mixed-mood

I Know I’m Hypomanic, Depressed or Mixed but I Can’t Help It

→ November 30, 2016 - 17 Comments

I Know I’m Hypomanic, Depressed or Mixed but I Can’t Help It

Many of us have the insight to know when we are manic, hypomanic or depressed or in another bipolar mood state but, unfortunately, even though I might know I’m hypomanic, depressed or mixed, I can’t necessarily help it. I wish I could. I wish that knowing what my bipolar disorder was doing would somehow alter it, but it typically doesn’t. I just can’t help it when I’m hypomanic, depressed or in a mixed mood – even when it’s clear to me.

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Win a Paperback Copy of “Lost Marbles” — GoodReads Giveaway

→ November 14, 2016 - 5 Comments

Win a Paperback Copy of “Lost Marbles” — GoodReads Giveaway

If you’re on my mailing list you head last week that a GoodReads giveaway was started. Right now I’m giving away three paperback copies of Lost Marbles: Insights into My Life with Depression & Bipolar

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The Underside of Bipolar Rapid Cycling Moods

→ September 28, 2016 - 10 Comments

The Underside of Bipolar Rapid Cycling Moods

I mentioned on Facebook recently that I’m rapid cycling. If I ever wondered if the bipolar diagnosis was accurate, the bipolar cycling moods have certainly convinced me that it is. If you’re curious, this is ultradian cycling — i.e. cycling where moods last only hours. That can also be classified as a mixed mood because the cycles are so short.

All of this is to say that I’m not well right now. It’s fine. I’ve seen my psychiatrist, we have a plan and I’m working the plan. But the plan takes time, as all plans do. 

So while the plan portends usefulness, I am stuck on the rollercoaster from hell. And in this particularly hellish place I wrote this piece. It is not cheery, it would trigger some and if you’re having a bad day these are not the 300 words for you. Proceed with caution

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Bipolar Symptom Psychomotor Agitation, Mixed Moods and Suicide

→ July 21, 2014 - 28 Comments

Bipolar Symptom Psychomotor Agitation, Mixed Moods and Suicide

Last year, I wrote an article on psychomotor agitation at HealthyPlace. Psychomotor agitation (or retardation) is a symptom of bipolar (and unipolar) depression as well as hypomania/mania and very little information about it is available (in spite of the fact that it is listed in the Diagnostic and Statistical Manual of Mental Illness (DSM-5)).

Most definitions for psychomotor agitation include the words, “inner restlessness.” I don’t know about you, but “inner restlessness” reminds me of a 22-year-old who can’t find himself and so is backpacking across the country. It really doesn’t sound like a mental illness symptom – let alone like a serious one.

But, as it turns out, psychomotor agitation is serious, highly indicative of a bipolar mixed episode and correlated with suicidal acts.

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Bipolar Terminology: The Difference Between Bipolar I and Bipolar II

→ October 5, 2011 - 53 Comments

Bipolar Terminology: The Difference Between Bipolar I and Bipolar II

Sometimes I get so wrapped up in research, I forget some people are looking for some introductory information like the different between the types of bipolar disorder. Thanks to commenter on my GooglePlus feed, I was reminded of this fact and I decided to answer her question here so I could give her more detail.

Bipolar Terminology

Unfortunately, within bipolar terminology resides more bipolar terminology. But don’t be scared, I have information on most terms on my site and I shall try to walk gently into that good encyclopedia.

But let’s try to get rid of the terminology confusion: What is the difference between bipolar type I and bipolar type II?

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Bipolar Disorder – When to Get Off Antidepressants

→ August 31, 2011 - 18 Comments

I try not to give medical advice here because I am not a doctor. But so many people ask me about this I felt I had to address getting off antidepressants without withdrawal. So many people with bipolar disorder (depression and others) need information about getting off psych meds and they are not getting it from their doctors.

This is the first in a three-part series:

  1. When to Stop Antidepressants in Bipolar Disorder
  2. How to Stop Antidepressants in Bipolar Disorder While Minimizing Withdrawal
  3. How to Stop Taking venlafaxine (Effexor) and Desvenlafaxine (Pristiq) – as they are particularly nasty to get off

This is an informational article only and should not be considered a recommendation. Talk to your doctor before any and all changes to your treatment. I’m not kidding about this.

These recommendations are primarily from PsychEducation.org and Dr. Jim Phelps with some commentary by me.

Bipolars Shouldn’t Take Antidepressants

Some doctors are on the fence about this, but more and more bipolar specialists are recommending people with bipolar disorder not take antidepressants. There are lots of reasons for this, and I have to tell you, they are compelling.

Why Shouldn’t People with Bipolar Disorder Take Antidepressants?

Some reasons people with bipolar shouldn’t take antidepressants:

  • Antidepressants may not work in bipolar disorder – believe it or not, the literature is mixed on how well antidepressants even work for bipolar depression.
  • Antidepressants can induce mania or hypomania (known as switching) – most of us have seen this and it happens all the time to bipolars who are prescribe antidepressants by non-psychiatrists because they just don’t understand the danger. And it is very dangerous because once switched, this type of mania or hypomania can be treatment resistant.
  • Antidepressants can induce rapid-cycling or mixed moods – same as above, this cycling can be treatment-resistant.
  • Antidepressants can worsen a bipolar’s illness overall – this is more controversial and I suspect varies case by case.

Bipolar Disorder and No AntidepressantsTo be clear some people with bipolar disorder will always need antidepressants temporarily, or long term, for their mood, but more and more, doctors are saying to avoid them whenever possible. (Alternatives will be presented in a future article.)

When to Stop Taking Antidepressants

Here are some guidelines from Dr. Phelps about when to stop taking antidepressants in bipolar disorder:

  1. If they have been on antidepressants a short time, I stop them.
  2. Less than a week, stop; two weeks, cut in ½, a week later stop.
  3. Likewise, if they just increased their antidepressants dose I will do the above, decreasing to their previous dose and get rid of the rest later.
  4. If manic or severely hypomanic, get rid of antidepressants now.  Usually can stop abruptly.
  5. If cycling or mixed get rid of the antidepressants.
  6. If they are not getting better after several add-on meds then slowly decrease.
  7. There are more exceptions to the above rules than there are rules.

When to Stay On an Antidepressant if You’re Bipolar

More guidelines from Dr. Phelps: When a bipolar should stay on an antidepressant:

  • If the patient is doing well, no mixed state symptoms or cycling, leave it.
  • I usually wait until the patient is doing better to much betterto stop an antidepressant; why:
  • Trust is an issue.  If the first thing we do is make them suffer more they will be unlikely to stay around long and may not even go to another psychiatrist.
  • Even though we know the antidepressant is causing harm often time the patient thinks either the antidepressant is helping or every time they try to go off they feel much worse.
  • Waiting until they are better is usually a good thing.
  • Also waiting longer usually means that the patient is going to be more educated about bipolar in general.

When to Get Off an Antidepressant Recommendations

I think Dr. Phelps’ recommendations are good ones, otherwise I wouldn’t have them here, but note where he says there are more exceptions than he has listed, so keep in mind, you might fall into one of the unlisted exceptions.

And I think the part above where Dr. Phelps talks about trust and making sure the patient is better before messing around with their cocktail is key. It shows he’s respecting the patient and their health, not to mention the doctor-patient relationship which is very important.

Talking to Your Doctor about Getting off Antidepressants is Scary

I know it’s scary to think about going off antidepressants, even if you do think they are causing problems. But think about it, discuss it with your doctor and make the right decision for you. And don’t do anything until you read the next part about how to get off antidepressants without withdrawal.

Bipolar Disorder – Getting off Antidepressant Series

  • Bipolar Disorder – When Not to Take Antidepressants

Coming up:

Mixed Bipolar Disorder – How to Treat Mixed Mood Episodes

→ August 23, 2011 - 23 Comments

In the final installation of my mixed moods series, I talk about how to treat mixed moods in bipolar disorder. If you need a refresher on mixed moods in bipolar 1 or bipolar 2, see the first three articles in this series:

Treating Mixed Moods in Bipolar 1 – Mixed Mania

We know most about treating mixed moods in bipolar type 1 as that’s what has been classically defined as a mixed mood in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Because mixed moods in bipolar disorder type 1 are considered a type of mania, one could think of treating them in the same way bipolar mania is treated. Typical mania treatments include:

  • Lithium
  • Some anticonvulsants
  • Antipsychotics (normally atypical)
  • Benzodiazepines (for acute anxiety, commonly seen in mania and mixed moods)

Often a combination of an anticonvulsant and an antipsychotic is used.

FDA-Approved Drugs for Treating Mixed Moods in Bipolar 1

Since mixed moods are defined in the DSM, there are specific medications approved by the Food and Drug Administration (FDA) to treat mixed mania. FDA-approved drugs for treating mixed moods in bipolar disorder type 1:

  • Carbamazepine extended release (Equetro)
  • Aripiprazole (Abilify)
  • Ziprasidone (Geodon)
  • Risperidone (Risperdal)
  • Asenapine (Saphris)
  • Olanzapine (Zyprexa)

Bipolar Type 1 and Mixed Mood TreatmentWhy lithium didn’t make the list I’m not entirely sure;* because, as I’ve mentioned, mixed moods and acute anxiety carry a significant risk of suicide and lithium seems to have a particularly strong anti-suicide effect.

Electroconvulsive therapy (ECT) is also indicated for the treatment of bipolar disorder mixed moods.

Treating Mixed Moods in Bipolar 2

As I mentioned in the article on mixed moods in bipolar disorder type 2, mixed moods can either have hypomania or depression as the primary mood. This primary mood then, dictates the type of treatment chosen.

Treating Mixed Hypomania

According to this two-part Psychiatric Times article by Steven C. Dilsaver, MD, mixed hypomania in bipolar type 2 can be treated similarly to treating a mixed mood in bipolar type 1.

Specifically noted is the concern of acute anxiety during mixed hypomania and the fact not all patients readily admit to psychological and physical symptoms of anxiety. However, this is critical information to your doctor and should always be offered, even if not specifically asked.

Other mixed hypomania treatment tips include:

  • Comorbid (co-occurring) anxiety may decrease the effectiveness of mood-stabilizing agents, so benzodiazepines may be a better choice.
  • Not treating anxiety aggressively can reduce overall long-term treatment outcomes.

Treating Mixed Depression

Mixed depression is particularly hard to treat as mixed moods often predict a lack of response to antidepressants, not to mention the fact that antidepressants can make hypomanic or manic symptoms worse.

A suggested treatment strategy for mixed moods in bipolar 2 with the primary mood of depression is the following:

  • Begin by suppressing hypomanic symptoms by using an mood stabilizer or antipsychotic (antipsychotics may work in 1-2 weeks)
  • Start medication at low doses and titrate (raise the dose) quickly – this is generally necessary due to the severity of mood symptoms
  • If depressive symptoms persist after response to the above medication, add a selective serotonin reuptake inhibitor (SSRI) antidepressant very slowly while watching for signs of hypomania – this requires very close monitoring and likely weekly doctor visits (impossible for some, obviously)

This is very similar to what many doctors are now recommending for bipolar disorder type 2 in general. First, stop the cycling (or hypomania) and see if that also corrects the depression. Avoid the use of antidepressants whenever possible.

Preventing Mixed Depression in Bipolar Type 2

How To Prevent Bipolar Disorder Mixed Moods

Obviously, no one can guarantee prevention of any mood, but there are some recommendations given in the article, as people with mixed depression are known to be at high risk for reoccurrence.

Tips on preventing mixed depression in bipolar 2 include:

  • Lamotrigine is the favorite prophylactic medication as it seems to prevent depression without being an antidepressant
  • Ongoing scheduled benzodiazepine doses can help prevent panic attacks^
  • A combination of an antipsychotic, plus lamotrigine, plus a benzodiazepine is often “highly effective” (words Dr. Dilsaver’s)
  • Lithium is known to be a highly preventative agent; however, in many cases divalproex (Depakote) is superior and has fewer side effects

Series on Mixed Moods in Bipolar Disorder

Whew. OK, there turned out to be a lot to know about mixed moods in bipolar disorder. I hope you learned something reading it as I certainly did writing it.

For your convenience, here are the links to the other three parts in the series:

——————————————————————————————————————————-

Notes

* I suspect there wasn’t enough money to be made on a generic drug to fund the studies, especially when doctors are going to use it anyways.
^ Yes, I know, long-term (sometimes any term) benzodiazepine use is controversial. Personally, I’m not against them and neither are many doctors – when used responsibly.

Reference

Psychiatric Times, Mixed States in Their Manifold Forms. Part one and part two.

Mixed Moods in Bipolar Disorder and Depression in the DSM-V

→ August 16, 2011 - 2 Comments

Mixed Moods in Bipolar Disorder and Depression in the DSM-V

The Diagnostic and Statistical Manual of Mental Disorders (DSM), the manual that defines all mental illness in the US, is being revised and a new version is due out in 2013. One of the proposed changes to the DSM is to the diagnosis of mixed moods. This change is being proposed by a mood disorders workgroup. It aims to reflect clinical practice where doctors already refer to a “mixed” mood that doesn’t officially meet the DSM criteria. (As I noted, mixed moods are only technically recognized in bipolar type 1.)

Changes to the mixed mood diagnosis will help people with bipolar 1, bipolar 2 and unipolar depression get better treatment.

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Mixed Bipolar Disorder – Mixed Mood Episodes in Bipolar 2

→ August 10, 2011 - 34 Comments

Mixed Bipolar Disorder – Mixed Mood Episodes in Bipolar 2

As I mentioned, mixed moods are technically considered part of the manic phase of bipolar disorder and thus, by definition, are only a part of bipolar disorder type 1. However, those of us with bipolar type 2 can tell you we mix it up with the best of them.

So, in part II of this series on mixed moods in bipolar disorder, I look at mixed moods in bipolar type II.

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Mixed Bipolar Disorder – Mixed Mood Episodes in Bipolar 1

→ August 8, 2011 - 27 Comments

Mixed Bipolar Disorder – Mixed Mood Episodes in Bipolar 1

Ask a Bipolar – What is a mixed mood in bipolar disorder?

As one of the Burble’s commenters mentioned, there seems to be a lack of good information on mixed moods available. After some Googling, I would tend to agree. While mixed mood episodes are pretty common for us bipolar folk, few people seem to be discussing it.

This is the beginning of a four-part series on mixed moods in bipolar disorder:

What is a Mixed Mood Episode?

By definition, a mixed mood in bipolar disorder is the presence of both depression and mania. According to the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), mixed moods are only present in bipolar disorder type 1 as mixed moods require the presence of mania.

Mixed mood episodes are (officially) found in bipolar disorder 1 and are characterized by:

  • Persons must meet both the criteria for mania and major depression; the depressive event is required to be present for 1 week only.
  • The mood disturbance results in marked disruption in social or vocation function.
  • The mood is not the result of substance abuse or a medical condition.

Mixed mood episodes are officially considered part of the manic phase of bipolar disorder.

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I’m Less Depressed and Crying More – Mixed Mood

→ December 3, 2010 - 4 Comments

I’ve been horrendously depressed. That sort of catatonic depressed where reality shows hum before your eyes one after another because that’s all the stimulation your brain can take. Flashing images of substanceless people performing meaningless tasks on light box that removes you from reality.

A Mood is Never Just a Mood for a Bipolar

But I woke up this morning feeling better. This is always a warning sign of hypomania, or in this case, a mixed-mood. Because a mood is never just a mood to a bipolar. A mood is always a warning sign of a problem. Bipolars have to pay attention to moods because even good moods lead to bad things.

I watched my brain get stuck on a song because I heard three notes of it on the TV. I couldn’t get it to shut up. Over and over. Over and under. Fucking brain. A broken record.

waterfall of tearsI’m So Grateful for the Good, I’m Crying

And I find myself teary. I’m crying over everything. I actually feel better than yesterday but so much more emotional. My bipolar knob for catatonia has been turned down while the emotionally, specifically weepy, has been turned up. Yay. What a trade.

It’s OK. My smile is closer to genuine in spite of the tears. I do feel something through the tears. It’s a mixed episode I know. The meds dampen hypomania so I get mixed moods with a crazy mix of tears, laughter, smiles, sorrow, racing, anxiety, productive mood. Or at least today. Mixed moods are an emotional storm so the combinations change from time to time. Bipolar is like a box of chocolates.

I am thankful to be feeling any degree of better and am trying to focus on what little there is of the something-other-than-sadness. I close my eyes and look inside to something sort of almost shaped like happiness. It’s not happiness, there are too many knives stabbing at it, but it’s something sort of like it. Something in its colour family.

Vaguely Reminiscent Happiness is a Miracle for the Depressed

I’m grateful it’s there. Transient, labored, perforated it may be, it’s like taking a breath of mostly air and less water, instead of mostly water and less air. It is so much better than nothing.