what is bipolar depression exactly?

Question

My dad recently passed away and I went to a psychiatrist who said I had bipolar depression. I had been on Paxil but couldn't sleep when I was on it and I still had anxiety.... So I went into this terrible cycle of not taking it-so I could sleep and then slowly plummeting into deep depression, so I would start taking Paxil again--then I would get sick of not being able to sleep-so I would go back off of it.

I don't have any mania at all, but I do get anxiety (it hasn't been a life-long thing--just since my dad got sick and died).. Anyhow, my doctor said I was bipolar depressed... which is odd b/c I do not have any manic days.

She put me on depakote and it is working okay but I still miss my Paxil... Anyhow, when I was upset and said, "I dont think I am bipolar.." she said that I had it all wrong-- i wasn't bipolar manic, ...I am bipolar depressed. Anyone else have thoughts about this? All the info I seem to come up w/online is that bipolar depressed is the same thing as bipolar manic/bipolar disorder. But she was adamant that they aren't the same...

I do feel better taking depakote, I can sleep better but I do still get anxiety. She said that the SSRIs were causing me to get too much seratonin and that is what keeps me up & gives me anxiety .

okay, baba.. I guess I should have backed up a bit. I had been on Paxil for awhile for just basic depression for about 8 yrs and I could take it or leave it, before my dad got real sick (he was real sick like 3 yrs ago and died 1 yr ago)... Anyhow, I always HAD done fine on Paxil until 3 yrs ago (2 yrs before his death) --when he was really sick, I was so worried and anxious... That is when I started the VERY bad roller coaster of going on and off of paxil--waiting until I got so depressed I couldnt get out of bed before taking it and taking it a few wks until I felt better but couldn't sleep..

I forgot to also tell you guys she put me on lunesta too--to sleep. she put me on another medication--(mirtazapine)--it made me a zombie and have horrible nightmares...and i got off of that.

Also, Clover.. I think you are right. I think I understand it all from what you typed. Any more thoughts, I would love to hear from any of you guys... Clover, I think you really made sense of it to me though-- the anxiety and insomnia are the mania??

So that psychiatrist did NOT put me on paxil..i had already been on it. She put me on Depakote, lunesta, and remeron (mirtazapine)---and I discontinued using remeron...

Answer 1

Some bipolar people do not have manic days. Some slowly go from being ok to being depressed, but the change can happen over weeks, and the depression can stay for months. It happens the same way inversely also, it take you a long time to get happy, but you're happy for a few weeks or a month, then you have your down times.

My best friend is bipolar like this.

Answer 2

Hello again,
It would have been easier to email this info to you - but your email is 'off'. Paxil, as I suggested earlier, is an old drug. It is not used to treat major depressive disorded (MDD). I believe what Psychegrad said: "Little known fact....in many people with true Bipolar Disorder, an SSRI alone can trigger a manic attack. ". I had a 'seratonin reaction" many years ago on that crap. In my humble opinion, the Paxil made you nuts, NOT mania. I think this is not beyond the realm of possibility. Antidepressants used to treat MDD include Venlafaxine (Effexor), Citalopram, Escitalopram and others . The above drugs are often prescribed along with Wellbutrin.

But you said your doctor diagnosed you as bi-polar? If this really is the case then you shouldn't be taking the above drugs either.

As I told you earlier, I think you have been misdiagnosed.

You wrote "That is when I started the VERY bad roller coaster of going on and off of paxil--waiting until I got so depressed I couldnt get out of bed before taking it and taking it a few wks until I felt better but couldn't sleep."

How is it you were earlier diagnosed with MODERATE clinical depression (and successfully treated with Paxil) and then the shrink decides that now you are bi-polar instead? I'm not a shrink but I suspect your moderate depression turned into major depression in the end. What do you think? Again, Paxil is NOT generally prescribed for major depression. There are so many newer, safer and more effective drugs for treatment I am stumped that you were prescribed Paxil. Get yourself another shrink for a second opinion; my "Spidey Senses" keep telling me something is wrong here.

Answer 3

There are different types of Bipolar.

The Bipolar Spectrum:

Bipolar I: Both mania and major depression (alternating)

Bipolar II: Major depression and hypo mania

Bipolar III: Cyclothymia: Milder depression and hypo mania though disruptive to those who suffer from it

Bipolar IV: Depression and usually no mania. Mania may be triggered by some antidepressants.

Bipolar V: Depression and no mania. Some blood relatives have had mania

Bipolar VI: Mania and no depression. The theory for classifying this among the "bipolar" disorders is that almost every manic will eventually crash into a depressive episode.

Answer 4

I would definitely get a second opinion. If none of these symptoms appeared before your father passed away, you may just be in a state of depression. Both forms of bipolar are misdiagnosed more than any form of depression disorder. Medications that treat these disorders can be harmful in the long term, and some of this medication you are currently taking may be unnecessary, and may be able to be taken down to 1 pill for your depression. IMO, this seems like only depression based on your question, and would definitely seek a second opinion. The bad thing about diagnosing is that there is no specific test for bipolar disorder. The diagnosis is entirely based on what you tell your psychiatrist. I was misdiagnosed and was on medication for two years that was completely unnecessary, and am off the medication and am on Wellbutrin for my depression only. As said, definitely seek a second opinion.

Answer 5

First, I want to comment on Baba Yaga's statement that Paxil is not used to treat Bipolar Disorder. It is. It is used to treat the depressive phase of Bipolar Disorder, but is rarely used alone. Little known fact....in many people with true Bipolar Disorder, an SSRI alone can trigger a manic attack. So, they usually give an SSRI with a mood stabilizer or anti-convulsant, like Depakote. That may have been why your psychiatrist took you off of the Paxil. When you were taking it, you had difficulty sleeping, which she may have misinterpreted as a "decreased NEED for sleep," which is a characteristic sign of mania. But from your description, it sounded more like insomnia, because you wanted to sleep.
I'm not your psychiatrist, so please don't take what I am saying as any form of medical advice, treatment, or diagnosis. There is so much that goes into a diagnosis and I certainly and ethically could not give you any psychiatric advice based upon your question alone.
Bipolar Disorder involves two distinct elements: A depressive cycle and a manic cycle. You must have had at least one manic cycle to be considered Bipolar. Everyone is well aware of what depression is. Mania involves elevated, expansive, or irritable mood, inflated self-esteem or grandiosity, decreased need for sleep (Note: NEED, not insomnia), increased talkativeness, racing thoughts, distractibility, increased in goal-directed activity, and/or excessive involvement in pleasurable activities. There are several subsets of Bipolar:
Single Manic Episode
Most Recent Episode Hypomanic
Most Recent Episode Manic
Most Recent Episode Mixed
Most Recent Episode Depressed
Most Recent Episode Unspecified
I think I can understand when she says that your are "Bipolar Depressed," in that she may mean, Bipolar, Most Recent Episode Depressed. However she is incorrect in saying that you are still Bipolar even though you have never had a manic cycle. You need both to be Bipolar, thus the meaning of the word...Bi = two and Polar = of two poles (manic and depressive).
You are right to question the diagnosis. Perhaps you should copy the diagnostic criteria out of the DSM-IV TR and bring it in to her. Though she may classify this as defiant.
Talk to her about the possibility of taking both Paxil and Depakote. I've had lots of clients that took SSRI's and anti-convulsants/mood stabilizers. If you are depressed, Depakote may help calm you down, but it may not address the depression.

I wanted to add:
"Paroxetine (Paxil) tablets, suspension (liquid), and extended-release (long-acting) tablets are used to treat depression, panic disorder (sudden, unexpected attacks of extreme fear and worry about these attacks), and social anxiety disorder (extreme fear of interacting with others or performing in front of others that interferes with normal life)."
http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a698032.html

Paxil tablets and oral suspension are used to treat:

Depression
Panic disorder
Social anxiety disorder (SAD)
Obsessive-compulsive disorder (OCD)
Posttraumatic stress disorder (PTSD)
Generalized anxiety disorder (GAD)
http://www.fda.gov/cder/drug/InfoSheets/patient/paroxetinePT.htm

Please, please, please consult your doctor before changing your medication regimin. Do not take ANYONE'S (including mine) advice on this site as a reason to discontinue your medication.

Answer 6

The distinguishing characteristic of Bipolar Disorder, as compared to other mood disorders, is the presence of at least one manic episode. Additionally, it is presumed to be a chronic condition because the vast majority of individuals who have one manic episode have additional episodes in the future. The statistics suggest that four episodes in ten years is an average, without preventative treatment. Every individual with bipolar disorder has a unique pattern of mood cycles, combining depression and manic episodes, that is specific to that individual, but predictable once the pattern is identified. Research studies suggest a strong genetic influence in bipolar disorder.

Bipolar disorder typically begins in adolescence or early adulthood and continues throughout life. It is often not recognized as a psychological problem, because it is episodic. Consequently, those who have it may suffer needlessly for years without treatment.

Effective treatment is available for bipolar disorder. Without treatment, marital breakups, job loss, alcohol and drug abuse, and suicide may result from the chronic, episodic mood swings. The most significant treatment issue is noncompliance with treatment. Most individuals with bipolar disorder do not perceive their manic episodes as needing treatment, and they resist entering treatment. In fact, most people report feeling very good during the beginning of a manic episode, and don't want it to stop. This is a serious judgment problem. As the manic episode progresses, concentration becomes difficult, thinking becomes more grandiose, and problems develop. Unfortunately, the risk taking behavior usually results in significant painful consequences such as loss of a job or a relationship, running up excessive debts, or getting into legal difficulties. Many individuals with bipolar disorder abuse drugs or alcohol during manic episodes, and some of these develop secondary substance abuse problems.

Answer 7

Hi. Both of my parents were bi-polar and so is my brother.I was diagnosed 18 years ago. I never had a true manic episode until the last 8 years or so. But i did have alot of periods of "hypo-mania". It's a trying type of mania that makes you feel very anxious and active and have insomnia and basicaly feel like crap until you can arrest it or it goes away. i USE OCCASIONAL MEDS. TO ARREST A HYPO-MANIC EPISODE.This would be in addition to depecote.Good Luck !

Answer 8

Simple terms: Extreem emotions and behaviors --- When it's good ... it's very- very good ... and when it's bad --- it's horrid.

It's normal for bi-polars to desire to get off medication when it's good because they're happy and it feels like you'll never have bad times ... but if you don't take med's during this time, your mood will quickly swing into another rut like anger, sadness, or paronioa.

A perosn who has bi-polar is Jim Carey. Funny guy, and his humor makes us all think he's the greatest ... however, for the extreem joy he brings us with his humor ... he suffers deep depression to counter this.

Answer 9

i dont know what to say to you other than my heart goes out to you .i went thru the same thing 30 years ago .at least you got help.