That sucks! If you moved back in with your parents, does that mean that you had to change pdocs? If not, I really think it was completely irresponsible for your pdoc to discharge you so soon after stopping meds. When I studied psychiatry it was very common to keep people who were doing well on annual appts just to 'keep an eye on them' and keep them 'on the books' in case things went south suddenly and they didn't have to wait for a brand new referral, which takes A-G-E-S as you know.

This pdoc seems determined for some reason to give you a mood diagnosis (mentioning bipolar before and now depression). You never mention mood symptoms here though - do you just not talk about them, or is this pdoc way off base? From what you've said so far, I much prefer your previous one. I hope he hurries up and sorts his practice out so you could go back! I also hope that the therapy wait isn't long cos I know you found it very helpful before - would it be CBT for psychosis again?

I don't know a lot about BPD only that I've never felt it resonated when I've read the criteria. People talk a lot about mixed states being like a yo-yo of mood, which always sounded more to me like BPD mood swings. I'm not entirely sure that I've had a mixed state or if it was severe akathisia from meds (but then I had 2 med-free so idk), but for me it was a mixture of manic and depressive stuff AT THE SAME TIME rather than really happy/angry, then depressed, then happy/angry again on and on (that doesn't sound mixed to me, but I'm not an expert).

A pdoc once explained mood states to me which explained mixed states, and I will try to describe it but it's difficult without a diagram. Most people consider depression and mania to be complete opposites and don't understand how you can be both at the same time, probably assuming swinging rapidly from one to the other. But he described it as a
H
with mania on one vertical line and depression on the other vertical line, and energy on the horizontal line if you imagine a graph. So the top left of the H is high energy mania with top right being high energy/agitated depression. Then the bottom left would be low energy/catatonic mania and the bottom right would be catatonic depression. In that description mania and depression aren't polar opposites once energy is taken into account.

What I've termed a 'mixed state' before was preceded by a 'hypomania' (very uncommon for me and different from a 'good week' in that I feel completely confident, am not socially anxious at all - none of which has ever been my baseline pre-MI and is what makes me think this is abnormal for me). Then the mixed state is awful BUT the feelings are consistent the whole time (no oscillating from good mood to bad mood for me) - racing thoughts, impulsivity, more energy/fidgeting/pacing for hours, colours are blindingly bright, noises are too loud, touch makes my skin crawl, very irritable and quick to rage. Along with the typical depression stuff of low mood, worthlessness, hopelessness, feeling suicidal (and actually having the energy & impulsivity to possibly act on it, which is dangerous).

Now this could possibly be agitated depression for me, idk, though Uni pdoc agreed mixed episode. The difference between the times it was on meds (so possibly akathisia) and off meds, is that on Abilify/aripiprazole there was no 'hypomania' preceding it and colours weren't jarring and my thoughts weren't racing, but on Fluoxetine/Prozac and Venlafaxine/Effexor and off meds there was. Then I have a huge crash where I become slow depressed and don't move/think/do anything for several weeks until it picks up and I'm my 'usual' low-energy-but-can-move depressed.

I have no idea if this is correct (only Uni pdoc was convinced that I was BP2, before he changed it to SZA - bp type) either for me or for mixed episodes in general, but that is my current understanding; hope it helps. And nice to see you Didgee!

*Willow*