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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by tina on June 11, 2000, at 7:53:43
Can bi-polar disorder cycle as fast as day by day? I have these really up, active, fun days and then the very next will be down, depressed and disgusting. Then I can go into rages and pacing fits. Can it cycle that fast or is it something else entirely? Thanks in advance for any and all input--Hugs to all--Tina
Posted by Mark H. on June 11, 2000, at 12:16:40
In reply to To all bipolar sufferers, posted by tina on June 11, 2000, at 7:53:43
Hi Tina,
Decades before I was diagnosed with bipolar, I experienced the kind of day-by-day extremes that you describe, so I would say "yes." Since most of what I've experienced on the "up" side has been hypomania, it was only recently that I experienced how unpleasant something approaching actual mania can be. Perhaps someone with more bipolar one experience could tell you the subjective differences between rapid cycling and mixed-state mania, which might be useful in helping you (and your doc) decide on a course of medication.
I recently tried an anti-psychotic that is also used as a mono-therapy for bipolar called Zyprexa. It's immediate effect was to enable me to sleep for 16 hours (it didn't "knock me out," but once I was asleep, I slept for a very long time). Then I felt more happy than I had in a long, long time, but there was an artificial, edgy, almost "metallic" quality to my happy mood. My closest friends didn't much like it.
After a couple of weeks on Zyprexa, I realized that the mania had passed and that I needed to stop the drug, which was affecting my work and attitude adversely (a real "didn't care" attitude). But I am glad and grateful to have it on hand should the mania return at some point in my cycle.
You may be "cyclo-thymic" or bipolar or simply allergic and moody right now. Clobbering your system with lithium may or may not be the right thing to do. Two decades ago, daily evening doses of Valium helped even out my days -- I'm suggesting that you and your doctor may need to experiment to find something that helps, and that it may or may not be a classical treatment for bipolar.
I hope others chime in with more seasoned advice.
Best wishes,
Mark H.
Posted by SLS on June 11, 2000, at 12:54:37
In reply to To all bipolar sufferers, posted by tina on June 11, 2000, at 7:53:43
> Can bi-polar disorder cycle as fast as day by day? I have these really up, active, fun days and then the very next will be down, depressed and disgusting. Then I can go into rages and pacing fits. Can it cycle that fast or is it something else entirely? Thanks in advance for any and all input--Hugs to all--Tina
Dear Tina,Yes, it can happen, although it is not a frequent occurrence. Usually, such a rapid-cycling disorder shows an extremely regular pattern - sometimes right down to the hour. It might be a good idea to create a daily mood chart that will allow you to discover if you do have such a pattern. You could try rating your mood by using numbers from 0-10, 0 being the worst. You may want to rate yourself 3-5 times a day, always at the same time. Also, take note of how well you sleep day to day.
It sounds like you are doing the right thing by investigating the possible causes of your distress. Good luck.
Perhaps you can describe in somewhat more detail what you experience and how it affects your life.
- Scott
Posted by judy1 on June 11, 2000, at 19:12:02
In reply to To all bipolar sufferers, posted by tina on June 11, 2000, at 7:53:43
Hi,
I used to have "ultra-rapid cycling" which was very similar to what you're describing. I think I was on depakote, klonopin, risperdal and effexor at the time. Once I stopped all anti-depressants I wasn't as unstable and fell into a more traditional rapid cycling- about 2 weeks of mania, a month of depression. My mixed episodes have been feelings of both states at 1 time- racing thoughts, agitation, paranoia and suicidal. They're the worst. If you're on an anti-depressant I would talk to your pdoc about stopping it. What meds are you on? Take care- Judy
Posted by Andre Allard on June 11, 2000, at 19:41:45
In reply to To all bipolar sufferers, posted by tina on June 11, 2000, at 7:53:43
I am not bipolar but I have studied the disorder extensively. Ultra-rapid cycling is or any cycling for that matter is known as bipolar II. People with this disorder do not reach full blown mania but rather hypomania. It is rare to cycle several times within a day but it does happen. Rapid cycling is cycling a minimum of four times in a year. The onset of bipolar II does not begin with ultra-rapid cycling. Bipolars who cycle rapidly have or will cycle normally. One factor a pdoc will look at when diagnosing bipolar disorder is family history.
Last summer, I thought that I was experiencing hypomanic at times and I expressed this to my pdoc. When I was in his office talking to him, sometimes I felt this "adrenaling rush" and expressed this to him also. Even though I had a flight of ideas, my speech was pressured and I felt like jumping around in his office he stated that hypomanics do not just think about it, they actually do it. He told me that if I was hypomanic, that I would not be able to shutup, that I would be talking about ludicrous things and that I would not be able to sit still in my chair.
One easy way to determine hypomania is little sleep. Not just insomnia from ADs but rather 2-3 hours of sleep a night and waking up feeling energized. Full blown mania is characterized by days on end without sleep. So if you are sleeping more than six hours a night then you can rule out bipolar disorder. I hope this helps. Good luck!
Posted by Janice on June 11, 2000, at 21:51:22
In reply to To all bipolar sufferers, posted by tina on June 11, 2000, at 7:53:43
Hi tina,
yes, that's called ultra rapid cycling. Some people with this get misdiagnosed with Borderline personality disorder.
I once worked with a man that cycled every 24 hours. Every second day, he was cheerful and pleasant, and every other day, everyone tried to stay far away from him as possible. A depressed person + a rather mean natural temperment + alot of power = an a**hole was the general consensus in the office.
Rages are pretty common in bipolar (me, me, me!).
Like Scott said, I'd keep track of your moods and your sleep to see if you notice any patterns.
Tina, You may also want to look into ADD/ADHD - raging and pacing fits could also be symptoms in this disorder, so would depression.
Good luck, Janice
I agree with Judy about the anti-depressants.
Posted by Janice on June 11, 2000, at 21:57:14
In reply to Re: To all bipolar sufferers, posted by Andre Allard on June 11, 2000, at 19:41:45
Hi Andre, (French was my mother tongue, and I am unsure as to whether I've spelt Monsiour correct)
Although what you wrote is a good general description of the various bipolar states, I could easily, by my experience alone, contradict at least half the statements you wrote.
What your doctor told you here:
that if I was hypomanic, that I would not be able to shutup, that I would be talking about ludicrous things and that I would not be able to sit still in my chair.
sounds only partially correct to me. There are many states of hypomania, and the one that he is describing sounds like one getting closer to mania.
I had a flight of ideas, my speech was pressured and I felt like jumping around in his office he stated that hypomanics do not just think about it, they actually do it.
Not in the earlier part of the hypomania.
just in case you may want to reconsider bipolar, Janice
Posted by judy1 on June 12, 2000, at 0:14:31
In reply to Re: To all bipolar sufferers, posted by Andre Allard on June 11, 2000, at 19:41:45
Andre,
I'm diagnosed bipolar 1, rapid cycling and have suffered psychotic manic episodes more times than I care to admit. Rapid cycling is a phase of bipolar- either 1 or 2, and simply means 4 or more episodes a year. Just thought I would throw that in. Take care.
Posted by tina on June 12, 2000, at 7:57:10
In reply to Re: To all bipolar sufferers, posted by Andre Allard on June 11, 2000, at 19:41:45
Well, from what you all have described, I don't really have BPD just some kind of weird depression/anxiety. Sometimes I do pace around not able to sit still for hours at a time and I do have days when people tell me to shut up because i'm talking too much and not making sense. Some of the stuff you all said sounds pretty familiar but I think I'm just being a hypochondriac. Thank you all for your input though, very useful information. Take care and I love you all--Tina
> I am not bipolar but I have studied the disorder extensively. Ultra-rapid cycling is or any cycling for that matter is known as bipolar II. People with this disorder do not reach full blown mania but rather hypomania. It is rare to cycle several times within a day but it does happen. Rapid cycling is cycling a minimum of four times in a year. The onset of bipolar II does not begin with ultra-rapid cycling. Bipolars who cycle rapidly have or will cycle normally. One factor a pdoc will look at when diagnosing bipolar disorder is family history.
>
> Last summer, I thought that I was experiencing hypomanic at times and I expressed this to my pdoc. When I was in his office talking to him, sometimes I felt this "adrenaling rush" and expressed this to him also. Even though I had a flight of ideas, my speech was pressured and I felt like jumping around in his office he stated that hypomanics do not just think about it, they actually do it. He told me that if I was hypomanic, that I would not be able to shutup, that I would be talking about ludicrous things and that I would not be able to sit still in my chair.
>
> One easy way to determine hypomania is little sleep. Not just insomnia from ADs but rather 2-3 hours of sleep a night and waking up feeling energized. Full blown mania is characterized by days on end without sleep. So if you are sleeping more than six hours a night then you can rule out bipolar disorder. I hope this helps. Good luck!
Posted by SLS on June 12, 2000, at 9:42:04
In reply to Re: To all bipolar sufferers, posted by judy1 on June 12, 2000, at 0:14:31
Dear Tina,
I'm so sorry to hear that this crap is still going on with you.
Have you ever tried Tegretol? This drug is particularly favored in ultra rapid-cycling presentations. Also, if you haven't tried combining both lithium and Lamictal to your other treatments, I would recommend that you look into it.
Good luck.
Sincerely,
Scott
> I'm diagnosed bipolar 1, rapid cycling and have suffered psychotic manic episodes more times than I care to admit. Rapid cycling is a phase of bipolar- either 1 or 2, and simply means 4 or more episodes a year. Just thought I would throw that in. Take care.
Posted by SLS on June 12, 2000, at 9:48:29
In reply to Re: To all bipolar sufferers, posted by judy1 on June 12, 2000, at 0:14:31
> Dear Tina,
OOPS !!
Dear Judy,
(and Dear Tina),
-------------------------------------
I'm so sorry to hear that this crap is still going on with you.
Have you ever tried Tegretol? This drug is particularly favored in ultra rapid-cycling presentations. Also, if you haven't tried combining both lithium and Lamictal to your other treatments, I would recommend that you look into it.
Good luck.
Sincerely,
Scott
> I'm diagnosed bipolar 1, rapid cycling and have suffered psychotic manic episodes more times than I care to admit. Rapid cycling is a phase of bipolar- either 1 or 2, and simply means 4 or more episodes a year. Just thought I would throw that in. Take care.
Posted by judy1 on June 12, 2000, at 13:17:12
In reply to Re: Sorry - I meant Dear Judy » judy1, posted by SLS on June 12, 2000, at 9:48:29
Hi Scott,
Unfortunately I have been through all the mood stabilizers (including lamictal, neurontin and topiramate) and combos. I am just extremely treatment-resistant, and feel ECT isn't acceptable for me. Essentially, we (pdoc and I) put out fires- step up neuroleptics when needed, hospitals when all else fails. Lamictal was great for depression, although I got hypomanic (which although I love being that way, no one else seems to). Thank you for your compassion, if you know of anything experimental that I haven't tried, please let me know. Take care.
Posted by SLS on June 12, 2000, at 13:51:31
In reply to Re: Sorry - I meant Dear Judy, posted by judy1 on June 12, 2000, at 13:17:12
Hi Judy.
Two comments:1. A relatively new anticonvulsant is being looked at for treating bipolar disorder. It is called Gabitril (tiagabine). I have absolutely no impression of it one way or another, except to say that a doctor I recently had a consultation with recommended that I consider it.
2. The Department of Biological Psychiatry at the NIMH stresses that the benefits from mood-stabilizer therapy may not appear for six months to a year when treating ultra-rapid cycling bipolar disorder. They have also found it necessary to combine two or three of them to reap any rewards. If you can establish a regime of two or three mood stabilizers that you do not find otherwise offensive, you might consider their observations regarding the time course of improvement.
What combinations of mood stabilizers have you tried, and for how long?Any nasty side effects?
I don't know to what degree Zyprexa acts to reduce rapid-cycling. Do you know?
- Scott
> Hi Scott,
> Unfortunately I have been through all the mood stabilizers (including lamictal, neurontin and topiramate) and combos. I am just extremely treatment-resistant, and feel ECT isn't acceptable for me. Essentially, we (pdoc and I) put out fires- step up neuroleptics when needed, hospitals when all else fails. Lamictal was great for depression, although I got hypomanic (which although I love being that way, no one else seems to). Thank you for your compassion, if you know of anything experimental that I haven't tried, please let me know. Take care.
Posted by judy1 on June 12, 2000, at 20:27:48
In reply to Re: Treating rapid-cyclicity » judy1, posted by SLS on June 12, 2000, at 13:51:31
Scott,
I'm seeing my neurologist (see new thread) on Friday and will ask about Gabitril, I'm not familiar with it and appreciate your suggestion. Your comment about being on mood stabilizers for a minimum of 6 months kind of threw me. My present cycling has been going on for about 3 years, before that I had been stable for 8 years, a professional with a husband and young child. I wasn't on any medications because I felt I was "cured" since I had not had problems since my early 20's. The long term readers of this site know about my bouts with noncompliancy, and until fairly recently have not taken a mood stabilizer or combination of mood stabilizers consistantly for over a month each. I know I am motivated now, but don't have a whole lot of faith in myself. I was on 20mgs of zyprexa daily for about 2 months, I gained about 30 pounds and loathed the way I felt-not capable of doing much but I sure didn't get manic. The pdoc I see now had me taper off of it and I'm on risperdal which helps me but does not prevent cycling. Thank you for your input and take care- Judy
Posted by Joanna on June 13, 2000, at 21:04:53
In reply to Re: To all bipolar sufferers, posted by Mark H. on June 11, 2000, at 12:16:40
Valium worked for me for a long time. Now it doesn't work if I get myself really revved up. I've been tapering off the valium at one a day since the end of May and had my pdoc put me on depakote. The depakote seems me from spiraling out of control but I have the munchies. Is this a common problem?
Joanna
Posted by Mark H. on June 14, 2000, at 10:51:24
In reply to Re: To all bipolar sufferers » Mark H., posted by Joanna on June 13, 2000, at 21:04:53
Joanna,
I don't know about the increased appetite with depakote, but Valium withdrawal does take a long time. When I quit taking it in 1980, my perceptions of time and tempo were not right for about 5-6 weeks, as I recall. Tapering is a good idea.
Clonazepam is helpful and seemingly benign (at least in my body). It is the least addictive of the benzodiazepines, promotes good sleep, and doesn't leave me feeling dopey the next morning.
Mark
Posted by PB and J.C. (my dog) on June 18, 2000, at 20:28:37
In reply to To all bipolar sufferers, posted by tina on June 11, 2000, at 7:53:43
Tina et. al
My first pdoc of 5 years diagnosed me as having
major depression. It was not until I hooked up
with my current pdoc in 1991 that I was diagnosed
as Bipolar II -- it certainly explained a lot of
the "up" times that my prior pdoc pooh-poohed.With that as an introduction, I agree with the
others in this thread that you can experience
rapid cycling - and even ultra-rapid cycling as I
have recently experienced. I didn't realize that
this could happen, until I met with my pdoc during my
first ultra-rapid cycling period and
we reviewed my daily charting diary and I told
her I was unable to chart specific days because I was
so up and down uneven. On my +5 (most hypo manic) to
-5 (most depressed) scale that I use, I was able to
identify days when I was anywhere from +4 to -4,
switching several times during any given day. As
some of the others in this thread have mentioned, my
pdoc told me to chart every 2-3 hours instead of
trying to chart for a whole day when I was feeling
so up and down uneven.An increase in my Lithium and other mood stabilizer
Lamictal broke the ultra-rapid cycling phase. Unfortunately,
we added Effexor XR for my depression and it set off
another round of ultra-rapid cycling. Currently
working on phasing out that med. The Lamictal, while
effective for me, is also being phased out of my daily
med regimen because once I got to a therapeutic dose,
I began experiencing major amnesia (see my thread
posted on this topic).Hope you find a med cocktail that works for you.
Best,
Philip & J.C.
Posted by Lorie on December 5, 2000, at 22:45:50
In reply to Re: To all bipolar sufferers » tina, posted by PB and J.C. (my dog) on June 18, 2000, at 20:28:37
Hi All:
I was diagnosed bipolar about 9 years ago...I've had 4 psychotic manic episodes in that time but 2 of them in the last two years. The first of those two I took stellazine and it would not get me back so I was given zyprexa and it worked miracles. I stopped taking it because I really didn't want to be dependent on anything besides lithium which I've come to accept and take religiously. Everything was fine until my father passed away about 6 months ago and I was back up again - not wanting to feel the pain. I took zyprexa again and it did work at getting me more grounded. Again after I felt more stable I stopped taking the zyprexa and was okay for about 3 months and just now started noticing symptoms of "going up" again so I'm back on it. I'm just wondering if I'm going to end up always on it. I appreciate it's super glue qualities for my psyche but the drowsiness is a drag - I can over sleep for hours.
This is my first time posting and thanks to all who have shared.
Lorie
Posted by SLS on December 6, 2000, at 6:37:52
In reply to Re: To all bipolar sufferers, posted by Lorie on December 5, 2000, at 22:45:50
> Hi All:
>
> I was diagnosed bipolar about 9 years ago...I've had 4 psychotic manic episodes in that time but 2 of them in the last two years. The first of those two I took stellazine and it would not get me back so I was given zyprexa and it worked miracles. I stopped taking it because I really didn't want to be dependent on anything besides lithium which I've come to accept and take religiously. Everything was fine until my father passed away about 6 months ago and I was back up again - not wanting to feel the pain. I took zyprexa again and it did work at getting me more grounded. Again after I felt more stable I stopped taking the zyprexa and was okay for about 3 months and just now started noticing symptoms of "going up" again so I'm back on it. I'm just wondering if I'm going to end up always on it. I appreciate it's super glue qualities for my psyche but the drowsiness is a drag - I can over sleep for hours.
>
> This is my first time posting and thanks to all who have shared.
>
> Lorie
Hi Lorie.I guess you must fully evaluate the benefits versus liabilities of taking Zyprexa indefinitely versus not taking it. Manic episodes tend to become more severe and more frequent with each successive episode, so prevention is critical. One option would be to add another mood stabilizer to the lithium. For me, Depakote acts as a potent antimanic when a mixed-state mania is provoked by medication. Lamictal has also shown itself to be a competent mood stabilizer, and is usually without significant side effects. It is not sedating. With Lamictal, it is important to start with a low dosage and increase it gradually over the course of four weeks. This helps to prevent a potentially serious allergic-type reaction and rash. After that, it can be manipulated as needed. It's a pretty clean drug. Using lithium plus another mood stabilizer might be worth a try.
By the way, you should be congratulated for recognizing the onset of mania and taking remedial actions to prevent it. Not everyone has this ability. I haven't in the past.
Congratulations on your first post! Well done.
Sincerely,
Scott
Posted by KarenK on December 6, 2000, at 8:16:47
In reply to Re: To all bipolar sufferers » Mark H., posted by Joanna on June 13, 2000, at 21:04:53
Joanne,
Yes, I call it the depakote munchies. I had to lower the depakote and add topamax because I gained too much weight on the depakote even though it did work better in many ways. I take it for anxiety not bp. My son takes it for bp but he hasn't gained any weight from it.
Love,
Karen
>
> Valium worked for me for a long time. Now it doesn't work if I get myself really revved up. I've been tapering off the valium at one a day since the end of May and had my pdoc put me on depakote. The depakote seems me from spiraling out of control but I have the munchies. Is this a common problem?
>
> Joanna
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