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574118 tn?1305138884

My modest understanding of bipolar disorder

Being an engineer I believe that all phenomena are governed by equations only. Causality is my principle. Now after years of reading, contemplating my illness I came to the following conclusions:

At firt:  Emil Kraepelin theory (father of BP):

High mood + High energy = Mania
Low mood + Low energy = Depression
Low mood + High energy = mixed states, person is irritable, angry, having rage, he is suffocated (worst phase and very difficult to resolve, shoemakers - I mean pdocs - are bewildered thus giving it names like dysphoric mania, agitated depression, totally illogic of course because you can't mix mania with depression)

Bipolar people oscillate continuously between the above 3 phases, because their thermostat is broken.

Moreover, people will tell you that BP2 is better than BP1 because the issue in the former is depression while in the latter is psychosis. Usually you start by being depressed and the shoemaker - who is lazy enough in not to think about the case thoroughly, and having so many other patients making him earn a good living - doesn't give himself a chance of reflexions to check whether this is unipolar depression or bipolar one, so the automatic response for the 5 minutes meeting with him is to write to you an antidepressant. If you are lucky he may add an AP to cover it up. If not, he drives you manic so when you go to see him again he labels you with BP. Of course the symptoms get worse. You struggle to combat mania (although they tell you, I mean the shoemakers, it will extinguish itself with time, but by then you will lose control over your brain). The best drug in this case is a typical AP and not an atypical one, eventually you land in depression, Only the fortunate patient lands smoothly. But then you need to stand up again, hence the vicious circle. But worse the kindling effect due to the repeated episodes.

I happened to have posted a few years ago saying: if no depression, no BP, this view I still hold. If you don't have depression, you don't need an AD, so no mania. Only very few cases in which the person is manic by himself or better hypomanic, usually most if not all of the cases are a mistake of the pdocs, an abuse of the drugs.

Now the illness is called mood disorder and not energy disorder because it's the mood where lies the clue, although the mixture of both is crucial. Mood stabilizers' job is to maintain the mood stable. OK, but the 3 conventional and historical musketeers (lithium, tegretol, depakote) are plenty of side effects so are the rest of the drugs of course. Besides, they were originally designed to stop the mania, why?, for the angry people, dangerous, etc…. Perhaps lamictal helps depression !! Coming to BP2, mostly depressed so there is no solution except an antidepressant, but this is not a solution as I said. Usually the guy after a while turns into BP1 after abuse of the AD. He has mixed states. The trick is to lower your dopamine but without lowering your mood. An atypical AP is not bad here.

Now BP is very difficult to resolve, except ONE day if they discover an antidepressant that doesn't drive you manic in order to up your mood. Only then this illness is resolved. So to help yourself until then (if this occurs one day) is to combat depression if you have some energy of course to spend by sports, eating fish, supplements, tryptophan etc.. but beware of AD's as much as you can. Taking an AD is equivalent to saying make me alive today and I accept that you kill me tomorrow.
13 Responses
Avatar universal
Wow,,you said a mouthful.  Taking celexa led me to hypomania which advanced to mania and psychosis.
Avatar universal
You are completely disregarding the fact that bipolar disorder existed long before antidepressant drugs came out.  And there's also a huge variability in presentations of BP.  Some come with more depression, and do get mistaken for depression, but an episode of full mania is sufficient for a BP I diagnosis--no depression required.  And yes, some people do go back to normal on their own eventually, although others flip flop with no middle or have swinging gradients between depression, mixed states, and manias.  Other people are manic for years, either constantly or intermittently, without ever having touched drugs (while drug abuse is a common problem/symptom in BP I, there are plenty of people who don't have that particular symptom and are still really manic).  

Lamictal is actually one of the few drugs approved for monotherapy (as in it is the ONLY drug you take) in BP I.  It increases the time between relapses, although it seems to do better with depression than with mania.  It still counts as a mood stabilizer though.  I am currently on it as my sole mood stabilizer, and it is working quite well, thank you very much.  I also take buspar for anxiety, but that's not an antidepressant.

It's pretty well known that SSRIs (and other antidepressants) CAN cause mania in someone with bipolar, but it's not a guarantee.  Some people with BP have no problems with them (prozac didn't change anything about my hypomanic symptoms that I can remember, although it's tough since I didn't know it was BP II at the time).  Other people are ok on an SSRI as long as they are stable on a mood stabilizer first, and some just can't touch them.  Screening is vital and is too often not done, but it's tough.  I have major trouble remembering being anything but depressed when I'm depressed, and I don't tend to have very long hypomanic episodes, so even though the first psychiatrist did do a (very simple) screen, he didn't catch it.  It didn't help that I hadn't heard of BP II, and knew I wasn't BP I, and the screening questionnaire was geared towards BP I.  But even then, I might have denied it/forgotten any symptoms due to the horrible depression I was in at the time.  So then I was on prozac for a year.

But if you find the right mood stabilizer, you won't generally need to look at antidepressants, because mood stabilizers DO help with depression as well as the mania.  Some seem to be more geared towards mania (like zyprexa) while others seem to be used more when depression is the issue (like seroquel and abilify), but they all act on both.  Lithium even has some evidence of being rather good at decreasing suicidality in particular.
329165 tn?1515475590
Thank you for taking the time to write the post!  I laughed my *** off at some stages (the shoe-maker) even though BP is no laughing matter... I'd rather laugh than cry.

I am still in the very beginning of finding out what is going on with me.  I had a hyper-episode 3 weeks ago (I thought I finally broke through by quitting my job and that I was happy at last! but then developed a very upset stomach and after 5 days decided I'll see my GP).  The shoe-maker told me:  oh no, you either have major depression or Bipolar Disorder.  Here is a dose of Valpro to start you off with and please see me for the next 4 days on suicide watch!

WTF?  not sure yet.  seeing my GP and the Psyco doc today again.  I have had a horror of a medical history and after 2 open-heart surgeries and some other major stuff I was expecting major depression.... but the anti-depro's did not work and I was still sad to say the least... but I kept on smiling and to the world I am Smiley and they can not handle anything else... but now I have to face that maybe I have BP....

one thing for sure:  an illness does not defy me!  I defy my illness.  And as far as possible, I'll keep on Smiling causing it makes my wrinkles fade :)
329165 tn?1515475590
not swearing here:  lauging my b u t t off and WTF means:  what's the future?
574118 tn?1305138884
thank you for your constructive comments.
Of course I am aware that BP existed long time before the drugs were there; otherwise Emil would not have discovered it before he thought how to cure it. Indeed, one can have the illness without taking an AD. But this constitutes a very small minority of the population, and of course I couldn't be one of them. Only when I took an AD that I (became) a BP pt. If you contemplate the statistics of BP worldwide, you discover that everybody has it nowadays, the reason is the drug abuse, especially AD's.

There exists though a percentage who are by nature hypomanic and those we found them in the streets and any social gathering, they are anxious and feeling high, but they don't need to be fideled with by drugs.

As for mood stabilizers, if you are not at ease with lamictal you are lost. Because I hate to differ with you but that most of the MS around are for mania mainly and even from the historical point of view, although they say otherwise. Again depakote causes ovarian cysts in young girls with all its consequences. Lithium is plenty of side effects, the least is tremors, tegretol perhaps the least but still has itsadverse effects, headaches...etc.. you need to do blood tests everynow and then. There exist others, many others, but each is develish. I am on seroquel 100mg not bad but also full of other things.

You know really if the medical circle can come out with an AD that doesn't bring mania, a very weak AD something that makes you just stand up they would have made a great favor to us. My vitamin B makes me manic after a while. There was someone here suggested deplin (folic acid) I live in the middle of nowhere I tried to buy tryptophan but in vain

thank you anayway
Avatar universal
Adel, the Deplin is a prescription by your dr. If your pharmacy does not have it in stock he should be able to order it.

AD's make me hypomanic. I have tried just about all of them. Not for me. Lamical, Depokote and a very long list of other meds were bad for me. I am very sensitive to meds. Lithium has been good though. I only had side effects in the beginning but no more and it's been maybe 3 or 4 yrs now.

I often ask myself if the AD's kicked into gear the Bipolar. I took them long before I was diagnosised and after for a short while. I guess at this point it doesn't matter because I can't go back but I sure am curious.
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