4 ms·

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 depre

by 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

by 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