Dysthymic Disorder

No wonder you're confused Tabby, I put the wrong draft up! Originally I wrote about dysthymia and its relationship to bipolar. Then I ran over my word limit so I cut a lot out and restricted the topic to dysthymic disorder. Some clumsy editing on my part - apologies.

Hi Tabby, I am confused now. John did not start out with any mention of "Bipolar people" experiencing low levels of depression from which they don't seem to fully recover and that this might be Dysthymia. He just said "people" sometines experience low levels of depression. There was no mention of Bipolar in the article, as it was not related to bipolar. As far as I read it, it was about Dysthymia, low grade persistent depressive mood lasting over two years which can like any depression drop down even lower, unless we are reading a different article. Highs are not a feature of Dysthymia as far as I am aware. Though as we know anything can change along the line, but it appears Bipolar is not diagnosed as such until there is evidence of an actual distinct manic episode. Dysthymia would then appear to be a unipolar condition, with a return to a euthymic , or normal mood when well, not hypomanic even mild sometimes when it starts before escalating , but usually escalates fairly quickly over hours or a few days from my experinece . I have found that even mild hypomania whe recognised is still a distinct difference from euthymia, though I am sure it is much harder to distinguish. I think mild hypomania would be identifiable by it's deviation from the usual behaviour or character of the individual,the possible suddeness of these changes , length of noticeable objective changes, possibly more noticeable to onlookers. I still received no help from editor about paragraph separation, sorry. I have asked.

Jerry has, or someone here at the site has, edited out the post from the version that initially posted.  He did mention a relation to Bipolar... as you would see in his reply back to me.. he noted that the wrong draft went up.

Hi Tabby, I am confused now. John did not start out with any mention of "Bipolar people" experiencing low levels of depression from which they don't seem to fully recover and that this might be Dysthymia. He just said "people" sometines experience low levels of depression. There was no mention of Bipolar in the article, as it was not related to bipolar. As far as I read it, it was about Dysthymia, low grade persistent depressive mood lasting over two years which can like any depression drop down even lower, unless we are reading a different article. Highs are not a feature of Dysthymia as far as I am aware. Though as we know anything can change along the line, but it appears Bipolar is not diagnosed as such until there is evidence of an actual distinct manic episode. Dysthymia would then appear to be a unipolar condition, with a return to a euthymic , or normal mood when well, not hypomanic even mild sometimes when it starts before escalating , but usually escalates fairly quickly over hours or a few days from my experinece . I have found that even mild hypomania whe recognised is still a distinct difference from euthymia, though I am sure it is much harder to distinguish. I think mild hypomania would be identifiable by it's deviation from the usual behaviour or character of the individual,the possible suddeness of these changes , length of noticeable objective changes, possibly more noticeable to onlookers. I still received no help from editor about paragraph separation, sorry. I have asked.

Hi again Tabby, I have just read the last line of your post re "would that leave Bipolars who can not remember when they last felt good or felt high" when presenting with depression to the doctor .You implied correctly that they would most likely be diagnosed with unipolar depression and be prescribed antidepressants. Well this is exactly what happens, and which trips up many budding or even established bipolars in the hands of inexperienced or incompetent mental health staff, particulalry those who do not take notice of partners / family or carers observations as some, not all, are often experts in their loved ones Bipolar presentation . Most people when low have difficulty remembering when last they felt good, and are very unlikely to actually recall it as a mania or hypomania if they were aware of when they last felt good, or report in such terms as they often do not see it as it was, and will dismiss it ashaving been a high, or may not have insight into any past altered mood phase other than depression, in many cases . Tis is exceedingly common well researched and documented, bit doctors still do not seem to take it on board, and take what the client says at face value. That is exactly the dillema many GPs or psychiarists who do not probe a little further into what activities took place when the person last felt well, or if the Doctor is inexperienced. This is historically how Bipolar is often missed initiialy and often for very long periods by the medical and psychiatric profession, and treated as uniploar with antidepressant, as if dealing with a clinical unipolar depression. The problem is most people usualy only go the doctor in the depressive phase,. and the highs are rarely sewn, unless being monitired regulalry, even the there will a tendedncy to avoid the doctor when high as other appointments and activities often take precedence, and appointments will be politely cancelled as the individual feels no need to go to the doctor.You are right, and this is often what destabilizes and exacerbates their cycling or heralds the first major episode of mania or hypomania if they have a underlying Bipolar Illness not yet manifested by an episode of either Hypomania or mania and had preciously been treated incorrectly for a unipolar Mood disorder . If the individual is only unipolar, antidepressants should not cause mania or hypomania as far as I am aware, except in very high doses as a side effect it can happen and I have seen this, however, whereas this used to be considered not bipolar, now the research says if antidepressanst trigger a first hypomania or mani, it kis hughky indictative of an underlying Bipolar Disorder. Some psychiatrists still disagree iover this and say it can occur as a side effect , not just a switching or cycling to the opposite pole of mood . If it is a side effect I believe that the antidepressants induced higb is less likely to last as long as a switch if it is just a sude effect. Usually ifa switch occurs in someon ehwo is actually Bipolar whilst on antidepressants then the high is lilely to run its eoisode course and be more severe , and persist even when the anti Ds atre stopped. Antidepressants if used in unipolar depression should just restore the individual to a normal functional level of mood state and not beyond it ,though if they have had a low grade dysthymia for some time or majpr depression, then it night appear they are slightly above the norm if people have becoem so used to their low mood and accepted that as the person's normal personality almost, then their keeness to attend to eveything and sort our thinsg and e back in contac t with people could be cobstrued as hypomania, but I would suggest it differs if examined closely in terms of the absence of other hypomanic classic symptoms, or in that the behaviours are still within normal ranges and not disturbing or excessive, just enthusiastic or motivated. It is a tremendous relief to come out of any level of depression, as they all feel the worst to the sufferer than ever at the time I think, even when mild, especially in those who have not experienced or witnessed moderate to severe levels for comparison , and there is a great sense of urgency to pick up where one left off and return to old friends or old hobbies or activities with renewed enthusiasm, gratitude and pleasure. I am currently experiencing that. An initial buzz of relief to be well again is to be expected but if euthymic would still be within the normal range and free of other objective or subjective symptoms if that makes sense. There is however a school of thought that suggests that all depressive illness, bipolar or apparently unipolar or dysthymia and seasonal depression is actually all part of the same illnnes just on parts of the depression spectrum, and that some individuals will not experience all phases, and are treated for the predominant presentation until there is evidence of having moved into a different illness pattern. Tihs actually makes sense I feel. Julie fast talk of a Multipolar illness which I feel is a good and more accuarate description which also encompasses Mixed Mood States and dysphoric or euphoric highs. Food for Thought. Her Book , "loving someone with Bipolar Disorder Co written with a doctor is excellent ,I personally feel. Galaxy .