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Is this bipolar?

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pumpkinc

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Hi there. I am new here. My husband, who is 51 years old, has struggled with depression and anxiety for many years. He also has intrusive thoughts. He has been on several kinds and doses of medication, but with the pandemic and other stressors, he is very off kilter.

Doctors have asked in the past if he thinks he is bipolar, but we dismissed it because although he has periods of extreme depression and manic behaviors, he is never "euphoric" or even just really happy. He wavers between really down, hopeless and irritable and reasonably stable and ok.

We seem to have really run into a wall with treatment, and he is really struggling. I am wondering if one can be bipolar without euphoric highs. Also, what other mental health illnesses fit this description?

Thank you in advance for your thoughts and support. This is really hard.
 
Wishbone

Wishbone

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Hi welcome. You can have euphoric mania or dysphoric mania. The latter being mixed up and irritable etc. So yes, it could well be right but that's for the docs to decide. You can also be irritable with depression though. What are his mood patterns like: daily, weekly, a few months, long gaps in between, always swinging between etc? Any other things that would be suggestive other than depression and irritability? How is his sleep?
 
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pumpkinc

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Aa for moods, he can be fine for a few days but then something happens that knocks him off his game and he falls hard. There used to be more time between episodes but that has changed since the pandemic and its added stressors. In general, his reactions are far stronger than the cause. He is convinced that everything is going to go wrong- the future of our children, his job, our financial stability, although there is no clear sign that any of that is true. Everything seems exaggerated and framed in the negative. He can't seem to just be. His mind seems to always be gaming out the next bad thing.
 
Wishbone

Wishbone

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I should point out that a dysphoric mania is one of the most horrible experiences and is known to be one of the most dangerous too, so you're not just talking about being snappy and angry and depressed, you're talking about being those things plus in and out of bouts of manic frantic energy where you feel like you want to burst out of your own skin or something. So what I would suggest is that if he's not doing things a lot faster than normal, a lot more angry than normal, and isn't showing any signs of any kind of a very good mood in with it all (because you can still have bits and pieces of this even in a dysphoric mania) then it might be more so a case of worsening depression. But I can only go on so much and I'm not a doc, I just know the condition pretty well. Have you spoken to him about it all?

Things I would look out for are:
- Is he able to maintain relationships at the minute or is he like the Tasmanian devil and falling out with everyone?
- Is he sleeping a normal pattern or is it more or less than usual?
- Is he drinking alcohol or anything like that more than usual?
- Is he engaging in anything else that could be considered reckless, like gambling, spending more money than usual etc?
- Has his sex drive changed recently?
- Is he taking on different tasks/jobs and seems more active than usual?
 
P

pumpkinc

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Nope, that is not him. He is very good at disguising his feelings and acting normal. Other than us, his family, I doubt anyone knows there is a problem. He has two personas- the public and the private. When he had a nervous breakdown several years ago, no one outside the family even knew.
 
Wishbone

Wishbone

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Ah okay. See for me that says it's not Bipolar because you can't control mania; you can't switch it on and off. You can pretend to be okay when you're depressed (although I couldn't if severely depressed) but the mania end of things is more a case of you doing things you wouldn't normally do, things you can't control, and at it's worst, things you didn't even know that you did.

I know you said he's had this before but it seems worse now because of the Covid stuff, but has he had plenty of periods since you've known him where he's totally normal or do you think there is always something there just in lesser degrees?
 
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SFGuy

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I was diagnosed with bipolar 2. I don’t have full-blown mania or any psychosis. I have mixed episodes when I am abnormally jacked up and depressed simultaneously. I also have hypomanic episodes in which I get a little grandiose, irritable, and sleep very little, and I have periodic killer depressions. To the outside world, I look ordinary. The suffering stays inside.

I had been diagnosed with anxious depression for decades and was only convinced I have bipolar disorder when I started a mood stabilizer at the suggestion of a new psych. It changed my life! Other than tranquilizers, psych. drugs had never worked for me before, but the bipolar drugs fixed things I didn’t know were broken.

It’s important to get the diagnosis right because meds for depression can make bipolar symptoms worse.

My own experience leads me to believe that a trial on a mood stabilizer or two might pay off.
 
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pumpkinc

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Thanks for your insights. Sounds like we were right to dismiss bipolar as a diagnosis. My husband is very good at dissembling. He's like a different person with "outsiders" than he is with insiders, so he definitely has control over how he interacts with the outside world. It's just that with me, I guess he feels safe, so his defenses are down.
 
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pumpkinc

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Thank you for your comments. I'm glad you have found some relief. What drugs fall under the umbrella of mood stabilizer?

I was diagnosed with bipolar 2. I don’t have full-blown mania or any psychosis. I have mixed episodes when I am abnormally jacked up and depressed simultaneously. I also have hypomanic episodes in which I get a little grandiose, irritable, and sleep very little, and I have periodic killer depressions. To the outside world, I look ordinary. The suffering stays inside.

I had been diagnosed with anxious depression for decades and was only convinced I have bipolar disorder when I started a mood stabilizer at the suggestion of a new psych. It changed my life! Other than tranquilizers, psych. drugs had never worked for me before, but the bipolar drugs fixed things I didn’t know were broken.

It’s important to get the diagnosis right because meds for depression can make bipolar symptoms worse.

My own experience leads me to believe that a trial on a mood stabilizer or two might pay off.
 
S

SFGuy

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What drugs fall under the umbrella of mood stabilizer?
I don’t know them all, but here are a few common ones: Lithium, Lamictal, Depakote/Valproic Acid, and Tegretol.

Some doctors use some of the new antipsychotic drugs like Aripiprazole, Quetiapine, etc., which gives them even more options.

I have tried Lithium, Lamictal, and Depakote. I’m glad I had 3 choices because Lamictal and Lithium had intolerable side effects in me. It can take some trial and error to find the right one since we’re all so different psychiatrically and medically.

I wish your husband and you luck finding the right diagnosis and meds.
 
E

emmaleemochizuki

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I am not a medical professional.

But personally I don't think it's bipolar but definitely get a psychiatrist to have a closer look.

both mood stabilisers and antipsychotics can be used as a mood stabilising agent. if your husband does not have bipolar, medication would most likely not work.

it sounds that most of your husband's triggers are rather interpersonal, then I would suggest therapy? getting the right diagnosis is quite essential when it comes to getting the right treatment.

also bipolar tends to start much earlier on, I was diagnosed in late teens.
 
Wishbone

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Has he ever been on antidepressants, or is he on them now, and if so, how did he react to them? @pumpkinc
 
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keith74

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Ah okay. See for me that says it's not Bipolar because you can't control mania; you can't switch it on and off. You can pretend to be okay when you're depressed (although I couldn't if severely depressed) but the mania end of things is more a case of you doing things you wouldn't normally do, things you can't control, and at it's worst, things you didn't even know that you did.
I've seen that it is possible (to some degree) to control your actions a bit while manic. I found this out in my wife's last dysphoric manic episode. She would rage hardest at the people closest to her (family) but be able to keep things somewhat under control for a short period of time when she feels it is in her best interest. Her psychiatrist explained that this is because of an overactive amygdala during a manic episode. The key thing though is that people in this situation can only maintain this control for a short period of time. It is pretty common for someone who is manic to be most harsh against the people they are closest to since they feel like they can get away with it the most.
 
Wishbone

Wishbone

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I can only go by what I've read and my own experiences of it and I was not able to do a damn thing about it because I didn't even know it was happening at the time, I was out of it that much.
 
JessisMe

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It sounds like standard depression to me. xo, j
 
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