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Gabyunbound
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Default Apr 08, 2021 at 08:17 AM
  #1
I posted something on another thread a while ago alluding to this, but I'm curious as to what you guys think.

As I stated before, I strongly believe that although we have Bipolar Disorder, we also suffer from deep sadness as well as elation, without them being part of Bipolar episodes.

Part of distinguishing these, is to be aware of one's 'normal,' or, in other words, when we're experiencing some sort of distress or intense feelings (high or low) that are not episodes, that are part of the ups and downs we actually share with people who do not have Bipolar Disorder.

So my question is this: when to let time and/or therapy do their thing, using coping skills, whatever they may be for each individual, and when to change around meds?

What if you're very very distressed because you were betrayed by a friend? What if you're feeling elated because it's beautiful outside, or for no discernible reason (yes, I believe you can experience joy/elation without it being hypomania)? Really, the reasons for changes in mood, even intense changes, are practically endless. And, again, I think we share these changes, this intensity, with people who have no mental health problems at all.

I remember being very upset about something a couple of years ago (and I can't even remember right now why), and my pdoc told me, well, this is really about x, but I'm going to prescribe you zoloft anyway (a medication I continue to take, though I wonder at times if I should). Should she have prescribed it? Frankly, I suspect I could have worked through whatever was going on without it. Painful doing so? Yes. But to try to medicate away situational depression? I think, now, that that can be a fool's errand: unnecessary and ineffective at best and experiencing needless side effects at worst. And, in any case, how do you know, when you feel better, if it was the med or just the passage of time and/or therapy that helped you? Or even the placebo effect, for that matter?

Thoughts?

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Bipolar 1
Lamictal: 400 mg
Latuda: 60mg
Klonopin: 1 mg
Propranolol: 10 mg
Zoloft: 100 mg
Temazepam: 15 mg
Zyprexa 5-10mg prn

(for Central Pain Syndrome: methadone 20 mg; for chronic back pain: meloxicam 15 mg; for migraines: prochlorperazine prn)
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Default Apr 08, 2021 at 10:20 AM
  #2
Hi Gabyunbound. Of course you're correct that people without bipolar disorder can experience great sadness, and what might seem like ultra happiness. However, there are two main differences between the depression and mild elation that people withOUT the disorder experience, and those with bipolar disorder (or other mental health disorder) experience. People without generally must have some major reason/cause for experiencing deep sadness and mild to moderate elation. Such causes could be major loss/grief, severe pain (physical or other emotional), or the like, for depression. Or a joyous occasion or experience that goes beyond the average (i.e. one's wedding, birth of a child, adventure in a beautiful place, extreme accomplishment, winning the lottery, etc.) People with bipolar disorder do not need such extreme triggers for episodes. Also, the elation a person experiences from bipolar disorder can be so far beyond the normal possibility, that it becomes dysfunctional and not understandable. Ditto for depression. In dysfunctional cases, therapy alone is usually not enough, as much as one would like it to be. This is particularly true in cases of full blown mania and severe depression. Or if no medication intervention is accepted, chances are great suffering or ramifications will occur, beyond the norm.

I agree there are times when psychiatrists look at understandable mood shifts as part of the illness, when they rather fall within normal realms. There's no reason one with bipolar disorder can't be understandably full of grief after, say, the death of a parent. That need not be labeled as bipolar depression, though sometimes it transitions into it. It is frustrating when normal happiness is labeled hypomania. Frankly, normal happiness (even great happiness) should likely never be labeled full blown mania, unless it truly morphs into extreme dysfunction. Believe me, full blown mania and severe depression are so extreme that they cannot be experienced by "non bipolar" folks, or if they are, such states are still dysfunctional enough to warrant major medical intervention. Or, perhaps they were caused by some kind of substance (i.e. cocaine, heroin), which alone is NOT normal.

There are people with bipolar disorder that are quick to forget severe episodes. That, in itself, is a dysfunctional tendency. Or if episodes were truly comparatively mild, it's possible therapy could be sufficient. I believe in the bipolar spectrum. We don't all have the same severity of illness. I can say that my illness has been quite severe, in the past. Severe! Though I do sometimes manage to tame my developing bipolar beast without major medication changes, I cannot keep it at bay, sufficiently, without any medications at all. Even if I managed to get through an episode without meds, the beast would come back again, and very often worse. I'm almost 50 years old now and can tell you it always did. Always, without fail. Again, perhaps others are luckier, but it's a real gamble. My nephew thought he could stop medications. He had a nice "honeymoon period" for a while, but then his illness came back with a vengeance, and he was gone very soon after...at 24 years old.

If you think your illness was truly a "one-off" or is not that severe, it's something you should discuss with your doctor. You have the right to be medication free, but if so, you must accept any consequences.

Last edited by Soupe du jour; Apr 08, 2021 at 10:33 AM..
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Default Apr 08, 2021 at 11:11 AM
  #3
The concept of medicating a patient is, as I see it, not to "medicate away" feelings or experiences, but to allow the person to have and feel more normal emotional responses to events - whatever those events may be. I look at meds as a "screen" that filters out extremely painful and overly intense emotions, feelings, reactions and allows a stable perspective on life events. So in that way, medication allows me to feel and to better cope with life.

I've discussed this subject at length with my therapist. She has told me that clients who need medication, but are not on it, tend not to grow in therapy. But clients who are taking the medication that keeps them stable are better able to do the therapy work and benefit from it.

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Default Apr 08, 2021 at 11:33 AM
  #4
I agree with BethRags. For me, medication has never been, as some people see it, an "easy way out." In contrast, accepting that I need meds has been one of the hardest things I've ever had to do. My goal with meds, as Beth said, is not to medicate anything away, but just to enable myself to live my life as normally as possible and to stop pathological mood states from developing. I agree that if a depression is situational, and has a clear cause that you can do something about, then you should. In that case, I probably wouldn't even classify it as a major depressive episode that warrants medication in the first place.
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Default Apr 08, 2021 at 01:55 PM
  #5
I only medicate to the point that if I have hopelessness it needs to be medicated. Self harming action? need to be medicated. The anxiety feeling like it's ripping apart my chest? do not need to be medicated. No sleep for more then 24 hrs? medicated. Everything else needs to be watched and assessed and treated with therapy.

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Default Apr 08, 2021 at 02:23 PM
  #6
i agree with you and with the other wise and wonderful posters as well. i think meds should be taken when one is feeling distressed without a strong enough "reasons" for it (although of course everyone has different reasons and different reactions) or if one is finding it rather difficult to cope with it. i think it may be a good idea to discuss this with your own pdocs and therapists if you ever have doubts about what is happening then. i don't have bipolar though so Please do take my words with a grain of salt. It is just my opinion i think. Sending many safe, warm hugs to BOTH you, @Gabyunbound, your Family, your Friends and ALL of your Loved Ones! Keep fighting and keep rocking NO MATTER WHAT HAPPENS, OK?!
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Default Apr 08, 2021 at 04:18 PM
  #7
As Soupe pointed out, bipolar disorder probably exists on a spectrum as far as symptoms & severity go. In recent years, I've had good luck working with my pdoc to minimize the number & amounts of meds I'm on. I take a relatively high dose of Depakote (mood stabilier), Trazodone (a mild AD & sleep aid) & have Klonopin for anxiety. I went off my anti-psychotic & AD, but have a supply both if my behavior or moods get out of hand....my partner has seen me get in a bad way, so she knows the signs. Anyways, that's just me. Your mileage may vary...

As has been noted already, I think bipolar disorder is especially notable for the longevity & severity of symptoms. I can still get elated for no reason, but as long as things don't get out of proportion, it's all good. When such a mood lasts weeks or months, however, it's time to act.
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Default Apr 08, 2021 at 04:32 PM
  #8
I’m a wait and see type. Mood changes don’t send me running for meds. I totally believe that bipolar people can have normal ups and downs without wigging out about it. If the up or down last for more than 3 days I start to keep an eye on it. As I’ve gotten older I’m better able to utilize the coping techniques I learned from therapy. I’m on less psych meds than I’ve ever been on and I blame some of my past tetter-totter moods on too much meds.

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Default Apr 09, 2021 at 07:07 AM
  #9
Quote:
Originally Posted by Soupe du jour View Post
Hi Gabyunbound. Of course you're correct that people without bipolar disorder can experience great sadness, and what might seem like ultra happiness. However, there are two main differences between the depression and mild elation that people withOUT the disorder experience, and those with bipolar disorder (or other mental health disorder) experience. People without generally must have some major reason/cause for experiencing deep sadness and mild to moderate elation. Such causes could be major loss/grief, severe pain (physical or other emotional), or the like, for depression. Or a joyous occasion or experience that goes beyond the average (i.e. one's wedding, birth of a child, adventure in a beautiful place, extreme accomplishment, winning the lottery, etc.) People with bipolar disorder do not need such extreme triggers for episodes. Also, the elation a person experiences from bipolar disorder can be so far beyond the normal possibility, that it becomes dysfunctional and not understandable. Ditto for depression. In dysfunctional cases, therapy alone is usually not enough, as much as one would like it to be. This is particularly true in cases of full blown mania and severe depression. Or if no medication intervention is accepted, chances are great suffering or ramifications will occur, beyond the norm.

I agree there are times when psychiatrists look at understandable mood shifts as part of the illness, when they rather fall within normal realms. There's no reason one with bipolar disorder can't be understandably full of grief after, say, the death of a parent. That need not be labeled as bipolar depression, though sometimes it transitions into it. It is frustrating when normal happiness is labeled hypomania. Frankly, normal happiness (even great happiness) should likely never be labeled full blown mania, unless it truly morphs into extreme dysfunction. Believe me, full blown mania and severe depression are so extreme that they cannot be experienced by "non bipolar" folks, or if they are, such states are still dysfunctional enough to warrant major medical intervention. Or, perhaps they were caused by some kind of substance (i.e. cocaine, heroin), which alone is NOT normal.

There are people with bipolar disorder that are quick to forget severe episodes. That, in itself, is a dysfunctional tendency. Or if episodes were truly comparatively mild, it's possible therapy could be sufficient. I believe in the bipolar spectrum. We don't all have the same severity of illness. I can say that my illness has been quite severe, in the past. Severe! Though I do sometimes manage to tame my developing bipolar beast without major medication changes, I cannot keep it at bay, sufficiently, without any medications at all. Even if I managed to get through an episode without meds, the beast would come back again, and very often worse. I'm almost 50 years old now and can tell you it always did. Always, without fail. Again, perhaps others are luckier, but it's a real gamble. My nephew thought he could stop medications. He had a nice "honeymoon period" for a while, but then his illness came back with a vengeance, and he was gone very soon after...at 24 years old.

If you think your illness was truly a "one-off" or is not that severe, it's something you should discuss with your doctor. You have the right to be medication free, but if so, you must accept any consequences.
I very much appreciate your reply, but I think you misunderstood parts of it.

I'm not advocating being medication-free (I am not, and CANNOT be, I remember what it was like without them) and I'm not speaking to severity of illness.

Only that, those of us with the illness, may -in ADDITION to bipolar episodes, not instead- may experience intense emotions that do not always require changes in meds.

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Bipolar 1
Lamictal: 400 mg
Latuda: 60mg
Klonopin: 1 mg
Propranolol: 10 mg
Zoloft: 100 mg
Temazepam: 15 mg
Zyprexa 5-10mg prn

(for Central Pain Syndrome: methadone 20 mg; for chronic back pain: meloxicam 15 mg; for migraines: prochlorperazine prn)
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