From inside my own experience of my moods, which can be somewhat unreliable I would characterize my Bi-polar dx as Bi-polar 1V - V hybrid. Carbamezapine alone does not do enough but did for 3 years. And that was at only 400mg's per day. As we all know I had a bout of extreme rapid cycling then to "normal" 2 months ago and my psychiatrist cranked up the dosage to 600 and it's been working pretty well. I cycled maybe one half day a week ago when I was about to go back to see my psychiatrist for my bi-monthly check in. Sometimes seeing him is a trigger for depression. But for the most part I do my job, sleep way too much because of the Klonopin and just do what I do without too many symptoms. When I cross to "mania" it looks more like "road rage" or being bit#hy, but it has never been "up" as described in the DSM. So I'm glad for me to see your re-evaluation/re-appraisial. It does help to see that I do fall along some sprectrum that perhaps may not have been considered by others in the past. Thank you
Bipolar is a cyclic illness, at it's most basic form. You either have "up" or you have "down" but the main point is... it cycles. Bipolar has 2 poles, that's why it's called Bipolar. To have Bipolar, at it's most basic form, you have to have 2 episodes opposite of one another, cycling.
I have "ups" that are not normal for me, that bring me much much energy, less inhibition, and more impulsivity. I then have "downs" that are so bad that I can barely breath. I then have, from time to time, "normal periods" where I am neither up or down... I'm just there.
As time has worn along... I have developed more and more "mixed" episodes that tend to happen when I'm either transitioning "up" or transitioning "down". For about a week - up or down - I have symptoms of both at the same time. That... that is horrendous because I don't have a clue which direction I'm in and it's just horrendous, plain and simple.
I've had the high manias that landed me IP a few times. This qualifies me for the Bipolar I diagnosis and often times.. I have psychotic symptoms. Yet, I struggle more and are more in danger of harming myself... during the depressions. The depressions last longer than the manias and because of that... I've often received the Bipolar II diagnosis - still with some psychotic symptoms. I've also been IP due to the suicidal depressions.
I've also received the Bipolar NOS and I've received the Mood Disorder NOS when I've been "stable" or in the "normal" period and the doc or docs I'm seeing at the time are new to me.
then the therapists, new and interchanging, tend to diagnose me with Recurring Major Depression... which is also a cyclic illness. Again, because they are often new to me.
My hypomanias cause increased productivity, socialization, and lots of humor. My manias cause interruption, dysfunction, confusion, chaos, and disorientation. My depressions cause no movement, no desire, lack of thought and focus, and the strongest desire to die.
I don't like the term "bipolar disorder". The two "poles" are on opposite sides of, say, a sphere. It implies your are at one or the other. But as you have pointed out, things get all mixed up. My psychiatrist doesn't like the DSM. Instead of the "bipolar" label, he prefers to call my illness a cycling mood disorder with psychotic symptoms. I prefer that. It fits me.
My natural temperament is shy, introspective, a little timid about putting my opinions out there, inhibited, anxious, and deeply empathetic. When I am cycling upward, I am more outgoing, certainly more willing to reveal who I am, more of a risk-taker, more energized and focused, less controlled, more explosive, more easily aggrevated and less forgiving. It is much easier to be selfish and to have a "give-a-shit" attitude about things.
When cycling downward, I long for solitude. I don't want any demands put on me. I won't answer my phone, check my mail, or talk to anybody when I take my dog to the park. Because I am recently married, I don't have the luxury of that when he is home, so I fake it when I have to. He is smart enough to catch on quick, but kind enough not to push it and has learned to recognize the signs when I need space. Just not having to go through the motions of daily small talk, is a blessing when I am depressed. I think I don't want or need anyone around, but I know that without some connection to another person, I would turn too far inward. That is a dangerous place for me to be.
As one person commented, I could be described as having a cyclic illness with psychotic symptoms. At one time I was labeled "bipolar II." At still another time, I was labeled "schizoaffective." Right now, the diagnosis is "schizophrenia." The thing is...the labels tend to change according to the effectiveness of my meds. But most of this confusion in my case tends to center around depression partnered with agitation and anxiety and insomnia. I was labeled "bipolar" when my moods were uncontrolled and definitely mixed, periodically tending toward one extreme or the other. But as soon as the medications took care of the manic or hypomanic end, I was relabeled because of the uncontrolled psychotic symptoms. Why do doctors change the "label" when, to me, it just looks like medications are responsible for the changes in symptoms. The underlying symptoms are doubtless still all there beneath the meds.
Hey, everyone. If the various DSM-5 work groups put as much thought into these matters as you guys are doing, I'd have a lot more confidence in psychiatry. I recently attended a symposium which featured prominent docs from the DSM-5 group that is working on bipolar and it was a counting angels on the head of a pin exercise. I'm learning far more listening to all of you. :)
so, John, why don't the docs and therapists listen to us?
I work with 2 psychiatrists, 3 Psychiatric Registered Nurses, and a slew of Licensed Clinical Social Workers - some with Master's, along with a few case workers... every day that I work. I see and hear how they think and write... it comes from a "clinical", textbook, educated standpoint....
Why can't they just, for one minute even, look and listen to us as human beings struggling and trying to survive and live day by day? I mean really try to see us from our side looking in....
The majority of us are capable of insight, we do know what our illness(es) are doing, we know how the illness(es) are causing us dysfunctioning... most of our 24/7s... we just have little control over it all. Most don't want it and yet we are left to live with it and are unwanted because of it by various groups and folks in society.
The majority of us are doing the treatments, the regimens that they - the professionals - want us to do but they - the professionals - are typically of differing thought as to what is best for us, or what we actually have (from one to the next) or what best med to take and the meds are, in general, atrocious. If some of us can't physically handle the atrocious meds, or don't want to be semi-comatosed "zombie unichs" as you put it - then we are then labelled non-compliant like it's OUR fault and we are not wanting to get better...
At least from my standpoint and personal battle, that is.
I apologize... just feeling a bit desperate right now.
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I have bipolar I with extreme depression, mixed states, rapid cycling, hypomania, and full blown mania. Sometimes I worry when I enjoy myself too much. I am scared that I will eventually become dangerously manic and end up in the hospital as I have before. Lithium really helps me though. The times I have ended up in the hospital are times that I either forgot to take my Lithium for a few days, or I went off of it to try to lose weight, or because I felt that I was becoming too dehydrated during my workouts. At this point in my life, I never want to stop my Lithium ever again. It is the only medication that has kept my energy level in check.