On my emotional state, and how my depression is reacting to medication.

[xiphias]

So, a couple days ago, I all of a sudden had enough energy to take care of normal tasks. I was able to mail letters, do laundry, do some cleaning.

And the weirdest thing happened that day. As I was walking to the post office, I passed the donut shop, and considered stopping in for a donut. And I realized I didn't really want one. That totally threw me, so I decided to stop in on the way back from the post office, instead.

When I came back, I still didn't want a donut.

I felt greatly uneasy and disturbed by this. So I went home and ate a tub of marshmallow fluff, which made me feel sick, rather than elevating my mood. (Okay, to be fair: there was like half an inch of marshmallow fluff in the bottom of the tub. It was really only like a half-cup of fluff, not a whole tub. Which makes the fact that it made me feel sick truly strange.)

This state of events went on for the next few days. Every night, I'd want to go to sleep at some kind of hour like 9:30 or 10:30 or so, and would wake up nine hours later, refreshed and ready to face the day. Rather than avoiding bed as long as I could, staggering in, and then staying in for ten hours and waking up groggy and unable to function, as I usually do. I'd wake up and I'd shower and get dressed. And then I'd do stuff around the house. Like, my chores and stuff.

This morning, I went to a restaurant in Ipswich for breakfast. I got a hash omelette, and I realized, after eating half, that I was full. And then I stopped eating, got a to-go box, and packed it up to have the other half for lunch. Which I did.

I washed the kitchen counters today -- something which I'm supposed to do, but never do. I got the recycling together. I did laundry and dishes.

The housework didn't seem overwhelming. Things like getting a full-time job seemed possible.

I realized I wasn't feeling depressed, and wondered if the medication was working.

This afternoon, I started to feel logy and slow, and, as I started to drive out to pick Lis up from work, I felt my mood start to fall. It fell a lot slower than it has in the past -- it took a good half-hour, forty-five minutes to crash out, and it didn't hit rock bottom like it sometimes does. And I managed to pull my mood up somewhat.

And as my mood fell, I craved sweets -- chocolate, a donut, cake, SOMETHING. In the way that I haven't craved sweets in the past few days.

So I know that my overeating is 100% dependent on my mood. When I wasn't depressed the last couple days, I didn't even have any URGE to overeat. The marshmallow fluff thing was because I was truly, genuinely confused about my lack of craving.

And now the cravings are back, although not as strong as they usually are.

Here's what I'm worried about: I've been diagnosed with bipolar disorder minus the manic phase. There's some term for that; I don't recall what it's actually called. But basically, it's unipolar depression, except it's different than regular unipolar depression in some subtle ways, and it responds to anti-bipolar-type drugs better than it responds to SSRIs.

So what I wonder is if the last couple days actually have been not me kicking off the depression and being normal, but rather simply a manic episode. What if I'm really manic-depressive, except that on my manic days, I hit "normal"? If that's what is going on, is it possible to maintain a constant "manic" phase?

Comments

[rosefox]

Everyone has mood swings to some degree or another. Picture your mood swings as a sine wave on a graph. I think two things are happening:

1) The middle y value of the sine wave--the "average" state, halfway between the highest and the lowest--used to be somewhere below zero. It's now shifting up towards zero, where "normal" people are.

2) The curve itself is flattening out; probably both amplitude and frequency are decreased. Mood changes happen more slowly and less often and are less drastic, and you spend more time near the middle.

If this is correct, then it sounds like 1 is happening faster than 2, which means your high points are much higher than you're used to them being but your lows are still fairly low. Give it a little more time to settle out and see what happens. You may find that your mood starts spending plenty of time right around that "normal" mark.

It sounds like you've got exactly the right meds at the right dosage. I'm really glad they're working for you.

[rosefox]

A graphic for those who prefer pictures to words for things like this:



I note that many, many bipolar people would love to find a way to stay hypomanic or manic all the time. No one's yet managed to find a method that works for everyone, though. The best you can do is raise your baseline so that even the low moods are still functional and the high ones are super-functional.

[ewtikins.livejournal.com]

Pretty pictures!

[gilmoure.livejournal.com]

The sugar thing might be indicative of either thyroid or pancreas changes. Most of my families diabetic, and most of us have found this out in our late 30's on up. Several family members also have thyroid trouble that can effect sleep, energy, and moods. Might be something to look into. Problem with thyroid is that it can have such minute changes that have large effects on the body, that are difficult to detect from a random blood sample.

[xiphias.livejournal.com]

If I have thyroid problems, they're not so blatant as to be evident on a first-pass test. I've had one, and it was fine. Doesn't mean that my thyroid is fine, I suppose -- just that it's not bad enough to show on that particular test.

[nancylebov.livejournal.com]

I think the manic-depressive with little or no manic is called Bipolar 2.

[xiphias.livejournal.com]

Sounds familiarish.

[sarianna.livejournal.com]

Bipolar II is summarized in the DSM as "recurrent major depressive episodes with hypomanic episodes." However, the hypomanic episodes must last at least four days.

I'd be more inclined to guess at dysthymic disorder, but that's only half-assed former-psych-student stuff.

[xiphias.livejournal.com]

But dysthymia responds to SSRIs. In any case, I don't have dysthymia, because I do have major depressive episodes. So I either have Major Depression, which is what I've been treated for most of my life, or I have this weird form of Bipolar.

Or something else entirely, 'cause, y'know, brainzzzzz are confusing and complicated, as well as tasty.

Studying psych made me crazy. I like being an English major. :)

[sarianna.livejournal.com]

Mm, tasty..

I also have major beef with DSM definitions, because honestly, they don't apply to everyone, and the requirements and/or wording on some definitions are questionable.

We have brains. They do stuff, and sometimes they don't. And some drugs are good. :)

[juliansinger.livejournal.com]

And given as the meds appear to be working at least somewhat, it would seem that even if you don't have Bipolar II, you have something /compatible/ with Bipolar II.

[ewtikins.livejournal.com]

Possibly cyclothymia with major depression?

[rosefox]

Bipolar disorders are identified with increasing frequency in clinical practice. Until recently, patients treated in outpatient psychiatric settings were presumed overwhelmingly to have unipolar diagnoses. However, later studies on the affective subtypes treated in this setting reveal a different picture. These investigations suggested that approximately 30% of depressed patients treated in outpatient psychiatric settings may have bipolar spectrum illness. A prospective study conducted by the National Institute of Mental Health (Rockville, Md) found that 12.5% of patients initially given a diagnosis of major depression eventually had a bipolar illness. Among those in whom the polarity of illness switched, Bipolar II (major depression with hypomania) predominated over Bipolar I (manic states).

More useful info at the link.

[linenoise.livejournal.com]

*puts on his psych-student hat*

The diagnosis for Bipolar II requires the presence of "at least one Hypomanic Episode". Hypomanic episode has the same diagnostic criteria as the Manic episodes of Bipolar I, but without significant impairment of normal functioning.

So if you've never had any kind of manic or hypomanic episode, then the diagnosis has to still be Major Depressive Disorder, or some other form of mood disorder. At least until the next revision of the DSM.

Now, it's entirely possible that you could have Bipolar II *on top* of something like Dysthymic Disorder. And your hypomanic episodes, combined with non-episodic "depressed mood" just means that once in a while you approximate "normal", and then go crashing back down.

Nitpicking aside, Bipolar II is probably the nearest fit in the current version of the DSM, especially if it's something that responds better to bipolar meds than SSRIs.

[xiphias.livejournal.com]

Basically, that's what happened with the diagnosis. The shrink said, in effect, "You don't quite fit the definition of Bipolar II, but it feels right, and let's see if you respond to the medications that it'd be if it was Bipolar II." So we tried it, and his instincts seem to have been right.

The fact that my father has full-blown bipolar was a factor in this.

[(Anonymous)]

Was??? Anyway, another discovery you may find useful is the concept of a bistable circuit. When you're down you stay down, when your up you stay up. Both states can be kicked into the other by an "event", such as a fall from a roof or a case of the flue or a real doozey of an argument (the last is rarely available when down, but may be worth a try, since you are a very economical argue-er). Note that a decrease in energetic states is more common than a kick "up". Your thoughts?
Duzzy

[brooksmoses]

Yup. Though I suspect that this is one of the cases where the DSM is lagging the state of the medical art. A person I know well was recently put on medications for depression; one of the initial bits of the trying-out-medicines was "Now, you could have something that works like depression, or you could have something that works like bipolar without the manic cycles. If it's the latter, these drugs that normally work against depression will push you manic in pretty short order -- if that happens, stop taking them immediately and call me."

(And I seem to recall knowing someone else via LJ who does have the form of depressive disorder that responds medically like bipolar rather than like the more-usual depressive disorder, but doesn't come with hypomanic episodes.)

I do remember, in discussions around both of these, getting the impression that the idea that such things existed was relatively new, and that the were finding that a lot of people hadn't been diagnosed because the meds for bipolar things weren't being used for people who weren't Bipolar according to the DSM....

[navrins]

Sounds a lot like me, except that when my mood falls it generally takes days, not minutes. Especially the last paragraph.

[xiphias.livejournal.com]

Well, taking days for the mood to fall is usually more typical of major depression. Taking minutes is usually more typical of bipolar-type-stuff. So, if you were on drugs to treat it, as I understand it, odds are that SSRI-type stuff would help more than anti-bipolar-type stuff.