, is this a mixed episode? or rapid cycling?
I am not a fan of making these phenomenon into something more than they are by trying to fix a diagnostic label on every part of the experience....the mania and depression are mixed because the euphoria is an exaggerated attempt to subjugate the depression, therefore both trends always coexist until you get down the source of the depression, which is something you should search for in therapy.
Excuse me for trying to understand my disorder a little better. And I disagree with your theories- that the euphoria is an exaggerated attempt to subjugate the depression, also that they always coexist. My disorder is medical, biological. I do use therapy to help process the issues that go with having the disorder, and to help deal with things that come up in my life so they don't cause the stressors that in turn cause the mood shifts, such as being unable to sleep because my mind is preoccupied.
If all that was needed was for me to 'get to the source of the depression' with my therapist, then why am I taking Lithium and Seroquel? And why do they help? And what would I need a psychiatrist for? And that doesn't mean I don't shoulder most of the responsibility. I take care of myself, I take my meds, I make my appointments, I have insight and am aware of my moods, and I am educated on my disorder- except on this particular clarification.
I looked into your theory regarding mania in bipolar disorder. Your ideas are ancient, outdated and dangerous. To suggest that all a person needs is some psychotherapy to control their bipolar moods is from a time long ago when the medical community didn't know what they know now about brain chemistry. Without the MEDICAL treatment I get, I wouldn't be here typing this right now.
For anyone else reading-
Agree completely - as a Bipolar Type 2 who uses both therapy and medication under the care of a psychiatrist I am alarmed that mania would be dismissed in this way - Mania is part and parcel of a mood disorder and advising a patient they need therapy is very very dangerous - Im astounded that a board certified psychiatrist can make such an outdated statement particularly in this day and age.
I admit I have just read this 5 times now : "the mania and depression are mixed because the euphoria is an exaggerated attempt to subjugate the depression, therefore both trends always coexist until you get down the source of the depression, which is something you should search for in therapy."
And it took me more than 1 to even grasp what you are trying to say here and then it hit me - you don't know what mixed state means - again youre a Psychiatrist (although writing books seems to be more your gig now) and I would expect that if an educated BP sufferer who understands his or her illness can explain what mixed states are then you should be able to - my psychiatrist certainly can. Mixed states are very common in transition and no amount of therapy is going to fix them - what therapy gives to Bipolars is coping and management skills for stress and relationships and ways to control manic and depressive episodes before they escalate.
Not only that but you totally missed any explanation of atypical depression which is another bipolar trait and can present as mixed state - bipolar depression is not the same as classical depression and Id expect an MD to be able to see that.
It might help to update your reading on bipolar in the modern world - things have moved on since 1965 and the illness is much better understood - for one thing psychiatrists no longer make statements like yours because there in fact is often NO reason for our depressive or manic episodes that is treatable by a therapist or discernable by one - this is why mood stablisers exist.
Its this sort of psychiatry backwater thinking that sees bipolars prescribed SSRI's which send them sky high into manic episodes or ignores the danger signs and sends someone packing without taking the depression seriously leading to suicide attempts.
Mania and Depression are 2 very different things and in bipolars they are 2 very different mood states - this is brain chemistry and not mumbo jumbo.
I completely agree - I am shocked by the so called professional response. I would like to repeat what monkeyc says - there is often no reason for the depressive or euphoric state therefore therapy is of no help.
Living with BP requires help in learning to live with it, recognizing stressors, understanding our body signals.
It is like telling a person with diabetes that they can be made better with therapy - you would be struck off for that, yet you come on here saying that a chemical imbalance in the brain can be solved with therapy -PAH!
Hey guys, I think sometimes I'm so desperate to get out of a depressive state I push myself to be more "up" and then I just go way "up up up" and right into mania. For instance, when I go to work as a flight attendant I can't be depressed. I'd be fired in one day. So I push myself and end up manic (laughing, happy appearing, friendly, feeling like I had four pots of coffee) Then I go home and draw the curtains for four days. I actually think you all are both right. I think he was saying labels aren't always helpful and maybe it's a good idea not to worry to much about a "label" but to try to find a solution to what you're feeling. One thing that is helpful is talk therapy along with meds, for me, at least I keep trying.
I see things similar to Dr Gould. Although I don't have a diagnosis of bipolar, I am very conversant with how mental health symptoms are often manifestations of defence mechanisms at their most extreme.
You can 'protect' yourself from the pain of existence by falling into depression, but depression can be frightening, so you frantically take flight from it, and get caught on the wings of mania. The human being cannot sustain such lack of grounding, and so you fall back into depression. Until you find a middle ground.
From this perspective, a mixed state might be where you're trapped in limbo and don't know where to turn.
This dynamic doesn't necessarily happen with everyone, but it can happen. I see similar happening with myself and my depression-anxiety-dissociation cycle.
Sometimes it may apply to you and you're not aware of it - because the defence structure is so rigidly in place.
The bottom line is that it's one way to see things, not the only way maybe, but one way.
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