Bipolar and Ocd: Similarities? During Manic Episodes Do You Have Trouble with Obsessive Thoughts?

[ILADVOCATE]

Obviously, I know the difference between bipolar and ocd. But I notice during moodswings, mainly manic I have obsessive thoughts. Not always disturbing ones but they can difficult. And this must be true for some other people as well. I don't know if there is any overlap between the two disabilities but to some extent there must be as a person going on a spending spree may be a compulsive spender or they might be having a manic episode and binge spending. I know that before recovery that I would spend a lot of money and becoming obsessed with having certain cd's. It wasn't always a matter of money. There was an obsessive element. Or wanting to travel somewhere for no reason on impulse. The impulsive behavior was manic but there was an obsessive nature behind it as well. Have people been through this as well? Perhaps someone could explain.

[sweetboredom]

Was just reading an article about this today, maybe you might find the information in this Psychology Today blog post helpful.  I promise this isn't spam or anything like that.  

http://www.psychologytoday.com/blog/bipolar-you/201110/is-there-such-thing-bipolar-ocd-disorder

[ILENGINEER]

It's interesting what you're saying, While I had a manic episode (and I have OCD) I didn't suffer from the stress usually involved in OCD. In me also - the impulsive behavior was manic but it's nature was obsessive.
regards

[bernie40]

Its a shame that we seem to "focus" on the wrong things - that's not to say they are bad things, just not the things we should be focusing on.  I am the same when heading towards and during hypomania.  I don't mind when it's something constructive like cleaning or tidying but when it's something like my art or writing or playing for hours on end on a word game, then it becomes a problem because I get nothing else done.

Then again, I enjoy those moments and why not?  For me the moments of hypomania are infrequent as I tend to lean more towards the depressive end of the spectrum, so in a way I look forward to the odd mad few days or so.  I am lucky in that my behaviour does not impact on those around me, it is not harmful to me or others - well apart from spending too much money which is a financial stress on the family.  Those periods help me feel alive.

[ILADVOCATE]

Well I could say for myself that as I pointed out on another thread one prescription I am taking (for a physical disability, at the prescribed dosages) Tenex (although it has some mood stabilization effects, its related to Clonidine) is making me somewhat elated (as I said I'll be speaking to my psychiatrist and neurologist about it). I've haven't done anything inappopriate nor do I have the urge to (I wouldn't be posting here if I did) but I've been on an internet debating site all day. You could say it was obsessive because I feel like I am "stuck" on there but its obviously coming from mania. Its not really "internet addiction" as I am not doing something destructive or pointless. Some people I provided cogent advice to on the "health forum" and the music discussions were interesting but clearly its going to occupy a good part of my day although I don't want it to. And for me, mania whether from a medication or natural always manifests itself in that way. I can concentrate But on all the wrong things. And then I become obsessed.

[bernie40]

Hi, has this become a discussion about adel's treatment or a discussion about the similarities of OCD and Bipolar?    

To get the thread back to its original purpose I'd like to comment that I can be quite obsessive when I am manic but not all the time, ie, not every time I'm manic.  I can get very very particular about where things are kept.  I notice that these things do bother me slightly at other times but not to the extent that they bother me when I am manic.  I should say hypomanic as I don't get full blown mania.  It can be anything from where clothes are kept, books etc.  Or I'll go mad and clean everything in sight and completely over react if someone comes along and moves a cushion I've placed for example.

I would never say I have OCD though as these are only brief episodes.

I wonder if you could clarify what you mean by OCD as a friend and I were discussing this not long ago and she said that a British psychiatric website discussed particular behaviours such as hand washing, locking doors or windows, counting etc and the fact these things were done over and over again.  Can we actually count a sudden desire to hoover obsessively for one day as OCD or the need to have all the books in the rigt order on the bookshelf?

[ILADVOCATE]

I'm sorry. None of us want to appear to be pressuring you. We do think your psychiatrist is potentially using poor judgment. If someone is on an anti-psychotic or mood stabilizer they need it for life in almost all cases. The symptoms of bipolar will return without treatment. It just happenned as I said that the Anafranil being an SSRI anti-depressent made you manic because you have bipolar. I know not that can happen not just as a clinical fact but from personal experience. No one here can provide a diagnosis and no one here can take the place of a psychiatrist but it does seem unfortunately according to what any psychiatrist would do in standard practice that your psychiatrist isn't showing good judgment. As for your family they may not understand the issue of mental illness well so if they are trying to guide you one way or the other, its best not to talk about it as much. Risperdal or Seroquel although antipsychotics are good working mood stabilizers and one of them at a working dose should be enough to help you. See if that works out. I do think most psychiatrists would agree with that idea but you can post in the appropriate forum for that if you want.

[adel_ezz]

hold on and you will be OK. i know abilify is quite used widely in Britain so ireland must be the same. You know something about psychic diseases they have got a psychological part sure it isn't only the chemistry which plays the central role. So if you convince yourself that you will be OK you will be OK
good luck and report
ezz

[irishwriter]

thanks ezz, i'll just have to wait and see how they work for me. having a really really really bad day today!

[adel_ezz]

Alright you convince me. i will not pursue this silly discussion about AP and MS etc...

one point though is that our family has one remorse or regret concerning what happened in 2006 the turning point in my life. I told you i was dx originally OCD whether it was really it or confused for BP alright. Suppose even i was BP from start, i was on risperidone 1mg , stelazine 2 mg and anafranil 25mg and life went on until i or we decided to stop the meds. Believe me it was the pdoc who put this decision in our mouth because he said once you graduate it's finished and you can be normal and no need for meds. Whethet ignorant or dishonnest because before this date i.e. in the course of my illness he must have been told that i was hypomanic many times so he shouldn't have other thoughts if he is really a psychiatrist except doubting that i am BP. But this is easily said than done, because at that time nobody in the family read anything about BP as we were concentrating on the OCD. Now my father after graduation reminded the pdoc of his promise i.e. should be able by now to stop the meds. The dirty ***** agreed whether by mistake or not!!! of course i was happy and my father too. so we stopped the stelazine first and no harm done then the risperidone and no harm done either. but the anafranil we kept on and off but mainly on. after 3 months i got my first mania, the euphoric one.

my question is (think well about it) - because it is still an argument in the family that my father is responsible for this mistake and they both quarel and my father repenting, whereas he says the pdoc responsibility not to agree because he is the one knowledgeable between us and that the pdoc himself who presented this idea before, yet my mother says that had it been the nagging of my father to him he wouldn't have perhaps agreed.

Anyway the QUESTION is. Suppose i continued indefinitely on the risperidone as MS with the anafranil, would i never had become clinically bipolar. so life would have continued peacefully without mania therefore i should be OK for good. In all religions this is called the WHETHER IF question. because we all are regretting this decision. so could what happened must have happened or will happen no matter the decision we took (i mean not knowing this BP business forever). because if this mania was bound to happen one day as monkeyc says either you are BP or not then possibly it will show up one day especially that things worsen with time usually.
thanks
ezz

[adel_ezz]

Hey look what i have done, i am sorry to confuse you i didn't mean it at all. None of us is a pdoc, your info must be deduced solely from the doctor. We are only trying to draw your attention to things the best we can in our opinion of course. i never tried lamictal neither abilify it's only readings that i've done and monkeyc says online reading may not be correct. so i could be totally wrong. I know a lady on another forum who was on lamictal and abilify. she said she was tense after a while and her pdoc changed abilify to seroquel. since then i hear from her sporadically but she seems ok.

[irishwriter]

pk. i am now totally confused. have just started lamictal and pdoc is talking about adding in abilify. is this a bad combo? as you all know i have tried so many different antipsychotics, tricyclics, ssri, mmri? and lithium to no effect. any questions i should ask my pdoc about above two drugs? sorry to get off the ocd/bp discussion. i asked pdoc about topamax and he wouldn't even consider it. don;t know why. have bipolar with dysphoric mania and cutting. got through twenty four hours without cutting but not twenty six! an improvement anywat. again sorry for digression. btw zyprexa nd effexor was a really bad combo for me, extreme agitation and start of cutting and burning.

[monkeyc]

Adel you are not on 3 AP drugs you are on 3 sedatives which just happen to be AP drugs.  There is a huge difference between drugs being used as designed and drugs being used for another purpose.

And in fact Anti Psychotics DO work as Mood Stabilisers - Zyprexa is just one example.  Im not sure where you get the impression that we say they dont.

What we say is that theyre not true Mood Stabilisers they are Anti Psychotics with Mood Stabilising properties the same as they have Anti Depressive qualities but they were not designed as MS drugs.  

Lithium is in fact equally effective in both phases and does work on Depression - Im not sure where you are getting your information but its not what i would call clearly defined - Lithium is STILL 50 years on considered the best mood stabiliser.

This is also the danger of reading resopnses from people on web forums - they say "X causes Y" but you have no idea of their actual drug mix, general health, stress factors, sleep patterns, diets etc - this is what irritates me most about Lithium haters who throw abuse at the drug and when you get them talking you invariably in 8 out of 10 cases that they did not follow the instructions, ignored warning signs of toxicity etc etc.

You dont know me, I dont know you - nothing I or anyone on the web say should ever be taken as gospel and that means read reputable sources and speak to a competent medical person.

As to why I am monkeyc and not john which is my real name - ive used monkeyc for a very long time and its also my domain name and nickname on a lot of sites - I dont much hide myself as use a consistent name.

[ILADVOCATE]

Abilify is activating. It can't make a person manic. But it can cause insomnia and on occasion nervousness. That's correct. Lamictal in higher doses can sometimes worsen mania. I was taken off it for that reason. Generally at standard doses its well tolerated though. That's why Lithium is the most effective mood stabilizer overall and the only one developed for mood stabilization originally. If you are on 3 antipsychotics together it puts you at risk for certain long term side effects. One is much safer. Seroquel does work not only as an antipsychotic but as a mood stabilizer and actually more in that regard than Abilify. Ask the people who take it here. If your psychiatrist is agreeing you should be on a working dose of Seroquel and that alone I would go along with that. That's the best plan and I would say anyone would agree, including any psychiatrist you would speak to anywhere.

[adel_ezz]

About lamictal and abilify causing mania, this I was not precise and i am sorry for it. Yet lamictal OK it's an AC and abilify an AP (2nd gener. atypical) but both are working well for depressed people more than for manic like lithium say. some people find abilify perfect, many though brought anxiety to them they feel agitated and brings insominia this is why it's better taken in the morning and this i am definite about reading it from responses of patients, it isn't like seroquel which tends to be sedating yet both as AP can work as MS. Same for the AC lamictal it is best used for depressed people. Of course one assumes since both are MS then they are good for BP in general but one finds that lithium is good especially for mania and for lessening suicidal ideation, etc.. others depakote works perhaps for cyclers etc... so although my guess could be right my conclusion is of course wrong since i had no proof. Still what i meant is that since both work upwards then i EXPECT that the person will be tense, contrary if you use lamictal and seroquel because they equalise each other as seroquel is a strong antimanic.
i hope i corrected my mistake.
as to trying to prove that i am not BP on the contrary i can admit it and am in fact admittimg it, except that no one can say that AP cannot work as MS which you keep telling me that I should use an MS meaning not AP. However you have a point you and ILADVOCATE that 3 AP's is funny. Yes indeed, but i am OK so why going into the dilemma of trying a new thing. But don't you think i am worried of what i am taking, because as you said i can be manic from inside and a very simple straw can turn me manic. Of course i am on my nerves, but i am calculating the risk so long as i still don't crash into depression
thanks
ezz
ezz  

[monkeyc]

And this is what sometimes bothers me.

You see OCD and BP ARE very different things hence my comment on gateway diagnoses - the problem is that what looks like OCD can easily be something else to the untrained eye and most first line diagnoses are made by general practioners who know nada about mental illness beyond basic books and symptoms lists - at no time did I say OCD was not real I said that OCD and BP can and do share the same characteristics in come behaviours and this makes diagnosis hard - I also pointed out that ADHD is often a misdiagnosis for BP and in particular a worrying one as Ritalin can be very bad for BP's.

Now to your comment about BP onset - Its not remotely relevant as to BP being new to your family - its not always genetic or runs in families and it is entirely possible to be both OCD and BP no one says it is not - I am frankly bored with the argument that you caught OCD from something else - it doesnt work like that and you and I both know if adel - denial is denial.

Now you made a comment on Lamactil and Abilify causing mania.  I would like to see a source on this as theyre both Anti Psychotics and they do not cause mania - in fact neither of them have this as a listed or known side effect.  Lamotrigine (Lamictal) does have some anti depressant effect due to its action but it works as a mood stabiliser to control mania not cause it.

Thanks to my little episode of suidical ideration I have been getting an education lesson first hand in Anti Depressants and Anti Psychotics as im now taking Zyprexa for sleep and a big dose of Effexor and I have a pretty good working level of knowledge of AD drugs anyway with a history with SSRI's and having taken Mirtazapine, Prothiaden and now Effexor - All AD drugs can cause mania to bipolars which is why a mood stabiliser is needed - this is not a guess Adel this is documented  reality and the right combination of MS and AD are vital.

The problem I see is this - you are trying very hard to prove to yourself you are not bipolar.  I advised you get a second opinion 3 months ago, clearly you are suffering from manic episodes and clearly you are under medicated.

However reading web forums never gives the full picture - for example my old GP prescribed me Endep (amitryptiline) as an AD - its an older Tricyclic and I never took it - had the full pack of 50 50mg pills here ad was going to use them on thursday night in one hit.  BUT as my psych pointed out this is a drug that should NEVER be given to bipolars and it says so on the prescriber database - had I actually taken it I would have gone dysphoric at best and suicidal at worst as its very bad for us.

If you do not educate yourself you can have issues BUT that does not mean you should believe everything you read - reputable sources are resputable sources.

[ILADVOCATE]

Well that's just because its a public thread. Its a matter of confidentiality. And perhaps we should continue this particular aspect of the conversation in pm's if you wish. Thanks. People pick their particular screen name for their own reasons. I do advocacy for people with disabilities (in the independent living model) as a volunteer so that's how I got mine. Ask other people if you want.
  Anyway, back to topic, although anti-depressents can worsen bipolar, Lamictal is a mood stabilizer and an effective one at that. Abilify is an antipsychotic. They will help it. Sometimes antipsychotics can work on ocd. It depends on the person. Medication to be honest is still an art, not a science but they are learning and certain things are a known quantity. I think the sites on the "links" page should give you more cogent information.
  

[adel_ezz]

You thought I am trying to convince people of my ideas. On the contrary monkeyc helped me a lot and i am pleased to have somebody around for help. I feel he really cares, no doubt about it and i am not trying even to win in the discussion. All of you are more learned and besides, you have unfortunately a longer history of BP, however this is a forum and we are doing a brain storming. We are just trying to resolve a subject which nobody were able so far to resolve. How could we!! For instance people can report cases in which the meds were lovely for years then at a certain point in time they prove inefficient. Can you explain that. I usually read what you, monkeyc, bulldozer, leftcoastchick and the rest are saying whether i participate or not in the discussion I said before it's a jigsawpuzzle where i do my homework to grasp piece by piece. For example your friend with lamictal and abilify benefited for his OCD because both look like an AD, but beware if he is BP he can soon - hope not - have mania because both work upwards.
thanks a million

one point interesting though, i notice everybody keeps his true name in discretion. OK this is understood. Perhaps nobody likes to be called BP, even when you post the program asks for your nickname, apparently it is taken for granted  that nobody displays his true name. It seems - and that is so in another forum - that people guess this may cause them trouble. OK but why bizarre names, people from the west part of the globe can call themselves nicknames like john west or emily fitzgerald or chris appleyard or Jack smith etc... etc..., whereas from the eastern part nicko blakhoff or suki yakashima, why so complicated names even to spell.
"adel"

[ILADVOCATE]

  I think what he was pointing out was not our ideas about different diagnoses but concerns about your treatment. Actually the person I know who has ocd and bipolar with psychotic features now takes Abilify and Lamictal and it keeps the symptoms relatively in check. We just all had the concern of 3 antipsychotics being prescribed to you at once which clearly is not a good thing but you had said you were getting that updated to one antipsychotic which was Seroquel which at a working dose would be effective for psychosis and mood stabilization. There's still a potential you could have ocd as well and my psychopharmocologist never said I didn't have ocd. He just said the medications for ocd would not be a good idea for me as being SSRI anti-depressents they would set off mania. If there were a working medication for ocd that weren't in this category he would probably prescribe it but he's looking to treat what he can. I have an excellent working anti-psychotic, but need to find a better mood stabilizer but right now my and his concerns and primarily neurological treatment. I've found ways to manage the ocd symptoms and I really couldn't tolerate more medications. They are concerned I'm on enough medications already as per interactions.
  But as for yourself if you didn't have bipolar they would be nothing wrong with asking about an anti-ocd medication but there is the concern of them worsening mania but there's no reason, no to try cognitive behavioral therapy for ocd if that seems warranted. That can be helpful and might be a good way to resolve what medication can't treat.

[adel_ezz]

it's nice discussion, yet we will never know for sure what we are talking about. People who have studied for years don't know, i mean the doctors. Trying to hit our heads against the wall is a good pass time but we will not undo the puzzle.

It's true, sure OCD and BP are different, otherwise why calling them differently, especially that an AD like anafranil did me good one day, really good when my OCD was at its peak, today it does harm for me as it turns me manic. The idea that things change all the time with the brain, otherwise why from start we fall ill.

It's like how ILADVOCATE feels, that directly after signing my new contract of the new job i started yesterday, i went to check the toilets, they are clean. I am obcessed by the idea that i may have to go to the WC while at work and that i may find it dirty. I remember i had a brain lock for a few months on this issue of toilets and i kept thinking and rethinking when applying for a new job what will happen if i am stuck in a post with bad toilets. You don't know how lovely when i found this time everything clean. Again and many times when i put my shoes i like to put them spaced and parallel, of course now it's less but when under stress these things appear. Why i was sure at the onset of my disease that i am OCD is simple because my father is one. He was never manic yes he said during his life he was a little depressed but never alarmed like everybody else, but when i fell ill he started to go back in history to realize that he is OCD. Before my illness he never thought there was something serious about him only he said weird and odd but now my illness made him understand his case. He never took meds had no problem ever except he said he lost his first girlfriend whom he loved because he kept asking and asking and reasking her about her past history, after 3 years she got tired and left him. We realise at home that he keeps asking the same question in a different way to make sure he receives a convincing answer people say he can be a good district attorney, he never touches knobs, washes his hand quite often if he shakes hand with others. He put his cellular phone in his left pocket and uses his left hand which he keeps it clean to pick it up while his right hand he consecrates for shaking hands with people. He consumed 12 cellulars in 2 years because he sometimes forget and uses his right hand to answer the phone so he goes and washes the machine with soap and water (of course he knows well he is doing something crazy) so I think no need to doubt whether he is OCD or not and that by extrapolation I should have caught this from him, yet i shake hands with people easily, never get disgusted like him. So don't tell me my onset of the disease is BP. In the family we heard of BP only after 2006 after a 3 months solely of anafranil, then life went upside down, but from there on i became more liable to mania, you see now why i said that BP could be a complication. Especially as i was so stressful the 1st day in work i began to hesitate whether i should wear a hand watch or not, to either put it on my right arm or left, do things illogic, you can't convince me that my illness started with BP it was mere OCD, i was the type during my infancy calm quiet happy gentil tranquil with no noise charitable etc... so how come i developed this rage 3 times now in 2 years, beat my father in his stomack with my leg more than once and my legs on my mother face during my mania, how come i metamorphosed except the bloody anafranil which was my amazing pill one day because i stopped my risperidone 1mg during 3 monthsw i.e. my MS a mistake of the ignorant pdoc.

so my friend OCD and BP are different
ezz  

[ILADVOCATE]

I do wonder when people take medication and still have some remaining mania and these episodes occur that lead to behavior that isn't destructive but a bit unproductive if there isn't some way to redirect it. I generally try to do that but I do wonder if there's some form of behavioral therapy that can deal with that. I know when I used to have that problem I saved up chores and household tasks for those days and I knew as a rapid cycler they would happen. When I worked in the past, on those days I would get papers in order. A lot of what I do might happen more in a manic state but I catch the manic energy and redirect it. I do take a mood stabilizer but its not perfect. I think you can tell I just took it by post length lol.

[ILADVOCATE]

I agree about ocd and add. I also agree about people with bipolar who are misdiganosed with depression but that's because someone goes to the psych. hospital in a suicidal state and doesn't talk about their "really good days" as they see them which are actually undiagnosed mania or hypomania.
  I was originally diagnosed with paranoid schizophrenia. That was changed to schizoaffective. I know many people here have bipolar with psychotic features. I'm sure you are aware of how they differ so no need to discuss. But I would say a manic episode although it deviates from reality is something understandable. But psychosis even it occurs during mania is another issue. Sometimes its the symptom not the specific diagnosis. Psychosis is usually treated with an antipsychotic. Even if someone has bipolar if they are in an extreme manic episode will be given an antipsychotic to cool things down and then tapered off it. The best mood stabilizer I was on was Clozaril. It covered both psychosis and mania and I didn't require a mood stabilizer. That is common. Unfortunately it took care of my personality as well. I've never found anything, including the study antipsychotic I am on that can serve as both in a person with schizoaffective and its frustrating.

[monkeyc]

Yes people can have multiple diagnoses but that does not mean most do or that those diagnoses are right. Aspects of bipolar can and do look like OCD just as they can look like ADHD but that does not make you either.

How many manics in a psychtic state have been diagnosed as psychotic or schizophrenic? How often do bp patients in a depressed state get diagnosed as MDD and given AD drugs and end up dysphoric?

[ILADVOCATE]

Yes that's true but one can have a secondary diagnosis. The only reason I don't ask about it more is that all known anti-ocd medications will make me manic. I do think cbt would be a good idea. I just know the kind I tried that was helpful for a friend of mine who actually is diagnosed with ocd (and as happens has bipolar with psychotic features as well so they can indeed co-exist although they are different) from stopping taking 4 hour showers (at that time, there was no medication for ocd yet) was not helpful for me. It was called "flooding" and you described your obsessions and the therapist described giving into them in detail on a tape and you had to listen to it over and over which I did but it didn't convince me either way. I know there are other forms of behavioral therapy and perhaps some would be better for me.
  But clearly mania has a part in it. And in the past psychosis as well. Organizing your own house can be normal but some people with ocd do obsess on it and spend the whole day. And when I am manic I always put things in order. But in the past I would organize other people's apartments for them. I just couldn't stand to see a mess anywhere. When the local park was trashed by a bunch of kids who had a "rave" I reported it and nothing happenned so I spent hours in the hot sun cleaning it up. Clearly not very rational (later on the parks dept. finished "my" work). But that was years ago.  
  But a familly member as yet under treatment for bipolar when they get stressed or in a conflict with me will start organizing my stuff or fixing my clothes. And when I pointed out to them they were controlling me second hand they realizes it for themselves and stopped. And they thought they had ocd as well but I pointed out to them that certain nights they worried about "bad things they had done in the past" were when they were depressed and when they "asked for supportive advice" from a fiance who passed away on other nights they were manic. They spoke to their therapist who agreed and they are seeking psychiatric help. The psychiatrist of course will make the final diagnosis but it seems it was never ocd so people shouldn't confuse the two but when bipolar and ocd co-exist in a person they can and do overlap.

[Bear13]

I remember spending one day (literally 7 hours) vacuuming my apartment.  It's 850 square feet, I laugh now, but I honestly thought at the time, that my vacuum just wasn't picking up the dirt, and I could see it... it was crazy, I would vacuum, turn it off, and 20 minutes later I was vacuuming again.... cleanest floor in the state that day, I'm sure :)