Question:
Can anyone please refer me to information about this condition?
For years i was thought not to be manic/depressive because I don't
experience mania.
Apparently, they have a realtively new diagnosis for people like me,
Bipolar 2. I've been in a major depressive episode for15 months, and off work for
one year yesterday. they have me on effexor, but it's no silver
bullet. Effexor uis an antidepressant. You need a mood stabilzer if you do have
Bipolar Affective Disorder. Any help would be greatly appreciated. I'm especially interested in things i can do to get myself better.
Answer:
Biploar disorder (Manic - Depressive illness) is classified into Biploar
I disorder and Bipolar II disorder. Bipolar I disorder is diagnosed
based on the presence of atleast one manic episode with or without the
presence of major depressive episode. Bipolar II disorder is diagnosed
by the presence of at least one Hypomanic episode and one or more major
depressive episodes. Manic episode differs from hypomanic episode by the
presence of more sever symptoms for longer duration of time. In Biploar
I disorder, a person can have significant impairment in social,
occupational or other important areas of functioning where as in Bipolar
II disorder, it is unlikely. What is the true definition of bipolar 2? What are its symptoms and
treatments? What other types of bipolar disorder are there, and what are
the distinctions? A. Bipolar 2 disorder involves the cyclical alternation of major
depressive periods with periods of so-called hypomania. Hypomania is a
state of elevated energy and/or mood that falls short of outright mania.
Hypomanic individuals do not become frankly delusional or require
hospitalization. Typical symptoms during the depressive phase of type 2 bipolar disorder
(or type 1, which involves alternating major depression and mania)
include persistently depressed mood (nearly every day), hopelessness,
poor concentration, increased or decreased appetite, increased or
decreased weight, loss of pleasure in most activities, and poor
concentration. (Bipolar depression more often presents with excessive
eating and sleeping than does unipolar depression.) The hypomanic individual typically presents with heightened energy,
elevated or irritable mood, increased talkativeness, decreased need for
sleep, increased social or sexual activity, and increased spending or
work-related activities. Some bipolar type 2 individuals get most of
their creative work done in their hypomanic periods, knowing that they
have only so much time before they "crash." Bipolar type 2 disorder is
associated with significant social and vocational disability and an
increased risk of suicide. In addition to type 1 (classical) and type 2
bipolar disorder, some clinicians speak of "type 3" bipolar in relation
to drug- or medication-induced bipolar mood swings. Many such
individuals have a family history of type 1 or 2 bipolar disorder. The
mainstay of treatment for both type 1 and 2 bipolar disorder is the use
of mood stabilizers, such as lithium, valproate and carbamazepine.
Recently, two new agents--lamotrigine and gabapentin--have been used
with some success in bipolar patients. Educative and supportive
counseling is also an integral part of treatment. Borderline or bipolar? A "pigment" answer Now let's take the "paint" approach to "borderline vs. bipolar", a
common diagnostic disagreement. You may have already
seen my essay on this, which notes the almost complete overlap of
symptoms between the two diagnoses. With that much
overlap, these people must have basically the same "pigments". One
person might have gotten them from genes, the other from
experience -- we can't tell the difference yet. However, one pigment seems to differ in each. They both have red for hot emotions, and blue for depressive symptoms,
and a sparkly pigment that makes them impulsive. But
the "bipolar" person has a magic ingredient that makes her pigments
vary cyclically over time. There is some consistency to
the way this magic pigment works: she tends to be either one way, or
another, all symptoms varying together. Remember, this
magic stuff is another "pigment". She could get a big dose of it, and
be bipolar I: extreme swings separated by years, looking
much the same each time they reappear. If she got a small dose of the
"vary" pigment instead, her symptoms might be less
clearly "cyclic", more mixed and muddled. On the other hand, the "borderline" person has a green ingredient that
makes her feel empty, and feel much worse in this way
when she is alone. Plenty of people who wouldn't be called
"borderline" have quite a bit of green in them, but if you get a lot
of
this green pigment, you're more likely to have trouble in
relationships. When two very green people get together, each will
feel
badly when the other goes away somehow (including emotionally; if one
gets mad at the other, for example). Imagine what
happens in a relationship if one person is very green, and the other
is not; this can be as troublesome as when both are green.
You've heard these matches described as problems of "co-dependency".
How much "green" a person has seems to depend on
both genetics and experience: some kids just turn green no matter how
good an upbringing they get; others can develop
emptiness from experiences that they had growing up (lots of real or
perceived abandonment may do it; certainly sexual abuse
seems to do it). Just to make it clear that this is not "always somebody's fault": the
"match" between a child's temperament and the parenting
they receive can be the problem, not the child's temperament or the
parenting either. Some kids can handle a pretty distant
parent okay; others can be devastated by this. Some kids will feel
"smothered" by an involved parent; others will thrive with
such attention. Children can show these differences right from birth.
You can read more about this "match" in the superb
scholarship of Marsha Linehan, Ph.D. Warning: her book "Cognitive
Behavioral Therapy of Borderline Personality
Disorder"Linehan prompted a psychiatrist friend to say: "never have I
read so important a book that was so boring". Dr.
Linehan repeats the same themes over and over, but for good reason:
they're crucial themes to understanding this personality.
You could go to a bookstore that has it and just read the section on
"Emotionally Invalidating Environments": it's in the first
chapters just after the definition of the disorder. So, to summarize: diagnoses are not based on known chemical
differences. They are conveniences for researchers, and are
also supposed to help you find the right treatment. But because
symptoms are spread over spectra, from a little to a lot, labels
can often be misleading. Finally, borderline patients have most of
the features of bipolar, plus an emptiness streak; and may
have less clear "cycling" of their symptoms.
