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Seasonal affective disorder or Bi-Polar???

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Posted 10/15/2005 5:08 PM (GMT 0)
I was put on Remeron for major depression and anxiety and have been on it for about a month now.  It seems to be working very well (except I still have a bit of depression right before that time of the month and a few days after).  Last month I went to a Psychiatrist who was very unpleasant and I decided not to go back to him.  I have an appointment with a new Psychiatrist on November 1st.  I was wondering, has anyone ever been told that they are Bi-polar if they get more depressed when the days start to get shorter and daylight savings end and then start to feel better around January 15th, when the days start to get longer?  I have this and the (unpleasant) Psychiatrist told me this was a sign of Bi-Polar.  It is all very confusing and I embarrased to admit that I am confused with Bi-polar and I have a Psychology degree!  The Textbooks say one thing, the Mayoclinic says another, and the Psychiatrists say another. When I was hospitalized the Psychiatrist there said I had major depressive episode and anxiety and then a week later, when I went to the (unpleasant) Psychiatrist, he said in the first five minutes that I was Bi-Polar and prescribed Lamictal. I sometimes think that no one exactly knows what this disorder really is, and just another label to confuse us all. Thanks for listening.
Posted 10/15/2005 11:13 PM (GMT 0)
I think that the two disorders are completely different. With seasonal affective disorder, there is depression in certain months of the year, usually helped with phototherapy with a antidepressant. That type of depression usually subsides after February. With Bipolar we have manic and depressive episodes throughout the entire year. With me, my episodes can go up and down lots of times throughout the day, manic , hypomanic, and depressed. I personally feel " more depressed" in the winter time , and really don't understand why. I don't like the sun anyways, hate to be outside in the heat. I live in Michigan , and maybe I feel this way due to the dreary looking days, cloudy , cold and alot of snow. It gets dark here by 7:00 right now and i feel more tired and down. So the weather does affect my mood, along with everything else affecting it. LOL If you don't feel depressed all year round and have the typical symptoms of Bipolar, then your not. Any Pdoc that dx you in less than 5 minutes shouldn't be a Pdoc. It took months for my doc to dx me, and he has been treating me for a long time. Originally dx with depression , eventually Bipolar. Of course he is just an MD, and he is great but not specialized enough to treat me.  I am sorry you have experienced a "bad" doc, but keep trying! I understand being Bipolar more now then I ever have since being dx. This board when I first started here helped me tremendously.I started to read more and learned alot by having similiar episodes with other Bipolars. Depending on what your reading, I think the books are accurate, but you get a clearer understanding by talking with others. Being Bipolar is the confusing part. Understanding why , what.... is also confusing. I don't pay much attention to my label as much as I pay to my treatment. Bipolar is so hard to treat and even harder to try and become stable. I hope I reach that point one day, and I think I am well on my way.That is my goal, and also to try and educate others. Shannon (pyschnurse) has posted the symptoms of Bipolar many times, take a look at it and see if you think it is what you go through. I hope it is not, but it is a good indicator to compare the symptoms. Although it is not a dx , but it is informing. Thanks for listening, and have a great day. Nickie  

Posted 10/16/2005 9:51 AM (GMT 0)

Hi, Rianna

I totally agree with Nickie, any pdoc that diagnoses you in 5 minutes is a quack IMO.  BP is difficult to diagnose and things like ADD and extreme anxiety with major depression are mistaken sometimes, but the features are really quite different.

This criteria is from the National Institute of Mental Health, the major organization in the US for mental health information on all illness.  Pay special attention to the last paragraph and know that hypomania or mania consists of either euphoria or extreme irritability - if euphoric, three symptoms must be present at the same time, and if irritable, 7 must be present at the same time.  True BP cannot be diganosed without at least one episode of mania and it has to have lasted a week or more all day, every day.

Like Nickie said this is not to diagnose you over the  internet; but to give you a clearer understanding of what BP is and isn't.  It seems many GPs and BPs alike are overdiagnosing BP and giving people meds that make them just tired, but do not really relieve their symptoms.   Meds are very different for BP and depression/anxiety even tho anxiety is usually present in BP along with several personality disorders.

In my following post I will also give you a link for a short test, giving you a better understanding still of your personal experiences and it is a really good one.   A GOOD doc or pdoc will give you written tests to help diagnose you, too.  These tests are very very important.

Signs and symptoms of mania (or a manic episode) include:

  • Increased energy, activity, and restlessness
  • Excessively "high," overly good, euphoric mood
  • Extreme irritability
  • Racing thoughts and talking very fast, jumping from one idea to another
  • Distractibility, can't concentrate well
  • Little sleep needed
  • Unrealistic beliefs in one's abilities and powers
  • Poor judgment
  • Spending sprees
  • A lasting period of behavior that is different from usual
  • Increased sexual drive
  • Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
  • Provocative, intrusive, or aggressive behavior
  • Denial that anything is wrong

A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present.

Posted 10/16/2005 9:52 AM (GMT 0)
http://www.dbsalliance.org/questionnaire/screening_intro.asp
Posted 10/16/2005 10:09 AM (GMT 0)
Hey Rianna,

One thing of note is that many disorders in the psychiatric realm (or any realm for that matter) have an overlap with others. One of the largest offenders of misdiagnosis in bipolar-I disorder is the anxiolitic symptoms that patients present with. Often, anxiety can mask mania. Additionally -- many people are diagnosed with ADD/ADHD that might actually be bipolar-I because of the similarity of sypmtoms between hyperactivity and mania. Note that the only thing that differentiates bipolar I disorder is the history of at least 1 manic episode.

One thing that I'm very concerned with recently is the surgance of Adult ADD/ADHD diagnoses (with the introduction of Stratera, an SNRI) as I believe that many of these patients could be Bipolar-I and undiagnosed (and ... as we all know ... SSRI/SNRI's can induce a manic switch).

Remeron is an interesting drug ... although it seems that it might induce some metabolic problems (such as weight gain), it does act partially on the D2 receptors (although not as well as the atypical's) as well as serotonin and others. As for anxiety - it seems to have quite a calming effect because of it's derivitive compound (a benzodiazepine).

Hope this helps -- let me know if I can be of any other assistance.

best,
ckgMD
Posted 10/16/2005 10:34 AM (GMT 0)

Hi, ckgMD!

Firstly, I hope I didn't offend you in any way in my last post to you; if I did, I apologize.

I did read that Remeron affects seratonin the same way as SSRI, and norepineperin, too, but also dopamine, like you said.   How?   The same way as wellbutrin?  Does it block the effects of dopamine, or increase production?  I am curious about that. 

And I also have to add that the main difference between hypomania (type II and full blown mania type I, as you know, this is for Rianna) is that type I has psychotic features, like hearing voices, hearing someone call your name frequently, smelling things that aren't there, losing touch with reality, etc. - you are totally right about BP II not having full mania, only hypomania (only, like it's nothing! Same as mania without psychosis) and just as dangerous ruining lives. 

Also, Rianna, about SAD.  It seems to be a major feature in BP, but can also greatly affect people who are not, and it is the lack of sunlight that is the culprit.  Nickie's right about the lightboxes as therapy during fall/winter and an antidepressant as well.

Hope this helps,

Shannon

Posted 10/16/2005 7:29 PM (GMT 0)
Hi Rianna,

I don't know much about the technical side of things, but I know that I've had some experience with SAD. I've talked with my pdoc about it and he explained that its often a feature of BP. I dealt with it all last winter and am trying hard to avoid it this year.

I just wanted you to know that it is a possibility that both BP and SAD may be playing a role and that its worth discussing both with your new doc.

I believe that the university of british columbia published some pretty useful info on SAD.

Good luck with the new doc,

Putter

Posted 10/17/2005 12:01 AM (GMT 0)
Hey Shannon!

Yes, Mirtazapine upregulates D2 production in much the same way as Bupropion does. Which, as you know, is very little. I believe that the one big advantage of using Remeron is it's tight binding profile to the H1 receptors. This profile on this receptor (H1) is similar to that of some of the atypicals too (Seroquel, Zyprexa) as one of the hallmarks of mania is insomnia. Additionally -- Remeron antagonizes alpha-and2 while enhancing NA transmission (but not via reuptake inhibition --- a very interesting drug, indeed!).

As for the last post that you wrote me, I'm unable to find it (sorry!). I would like to know, though, if you've ever increased your Seroquel to a higher dose. I'm still a little confused why someone would add an additional antipsychotic to work on the same receptors when they could simply increase the dose of 1 agent to do the same thing (as, if I'm not mistaken -- aripiprazole and all atypicals work on the exact same binding fulfillment sites)?

I look forward to your feedback -- and hope this finds you well!

best,
ckgMD
Posted 10/17/2005 12:25 AM (GMT 0)

Thanks for writing back, ckgMD -

But, I only understand about half of that, haha!   I guess I just wanted to know if it worked on dopamine the same way as wellbutrin, and it sounds like it does.  It is one of a kind, and I'm interested to see how more people react to it. 

Actually, my doctor wanted me to d/c the Seroquel, I just didn't hear her, lol!   (Selective hearing maybe, I love Seroquel).   I cannot sleep without it, nothing else works, we've tried it all.   I am the kind that even "stable" will be up the entire night, and develop psychosis very easily from that if I don't have something of a horse tranquilizer!   So, I'm taking 50mg Seroquel now (was 250) and .5mg klonopin.  Not sleeping more than 4-5 hours a night, so I will be calling her tomorrow to see what else we can do, I don't like to take any controlled substances, but admit klonopin is great at 1mg or more (for me).  The thing is Abilify doesn't really cause drowsiness, so it's a little different in that respect, but nonetheless an atypical, and shouldn't be taken with another.

The Abilify has made me probably the most stable of anything I have ever tried, and that would be everything but Topamax.   But I also take Trileptal, Seroquel (for now), wellbutrin, and Lamictal.  It was the piece de resistance!

Have you written Abilify for anyone yet?  I know it's so new and really not as proven as others, not to mention $$$$$$$$$$$$$$.  There are three of us on here that tried it and all had really good results, tho.

Glad to see you back!

Shannon :-)

Posted 10/17/2005 12:51 AM (GMT 0)
Hey Shannon!

It's good to be back!

No, I haven't written for Abilify yet -- I was considering it the other day for a patient who had somnolence throughout the day with her current treatment regimen. However, I stuck with Seroquel. It seems to work very well and (thankfully) I've only seen 1 episode of EPS which was easily corrected. Before Seroquel - I used to use a lot of Risperdal, but once I got people up to 8-10mg's -- I started to see the emergent EPS. It actually made me a little scared to treat BP or psychosis, at all.

The Abilify reps have been in my office quite a bit lately -- I guess whatever pharmaceutical company is pushing it, is pushing pretty hard. They keep stressing the somnolence of Seroquel with me -- but I tell them that I only dose it QHS for patients, so that's not an issue.

Have you tried AmbienCR or Lunesta for sleep? The half-life on these is pretty long ...

Hope you had a great weekend!

best,
ckgMD
Posted 10/17/2005 1:53 AM (GMT 0)

My doc rxd regular Ambien for me - even with 50mg Seroquel I slept a total of 3 hours!

I didn't know there was a CR version - I'll try that or Lunesta, I read it has a 6 hour half life, so that may be a good idea, thanks!  I'll ask  her tomorrow.

I love Abilify, but the sleep issue is a problem, unlike with Seroquel, but Seroquel didn't stabilize me this well, and at the higher dosage (400+) for me anyway, somnolence was an issue.  I just wish it would be safe to take both!   If it would just make you sleep at night, it would be awesome!  

How many BPs do you treat, average?  Do you see a lot?

Posted 10/17/2005 2:40 AM (GMT 0)
I seem to be at least initiating treatment more and more for BP. I screen all patients (as I mentioned to you before) who present with depression (or whose chief complaint is depression). I also have started to screen people who have chronic pain disorder, adult ADD/ADHD, chronic fatigue syndrome, insomnia, and others. I would guess that I see at least 1-2/week with at least a history of a manic episode. I usually only see them when they're depressed. Giving them a medication that makes them sleepy sometimes makes them a little angry with me -- but after 5 days or so, they level off and are able to start their lives again.

AmbienCR is pretty new. I just started writing it the other day -- 6.25mg or 12.5mg

Talk to you soon! I just got my new journal of psychopharmacology -- i hopefully will have some things to share tomorrow!

till then,
ckgMD
Posted 10/18/2005 12:00 AM (GMT 0)
   Hi Rianna---It could be bothv

BP and SAD.     Many people suffering from BP also have SAD----I'm BP-2----& also have SAD.      Hope thi helps---blessings--Robert

Posted 10/18/2005 12:13 AM (GMT 0)
Which means according to all these posts, and PDocs, I have Anxiety, Major depression, Bi-Polar, SAD, BPD. Cool - I'm a real mess - why on earth have they not put me in the nut house with all these diagnosis? Keep 'em coming. Pass the labels please, and don't forget the butter.
<g>
Posted 10/18/2005 4:29 PM (GMT 0)
my wife has just been given REMERON RD because she was complining of anxiety and and
anger... she also has a pituitary abenoma....
my question is does the remeron rd control the anxiety and the anger, to the point where
she is just calm for a few hours, or will this drug actually correct her problem (anxiety and the anger)

i can really use some help here..!!

thank-u
Posted 10/18/2005 5:57 PM (GMT 0)

Is your wife bipolar or are her mood swings due to the pituitary adenoma?    What did her neurologist (not psychiatrist) say about that if anything?  Or is he treating her with the Remeron?


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