Bipolar Depression?
May 16, 2011 11:33 AM   Subscribe

Could I actually have bipolar depression?

This is long, so I'm sorry in advance.

I've struggled with major depression since my sophomore year of college. It's not always present, and I wasn't always medicated for it. Since 2005 it has been present almost all the time. I'm currently taking Wellbutrin and Prozac, a combo that has worked for me in the past.

However. In 2009 when I was on this combo, I had what I now believe to have been a manic episode that lasted for 9-10 months. I was extremely promiscuous, despite my being married. I was constantly lying to my husband about where I was, and slept with probably close to 20 guys in that span of time. This is extremely uncharacteristic of me. In early 2010, my husband found out what I had been doing. In the aftermath, I started wondering whether it was indeed a manic episode, since I had no ability to judge that while it was going on. I went off the Wellbutrin/Prozac combo and went to trazodone.

I went back on the Wellbutrin/Prozac 2 months ago because dammit, it works for my depression. And now that I know what to look for, I can hopefully catch a manic? episode before it gets out of hand. Last week, though, I had 3-4 days where I was extremely fidgety, hypersexual, and feeling GREAT. Not just great, but GREAT.

I'll be getting back into therapy this summer after an HMO change, and might see a psychiatrist if the therapist thinks that it's a good idea.

My question is this: does one (and a half) manic episodes automatically mean bipolar depression/bipolar II? Does it sound like I've actually had manic episodes? Is 31/32 too old to be having a first manic episode?
posted by altopower to Health & Fitness (24 answers total) 1 user marked this as a favorite
There are other drugs that can lift you from a depression without exacerbating any mania/hypomania issues you may have. See a doctor as soon as possible, and please do not walk in with a diagnosis, just give the facts and let the doctor decide if SSRI's are contributing negatively to your illness or if you need something more along the lines of a mood stabilizer.
Do this soon. Please do not wait until summer. There are sliding scale clinics everywhere and lithium is like $5 generic.
posted by 8dot3 at 11:39 AM on May 16, 2011

It sounds like it to me. Especially knowing that SSRI's can trigger mania in people w/bipolar. I'd definitely talk to the doc, but yeah - SSRIs + bipolar not a good combo.

hopefully they can find something for you that isn't too strong.

For bipolar, I'm of the understanding that Lamictal is an anti-depressant for bipolar that doesn't kick up mania (at least according to wiki):
While traditional anticonvulsant drugs are predominantly antimanics, the best evidence for lamotrigine’s effectiveness is in the prophylaxis of bipolar depression. As a consequence, it is approved in the US for maintenance treatment of Bipolar I disorder.[3] The drug seems ineffective in the maintenance of rapid cycling bipolar disorder.[6] According to studies in 2007, Lamotrigine may treat bipolar depression without triggering mania, hypomania, mixed states, or rapid-cycling.[7]
posted by symbioid at 11:40 AM on May 16, 2011

Maybe. The only way to know is to see a Psychiatrist. That should be your first step if you think this a real possibility.
posted by dchrssyr at 11:41 AM on May 16, 2011

I think my mom had her first manic episode when she was 32. It takes a while to get the medication right, so work with your doctor and be patient.
posted by bananafish at 12:00 PM on May 16, 2011

Manic episodes are relative (like so much else in psychology). Keep that in mind when you're talking to people. Everybody will compare it to (1) personal experience, and (2) what they've "heard" about it. Most people have gone through something in their life that feels "manic" at some point, just like most people have felt depressed at some point, too.

From what I understand, "manic episodes" last minutes or hours -- I've never heard of a manic episode lasting months. It seems more plausible to me that each time you slept with someone was an individual manic episode. The context in which these events happened is crucial to determining if it was, in fact, manic.

But it sounds like for the moment at least, you're more concerned with how the diagnosis affects your medication, right? Regardless of whatever consensus you come to about "mania," I think you should definitely talk to psychiatrists -- plural. You want multiple opinions on something like this. You don't have to see ten psychiatrists, but talking to two different ones could give you some perspective. It's not that you're assuming that either psychiatrist is bad; it's just the smart thing to do when it comes to medication situations like this. Get some recommendations, explain the situation, and see what they say.

Good luck! :)
posted by hypotheticole at 12:05 PM on May 16, 2011

The Internets are not equipped to help you. Bipolar disorder is something that takes a looong time to diagnose for good reason. Stick to your therapist and see a psychiatrist if you really have to. We really have no idea who you are based on a few paragraph summaries of what you've written (that could be biased).
posted by xtine at 12:06 PM on May 16, 2011 [4 favorites]

Just to clarify something in hypotheticole's response:

It's actually more common for hypomanic and manic episodes to last days to weeks. The shorter/more rapid cycling is much, much less common.

To the OP: How was your sleep and energy level during these episodes? Did you notice any changes in the way your were thinking or talking (ideas and words coming more quickly, feeling pressured to get it out?) Those changes can be really helpful in sorting out diagnosis.

Let me echo drchrssyr's recommendation. Talk to a psychiatrist sooner rather than later. Antidepressants can absolutely induce mania in some people, and it will be important for a physician to help you sort out how to medically address that. It's really, really difficult to "catch yourself" in a manic episode before it goes to far, and you can get yourself in a lot of trouble if it's not addressed quickly.
posted by goggie at 12:17 PM on May 16, 2011

It doesn't have to be specifically bipolar to have manic episodes, and manic episodes can be a result of a number of different pathologies OR a side-effect of treatment. It doesn't matter. If you feel you are cycling up to a manic episode for any reason, that is all that matters - contact your prescribing physician NOW and take it from there.
posted by Lyn Never at 12:19 PM on May 16, 2011

Yep, sounds like it could be.

A heads-up-if you are, lamictal is a great med. You can still take welbutrin if you need to. But you really should see a doc about this, mentioning what you told us, because manic episodes are very risky both emotionally and financially, not to mention if your meds are triggering them, this is NOT GOOD for your eventual prognosis.
posted by St. Alia of the Bunnies at 12:22 PM on May 16, 2011 [1 favorite]

altopower: And now that I know what to look for, I can hopefully catch a manic? episode before it gets out of hand.

Please don't do this. If you are experiencing an actual manic episode, not only are you supremely poorly placed to judge that by definition, but the complication is that you are almost guaranteed to not believe anyone else who tells you that you are, either.

I stood in my shrink's office one day dressed like a Jesus knows what on my way to have the most ill-advised sex I've ever had, speaking 300 miles an hour and pacing up and down the room like a jungle cat in stilettos. He said "You're manic." I said, "I'm not."

That worked out about as well as you might expect. But regardless of whether you are bipolar, having a meds issue or just having an interesting brain ride (none of which anyone here can answer for you), you seem aware enough that all is not currently well. You've basically had a recent experience where you have been able to sense a disturbance in the force, so to speak. HEAR IT LIKE A RINGING BELL. You need to consult a qualified therapist immediately, regardless of your HMO situation. Private fees will be far less than the cost of divorce.
posted by DarlingBri at 12:25 PM on May 16, 2011 [13 favorites]

Your symptoms don't necessarily (don't even probably) mean bipolar. It could just as easily be the chemical cocktail of Prozac and Wellbutrin sloshing around in your brain with natural highs/lows of serotonin, dopamine, etc. Watch your behavior closely and stay in touch with your doctor.
posted by Gerard Sorme at 12:49 PM on May 16, 2011


With the history you describe, I would consider anything other than making an urgent appointment with a doctor to be a reckless course of action. A family practitioner would be fine to start with; he or she may refer you to a psychiatrist.

No, 31 isn't too old for a first manic episode; what you describe in your past sounds consistent with one; what you describe about your present state sounds consistent with hypomania. Unchecked hypomania can easily lead to mania; mania is a state in which you can be a danger to yourself or others.

I'm not a health professional; I'm an idiot on a website. But speaking as an idiot on a website, this situation is much too important to leave to idiots on websites -- SEE A DOCTOR. please.
posted by Zed at 1:29 PM on May 16, 2011 [4 favorites]

This random Internet stranger thinks that whether it is or is not bipolar disorder, seeking professional help from a qualified medical professional is the action most likely to have positive results for you, for your husband, and for your marriage.

I don't think that leaving it unaddressed can have any good results.
posted by Lexica at 1:50 PM on May 16, 2011

To the OP: How was your sleep and energy level during these episodes? Did you notice any changes in the way your were thinking or talking (ideas and words coming more quickly, feeling pressured to get it out?) Those changes can be really helpful in sorting out diagnosis.

I was sleeping fine and had a normal energy level. I'm somewhat low-energy anyway, so maybe it was slightly more than my baseline, but not anything that tripped any sensors for me. Just this past week when it sort of happened again, I was sleeping fine too (but am using trazodone and melatonin to help my sleep), but had much more energy than usual. I was a cleaning machine, couldn't stop moving, the whole nine yards. My thinking is usually pretty scattered and hard to keep up with sometimes, so that's not a really good indicator. I'm not sure how my speech/talking was affected, I might ask my husband what he thought but I'm not sure his answer would help at all.

I have seen my family practice doctor twice in the last couple of months. I told her about the 2009 episode almost immediately after it was over, and she pretty much furrowed her brow and didn't have much to say. I mentioned it again the last time I was in, and it was the same deal.

As far as the HMO thing goes, it's virtually impossible for me to get in with anyone right now. I can only use the county mental health center with the HMO I currently have, and they schedule appointments 3 months out. So, as of July 1 when I've made the switch, I'll have plenty of options for therapists and psychiatrists, so my thinking is that I might as well hold out for that, it's only another 6 weeks or so.

Oh, and to clarify, I'm not currently in any state that I would consider hypomanic or manic. The episode last week lasted about 3-4 days and then ended. Right now I'm feeling completely normal.
posted by altopower at 2:01 PM on May 16, 2011

I've seen one friend go through an episode which was maybe mania. It was instantly obvious to outside observers that something was Wrong, but he wouldn't believe anything anyone said. It was really, really dangerous (like drive your car 100+ mph dangerous) and not a state that you'd want to be in when taking care of kids. It was caused, we think, by him taking an anti-depressant. If you think this is even a possibility, especially if you're taking care of kids, I would move mountains to get a sooner appointment or change meds or something.
posted by LobsterMitten at 3:12 PM on May 16, 2011

There are screenings that will give you some additional information. I believe bipolar is a spectrum disorder, i.e., there are mild cases and severe cases. As with many illnesses, prompt and effective treatment makes a huge difference. Please SEE YOUR DOCTOR as soon as possible. Effective medication is very important, and not always easy.

The fact that you are willing to work on this, not resistant to the possibility that you could have a psychiatric label, is a very big help. Good luck.
posted by theora55 at 4:37 PM on May 16, 2011

Make your appointment now, but for when you switch insurance. Trust me, they have waiting lists too, particularly if they are any good!
posted by St. Alia of the Bunnies at 4:57 PM on May 16, 2011

Oh, and just so you know, there is something called hypomania. Not quite as severe as fullblown mania but different enough to get you in a wee bit of trouble.
posted by St. Alia of the Bunnies at 4:59 PM on May 16, 2011

Antidepressants can definitely trigger a manic (or, as St. Alia suggested above, hypomanic) episode. You definitely need to see a psychiatrist, as soon as possible. You also need to let your husband, and any close friends you see on a regular basis and can trust with this, know about your concerns. Having people watch out for you while you wait to get in to see a doctor is a good idea.

Psych meds are TIRESOME (says the girl on her first day of no effexor after a month-and-a-half taper... ugh). But you may indeed need something else. And a psychiatrist is really the best person to help you through figuring it out. Good luck.
posted by Because at 6:32 PM on May 16, 2011

A side effect of Wellbutrin is increased libido
posted by fernbritton at 8:40 PM on May 16, 2011

I've read some about hypomania and it does sound somewhat familiar. However, I don't get how you can tell the difference between hypomania and just feeling good. I hate the idea of having to analyze myself every time I'm feeling good and trying to decipher whether I'm feeling TOO good.

St. Alia, thanks for mentioning that I could make my appointment now...that hadn't even crossed my mind and it's a great idea.

Because, I have told my husband and he's keeping an eye out, but I'm not sure how useful it would be. I was able to hide my promiscuity from him for almost a year, and I would bet that if I went full-blown manic again, I'd be back to lying to him and sneaking around. I also have told 2 friends who I see often enough that they might see something.
posted by altopower at 6:56 AM on May 17, 2011

altopowerPoster: However, I don't get how you can tell the difference between hypomania and just feeling good. I hate the idea of having to analyze myself every time I'm feeling good and trying to decipher whether I'm feeling TOO good.

The point is that you can't. You are the person least suited for that job if you are in fact having a manic episode at that point. So what you've sort of done is common; my shrink (with my permission) gave my partner the toolset he needed to pull the alarm cord if required. The difference is that when he did that, it was effective because there was already an entire plan of action and support structure in place for that possibility. You do not have that.

I get the insurance thing etc and certainly you get to make your own call on your own mental health, so I guess in your position I would make sure your husband had an emergency number for your GP's practice, and some good local information about which hospitals you do and more importantly do not want to go to for emergency intake and the insurance procedure for that in the worst case scenario.
posted by DarlingBri at 7:15 AM on May 17, 2011

Those are good tips, DarlingBri...I will get that information together and tell him about it.

I called to set up appointments for July, and they refuse to schedule anything until the HMO change is official. So my next step is to call our caseworker (we have BadgerCare/Medicaid) and see if they can at least update our file to say that we will have the new HMO on July 1 and not actually make it so till then.
posted by altopower at 12:14 PM on May 17, 2011

what you know for sure is that you are either susceptible to getting manic, or your medication (or something else that affects your body' s rhythms) creates them in you.

your next questions should be ones exploring measures to take in order to avoid mania, and of examining carefully the effects of changes in your sleeping and eating routines, as well as the effects of your medications and anything else you may take (coffee?)

and informing the doctor who prescribed you antidepressants, that they are possibly creating side effects.

My question is this: does one (and a half) manic episodes automatically mean bipolar depression/bipolar II? Does it sound like I've actually had manic episodes? Is 31/32 too old to be having a first manic episode?

i don't mean to sound critical of you, but of the industry which creates such worries about these terms:
those questions have little point asking or answering: each individual on the planet has different inner workings, and just because psychiatrists have found it useful to create dichotomies does not mean that all individuals who exhibit psychiatric symptoms fall neatly into them.

there is not a cluster of relative disorders whose carriers can be discerned by counting numbers of episodes, etc. - there is a spectrum of symptoms, that psychiatrists try to keep up with, without stupendous success, judging by their periodic reshuffling, renaming, deleting, and discovering of new ones. what' s more, the world is changing very quickly and in our daily lives we are all likely to encounter more pollutants, more triggers for stress, etc than ever before, in our generation, depression is rampant, in the next, it seems already that ADHD could be ubiquitous in the next - classifying our symptoms is not as important as managing them.

in any case - any psychiatrist would be more than happy to answer those questions for you, but i would pay more attention to what symptoms he considers significant and what he suggests to do about them. the medication route is long and full of readjustments as your system gets used to everything and changes.
posted by glassy sesames at 7:13 PM on June 1, 2011

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