4 ms·

Did you always know it was bipolar depression? If not, what eventually made you realize it was bipolar depression and not major depression?

asveikau 5y ago
Not op, but I lived with a bipolar patient and had a relative who was schizoaffective, bipolar subtype. It's pretty common for bipolar patients to be misdiagnosed as having depression because mania or hypomania "feels good" and they don't seek treatment until they crash into a depressive episode. Or sometimes the mania just emerges later in life, as the course of the illness can vary and develop over the years, so maybe in the earlier phase it is more mistakable for unipolar depression. Lastly, antidepressants can trigger a manic episode in bipolar patients.
- R0b0t1 5y ago
  I see a lot of people talking about their bipolar diagnosis that has no or very little manic component. Why call it bipolar then? It's just cyclical major depression.
  - r_hoods_ghost 5y ago
    Because it's not just cyclical major depression (and there's no "just" to major depression either, but that's another rant). The diagnostic criteria for bipolar is that you have had at least one extended episode of mania or hypomania alongside a depressive episode, so you're not going to have the diagnosis unless you've been manic or hypomanic at some point. Although it may not be a major or dominant part of someone's presentation, mania or hypomania is nevertheless there and it effects what treatments are appropriate. Certain SSRI's may trigger off hypomania or mania in a bipolar patient, or simply be utterly ineffective, whereas in someone with cyclical major depression their response would be different. I'm bipolar II and spend roughly 1/4 to 1/3rd of my life meeting the criteria for major depression but very rarely have hypomanic episodes, and this was the case even before I was on lithium. Indeed I've gone for years in between major hypomanic episodes. But hoo boy! When they hit there is no mistaking them. The other thing is that unlike with depression where you have to squint really hard to see much of an effect from most treatments, there are reasonably effective treatments for mania and hypomania, including good old lithium. So if you're being treated, while you might still suffer from regular bouts of depression, you'll likely have much reduced or even eliminated hypomanic or manic symptoms. So it's not unusual to see manic depressives who are treated showing very few manic symptoms for years on end.
    - asveikau 5y ago
      Just a small thing, I believe you don't need a depressive episode for a bipolar I diagnosis. For bipolar 2 I think yes.
    - R0b0t1 5y ago
      It seems very dangerous to diagnose as such. Perhaps someone gets depressed every three months near end of quarter when their hours get cut? Once someone demonstrably has issues with mania, yes, sure, I understand wanting to prevent it, but in a lot of cases I see very little separation from actual mania and "I felt good one day" (which if someone were depressed may feel very weird). There's also strong arguments that one or two manic or hypomanic episodes are not enough evidence for a bipolar diagnosis.
      - etripe 5y ago
        > Perhaps someone gets depressed every three months near end of quarter when their hours get cut? As someone who's been clinically depressed, your examples seem contrived to me. Are they based on any specific evidence, and if so, would you please share with the group?
  - YXNjaGVyZWdlbgo 5y ago
    There are different forms of Bipolar the most publicly known form is BP1 with Psychosis or what people call the manic component. People with BP2 (they never get really manic or get psychosis) have episodes that are called Hypomania which are debilitating for some even more than manic episodes. Here is a nice chart at how these hypomania episodes feel. https://imgur.com/a/9d0MrnD https://imgur.com/a/9d0MrnD
    - ravishi 5y ago
      I find it quite hard to not feel like I've lived or felt many of the symptoms on the second column. Yet, when I searched for help the diagnosis seemed rushed and I decided not to take lithium. Years later after much therapy a new psi prescribed me an SSRI. It did wonders to my anxiety and subsided the thoughts of taking my life. But the main motivational problems persist. Now I'm convinced to stop taking them because they make me kinda numb. It's like I miss crying or taking some issues as serious and important. Then a question arises: just from taking SSRIs these two years and not going nuts, does that prove I'm not bipolar?
      - AstralStorm 5y ago
        No, SSRI work well in a number of BP2 cases. Apparently yours do not quite work well enough, since you seem to be describing aboulia, which is a depression symptom.
      - YXNjaGVyZWdlbgo 5y ago
        You don't have to go nuts to be bipolar. If you are not going manic I would look to see if you had self destructive tendencies in your past like quitting a job on a whim, getting erratic with your friends over nothing etc. If you have them combined with some of the other symptoms of the chart I would speak with a pdoc. Here is a great video describing the differences https://www.youtube.com/watch?v=AM7vf5HJxaQ https://www.youtube.com/watch?v=AM7vf5HJxaQ
okareaman 5y ago
I started having my suspicions after I read what I consider the best book about the bipolar experience called "The Loony Bin Trip" by the late Kate Millet. She got more manic than I but eventually I got more depressed than she. Interviews with psychiatrists are where it was diagnosed. It's helpful before those interviews to think back about periods of childhood when you felt really disconnected and out of it and then the times you had long periods of a really good mood. Then relay those experiences to the pdoc honestly and let them tell you what they think. It's important not to tell them what you think they want to hear or bend the truth so you get a "trendy" diagnosis. Even if you think you're story is boring and you feel you have to punch it up, resist that urge. Just tell them like it is and they might surprise you with a correct diagnosis that you never heard of or never expected. You can't get treated right until you get honest, and this includes about drug and alcohol consumption.
YXNjaGVyZWdlbgo 5y ago
The diagnoses is most of the time not that easy. I was diagnosed really early with 16 after a suicide attempt with 13. I was diagnosed with MDD and ADHD at the time and the SSRI and amphetamines stimmed me right into my first manic episode with psychosis. If you are BP 1 and have psychosis while in a manic episode the diagnosis comes pretty fast. If you are BP 2 the diagnosis can be a lot harder because most of the time when people come out of a depressive episode they just feel "normal" before spiraling and getting erratic when in hypomania.
wayoutthere 5y ago
One of the differentials is that SSRIs generally send you into a manic or even psychotic state rather than a “baseline”.

asveikau 5y ago

Not op, but I lived with a bipolar patient and had a relative who was schizoaffective, bipolar subtype. It's pretty common for bipolar patients to be misdiagnosed as having depression because mania or hypomania "feels good" and they don't seek treatment until they crash into a depressive episode. Or sometimes the mania just emerges later in life, as the course of the illness can vary and develop over the years, so maybe in the earlier phase it is more mistakable for unipolar depression. Lastly, antidepressants can trigger a manic episode in bipolar patients.

R0b0t1 5y ago
I see a lot of people talking about their bipolar diagnosis that has no or very little manic component. Why call it bipolar then? It's just cyclical major depression.
- r_hoods_ghost 5y ago
  Because it's not just cyclical major depression (and there's no "just" to major depression either, but that's another rant). The diagnostic criteria for bipolar is that you have had at least one extended episode of mania or hypomania alongside a depressive episode, so you're not going to have the diagnosis unless you've been manic or hypomanic at some point. Although it may not be a major or dominant part of someone's presentation, mania or hypomania is nevertheless there and it effects what treatments are appropriate. Certain SSRI's may trigger off hypomania or mania in a bipolar patient, or simply be utterly ineffective, whereas in someone with cyclical major depression their response would be different. I'm bipolar II and spend roughly 1/4 to 1/3rd of my life meeting the criteria for major depression but very rarely have hypomanic episodes, and this was the case even before I was on lithium. Indeed I've gone for years in between major hypomanic episodes. But hoo boy! When they hit there is no mistaking them. The other thing is that unlike with depression where you have to squint really hard to see much of an effect from most treatments, there are reasonably effective treatments for mania and hypomania, including good old lithium. So if you're being treated, while you might still suffer from regular bouts of depression, you'll likely have much reduced or even eliminated hypomanic or manic symptoms. So it's not unusual to see manic depressives who are treated showing very few manic symptoms for years on end.
  - asveikau 5y ago
    Just a small thing, I believe you don't need a depressive episode for a bipolar I diagnosis. For bipolar 2 I think yes.
  - R0b0t1 5y ago
    It seems very dangerous to diagnose as such. Perhaps someone gets depressed every three months near end of quarter when their hours get cut? Once someone demonstrably has issues with mania, yes, sure, I understand wanting to prevent it, but in a lot of cases I see very little separation from actual mania and "I felt good one day" (which if someone were depressed may feel very weird). There's also strong arguments that one or two manic or hypomanic episodes are not enough evidence for a bipolar diagnosis.
    - etripe 5y ago
      > Perhaps someone gets depressed every three months near end of quarter when their hours get cut? As someone who's been clinically depressed, your examples seem contrived to me. Are they based on any specific evidence, and if so, would you please share with the group?
- YXNjaGVyZWdlbgo 5y ago
  There are different forms of Bipolar the most publicly known form is BP1 with Psychosis or what people call the manic component. People with BP2 (they never get really manic or get psychosis) have episodes that are called Hypomania which are debilitating for some even more than manic episodes. Here is a nice chart at how these hypomania episodes feel. https://imgur.com/a/9d0MrnD https://imgur.com/a/9d0MrnD
  - ravishi 5y ago
    I find it quite hard to not feel like I've lived or felt many of the symptoms on the second column. Yet, when I searched for help the diagnosis seemed rushed and I decided not to take lithium. Years later after much therapy a new psi prescribed me an SSRI. It did wonders to my anxiety and subsided the thoughts of taking my life. But the main motivational problems persist. Now I'm convinced to stop taking them because they make me kinda numb. It's like I miss crying or taking some issues as serious and important. Then a question arises: just from taking SSRIs these two years and not going nuts, does that prove I'm not bipolar?
    - AstralStorm 5y ago
      No, SSRI work well in a number of BP2 cases. Apparently yours do not quite work well enough, since you seem to be describing aboulia, which is a depression symptom.
    - YXNjaGVyZWdlbgo 5y ago
      You don't have to go nuts to be bipolar. If you are not going manic I would look to see if you had self destructive tendencies in your past like quitting a job on a whim, getting erratic with your friends over nothing etc. If you have them combined with some of the other symptoms of the chart I would speak with a pdoc. Here is a great video describing the differences https://www.youtube.com/watch?v=AM7vf5HJxaQ https://www.youtube.com/watch?v=AM7vf5HJxaQ

okareaman 5y ago

I started having my suspicions after I read what I consider the best book about the bipolar experience called "The Loony Bin Trip" by the late Kate Millet. She got more manic than I but eventually I got more depressed than she. Interviews with psychiatrists are where it was diagnosed. It's helpful before those interviews to think back about periods of childhood when you felt really disconnected and out of it and then the times you had long periods of a really good mood. Then relay those experiences to the pdoc honestly and let them tell you what they think. It's important not to tell them what you think they want to hear or bend the truth so you get a "trendy" diagnosis. Even if you think you're story is boring and you feel you have to punch it up, resist that urge. Just tell them like it is and they might surprise you with a correct diagnosis that you never heard of or never expected. You can't get treated right until you get honest, and this includes about drug and alcohol consumption.

YXNjaGVyZWdlbgo 5y ago

The diagnoses is most of the time not that easy. I was diagnosed really early with 16 after a suicide attempt with 13. I was diagnosed with MDD and ADHD at the time and the SSRI and amphetamines stimmed me right into my first manic episode with psychosis. If you are BP 1 and have psychosis while in a manic episode the diagnosis comes pretty fast. If you are BP 2 the diagnosis can be a lot harder because most of the time when people come out of a depressive episode they just feel "normal" before spiraling and getting erratic when in hypomania.

wayoutthere 5y ago

One of the differentials is that SSRIs generally send you into a manic or even psychotic state rather than a “baseline”.