Mixed state?????

[opus88]

This is for my son again, who has been pretty good for the last few months,
He is so confused whether he's dealing with just depression or BP.
He only feels the LOWS.....his psych continually assures him that the anxiety he suffers are the 'highs' of BP.
He's very confused.(he is on seroquel)
Anyone with any input???

[adel_ezz]

Hi Opus

My modest view this could be what is called mixed states. Books say it's when you combine mania and depression which is nonsense since both are the 2 extremes. The correct theory is when you combine the high energy of mania with the low mood of depression. You get what is called agitated depression or dysphoric mania.

When you read the definition of mania you always find the classical definition: euphoric, spending sprees, grandiosity, happiness, etc...why you don't get the dysphoric type because it's not mania it's mixed state. BP has 3 phases: mania when both mood and energy are high (so your son isn't manic now) whereas depression when both are low (neither is your son now unless he stays in bed tired and exhausted all the time and feels desperate like suicidal etc... i presume he has a job still) and mixed states in which the mood is low but the energy is high, he can be violent and has anger. A mood stabilizer is called an MS if it succeeds in narrowing the gap between the two situations. There remains the case in which he has a moderately high mood i.e. not depressed but his energy is very low which is pretty rare but can happen, in which case you find him tired and exhausted but is not depressed. the best situation is when one passes between the phases more or less, like going down from mania or going up from depression.

Unfortunately BP is difficult to handle because you try to adjust both waves and depakote can be ok for mania but not very good for depression. Seroquel is better in this case.

I really can't recommend anything, but i usually warn from antidepressants because all the literature describes the kindling process. it's like you prefer the fast solution but the long lasting misery. AD's are not the solution. My BP got worse by using AD's, because you are trapped in the vicious circle, you start by being happy then again the mixed states again.

Although the mania is what pdocs are afraid of to preserve the brain, but the pt's problem is depression from start and this applies to all psych problems. people go to pdocs when in their lows only.

in this forum, many wrote ways to combat depression like B12, vitamin D good diet, lot of sports, perhaps it's easily said than done.

BP unfortunately is a lifelong unstable situation, and we will never gain stability this is why a permanent job is difficult because once you find yourself OK (euthemic) you find a job but by the time you are stable in your job you get depressed or either in mixed states and comes the discovery from your employers. I read all the sites about it, but till now no light seems in the tunnel yet the no of BP pts is in the rise. Why ? "not because dx is better" but from abusing AD's

have a nice day

incidentally has he tried lamictal    

[opus88]

thank you so much for sharing you're feelings with me.
thats the thing really my son doesn't get the mania....unless he's drinking, that can cause him to be hyper...talkative for instance.
He is just darn well depressed..all the time!  except for the anxiety,  which causes him to appear hyper. But from all I've read he just doesn't fit the BP11 profile...he does have insomnia and his head is always full of racing thoughts along with the anxiety....his psych says that is mixed state BP11 and now he as well as I really  question the dx. especially since the Seroquel (also a mood stabilizer that he has since d/c)..hasn't really helped with his symptoms.
Do you think the doc is on the wrong trail and this is just plain old depression and NOT BP?
He is seeing him again real soon and wants to trial AD's instead of the Seroq....but this is such a stubborn psych...when he has his mind made up it seems he isn't gonna change it.
something HAS to change this young man is getting desperate, he is so sick and tired of living/feeling as he does.

[hell1971]

I am BP11 and mostly deal with depression and anxiety, when I was in a mixed state I was all over the place, one minute I was depressed the next minute I was laughing, one minute I was crying the next I felt normal. When I get " manic " it is mild in comparison to what you may think mania is like, yes I am happier than average, I feel like everything is wounderful but not to the extreme, yes I spend money that I dont have but again not to the extreme, yes I feel full of ideas and the dead give away for me is I dont need to sleep as much and I dont feel tired, my mind is busier than normal, I talk a little more and a little faster but its not that overwhelminly obvious, people around me just think im a little hypa, a little happy, the day doesnt just happen, this is hypomania and that is why I am BP11. My depressions are crippling and that is what I mainly deal with, now I am on medication my hypomania is even more unnoticable but always I have a crash after them, I am now on a mood stabiliser and a very small dose of an antidepressant and that has made the depression very mild, I still have moods swings but no where as bad as I have had, saying that this is all early days for me, it has taken two years of rapid cycling to get me to this point where I feel I am finally getting there. Perhaps your son needs his medication tweaked to deal with the depression but if you are questioning wether he is BP or not, ask his doctor why he thinks he is, get him to explain why it is not unipolar depression with anxiety. good luck, you need to be happy with the diagnosis to ensure he gets the right help.  

[opus88]

therefore you do think anxiety is mania??
he has been on high doses of seroquel and valporic acid and this still hasn't reduced the anxiety alot, neither has it improved the lows of depression....that why we question if BP at all?

[ILADVOCATE]

Perhaps the medication isn't working as well on depression as it is on mania and they could adjust, change or add another medication within their discretion but keep track of what goes on with him and when so you can directly let them know