Has anyone been diagnosed with bi-polar w/o mania?

Hi Hopeful,

The wisdom these days is that you cannot be diagnosed for bp without a manic or hypomanic episode -- basically because without the manic end of the spectrum the condition is (unipolar) depression rather than manic depression / bipolar.

A couple of good pages you could check out for more information on manic / hypomanic episodes are:

http://www.psychnet-uk.com/dsm_iv/bipolar_disorder.htm

http://www.mdf.org.uk/?o=1620

I think the way you describe not being sensible when it comes to soothing yourself is very common for depression -- especially when linked to anxiety. I am very much like that myself -- and I am a unipolar depression with anxiety gal (on this board because of my ex's bipolar). It sometimes takes a while to find the right meds for that too -- as well I know lol -- but I have eventually managed it with the help of a patient and thorough doc. Always worth pushing for more investigation into the meds side of things. :)

Rosie x

In the past 10 months I have been on Zoloft, Wellbutrin, Paxil, Geodon, Lexapro, Lamactil, Lithium and Xanax.  I have been working with a Pdoc the whole time and I either have the opposite reaction or no reaction to the meds he thinks will work (except Xanax, that works).  He asked me the other day "Do I look stumped?"  I said yes.  He said "Well that's because I am."  He referred me to a Pdoc that does what they call an rEEG.  It is used for people that have difficulty finding the right medication.  It basically maps your brain and compares it to a database of brain maps to find ones similar to yours and then the types of medication that have worked on those brains.  Problem is, you have to be off all meds to get the test done.  At the time I was on 2mg Xanax 3x day, 40 mg Lexapro, 600 mg Lithium, 666 mg Campral, and 6 mg Lunesta.  The guy said he wouldn't do it because I was on such high doses and different meds that he didn't think it was a good idea for me to go off the meds.  My original Pdoc and I called BS and I'm in the process of getting of the meds, Xanax first (not fun).

Crissi,

What you describe could be me.

I have done a lot of research on bipolar mixed the last couple of days in advance of my pdoc appointment this morning.  Here is a definition I found:  "Symptoms of mania and depression are present at the same time.  the symptom picture frequently includes agitation, trouble sleeping, significant changes in appetite, psychosis and suicidal thinking.  Depressed mood accompanies manic activation."  I also found this:  "Antidepressants can cause mixed states/  Remember, bipolar disorder is not like the north and south pole; hypo/manic symptoms can occur while depressed symptoms are also present.  In a way, this is the same as #2 above, except that instead of switching from one state to another, you have both at the same time.  Usually this looks like agigtation or anxiety, or irritability, difficulty sleeping and depression all at the same time."  This also "These findings suggest that depressed patients with atypical bipolar features that resemble anxiety or agitation may suffer from mixed states.  This has treatment implications for the diagnosis of bipolarity in patients previously thought to be unipolar, for antidepressant use (which may worsen such states), and for the selection of mood stabilizers (i.e., lithium vs. anticonvulsants) in know bipolar patients.  Patients with treatment resistant unipolar depression should be evaluated for symptoms that might suggest rediagnosis and alternative treatment with combinations of mood stabilizers, rather than antidepressants." 

So, basically, many times bipolar mixed is diagnosed as unipolar depression or unipolar depression with GAD (as in my case).  Antidepressants make it worse and lithium is a poor mood stabilizer for mixed states.  I took it a step further and analyzed what combination of mood stabilizers would be good for a mixed state.  I chose Depakote, an anticonvulsant (this class is recommended for mixed states) ("...if sleep problems and anxiety are prominent, Depakote may be a better starting place...", and Seroquel (an atypical antipsychotic) ("for sleep and agitation").  I presented all this to my pdoc this morning and he agreed, even down to the med combination.  So I am tapering off of Lexapro and Xanax and starting on Depakote and Seroquel.  I'll let you know how it goes.  Zyprexa was another med that was mentioned in many of the articles I researched but I have taken it in the past and it didn't help.  Lamactil is another med that is suggested if depression is prominent, but I tried that and only got to 1/6 of the therapeutic dose and couldn't sleep for days on end.  Hope this helps someone.