[PositiveKarma]

**** DISCLAIMER & HUMBLE REQUEST: ****
This originally began as one extremely long, very exhaustive, post! I wanted to be thorough addressing each of the diagnostic criteria so you’d have an honest and real picture of what I’ve been experiencing compared to yourselves. Due to the ridiculous length, I decided the best thing to do was to divide up this post into a few others over the course of the next few days. This way it’d be less time consuming for you in one sitting. I already feel like I’ll be trying your patience. I’d be ever so appreciative if you’d kindly bear with me, keep checking back in, and answer/address what you can along the way. Or, if you’d rather wait until this whole thing unfolds in its entirety that would be great too. Any and all insights are welcome and appreciated. Thank you for your time and patience.

Hi everyone,

Recently it was suggested to me by a pdoc that I might be Bipolar. This was not my regular pdoc. Fortunately he explained a Bipolar diagnosis could not be made without several more sessions, observations, and further patient reports. Never in a million years did I think this diagnosis would fit me. However, now, I can’t help but wonder if this pdoc may be onto something. Since he put this bug in my ear I’ve done a good amount of research and am seeing a lot of myself in this disorder.

Since then I’ve seen my regular pdoc to go back on antidepressants. While there I asked her opinion about this diagnosis. She explained that when I was on Prozac years ago, if I was Bipolar, it would have sent me into a manic state. Well, it didn’t. Prozac only increased my depression. So Lexapro was prescribed for me instead. This is what’s worked best for me and what I’m on now.

She offered to write a script for a mood stabilizer to see if this would help. She didn’t say one way or the other if she thought my symptoms fit the diagnostic criteria. I was left feeling the only way to discern this diagnosis was to experiment with mood stabilizers. I’m not comfortable just trying something, “To see,” if it works. I’ve begun a mood chart and explained this to her. So we decided to wait until my follow up appt. (a few weeks from now) and see how I’ve been feeling to decide if mood stabilizers should be revisited.

This is where you come in. I’d really appreciate your feedback and advice. Therefore, I thought I’d share my story with you- those who have been diagnosed and experience Bipolar on a daily basis. Please know I am not asking anyone to diagnose me! I understand you are not Dr.’s. I’d just like your opinions based on your experiences. Again, I apologize in advance for the lengths of these posts. I really do appreciate your patience in reading this.

Ultimately, I guess these are my questions. (For some you’ll probably have to wait until other posts follow):

1). Does what I’ve been experiencing sound like Bipolar II (with hypomania- highly doubt I’m fully manic), Mixed Episodes, Rapid Cycling, or Cyclothymia? Or a combo of any of these?
2). For those of you with Bipolar II does this sound familiar to you? Have you had similar experiences?
3). If you’ve been on Prozac did it send you into a manic state? What were your experiences whether this occurred or not?
4). If you were in my shoes would you try a mood stabilizer to see if it confirms or denies this diagnosis?
5). Is trying a mood stabilizer the only way to ascertain if one is truly Bipolar? Really?! Is it truly a process of feeling like a guinea pig through trial and error? Not sure I like this.
6). Finally, do you think my symptoms, behavior, etc… do fit into each of the diagnostic criterion?

MY CURRENT DIAGNOSES:
Dysthymia
Generalized Anxiety Disorder
Obsessive Compulsive Personality Disorder- NOT OCD! This is very different.

CHANGES IN MOOD:
This pdoc suggested Bipolar because of my sudden shifts in mood from depression, to feeling okay and balanced, to moments of irritability and frustration. Sometimes I experience this all in one day over the course of the day, or within an hour time span or so. Also, I’ll be in one of these moods for a day to a few days, then will wake up one morning experiencing the other, then a few days later another. (Ex: Feel depressed a day or two, happy and content for a day, then irritable and impatient another). These can be in any combination or order and are not extreme fluctuations in mood- just enough to be noticeable and wonder why I’m feeling this way since there seems to be no identifiable trigger.

This has been occurring over the past year or so. Maybe longer, I don’t know. I never really paid attention and didn’t think much of it. I thought these were symptoms of my depression since it’s common to experience agitation, irritability, etc… while depressed. My, “Pissy Moods,” (as I call them) are completely controllable. Meaning, I want to snap and rip someone’s head off, but don’t, because I don’t want to take it out on others. I’m normally a very kind, loving, bubbly person and this doesn’t feel fair to me. For this reason when I feel this way I usually want to be left alone. Plus, being around others tends to annoy me when I’m in one of these moods. If I’m in an environment which won’t allow me to be alone and try to shake off my mood, I fake it and behave as my usual, calm, bubbly self.

This is all I'll post for today. Other areas to be addressed will be: 1). Decreased need for sleep. 2). More talkative/Pressure to keep talking. 3). Racing Thoughts & Distractability. 4). Increased Goal Directed Activity. And 5). Inflated Self-Esteem and Grandiosity/Excessive Pleasurable Activities.

Again, thank you for your time and patience in reading this. I look forward to your responses as my story continues.

Just looking for answers to so many questions.

~* PositiveKarma*~

[Anneinside]

The criteria for a hypomanic episode requires a minimum of 4 days. Some people do rapid cycle but you need to have met the time requirement at some time. Have you looked up the DSM-IV (or even the not yet published 5) criteria for Bipolar II?

Also Substance-induced episodes do not count as part of bipolar. Although antidepressants can push you into a hypomanic or manic state, this happening isn't part of the criteria for bipolar.

[kindachaotic]

Mood chart is an excellent thing you're doing. Since it might be hard to remember everything you've stated here, print it out for pdoc.
You say there's more, post here & do same, print out for pdoc. Journaling along with mood chart would be helpful. Might help you both decide if mood stablizer will be next step.
Didn't look at your profile so don't know if you listed your age. Thru the years with different pdoc's my dx varied silghtly but BP stayed on the list. Everyone's different, make sure you get a good eval. Usually takes 2-2.5 hrs. It's nothing to be afraid of, just be honest.
Best wishes.

[kindachaotic]

Disreguard above post. Should have read your profile page...

[PositiveKarma]

Thank you both for your replies,

Anninside: Yes, I have read the DSM-IV. Thing is, I'm not really sure if these moods have lasted a min. of 4 days since I never really paid that close of attention. They may have, dunno.

One thing I expressed to both these pdoc's is the depression I'm currently experiencing (before started taking Lexapro again) feels different from prior depressive episodes. I was having a few days of feeling deeply depressed, then a day or two of feeling fine. Sometimes during these, "Fine," days I'd have moments of unexplained irritability and agitation which would pass then I'd either feel fine again or mildly depressed. Some mornings I'd wake up feeling pissy but wouldn't let my mood follow me to work. I'd be my usual, bubbly, self at work but as soon as I got home- BAM! depression would hit me again. This confused me and was the main reason I waited so long to go back on antidepressants. I wasn't sure I was really depressed! That is, until another wave of depression got a hold of me and I said, "Enough is enough. I gotta do something about this!" So here I am.

kindachaotic: Thank you for your suggestions and kind words. I am keeping a journal along with my mood chart noting events of the day which could be possible triggers for any mood swings. My pdoc does want me to bring this to my next appt. You asked about my age. I'm 44 and will be turning 45 end of this month. Does age play a factor in diagnosis? Gosh, I've read so much I can't keep it all straight. Also, you mentioned an eval. Is this something my regular pdoc does, a therapist, or someone else? No one has mentioned this to me yet. I'm beginning to wonder if it might be wise to get a second opinion.

Again, thank you both for you time and insights. I do appreciate them and you. Have a wonderful day and be good to yourselves.

~*PositiveKarma*~

[PositiveKarma]

Hi everyone,

I'm back with installment 2. This one is a little longer than the ones that will follow but made the most sense in breaking them up. This post includes: 1). Decreased need for sleep. 2). More talkative/Pressure to keep talking. And, 3). Racing Thoughts & Distractability. Again, thank you so much for your time and patience as well as your replies so far.

DECREASED NEED FOR SLEEP:
I have noticed a distinct change in my sleeping patterns over the past couple years. This seems to follow a fairly predictable cycle. Normally I require a good 7-8 hrs. of sleep to feel refreshed and rested, going to bed between 11:00 – midnight and waking around 6:30-7:30ish a.m. . I’ve always been a restless sleeper, tossing and turning frequently and flailing my legs (I’ve been diagnosed with restless leg).

Also it’s always taken me a good 20-40 min. to actually fall asleep since my mind races like crazy. I can’t shut it off! My pdoc and therapist told me this is due to my anxiety. But this happens even if I have nothing on my mind! This is my, “Normal,” and typical sleep pattern until the disruptive sleep cycle begins. I’ll sleep like this for about 1-3 months then the following will occur. Here’s what’s going on:

A few hours or so before my usual bedtime I won’t feel tired- at all! I’m wide awake, alert, and full of energy as though it’s day time. I feel like I could be very productive, but don’t start anything knowing I need to go to bed soon. So, usually I do one of two things:

1). I’ll wait about an hour or so then go to bed unable to sleep with major insomnia. No matter how many relaxation techniques I try my mind races, I toss and turn and quickly become frustrated not able to sleep. Sometimes I can cat nap, waking almost every hour, but ultimately I end up getting out of bed. I purposely don’t engage in any stimulating activities since I know this isn’t helpful in trying to feel tired. Eventually I do go back to bed (anywhere between 2:00-5:00 a.m.) and sleep, but it’s either restless cat napping knowing I can sleep in, or fair sleep with an early wake-up. Either way, when I wake up my body feels exhausted and sleep deprived but my mind feels rested and awake. On these occasions I’ve usually slept or rested on average 2-4 hrs.

2). Because of these prior experiences I won’t even try to go to bed. I’ll usually stay up late (until I think I feel tired) going to bed anywhere between 3:00-4:00 a.m. Again, the same vicious cycle occurs as before. I either get up and later try to go back to sleep a few times, or toss and turn in bed (usually getting up anyways), then eventually cat nap while I’m in bed. Again, I average 2-4 hrs. sleep feeling the same as above.

Regardless of whichever scenario occurs this pattern follows for a few nights. I’m wide awake, can’t sleep and only get a few hours sleep. Some days my body feels more tired than others, but my brain feels rested and alert. Sometimes mid-day I crash with exhaustion and can nap, others I can’t nap at all. Then a night or two later I’m dog tired at bed time, go to sleep without any difficultly, and sleep like a baby feeling rested and refreshed the following morning. Sometimes this is the end of this cycle and I go back to my, “Normal,” sleep pattern for a month or two, or my insomnia continues for about a week with a few, “Normal,” night’s sleep.

This became so bothersome a year ago I actually had a sleep study done thinking I had a sleep disorder. It proved inconclusive- no sleep disorder. The Dr. suggested I might have Delayed Sleep Phase Syndrome and gave me ridiculous day/night time instructions to follow. I did and it helped. However, since then this cycle still continues. I realize I should probably do this day/night routine again. However, I can’t help but wonder if my sleep issues could be actually be hypomanic episodes.

MORE TALKATIVE/PRESSURE TO KEEP TALKING:
I am a full-fledged, confirmed, rambler! Somehow, I don’t seem to possess the ability to make a long story short-ever! (Which is probably evidenced by the exhausting lengths of these posts). This bothers me greatly because the body language of others often indicates, “When is she going to get to her point, already?” I feel like a rambling idiot, then feel rushed to get through what I have to say, and then talk even faster! Also, I normally do speak quickly. But it doesn’t really affect the intelligibility of my speech and people are able to keep up.

My therapist told me my rapid speech and rambling is probably due to my anxiety. I can agree with this. Somehow I feel a need to keep talking without omitting any details. Problem is, I sometimes lose my train of thought and need to be redirected back to my point, or forget it altogether. Could I speak more slowly or condense my conversations? Do I have the ability? I think so. I have in the past, but it’s extremely difficult for me to do. Do I experience moments where I just have to talk with no purpose because I’m feeling a burst of energy? No, never.

RACING THOUGHTS & DISTRACTABILITY:
Ugh! I have random, racing, thoughts ALL the time! This can occur in just about any situation and any time of day (and already noted when trying to go to sleep). Like I’ve read in posts here this is much like what others experience. One thought leads to another, then another, and another. They almost always begin with a thought, or memory, associated with what I’m doing (reading a book, watching T.V., listening to a conversation, etc…), then will take on a life of their own leading me to something completely unrelated.

Also this occurs often when I’m in the middle of doing something. All of a sudden something else I need to do will pop into my mind, and I’m afraid if I don’t do it right now, I’ll forget. So I’ll break away from what I was originally doing to take care of task 2, then get sidetracked forgetting task 1. More times than not I’ll think, “Hmm… what was I doing?” pausing to get back on track. But sometimes I’ll forget because my mind is still racing. There’s just too much stuff going on in there.

My therapist and I felt I do this because of both my anxiety and OCPD. That I simply can’t stand to have something go undone so I have to do it right then and there. This makes sense to me. But, I also wonder if this could be part of hypomania? This does tend to occur more often when I’m racing around the house with lots to do, stressed, and have a lot on my mind. Is it possible it could be both? Am I capable of continuing task 1 and delay doing task 2? Yes, but I’d probably forget what task 2 was. This is the method to my madness.

This pdoc I saw (not my regular) cited this as a sign of ADHD and asked if I’d been diagnosed with it. Years ago I was diagnosed with a learning disability and it was also suspected I might have this too. However, because I seemed to have adapted coping strategies for it, ADHD was never officially added. In my research I’ve read ADHD can be a precursor to Bipolar. Hmmm…

Additionally, I believe these racing thoughts might be the culprit to my rambling and fast speech- maybe. My head will be in a tailspin overwhelmed with tons of thoughts and I can’t sort through them and think clearly. It’s like my brain is on overload and shuts down and I can’t process everything fast enough. Due to this I tend to stammer and repeat myself trying to formulate my thoughts coherently. This is embarrassing!

Does any of this sound familiar to you? Have you experienced this stuff? Again, any insights, thoughts or suggestions are much appreciated. Thanks again for your patience and checking back in.

Tomorrow I will post: 1). Increased Goal Directed Activity. And, 2). Inflated Self-Esteem & Grandiosity/Excessive Pleasurable Activities

Peace and healing energy to all...

~*PositiveKarma*~

[kindachaotic]

Dear Positive Karma, I don't have much else to offer. I will say this, we share "several" of same symptoms & for me meds have helped.
You asked about testing, I've been thru it twice, hub once & my mom once. Hub & I had it done at same office/clinic, my mom's was in another state, smaller town at a behavioral health clinic. I feel it is much more thorough but some pdocs just asked you some questions & go from there. It's whatever you're comfortable with & your rapore/bedside manner with this pdoc.
Before you consider a second opinion, call this pdoc you've seen already & ask if they do any testing. You say you live in a fairly large area, if it would make you feel better call other offices/clinics & ask about it.
I maybe the only reply you get here that has had any done so who knows.
Will look for next installment.
Best wishes.

A useful website for bipolar is psycheducation.org/ written by a psychiatrist. I'm not diagnosed as bipolar so I can't help with your questions, but I do understand the wondering. My pdoc dismissed my concerns out of hand so I'm waiting until I move in a few months to get a second opinion.

All the best,

*Willow*

[Anneinside]

One important issue - is the behavior different from your normal behavior? Have you always been very talkative? and the same for all the things you listed. It can be so hard to diagnose a mental illness..

[PositiveKarma]

kindachaotic: Thank you for the information. Yes, I'll be sure to ask my pdoc if she, or someone else in the office, does diagnostic testing. Okay, makes better sense to me now that I know this testing isn't always done. Thanks for the clarification.

WeepingWillow: Thank you for the resource! Much appreciated. I'll be sure to check out that site. I'm sorry to hear you felt dismissed by your pdoc. I truly hope you have better results when seek your second opinion. Best of luck to you as well.

Anninside: Very good, and important, point! Thank you for reminding me of this. My answer? Maybe? Some of this yes! My sleeping pattern/cycles is extremely different. My fast talking- no, not really. This has pretty much been a constant for me. The racing thoughts- I've had them for as long as I can remember. I just thought everyone was like this and it was normal! My mood swings? I never noticed it until my husband pointed them out a little over a year ago (we're now separated) and just recently when this pdoc suggested possible Bipolar. So I dunno.

Thanks again everyone for continuing to check back and for all your helpful advice and information. I really appreciate your objective opinions.

Peace and love to all...

~*PositiveKarma*~

[PositiveKarma]

Hi again everyone,

This is my last installment and is shorter than the others. What follows below is: 1). Increased Goal Directed Activity and 2). Inflated Self-Esteem & Grandiosity/Excessive Pleasurable Activities. Thank you so much for sticking with me.

INCREASED GOAL DIRECTED ACTIVITY:
From time to time I get into what I call my, “Productive Whirlwinds.” These are not frantic, excitable, states where I’m pinging around the house as if I’m jacked up on speed. Rather, they are tasks which need to be done and I either have a tendency to go overboard and do more than I intended, or overextend myself underestimating time needed .

Examples of this would be intending to only tidy up the house to make it look presentable. But then once I’ve begun I get on a roll and have to do more, unable or unwilling, to stop. I do feel slightly energized at this time, but nothing I’d call manic. I feel motivated, with a burst of energy, and a need to do it and get it done right then. Wanting to get it done and my motivation is my driving force- not a feeling of excitability or a need to move because of it. Could I stop myself and do something else? Yes, but it would drive me crazy knowing it wasn’t completed. I’d probably just take a break and return to it later.

I’m a compulsive list maker. I always consult my planner writing down, “Things to Do,” and will check it multiple times a day ensuring everything’s been completed. I will often spend inordinate amounts of time planning my days assessing what task, errand, etc… fits best into my schedule for maximum efficiency. However, I often find I’ll overextend myself poorly estimating time needed for some tasks. Therefore, I have to go back to the drawing board and begin this vicious planning cycle all over again. I have no problem with follow through except for the natural consequence of my unforeseen poor time management.

Also when I get depressed (and the funk begins to dissipate) I tend to get into my, “Productive Whirlwinds,” in an attempt to solve my current, depressing, circumstances. I will engage in 2-3 big projects at a time, spending days to weeks working on them, only to find the end result isn’t do-able because of some realistic factor I hadn’t considered. Then I crash into depression again with this realization and feeling like I’ve wasted my time.

I thought all of this was my OCPD getting the best of me, and it very well might be. But does this sound like hypomania to you? Is it possible what I’ve thought was my anxiety and OCPD all along might actually be Bipolar and hypomanic episodes? I do understand people are often misdiagnosed with depression when they actually have Bipolar disorder.

INFLATED SELF ESTEEM & GRANDIOSITY/EXCESSIVE PLEASURABLE ACTIVITIES:
I seriously doubt I exhibit or engage in any of this. On the contrary, I’m a very cautious person who rarely, if ever, engages in anything impulsively! If anything, I’m over conscientious about how my behavior may affect others. I’ve never had issues with drugs or alcohol, or engaged in questionable, random, sex practices or had any spending sprees. I’m an extremely thrifty person and carefully monitor my budget. Unless, of course, my, “Whirlwind Problem Solving," could be considered grandiosity instead of increased goal directed activity?

Okay, this is it. This now puts a close to my investigation. I am very grateful for everyone's patience, interest, and time spent offering suggestions, input and advice. I'll continue to watch this thread for any further posts and if you have any questions for me. Again, thank you!

Wishing everyone a beautiful day!

~*PositiveKarma*~

[hamster-bamster]

I think you are right. I think you DO have increased goal-oriented activity and DO NOT have grandiosity/excessive pleasurable activities.

[DaveyJones]

Hey PK...

Ahhh, the lovely diagnostic journey! I was treated for depression for nearly ten years before I crashed and wound up in the hospital. The pdoc there said when he released me that he didn't know whether I had depression or bipolar, but it didn't matter, he would treat me the same either way. Gee, thanks. I've come to the conclusion over the years that in a good number if not most cases the pdocs really can't say for sure what you have, so they pick the DSM criteria that sound best so they can justify the prescriptions they write. Then they keep trying things until you find relief. I know that sounds cynical, but they don't know how these meds work. Sometimes you are diagnosed by what meds give you relief.

Of course relief is what we're after, so I guess it doesn't matter. As far as your symptoms, the sleep thing sounds like it could be related, as well as the up and down moods. They don't sound serious, but could indicate some sort of "soft" bipolar. The grandiosity, you would know if you had had that. I've made a couple of ill-advised career moves due to that lol. Also the pressured speech. To me it's not like a regular can't shut up. For me there is a compulsion, a "pressure" that feels just that way. It's a pretty strange feeling.

Can't recommend psycheducation.org enough, especially for those of us who have something other than classis bipolar I. Hope some of this helps!