Typical? Or Not?

Does anyone here who is diagnosed with bipolar disorder have chronic mood issues? I know with bipolar disorder the moods are "supposed" to be episodic. The thing is, I have mood fluctuations that often occur throughout the day. This winter I've been feeling, overall, mildly depressed. But on top of that, at times I've been hypomanic (sometimes euphoric, other times irritable and angry). Last night I was so self-destructive I was actually in an unsafe state. Very possibly mixed-state.

It's the "normal and stable between episodes" that I don't experience. My mood instability is chronic. Can anyone relate?

This was my life before clozaril. I was always in some episode, usually mixed. I maxed out med after med and nothing really helped. When I started Emsam for depression that decreased but the bipolar raged on. 5 years ago I started clozaril and after maybe 6 months I started feeling a lot better. Now I have one hypomania in the summer every year that we treat with increasing my clozaril dose for 4 days. I sleep through those days pretty much and wake up better. I get symptoms often still but they aren't enough to need med changes or require much to handle them (sometimes I still do need more antidepressant and I have occasional psychotic symptoms that go away alone (I can't remember needing anything to treat them).

I still do weekly therapy (although I think my therapist thinks it could be less but I'm too scared to talk about it) and monthly pdoc. Those things won't change and are needed for the relative stability.

So far I'm even getting through grief without winding up IP. I really thought that would be part of grief and I'm doing ok instead.

There is hope. I didn't think there was when I was going through all the meds but there is.

Before meds i would always be in a lingering mood - never normal. On meds it is really only lithium that treated both sides of the coin for me. The other meds seem to only focus on one issue/symptom.

don't be too hard on yourself.
remember that you had a big reduction in your AP. IT takes a while to stabilize once you have mixed mood...the hardest to treat.
((((HUGS)))))
bizi

Quote:

Originally Posted by BeyondtheRainbow This was my life before clozaril. I was always in some episode, usually mixed. I maxed out med after med and nothing really helped. When I started Emsam for depression that decreased but the bipolar raged on. 5 years ago I started clozaril and after maybe 6 months I started feeling a lot better. Now I have one hypomania in the summer every year that we treat with increasing my clozaril dose for 4 days. I sleep through those days pretty much and wake up better. I get symptoms often still but they aren't enough to need med changes or require much to handle them (sometimes I still do need more antidepressant and I have occasional psychotic symptoms that go away alone (I can't remember needing anything to treat them). I still do weekly therapy (although I think my therapist thinks it could be less but I'm too scared to talk about it) and monthly pdoc. Those things won't change and are needed for the relative stability. So far I'm even getting through grief without winding up IP. I really thought that would be part of grief and I'm doing ok instead. There is hope. I didn't think there was when I was going through all the meds but there is.

Thank you, Rainbow. I sure do hear good reports about clozaril.

Quote:

Originally Posted by The Black Dog Before meds i would always be in a lingering mood - never normal. On meds it is really only lithium that treated both sides of the coin for me. The other meds seem to only focus on one issue/symptom.

Besides clozaril so many people are helped by lithium. I've suggested it to my pdoc, but for some reason she seems reluctant to prescribe it. Having to be on so many different meds gets discouraging.

Quote:

Originally Posted by bizi don't be too hard on yourself. remember that you had a big reduction in your AP. IT takes a while to stabilize once you have mixed mood...the hardest to treat. ((((HUGS))))) bizi

Good point, bizi. Sheesh...I really messed myself up by dropping the AP dose so fast. Weird, because for 2 days I felt great.

I would say if the mood fluctuations are throughout the day it might be mixed episode. BPD causes mood fluctuations throughout t day too.

I once had mixed states - not sure if this is also rapid cycling? could that be part of what you are experiencing? Lithium helped me a great deal. The mixed states evened out to fairly delineated manic & depressed states. Lithium does have many side effects, maybe that is why your doctor won't prescribe? For me it made my body break out into psoriasis, but I take Humira for that. Otherwise no side effects for me, although you must get your liver function monitored as it is pretty hard on the liver. Luckily for me no complication there. As others have said, don't be too hard on yourself! Can you talk more with your doc about it?

Quote:

Originally Posted by Crazy Hitch I would say if the mood fluctuations are throughout the day it might be mixed episode. BPD causes mood fluctuations throughout t day too.

I've been concerned about BPD, but they tell me I don't have it. I don't feel like BPD symptoms fit for me, aside from the chronic mood swings. But the mixed episodes...for sure.

Quote:

Originally Posted by wolftrap I once had mixed states - not sure if this is also rapid cycling? could that be part of what you are experiencing? Lithium helped me a great deal. The mixed states evened out to fairly delineated manic & depressed states. Lithium does have many side effects, maybe that is why your doctor won't prescribe? For me it made my body break out into psoriasis, but I take Humira for that. Otherwise no side effects for me, although you must get your liver function monitored as it is pretty hard on the liver. Luckily for me no complication there. As others have said, don't be too hard on yourself! Can you talk more with your doc about it?

Thanks, wolf. My pdoc keeps saying that lithium "requires those regular blood tests"...I've told her I don't mind that (I'm certainly not afraid of needles). She makes a big deal about it - maybe she's afraid of needles & is projecting her fear onto me .

I'm seeing my pdoc in a couple of hours, so I'll be discussing stuff with her.

I'm not sure if it's considered a mixed state or super rapid-rapid cycling, but I've dealt with that for a few years in the past. Never really reached a normal state unless you want to count being overmedicated and completely flat. I'm thinking my normal state just involves a lot of intensity, but there is definitely a difference I'm seeing between then (total out of control chaos) and now (chaos-lite).

I hope your pdoc appointment goes well and you guys find a solution

Quote:

Originally Posted by Sapien I'm not sure if it's considered a mixed state or super rapid-rapid cycling, but I've dealt with that for a few years in the past. Never really reached a normal state unless you want to count being overmedicated and completely flat. I'm thinking my normal state just involves a lot of intensity, but there is definitely a difference I'm seeing between then (total out of control chaos) and now (chaos-lite). I hope your pdoc appointment goes well and you guys find a solution

Exactly - chronic, intense moods or overmedicated flat.

Pdoc prescribed Wellbutrin. Fingers crossed!

Before the pandemic and stuff I was pretty stable most of the year. Then I’d get really bad depression and mood swings for a couple months in the winter before I’d feel better again for another number of months. Now these last 10 months I’ve had basically nothing but mood swings that rarely go away and I rarely have stable periods. Maybe a day here or there is good. But it’s rare that I am stable. Since October it’s been worse than ever.

Didn’t you have surgery recently? I’ve read that can change your personality. I am wondering if that’s been my issue. My big problems started right after my surgery.

I’ve been worried about BPD too. But my providers say I don’t have it. Although I’ll admit I’ve been having a lot of the symptoms these last 10 months. But according to the DSM they can’t make a diagnosis of something if there’s a possibility it’s just a reaction to a med. Which I am 99% sure my change in moods is a med reaction.

Quote:

Originally Posted by Mountaindewed Before the pandemic and stuff I was pretty stable most of the year. Then I’d get really bad depression and mood swings for a couple months in the winter before I’d feel better again for another number of months. Now these last 10 months I’ve had basically nothing but mood swings that rarely go away and I rarely have stable periods. Maybe a day here or there is good. But it’s rare that I am stable. Since October it’s been worse than ever. Didn’t you have surgery recently? I’ve read that can change your personality. I am wondering if that’s been my issue. My big problems started right after my surgery.

I had surgery in May, but I've had surgery several times in my life. I have a theory that it takes a solid year to truly recover from surgery. I think the entire surgical process is a shock to the body.

In my case, my mood states are generally episodic, however, if they became severe it was harder and longer to stabilize. Also, I believe the kindling effect really was a factor for me. As my moods became more likely to fluctuate wildly, it was harder to get them to stop. Like a runaway train or avalanche.

I certainly think that stress plays a huge part in keeping mood states in certain places.

I actually just explained that to my therapist this week. I said if I am bipolar, I have something else too because I just have too many unstable times. I’m not feeling well. I looked at borderline personality disorder and I just don’t relate to that. For me, I think some of my mood issues are related to anxiety. When I was in the hospital the psychiatrist said that I potentially had cptsd. I brushed it off at the time. I decided to take a look at it the other day and I can see it. I think there’s a good potential that I have that or something similar. Trigger warning...I deal with chronic suicidal urges and I had a big breakthrough with that. There is a potential the suicidal ideation is not a symptom of a disorder but rather a maladapted coping mechanism I learned from an unfortunate incident in early adulthood. That was a huge realization for me. I wonder if my therapist realized that already. Anyway I need to see what I can do to change poor coping skills.

Quote:

Originally Posted by Soupe du jour In my case, my mood states are generally episodic, however, if they became severe it was harder and longer to stabilize. Also, I believe the kindling effect really was a factor for me. As my moods became more likely to fluctuate wildly, it was harder to get them to stop. Like a runaway train or avalanche. I certainly think that stress plays a huge part in keeping mood states in certain places.

Soupe, maybe you can explain...what is the kindling effect? I've heard the term quite a bit, but don't know what it means.

If I remember correctly, it's a theory that bipolar episodes become more frequent, more severe, more out-of-nowhere-ish, and harder to treat with each passing episode.