Bipolar II?
April 25, 2010 4:01 PM   Subscribe

I've had serious depression for bassically my entire adolescence which has steadily been getting worse. After a particularly bad episode last year I went on a high dose of venlafaxine which triggered, what I'm now realising was hypomania. It was actually a pretty great experience - it bassically just made me really high functioning. I didn't do anything irrational or dangerous and I made tons of friends and did lots of creative work. That's worn off and now I'm depressed again. Does this mean I'm bipolar? I've had depression for a long time but I've never had anything close to a manic episode that wasn't triggered by drugs. If I am bipolar, are future hypomanic episodes likely to be as pleasant or could it turn into full blown mania? My uncle's bipolar I so I know what that's like.
posted by Chenko to Health & Fitness (16 answers total) 2 users marked this as a favorite
 
I don't have the DSM-IV in front of me, but I'm reasonably confident that the diagnostic criteria for Bipolar II disorder are more than one episode of hypomania coupled with recurrent episodes of depression. So on that basis, you do not have BP2.

I think from a purely statistical standpoint, having had one episode of hypomania probably means that you are more likely to have another in the future, but who knows - it could be entirely due to the venlafaxine.

I understand that there is some literature concerning anti-depressants triggering hypomanic episodes in susceptible patients, but I think the jury is still out on whether or not they are likely to progress to full-blown mania or remain hypomanic. Certainly, your mental health professional absolutely needs to know about your venlafaxine episode as it would influence the dose they prescribe and might suggest that it be combined with a mood stabliser like sodium valproate or lithium carbonate.

I am not a psychiatrist, but I do work with them and this topic has come up more than once.
posted by tim_in_oz at 4:32 PM on April 25, 2010


I don't have the DSM-IV in front of me, but I'm reasonably confident that the diagnostic criteria for Bipolar II disorder are more than one episode of hypomania coupled with recurrent episodes of depression. So on that basis, you do not have BP2.

The DSM-IV says that, among other things, all you need is at least one hypomanic episode and one episode of MDD to fit the criteria for BP2.
posted by thisjax at 4:48 PM on April 25, 2010


According to the DSM III-R (which is old but I don't have a DSM V hanging around here) if what you say is medically accurate (probably not) then you would be 296.70 Bipolar disorder Not Otherwise Specified

as a matter of fact on page 228 here it says: "Example: (1) at least one hypomanic Episode and at least one Major Depressive Episode, but never either a Manic Episode or Cyclothymia, Such cases have been referred to as "Bipolar II."

You would have to consult a medical professional to rule out other possible causes like substances, other mental disorders, or other disorders in the Mood spectrum like Cyclothymia or perhaps Dysthymia... and of course they would use more up to date books but...

So what?


If you are asking about drugs or treatments you need to talk to a psychiatrist who can talk through that, monitor you, and find what works for you. (btw, IANAD)

However, your last statement worries me "My uncle's bipolar I so I know what that's like." No. No you don't. You have no idea. Bipolar, and all mental illnesses, are by definition very personal and unique manifestations of "unusual" brain chemistry or physical neurological differences.

so
1) All brains are different (thus why we are all different people)
2) unusual brain chemistry will make those different brains even MORE different, in different ways.
QED: no one knows what your bipolar (or whatever) is like but you. YOU have responsibility to take control and make changes that improve your life, I'd recommend finding a doctor you trust who can help with those changes. More over, there is no one magic bullet or pill or diet or exercise routine or lifestyle or hobby or whatever that will "work" for all bipolars.

That said, this is not a burden (or at least it shouldn't be) it just adds challenges and urgency in your quest find yourself. Now probably a new and more interesting self than you first thought. Be glad, creativity is usually highly associated with the bipolar mind (Read Key Redfield Jameson... she wrote the book on Bipolar and is herself bipolar).

Finally, as Jamison describes in an Unquiet mind, the first "mania" (or hypomania) is usually a "white mania". It feels like the best drug you have ever been on. Usually they are not all like that, and get progressively darker, more agitated and even mixed (which can lead to suicide). Don't assume because the DSM diagnoses you Bipolar II that you are immune to manic episodes, mixed states etc. Bipolar II just means you are not Bipolar I.... yet.

Chenko..."that wasn't triggered by drugs"

and that chance for worse mania, mania that you can't get out of, or abyssal depression, or worse psychosis, gets higher the more you abuse your mind with illicit and uncontrolled substances. Ignore Keith Richards he is an aberration.

Don't take anything I am saying as word from on high, just friendly advice. The best advice is... keep an open mind and figure it out.
posted by DetonatedManiac at 4:50 PM on April 25, 2010 [2 favorites]


IANAD and have no idea it this means you're bipolar, but hypomanic episodes can go a number of ways, many unpleasant. This sort of sounds like you want more hypomanic episodes, and if that's the case, I promise you, you do not want to go down that road. I say this because I am a depressed person who had a severe manic episode induced by Effexor (venlafaxine).

It was a one-time event a few years ago, but it became very complicated very quickly. The self-destruction and ensuing fall-out was enormous. Based on my history before, during, and since, the medical consensus is that I am not bipolar, but should not take Effexor or Effexor-like products, and of course, should be careful when introducing new drugs into my system. I do treat my depression with prescribed medicines, one of which is even a stimulant, but I will never touch venlafaxine again, and if it triggered a manic episode in you, you shouldn't either. Please feel free to email me (it's in my profile), if you want more information or have any questions.
posted by katemcd at 4:53 PM on April 25, 2010


*I meant triggered by anti-depressants - I've never used illicit drugs
posted by Chenko at 4:55 PM on April 25, 2010


On review... sorry I realized that your substance you referred to (venlafaxine) was probably proscribed.... didn't mean to jump on you about that.
posted by DetonatedManiac at 4:57 PM on April 25, 2010


katemcd = what I should have said RE: drugs
posted by DetonatedManiac at 4:58 PM on April 25, 2010


I am not a psychiatrist either but from what I can tell, the science on this is not clear and there seems to be lots of clinical "anecdata" that suddenly decides if you have any vague hypomanic experience on antidepressants, you are bipolar II and shouldn't take antidepressants.

However, having bipolar in such a close relative does make it more likely that you would actually have some form of it. And there's now more research suggesting that even in bipolar II, some people can take antidepressants safely.

So, basically, you need to try to find a medication and/or med/therapy combination that works for you and if the "hypomania" isn't causing dysfunction, "watchful waiting" if you have it is probably fine. It's also possible that what you are calling hypomania is actually a normal, good, productive state that is unfamiliar to you because you've been depressed so much. And what you are experiencing now is what has been called the "prozac poop-out" where SSRI's randomly suddenly stop working.

This could be a unique reaction to that dose of that drug at that time of life-- or could be something you would always have with that drug at any dose or could be something you don't have at lower doses or are prone to with the whole class of drugs. No one really knows because individual responses are hugely varied and no one really knows why.
posted by Maias at 4:59 PM on April 25, 2010 [1 favorite]


This is not really the kind of thing that random strangers can diagnose over the web. You need to talk to your therapist about it. If you don't have a therapist, you need to start seeing one. (For your depression, not just because of this.)
posted by Chocolate Pickle at 5:37 PM on April 25, 2010 [1 favorite]


"It's also possible that what you are calling hypomania is actually a normal, good, productive state that is unfamiliar to you because you've been depressed so much."

That's what I thought was happening when I was going through it. There were a few weeks where I definitely felt euphoric (and was taken off the venlafaxine) but after that I just became really social (after being painfully shy for years) and really creative. I've had depression and social anxiety for as long as I can remember so I guess it's possible that that was just what me minus depression feels like.
posted by Chenko at 5:46 PM on April 25, 2010 [1 favorite]


If you are concerned that you are bi-polar II, you could always ask your psychiatrist to try lamictal- a drug used for bi-polar II. The side effects aren't nearly as bad as some of the others out there, but, over the internet, it sounds like you had a reaction to the effexor.
posted by TheBones at 5:49 PM on April 25, 2010


If you have had that reaction to your meds, there's a good chance your meds triggered a latent case of type II bipolar. You need to talk to your doc. And I second TheBones-if it turns out you do have it, it's an excellent drug for the condition. Talk to your doc.

(For anyone reading this thread, it's important to take seriously any "hypomania" triggered by an antidepressant. Because if someone does have bipolar of any type, it is unwise to continue taking simply antidepressants because they can and do worsen the condition.)

Oh, to the OP, since you have a family member with it, your doc definitely needs to screen YOU for it. It can and often is a condition that runs in families.
posted by St. Alia of the Bunnies at 6:21 PM on April 25, 2010


Oh, also, I need to state that as much fun and as productive as that mental state was for you, most cases of hypomania don't stay that way. They can and do turn into cases where you are irritable to an incredible extreme-like PMS on massive steroids times infinity. Wouldn't wish it on anyone. (And yes, it would be grand to stay in a happy hypomanic state, and as "normal" as it might seem for a naturally cheery person, it's a cycle and what goes up will go down and or go screwy.)
posted by St. Alia of the Bunnies at 6:24 PM on April 25, 2010


Chocolate Pickle: "This is not really the kind of thing that random strangers can diagnose over the web."

Seconded. This is the kind of thing that only a psychiatrist or other suitably qualified person, armed with a detailed history and an in-person assessment can help you with.
posted by xchmp at 7:08 PM on April 25, 2010 [1 favorite]


If I am bipolar, are future hypomanic episodes likely to be as pleasant or could it turn into full blown mania?

If you are bipolar (and I'm not saying you are), then you want to avoid future hypomanic episodes as much as possible. Yes, some can be pleasant, but most likely not (just like some sunny days are pleasant but others are torture) YMMV.

However, if left untreated, then the answer to your question is - yes, they can go into full-blown mania. It's called kindling. And trust me - mania is not a fun place to be.

I'd talk to a psychiatrist about this.
posted by patheral at 8:02 PM on April 25, 2010


It's been well-said above, but I'll say it again: the ONLY person who is capable of giving you the answer to your question is a mental health professional who is seeing you as a client or patient of theirs. Any answers you receive here are not valid diagnoses or a valid substitute for mental health care.

Bipolar disorders can be quite dangerous if not moderated by proper care, so I would suggest that if you are concerned about the possibility that you might be experiencing symptoms consistent with a bipolar disorder, that you see someone ASAP.
posted by so_gracefully at 8:33 PM on April 25, 2010


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