Irritable Depression vs Dysphoric Mania

I wonder if my pdoc wants to try Abilify monotherapy to start because she thinks I have irritable depression. She only wrote down "mood disorder" on my documents even though I've had multiple professionals in the past think that I get dysphoric mania or mixed states, and one who thought I was psychotic to boot.

However this episode I've been rolling into for the past several weeks seems to have heavier depression features than manic features. In fact the only manic flavor I detect lately is trouble sleeping, intrusive and rapid thoughts, paranoid anxiety and a lot of agitation.

But I'm also exhausted all the time, randomly tearful, tend to speak in a slow 'out of it' manner, have a lot of suicidal ideation going on most days, only shower if I absolutely must for someone else's sake, which is rare because I rarely leave the house. I have no social life and don't feel like there is any point to going out and trying to thrive.

So it's like I've been extremely depressed but with insomnia, paranoia and occasional mild psychosis.

I really hate it when professionals are not upfront and clear. She said that some of my past experiences sound like mania, and when I told her I didn't want to be put on an anti-depressant because they have made me extra nuts in the past, she commented that it's common for that to happen when a person is bipolar. But then she made a point to tell me that she's only going to diagnose me with "mood disorder" and she made a point to tell me she doesn't want me on a mood stabilizer.

So what is going on? And if she knows since I told her that I struggle really bad with agitation all the time, why would she want to use monotherapy with an activating medication? So it makes me wonder if she really thinks I have depression, but it contradicts some of the things she said, unless she was trying to placate me, since when the secretary asked me why I wanted an appointment, I said that it was for bipolar disorder but also added that it had been a long time since I'd been treated and I was open to discussing diagnosis.

But if she really thinks I just have irritable depression then she ought to shoot straight with me. Not really sure what to think today or whether to go with the med she wants or not.

Seems like she is wanting to take time to see what your cycles are like. You don't want the Bipolar stamp unless you really do have it. I appreciate Pdoc's that don't fling labels really quick

What medication are you currently taking? Are you seeing a Therapist?

I am not a psychiatrist, but your symptoms mirror mine a lot when I have mixed episodes. Sorry you are feeling badly, and I hope the medication starts to help.

Don't forget that agitated depression can be part of mixed episodes. I have dysphoric mania always and this last time I was saying I was manic, marking manic on my mood chart, using manic coping tools and yet looked depressed and sounded depressed. This made me decide there was nothing wrong with me and I was making it up but my psychiatrist said that it was a very agitated depression and I was cycling a good bit so that made the agitation feel worse and made it seem like mania. I didn't believe her for a while (see: paranoia) but I think it makes sense now, especially now that I AM depressed and haven't hit that hard, just slowly and fairly softly landed here, although it is still getting worse.

I think dysphoria makes everything so much more complicated than it already is. At least for me it does because I never trust myself. I know I"m really always mixed but they like to know which end and dysphoria can make that really hard to know.

I am not currently on any medication. I was extremely medication-phobic years ago when I had a chance to get treatment because I could afford it. But unfortunately I was in the middle of a really bad paranoia episode that had been going on for months at that point already. I was terrified of anyone and anything that seemed to have any type of authority or like they/it wanted to control me, and especially anything that has anti- movements against it. I had found anti-psychiatry material online and material about how the government is attempting to kill off and essentially torture mentally ill people using psychiatry as a weapon. I was too terrified to comply with treatment and bailed shortly after my diagnosis. Then I lost my insurance and couldn't afford treatment, anyway. Now I have insurance again and am trying to fumble through this process without getting too worked up.

I just feel like this is the riskiest type of episode I ever have. My mind and body are just loaded with agitation and morbid energy, but outwardly I know that I just come across as really depressed. I don't have pressured speech right now, fatigue despite being so restless, not very productive at all, etc. But internally it's such a different situation. If she can't see it and doesn't believe me, and gives me something to wind me up out of depression, such as a low dosage of Abilify, this **** is going to get extremely ugly. It's like a stealth madness that has gotten extremely bad by the time it breaks the glass.

From what you've described it sounds like my dysphoric mania ... it sucks.

I'm sorry you're going through this.

You are describing the same fears I had a few weeks ago. My therapist simply told me that I hadn't been even fair for weeks and did I really think I could cover that up from them? Granted both my doctors have known me a long time. But I think they could tell something was really wrong and I started mood charting in May to make my psychiatrist happy and the mood chart was showing something was very bad; sharp spikes between manic (agitated although maybe it wasn't manic although I still haven't figured out how to know that) and depressed, constantly.

I told them I felt like the mixed episode was so strong that it was like mania was pulling on my head and depression on my feet and they were playing tug-of-war so effectively I couldn't tell where I was, even though usually I can.

I think that description helped some and at least it made me not feel as bad about not being able to simply say where I was at any given moment. I had convinced myself I was making it all up because my feelings and behavior weren't meshing. It took being told very plainly that this was because of how sick I was that I believed it and not the messed up thinking in my head, led by the voices and thoughts that said I was stupid and everything I did was wrong, followed by a long list of examples from my entire life of things I screwed up.

I'm losing my will to even care. I've just felt apathetic all weekend. I have a feeling I'm going to get into that appointment and just passively accept whatever medication and whatever dosage she suggest. I almost feel like I want to go crazy at this point. I'm tired of fighting. I'm tired of being 'strong' and 'mature' all the time to the point that I get swept under the rug and then rejected or punished when I finally lose my mind. Every time I lose my mind, I've always tried so hard to not be a burden or a danger to others. It's usually the last piece of my sanity that I'll have left and always hold onto it fiercely. I feel tired of it, though. Keep teetering back and forth between apathy and seeing medication as just another self-destructive experiment no different from street drugs, and anger/defiance. I've been in touch on/off with my brother lately, and spending time with him or talking with him makes me want to live, makes me want to be strong and functional again. But he's the only element in my life that ever makes me feel that way anymore. But if I get the wrong medication, I could lose him, or if I off myself, then I'll lose him. He's all that I care about anymore, but I care about him a great massive deal.

i'm obviously not a psychiatrist, but you said that you have "only" x y z symptoms of mania combined with deep depression. to me, those sounded like a large portion of the symptoms of mania. even if you have fewer symptoms of mania than depression, still take those manic symptoms seriously. in a mixed episode, both sides need to be treated in order to achieve ideal relief. so be upfront w your doc about how severe you feel it is. mixed episodes are the worst, but with proper care they can be managed and then go away. good luck.

Thanks for the feedback. My pdoc appointment to start meds went really well. I can sort of see now that my mind was just very worked up and I wasn't making total sense. Dysphoric mania and irritable depression are basically the same thing, just with different tilts in either direction, they are both mixed states. My pdoc was very respectful and took me seriously. Started on Zyprexa now.

I have a very similar story. Dysphoric hypomania usually precedes a depressive episode for me. So, personally, I'd consider your symptoms - which closely resemble mine - to be dysphoric mania. (I'm no doctor though)

On a personal note, I was quite disheartened to see my pdoc had me listed as Bipolar NOS when I'm 100% convinced I'm bipolar II with predominantly dysphoric hypomania. So I understand your frustration with pdocs.

All the best with the Zyprexa, I hope it helps!