New to bipolar stuff, what will work?

[Arei]

It may seem like a silly question, but my doctor believes I have light bipolar. I am not manic depressive or anything, I just get unreasonably irritable, which I think is causing most of my problems. It's really stupid. He just gave me some abilify to try and it made it worse,and though its been 3 days since I last took it I am still really really irritable, and lately I haven't been too much.

Has anyone taken something for this that worked? I can no longer tolerate anti-depressants.

I've got to stop being so irritiable, I /have/ to. I have techniques to help not explode as much but I just cannot stand to have this feeling, it's so stupid and it's hindering my relationships. I don't have a very understanding family and I need to get rid of this anger to have them on my side as much as possible, they maybe unreasonable but it's all I've got >_<


Like example of something stupid making me soooo angry, I told my cousin she could NOT have my last Fuze as I was about to go work out and my grandma told her right then she could have it, and though it's stupid I'm SO F***ING ANGRY!!!!

I cannot stand to have these emotions anymore!!! They have to go! Does anyone have a treatment that worked for them?

[KMiller]

I don't understand how your irritability adds up to bipolar disorder. I guess maybe a different antipsychotic? Why are you opposed to antidepressants?

[Arei]

He told me there are 6 different stages to bipolar disorder, and it's not only being manic depressive.

I cannot tolerate anti-depressents, they make me ill/can't sleep/can't eat/mood swings/disorientation/no motivation, etc. I took them before with no benefits or side effects, and then I try to take them again and this happens. He said it's characteristic of the biopolar light, which is really only marked by unreasonable irritibility and the sudden intolerance to the anti-depressants, and he told me this before I ever said I was mad all the time lol.

[Twinz]

What about Lamictal? It is supposed to be an excellent mood stabilizer, and can work as an anti-depressant without the side effects of an anti-depressant. That should help with the mood swings, I would think.
Good luck,
Twinz

[KMiller]

"He told me there are 6 different stages to bipolar disorder, and it's not only being manic depressive."

Are you in the United States? This is not accepted practice or theory.

[trishcan]

I did a little googling, and found that there are five identifed types of bipolar (at least, according to this source).. which may be what your doctor was referring to.

Bipolar I
A person affected by bipolar I disorder has had at least one manic episode in his or her life. A manic episode is a period of abnormally elevated mood, accompanied by abnormal behavior that disrupts life.
Bipolar II
Bipolar II is similar to bipolar I disorder, with moods cycling between high and low over time. However, in bipolar II disorder, the "up" moods never reach full-on mania.
Rapid Cycling
In rapid cycling, a person with bipolar disorder experiences four or more episodes of mania or depression in one year. About 10% to 20% of people with bipolar disorder have rapid cycling.
Mixed Bipolar
In most forms of bipolar disorder, moods alternate between elevated and depressed over time. But with mixed bipolar disorder, a person experiences both mania and depression simultaneously or in rapid sequence.
Cyclothymia
Cyclothymia (cyclothymic disorder) is a relatively mild mood disorder. People with cyclothymic disorder have milder symptoms than in full-blown bipolar disorder.

Regardless of whether your symptoms warrent a diagnosis of bipolar disorder, a mood stabilizer could help significantly with extreme irritability. I think you asked this question in a different way the other day, and I suggested topamax.

When I was in my late teens, I experienced a lot of the symptoms you describe. Minor day-to-day situations incited some sort of carnal rage, and I became violent and destructive until I was able to exhaust the energy. At times, there was no apparent cause of the explosion of fury building inside me. I was not capable of handling it productively until I began taking medication. It sort of took the edge off for me, and gave me the ability to develop coping skills that didn't involve punching people, throwing things, destroying my own possessions, or harming myself. I've been off the medication for a number of years now, and very, very rarely (maybe once every 6 months) experience that sort of rage. Now, I'm able to talk it out (or at the very least, avoid breaking things). I wish you the best in getting this under control.

I've also heard good things about lamictal. Risperdal is another option. Others include zyprexa (I tried the lowest dose of this and slept for 40 hours straight), lithium (old school and requires a lot of monitoring to avoid toxicity), depakote (though many report significant weight gain), and others that I can't think of at the moment.

Maybe do a little research into each and see if anything sticks out for you.

[Archon]

Aripiprazole (ablify) is likely making it worse because it's a partial dopamine agonist. Its probably making you obsess about stupid **** and you can't get it out of your mind right? Do you feel like you can't relax and are wound up all the time? How's your sleep?

[KMiller]

Alright, I might as well contribute positively to this thread.

Let's assume it is bipolar disorder and it is severe enough to warrant standard treatment: the golden standard of care for bipolar disorder is a mood stabilizer and an antipsychotic, with or without an antidepressant.

There are three main mood stabilizers. By far the most effective is lithium, but it requires careful blood level monitoring to avoid toxicity, in the form of monthly blood tests. It is bar none the most effective mood stabilizer, especially for mania.

The other two are valproate (Depakote and related brands) and lamotrigine (Lamictal). Valproate is typically indicated for mania, and lamotrigine is typically indicated for bipolar depression. They can also be prescribed in tandem, for cases where mood is very unstable. Valproate can cause weight gain.

Antipsychotics include risperidone (Risperdal), quetiapine (Seroquel), olanzapine (Zyprexa), ziprasidone (Geodon/Zeldox), aripiprazole (Abilify), and paliperidone (Invega). Of these, quetiapine is the most commonly prescribed. Risperidone is the oldest. All of these are D2 and 5HT2A receptor antagonists, except aripiprazole, which is a D2 partial agonist. All of these may cause weight gain. Each has associated blurbs of information: risperidone and paliperidone in particular causes elevated prolactin levels, which can lead to breast development in males or females. Quetiapine causes extreme drowsiness due to a heavy antagonistic effect at H1 receptor sites. Olanzapine is notorious for extreme and virtually unlimited weight gain and associated acquisition of type II diabetes. Geodon causes potential weight loss. Aripiprazole can paradoxically cause activation into mania.

A usual firstline treatment of bipolar disorder will choose either lithium or valproate for a mixed or manic state, or lithium or lamotrigine for a depressive state. It will also select an antipsychotic, based on what the doctor prefers. Risperidone is the cheapest at about $115 for 30 pills cash, and the only one that comes in a generic. Aripiprazole is indicated for depression, quetiapine is on its way to being indicated for depression, if it isn't already, and there's a body of evidence that ziprasidone is effective for depression.

In cases where the patient is also depressed, the doctor may choose to add an antidepressant. Bupropion (Wellbutrin) is my doctor's preferred one for this, because it's not an SSRI - SSRIs can cause activation into mania. Since depression isn't your primary complaint, and you don't tolerate antidepressants anyhow, you'll probably skip this.

Soooo basically a combination of one (or two, rarely) of those antiepileptics and one of those antipsychotics is "what will work," assuming it's actually bipolar disorder.

And for the record, "manic depression" is an old term that does not describe any bipolar disorder anymore - it's an obsolete term, like ADD. Unlike ADD, however, nobody uses it any more in the medical community and only a few rare patients who are "proud" of their label continue to use it.

[wifeandmom]

Regarding types of bipolar,

Two additional cycling terms are now beginning to enter the literature. Ultra-rapid cycling is in use to describe cases where complete mood cycles occur in less than one month. Ultridian cycling is in use to indicate cases where complete mood cycles occur inside the space of one day (and thus might be confused with a mixed episode). It is important to note that ultra-rapid and ultridian forms of mood cycling are not yet formally recognized in the DSM and thus are not currently official terms.

Source: http://www.mentalhelp.net/poc/view_d...e=doc&id=11196

[KMiller]

Rapid cycling and mixed aren't actually considered "types" of bipolar disorder, either. Mixed episodes indicate Bipolar I Disorder and "with rapid cycling" is just a qualifier. Usually Bipolar Disorder NOS is used for rapid cycling such that it violates the general criteria for episodes. Bipolar disorder isn't usually something that comes with a "light" variety, other than Cyclothymia, which is part of why I'm responding how I am to the OP - the treatments for bipolar disorder aren't "light" treatments; antiepileptics and antipsychotics, while becoming more commonly used, are not "light" medications.

[Archon]

Bipolar is a pretty cut and dry condition in many ways and the notion of calling an unidentified mood disorder "bipolar light" dilutes the clinical validity of the diagnosis in my opinion.

I'm not saying for a moment that your symptoms aren't real, it's just probably not bipolar.

[KMiller]

I think "Mood Disorder NOS" might be more appropriate, personally, given that you haven't described having actually had a Manic Episode or Mixed Episode or even a Hypomanic Episode.

[wifeandmom]

There's been a lot of scholarly research on the concept of bipolar as a spectrum disorder, with unipolar depression at one end and Bipolar I at the other end. I didn't realize this until lately (we're awaiting a January appointment for 18 year old DD who has more going on than "just" ADHD). Anyway, type "bipolar spectrum disorder" into Google and Google Scholar and you'll find lots of research and explanation of this concept.

[KMiller]

I'm familiar with the concept, I find it is part of a general trend to place pretty much everything on a "spectrum," following suit with the "autism spectrum." I think this is very problematic - it pathologizes everything. Basically, if even people who are a little moody are just on the "light end" of bipolar, then we extend bipolar disorder too far, and risk pathologizing normal variation in mood. Is a teenager angsty or do they have "light pediatric bipolar?" How can we tell the difference without clear thresholds and boundaries?

This dilutes the severity of the diagnosis, makes accurate communication of information via diagnoses difficult, and also creates problems - what is the spectrum? Is it unipolar depression - bipolar disorder - psychosis, or is the gradation from unipolar depression to increasing levels of mania? The vast majority of individuals who present with depression don't qualify as bipolar, which has entirely, drastically different treatment plans. If I say someone is "light bipolar," what does that mean? They meet 1 criteria instead of 3? That makes it subthreshold. Does it simply mean that they are moody? If so, why are we treating this with antipsychotics, instead of therapy? Does it even respond to therapy? Therapy can help cope with episodes, but there is no full remission for bipolar disorder.

Perhaps the biggest problem is that diagnoses serve a specific purpose: to quickly describe the general idea and symptoms of a person's problem to other professionals. If I say "Bipolar I Disorder" there is a very clear image with very clear treatment goals associated with those symptoms. If I say "light bipolar," what the hell does that even mean? Or say we accept a spectrum - "moderate bipolar," ok, in what ways? What symptoms are absent that make it not a standardized bipolar disorder? What symptoms of mania are there that make it not simply Major Depressive Disorder?

And the Internet user in me dreads a "bipolar spectrum" because suddenly everybody who needs a community to fit into who has slight mood problems will be "mild bipolar," just like everyone with poor social skills calls themselves "mild autism" or "mild Asperger's disorder," Internet code for "I am socially awkward." In fact, the proposed autism spectrum for DSM-V actually includes on one end of the spectrum "normal variation" to describe people who are simply socially awkward, to avoid them being confused with something abnormal requiring more treatment than basic skill-building therapy.

DSM-V is considering a sort of spectrum, but it cautions the importance of doing so very carefully, and it's not the kind of spectrum most people are proposing.

Originally Posted by DSM-V Mood Disorders Working Group

The literature showing that subthreshold manic symptoms predict a switch to a bipolar diagnosis over time in patients originally diagnosed with major depression together with the evidence that a delay of up to eight years is reported in making a bipolar diagnosis is being reviewed. Since classifying all such patients could result in up to 30% of major depression diagnoses being converted to bipolar diagnoses, the committee is cautiously examining thresholds based on available data to better differentiate this boundary or possible spectrum, since major treatment implications are involved. A bipolar features specifier added to the diagnosis of major depression is being considered.

In my opinion, it is much better for them to determine a boundary than to create a spectrum for this disorder. It's simply more trouble than it's worth, and it confuses diagnosis.

[EYEFORGOT]

***Moderator note***

The information about different types of bipolar is very interesting, and I encourage the education.

I would like it to start going in a new thread, and let Arei, our original poster, get her questions answered.

I know we often go on a tangent in the forums, and I'm not discouraging the discussion, but it isn't fair to the OP.

Thank you for your understanding.