Might be bipolar

I've dealt with depression and anxiety ever since I was a teen (25 years). Every 3-5 years I would have to change meds because they stopped being effective. I currently take two different sedating drugs and still manage not to sleep.

After a breakdown at work I saw a psychiatrist (most of therapy has been psychologists or MDs who have a counselling type practice but not actually psychiatrists). I don't have the official report and recommendations yet but he's leaning towards an atypical presentation of bipolar disorder. He thinks episodes that were always attributed to anxiety were actually hypomanic episodes.

Now I'm a bit freaked. How is treatment for bipolar different than tx for depression?

I currently take Effexor, Wellbutrin, seroquel, and amytriptaline. I'm Canadian so some of the names might be a bit different. I've done CBT, mindfulness, now a combined course in mindfulness based CBT.

I guess I don't know what to expect. The official report will take 2 weeks to get to my family doc and the wait is driving me batty (it's only been 2 days)

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A mood stabilizer. It helps to keep it all in check for some. And APs also help others. It's really only a difference in meds IMO. Plus working with your T to learn how to manage your symptoms, emotions, behaviors, all that fun stuff. It sounds like you're being proactive, so I'm sure you will be fine. Please take care.

Did you have any hypomanic-like (overly active, led and leading (from the front), out of control, "perceptive" and irritable/sensitive, possibly with some euphoria, not necessarily all in equal or even perceptible amounts) symptoms/behaviour/feelings while not taking all those meds.

I'm honestly surprised you don't get very manic using all those drugs, unless you take high doses of Seroquel compared to the rest.

I would suggest you try to manage with just quetiapine/Seroquel and maybe one of those other meds. I'd try just amytriptyline. It has a broad profile, like quetiapine (but it doesn't do anything to reduce (the effects of) dopamine). It also grounds/directs you more than typical antidepressants, being a bit more like a psychostimulant.

If those two don't work maybe try quetiapine on its own and only if that doesn't work try another/one of your antidepressants.

If you have experienced hypomania without meds, a mood stabiliser is indeed a good idea, but try quetiapine first: it also stabilises you mood, it works as a mood stabiliser (too).

Pharmacologically I'm good I have three physicians I trust working on that aspect.

I guess what's bothering me is that what I thought I knew might be all wrong.

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You'll be ok. It is shocking for many of us the first time we hear that diagnosis. But you have a community here of many people to support you. Although we are not doctors/pharmacists, we lend our support through personal experiences in hopes that you can cope with your illness.

I was in denial about the diagnosis for a while. I was first diagnosed with just "depression", no MDD or anything. Then it evolved into MDD, then finally Bipolar 1

It helped me when my pdoc and I reviewed my psychiatric history. My pdoc told me, "I knew something was wrong when you said you were depressed and full of energy at the same time, as well as getting 3 hours of sleep a night. It's not normal to be energetic when you're depressed. That's a mixed state."

That convinced me. It might help you if you do the same

You should do what you think is best. Doctors may advice you and it might be great advice, but it's always just experimenting. Just purely from that perspective, adding meds only makes it worse.

What you knew might still be correct. It's hard to tell with effectively four antidepressants (as quetiapine is an atypical antipsychotic, being antidepressive). Of course, it might've been wrong, but by no means is it certain, unless you experienced problems before the use of antidepressants. No matter how many doctors you visit, you can never be certain, unless you experiment, assume that it may be med-induced..

It does depend on how you define BP, of course, but the newest DSM has a separate category for med-induced BP. Again, it might be "just" BP, but you may want to make sure.

They difference medications wise is the add on of a mood stabilizer, and a probable reduction of your antidepressant. Antidepressants can exacerbate mania I bipolar disorder. Seroquel is an antipsychotic. You.may need a dose increases or an add on if your symptoms are not under control. There are many good books, or online resources that can help you understand the diagnosis better
I keep a journal to help me keep track of my thoughts and emotions. Especially if there are any medication changes. This way I can see if there are any positive or negative emotional or cognitive changes. Therapy is also different when dealing with bipolar disorder.

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That's one thing I disagree with -- the "med-induced BP". I don't think it should be considered criteria for BP... DSM-IV specifically says that med-induced BP should not count toward a diagnosis of BP, but then the DSM-V says the exact opposite.

There are some people who never get hypo/mania, but they do get it when they try an antidepressant for the first time. Then when they get off the medication and their depression goes away, they never get depressed again. Should that count toward a diagnosis of BP? I think not

IDK. I've always had qualms about that clause in DSM-V

I've been on and off meds of varying varieties and doses for 25 years. The combo I'm on now has worked the best for the longest. It evolved gradually increasing, decreasing, adding and removing. I do not do well off meds. I know it's all a guessing game of trial and error. I have never been on a mood stabilizer so the side effects of those scare me a bit (not knowing what to expect)

Nothing with me ever presents normally. I had mono as a teen and couldn't sleep.

They think I had parvovirus because they couldn't find another explanation that fit the symptoms.

I had my gall bladder out 8 years ago but was hospitalized with gall stones last year. My bloodwork still hasn't come down to baseline and there's no apparent cause.

I get a cough when I'm tired, sick, upset, stressed, and on exertion that can send me into bronchospasm but doesn't quite fit the asthma definition.

I had joint pain in my big toe that responded to the first line treatment for gout. Only problem is that nothing else about it fit a diagnosis of gout.

I'm used to feeling like a Guinea pig.

I don't know why giving what I'm feeling a different name bugs me so much.

To answer your original question the symptoms have likely been present since I was about 12 (onset of puberty). My mom always thought I had ADHD (high on the inattention side). I remember a lot of anxiety (didn't know what it was at the time, I was just afraid of everything). Sleep has been an issue ever since I can remember. First major depressive episode was at 14. I am constantly fidgety and always have been.

Until the report comes in I won't have all the information and that's the hardest part. I hate med changes I always feel wonky while one tapers off and another one kicks in but I know it's necessary. It's not the first time bipolar has been mentioned but I've never fit the cookie cutter diagnosis. My sister who knows me and my moods better than I do, and is also a physician, isn't disagreeing with the diagnosis and she would tell me if she thought it was way off base.

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If they really think you have bipolar then they should give you a break from the Effexor, Wellbutrin, Seroquel, and amitriptyline and see how you do a lithium monotherapy at 1% of the cost and a quarter of the combined side effects.

There's a bipolar NOS category. I'd highly recommend you look into that.

The "bipolar NOS" label is given when a patient doesn't meet the full criteria for bipolar 1 or bipolar 2, but clearly the patient is experiencing ups and downs that can't be accounted for with the Major Depressive Disorder label or other mood disorder labels.

So, that could explain why you don't fit the "cookie cutter diagnosis".

There are actually a lot of people who fit under the bipolar NOS category. The NOS category is used for people who sit on the bipolar spectrum.

As I said I don't have the psychiatrist's recommendations yet. I know it will involve adjustments to the cure regimen. I can't think about anything else. It's going to be a long few weeks.

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We cannot diagnose or provide treatment. Please let Tsuki632 discuss the treatment plan with the doctor.
Don't worry about a diagnosis, as long as you seek treatment and you feel comfortable with your doctors and/or therapists, you will be fine. Take care.

The DSM has (and had in previous editions) a diagnostic hierarchy made explicit by exclusion rules in the "normative" descriptions of all mental disorders. The DSM-IV states that if a mental disorder is due to the use of substance, it should be diagnosed as such. Between parentheses it says in could be a drug of abuse, medication or something else (elsewhere it mentions toxins as another example).

The DSM-V uses a similar hierarchy and similarly explicit, but it also adds "medication" to the name of the substance induced disorders (so it becomes "substance/medication". That's a win.

The new DSM also, and this is critical, describes a med-induced BP, not just a med-induced mood disorder (which can be anything). The specificity, therefore, is greater than the BP diagnosis (arguably), while that didn't use to be the case. That's a huge win.

That the DSM-IV mentions, in a note, not the actual criteria, that a diagnosis of BP can be made is just a reminder (that's how I read it), but it doesn't really matter since it's just a note in the margin, that a history of substance use doesn't disqualify someone, that one might have BP regardless of antidepressant use.

That's good advice as well. Or another mood stabiliser (which could be quetiapine). But if you tried just quetiapine, maybe a/another mood stabiliser is best.

As a cost-cutting measure you may want to use generics instead of original brands. You really should, whether it's fully covered or not, I very strongly believe.

Edit:
As depression seems to be your biggest problem, maybe you could try the antidepressive mood stabiliser lamotrigine first. Lithium is powerful but unhealthy (in the long term). But no meds are particularly healthy in themselves, of course.

Thanks everyone. I'm slowly getting my head around this. I just wish life would stop throwing me curveballs. So many destabilizing events in such a short time.

The psych report is in. My therapist went over the gist of it with me, no big surprises there. Although he seems to think I had issues with weight gain and I'm not sure where he got that idea. I'm no skinny Minnie but my body has stayed within 10 lbs of where is has been since 2001. I still have to wait 10 days to see my family doc to discuss which rabbit hole we're going to try going down first.

Does anyone know about a drug called epival? Apparently it is a mood stabilizer and migraine reducer. Migraines are the reason I take amytriptaline.

The destabilizing events just keep coming and it's ramping up the anxiety/fidgety-ness and generally making me feel like I'm going to fall apart. Today was my mom's birthday (she passed away last November) and then we came home to drama with my partner's ex. So now I'm feeling physically sick, like I ate a bunch of butterflies. I'm ruminating over what I want to say to this woman but can't ... I can't even begin to sort out what the feeling and thoughts are fuelling this.

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