I’ve had this post in the hopper for a while, and finally decided to publish it after reading another blogger’s post today about what she believes are the differences between Bipolar I and Bipolar II.  Basically, I believe she is incorrect.  But thinking about the real differences between Mania and Hypomania prompted me to write a post about how I believe my diagnosis of Bipolar II may be incorrect, and the thought process that drove me to the conclusion.

Last year, I was hospitalized for depression.  I was fed a whole slew of antidepressants and within three days the Drs were calling my miraculous turnaround a success story.  They promptly pushed me out the door and onto the street.  What they incredibly seemed not to realize is they let me discharge in a full-fledged manic state.

Yes, psychiatrists should know better – they should know that patients who show such marked improvement on antidepressants over such a short period are Bipolar and that a completely different intervention is called for.  There are many studies citing just how bad antidepressants are for BP, and many of those even go as far as crying out for elimination of antidepressants from everyone’s Bipolar cocktail.  But then there are those psychiatrists like the ones I came across, who are only interested in treating the immediate symptoms and turning over a bed in a ward.

Eventually, I did come down out of the clouds, was able to function on this plane again and found a psychiatrist who knew what to do with me.  Unfortunately, this was after a lot of damaging behavior on my part. My new psyc and I tried new drugs, tweaked my cocktail and fine tuned all meds.  Now, I’ve finally arrived at a place where I am basically OK.  At the end of all the med mixing, my psyc did say something pretty interesting.  That although I was diagnosed as BP II, I respond to med as a BP I would.  This got me thinking.

As far as I can discern from the DSM IV and the proposed criteria for BP in the DSM 5, the major difference between the two types of BP is to what degree the manic episode was debilitating to the sufferer.  This excerpt regarding mood severity is from the proposed criteria for a manic episode in the DSM 5:

The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. 

The italicization of the ‘ors’ is mine.  Because there sure are a lot of ‘ors’ in this full-blown-mania criteria.

This excerpt is from the proposed criteria for a hypomanic (or lesser-mania) episode in the DSM 5:

The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.

Again, italicization is mine.  Because this time, although there are still ‘ors,’ with the ‘and’ present, it changes the game.  Mania may have psychotic features, but hypomania does not.  Mania encompasses an impairment in day-to-day functioning, but hypomania does not.  Also, note that in both the DSM IV and the DSM 5, it explicitly states that when in a Mania, hospitalization is definitely in the ‘or’ category and is not necessary to diagnose a full-blown Mania.  This last piece of criteria is what I have seen misquoted time and time again – hospitalization is not necessary to diagnose a full-on Mania .

So, after digesting all the DSM IV and DSM 5 verbiage and ruminating on my behavior from both my personal view and contributions by second parties, it is the severe impairment piece that is the lynchpin to my suspicion I may be Bipolar I.

I can honestly say although I have never experienced psychotic features, my occupational functioning was hugely impaired – I was vibrating so much, I simply could not and did not work for the first two weeks out of the hospital.  It was during this time I also, ‘…engaged in unusual social activities and relationships with others,’ and to this day really don’t remember a large chunk of that period of my life.

For those of you familiar with the DSM, you may have by now spotted a hole in my thought process.

Episodes of Substance-Induced Mood Disorder (due to the direct effects of a medication, or other somatic treatments for depression, a drug of abuse, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Bipolar I Disorder. (DSM IV)

But, I had previously been diagnosed with BP and medication-induced switching happens.

As of late 2007, three recent studies have addressed the question as to whether antidepressants can induce switches into mania or hypomania. The bottom line: switching happens, but now often seems to vary widely, depending on the patient, and to some extent on the antidepressant chosen. (Read more here.)

Especially for those on the antidepressant I was given, bupropion (Wellbutrin ).  Even my psyc confirmed this.  There’s no doubt in my mind I am living proof that switching happens.  So, I am now back to the question of Mania or Hypomania.

Given the severe impairment I experienced while clearly displaying two of the four Mania criteria listed above, and a further five of the seven pieces of criteria listed in Part B in the DSM IV for a Manic episode, I now believe that what I experienced was a true Mania as a result of antidepressant ‘Switching.’

Why haven’t I brought this up with my psychiatrist – the one who commented that my reaction to medication is more akin to someone with Bipolar I than Bipolar II?  Because by the time I was stable enough to reason all of this out, I’d relocated.  I need to find a new shrink.  I’m sad that the relationship with my wonderful Dr had to end, and even more sad that we’ll never have the opportunity to explore this hypothesis together.

I am afraid of having my diagnosis changed.  I am petrified the possibility of experiencing psychotic features may have grown. But, I have to put on my big-girl-pants, level with my new psyc and see what they have to say.  If I am truly BP I, what changes, if any, will have to happen to my treatment?  I am not sure.  But, I need to find out.  Because as we Bipolar sufferers know, BP just doesn’t get any better.  It degrades and worsens without the proper treatment.

I know this is an exceptionally long post, but if you’re still with me and if any of you have had the experience of having your diagnosis changed from BP II to BP I, I’d love to hear from you.

Advertisements