[Razzleberry]

I had an incident 2 years ago, about 4 or 5 weeks after starting on anti-depressants for the first time in my life. I was not myself - I would call in sick to work but pretend to go, then spend all day binging on food, driving around aimlessly, gambling, surfing the net, and meeting strange men. I was also highly suicidal, and even had thoughts of harming my then 6-month-old baby (but I NEVER actually hurt her, I just had the thoughts, and those thoughts scared the living crap out of me!!!)

At that time, I had never really done any reading about mental illnesses - I just thought I was depressed - postpartum depression - I had heard of Bipolar but didn't really know what it was. My doc never told me what to look for. I did tell them what was going on, but they, too, failed to notice what it really was. Or at least they failed to tell me what was going on.

Looking back now, it seems clear to me (and my new therapist) that it was a Bipolar manic episode, triggered by the meds.

Soo....my question is this. I read all the symptoms and a few books about Bipolar, and about Borderline. Except for that one incident - I really have never been "manic" at ALL. I never get the racing thoughts, speedy, hyper, lack of sleep, feeling "high" stuff. NEVER.

And that little episode - the worst symptom was really the "impulsiveness" - even then, I was not really speedy or hyper or sleeping less or any of that. Just the impulsiveness.

I do also fit a lot more of the symptoms of Borderline. The fear of abandonment. Clinging to my bad marriage, afraid of being alone, doing anything possible to keep him even though it's not working. One day I hate him, the next day I love him. There's the impulsivity. The mood swings. Suicidal in the past - and thoughts now, but not acting on it.

In fact, if you look at the symptom list for Borderline - the only one I do NOT have is the paranoid / dissociative one. (thank god!) And I am not a self-injurer, but I have been suicidal in the past (and that is on the same bullet-point as the self-harm)

But when I look at the symptoms for Bipolar - the ONLY symptom I DID have was the impulsivity, binging, sex, spending, etc. - but I do not have any of the other symptoms (except the depression side, of course).

I guess what I'm saying is - can I really be Bipolar if my only manic episode was triggered by meds?

Could it be that I am really Borderline? Can anti-depressants "trigger" a Borderline impulsive episode just like Bipolar?

Or...am I just making this all up??!!!!

I don't know why, but for some reason I am not really 'accepting' the Bipolar diagnosis. I just don't think it fits me, and I'm scared to get on the wrong meds again.

I've only been back in therapy for one week so far, I know, I know, it takes time. I just don't want to mess it all up like I did last time.

[RiverX]

Hi,
I think you're right, you're sort of telling yourself to calm down. I dont have info about meds, but I'll try to see if I can be at all soothing. It seems like you're doing all you can at the present, if you make no sudden changes with any meds, and even, I'd think that eventually, if therapy does its job, you can come off the meds altogether. Actually, I just finished reading a chapter on bipolar as compared to personality disorder. The bipolar is a chemical thing, but the disorders are more emotionally based, thats as I understand. But then, of course emotions affect us physically too, and chemically. If instinctively you dont feel you're bipolar, then trust you instinct.
did you consider giving that phone no a ring?

riverx

Hmmm...actually No. Borderline is a personality disorder. It is ingrained in your being. It is not a chemical imbalance, so medications do not get rid of it.

Bipolar is a chemical imbalance that occurs because of problems with dopamine, serotonin, and ,.....shoot I can't remember the other one. Anyway, Bipolar can be "fixed" with medication. It is not a part of your being.

So, chances are if anti-depressants triggered something, it was Bipolar.

BUT.....the overlap between Bipolar and Borderline is amazing...so much that some psychiatrists have theorized that Borderline and Bipolar are related somehow.

Hey there.

It sounds to me that the incident was drug (medication) induced. What you describe is a well-documented side-effect of anti-depressant medication that a number of people have reported. After they take the meds for a bit they start to feel irritable and anxious and frustrated and a bit compulsive. They may experience suicidal ideation that is both qualitatively and quantitatively different from suicidal ideation that they have had before. They may start to have urges / desires to hurt others. Some people have gone on to attempt suicide or to hurt others. There have been legal cases about this where people have sued their doctors for not seeing that these were side-effects of the medications and for not taking them off the medication when they told their doctors about their side-effects. The pharmaceutical companies have given some of these people huge out of court settlements to keep the cases out of court. There still is something that is referred to as the 'Prozac defence' however. Basically... 'The Prozac made me do it'.

The symptoms most often remit once the medication is ceased. There are some symptoms (movement disorders - tardive dyskinesias) that do not remit once the medication has ceased, however.

> Looking back now, it seems clear to me (and my new therapist) that it was a Bipolar manic episode, triggered by the meds.

Mmm... No, I don't think so. A Bi-polar manic episode is different from a drug or a medication induced manic episode. And I'm not sure that it is a 'manic' episode so much as the well documented side effects of agitation / compulsivity etc.

There is a great deal of controversy over the limits / boundaries of the following diagnoses:

1) Borderline personality disorder.
2) Rapid cycling bi-polar disorder.

Basically... If you see someone who focuses in on therapy you are likely to get the first diagnosis. If you see someone who don't feel they have the skills to see you in therapy and therefore wants to refer you on for medication or you see someone who deals in medication rather than therapy they are much more likely to diagnose you with rapid cycling bi-polar disorder.

Both conditions are sometimes treated with mood stabilizers (which were developed as anti-epileptics originally). The difference between the diagnoses is really a matter of 'personality' vs 'organic' connotation. And it will probably turn out that they are the same condition really at the end of the day and that the choice in diagnosis comes down to differences in theoretical orientation between clinicians.

[Rapunzel]

Personality disorders aren't caused by taking a med. They are long-standing patterns of behavior that are pervasive through your whole life, with roots that go back to childhood and adolescence. But it is true that BPD and bipolar can resemble each other, and there are plenty of people who have both.

Also, by definition, if your only manic episode was triggered by medication, you can't technically be diagnosed bipolar. The criteria for bipolar disorder say that it is not induced by any substance. But what you experienced does sound like a manic (or mixed) episode. It is important to be aware that anti-depressants can have that effect on you. But I wouldn't call you bipolar if you don't get manic when you're not on antidepressants. Even if your doctor decides to use a mood stabalizer instead.

You and I have had so many similar experiences! I also had at least one (maybe a couple more) manic or hypomanic episodes when I started to take St.John's Wort. I hadn't ever not been depressed before discovering SJW, and I overdid it a bit at first. That only happened the first few months that I took SJW. There have been a few times after that when I tried to get manic and took too much SJW, and I don't seem to be able to get manic on it anymore. So you might be fine on antidepressants.

[Razzleberry]

I'm just so confused on this whole thing. I thought I had read enough to kind of understand things...but now I think I've read TOO MUCH and I'm just confused.

People talk about Bipolar like they have "episodes" that last weeks, months, even years.

My moods change DRASTICALLY...within the minute, hour, day, week. Never the same for more than a week. And my "normal" state is always constantly somewhat depressed. I'm never happy, just numb.

But then those things I did all happened right after I started the anti-depressants. So that makes it sound like a manic reaction. But I wasn't manic. I wasn't hyper or moving faster or sleeping less, I have never had racing thoughts or increased self esteem or ANY of that...the ONLY thing was the impulsiveness.

And maybe the impulsiveness really isn't impulsiveness?? Maybe when I get extremely depressed, I'm just trying to fill that "void" with something....be it food, clothes, shopping, or in the worst cases..men. Maybe it's got nothing to do with borderline OR bipolar, I'm just doing bad things and I KNOW I'm doing bad things and it's got nothing to do with impulsiveness.

I just don't know. I wish I could just find a doc who could explain this all to me but it takes me months just to get a damn appointment and then it is just so slow. I'm impatient. I want to know what's wrong with me!!! If there even is anything wrong.

I'm just so frustrated.

Um, traditional Bipolar like what I have, my mood "episodes" last weeks or months. I was depressed for 7 months last time.

Some Bipolar 2 may have "rapid cycling" or "ultra-cycling" where they experience mood swings throughout the day. This tends to be a more conterversial diagnosis, because mood swings happen. But there are still criteria for episodes.

Your mood changes could also just be normal moods. There are criteria that T's and docs use to "label" and you could look at those criteria in the DSM IV.
But honestly, many of the symptoms and criteria overlap. Honestly, the only criteria that makes a Borderline label more likely is an intense fear of abandonment. The other criteria are similar in BPD and Bipolar 2.

That being said.....maybe you should just stop focusing on a "label" and focus on feelings and symptoms.

[PsyChris]

You are describing Bipolar Type II. It is characterized by hypomanic episodes vs Manic episodes seen in Bipolar I.

It can be hard to differentiate between the symptoms of BPD and Bipolar II. For now the DSM considers them separate diagnosis.

[Razzleberry]

Ok....here's why I'm confused. This is straight from the DSM:
Those in <font color="blue">blue </font> are the only symptoms I have - even when I was on anti-depressants. Those in <font color="green"> green </font> I do not have.

</font><blockquote><div id="quote"><font class="small">Quote:</font>

Criteria for Hypomanic Episode (DSM-IV, p. 338)

A. A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days , that is clearly different from the usual nondepressed mood.
B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

<font color="#008800">
- inflated self-esteem or grandiosity

- decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

- more talkative than usual or pressure to keep talking

- flight of ideas or subjective experience that thoughts are racing

- distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
</font>
<font color="blue">
- increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

- excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
</font>

C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.

D. The disturbance in mood and the change in functioning are observable by others.

E. The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.

F. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Note: Hypomanic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar II Disorder.

</div></font></blockquote><font class="post">

So....I'm just confused.

I only have 2 of the symptoms, not 3 or 4, and I only get irritable, not high. And the biggest episode happened when I was on Celexa. So that doesn't count towards the diagnosis...right?

I'm so confused...

My moods NEVER last 4 days at a time. It's never even four HOURS at a time.

I know if I could ever FIND a doc who knew what they were talking about maybe they could explain it!...but that's another issue. I'm working on it. Today, at 11:50, I'm going to just a regular family-practice doctor. I couldn't get in anywhere else until about 2 weeks from now. So...I dunno. I guess just tell him I think I'm Bipolar. And if the meds screw me up, I have an appointment with a Psych nurse practitioner on the 24th..and I think I'm still on the waiting list for the psychiatrist. Who knows when she can get me in...