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Tuesday, December 20, 2011

Ultra Rapid Cycling Bipolar Disorder

OMG! Watch out for flying pigs!  DUCK!

Pigs in Spaaace

Something I have been harping about for years was finally correctly set straight in - of all places - a throwaway, drug-company supported, pharmaceutical-advertisement infested psychiatry journal - Current Psychiatry. Frozen hell!


In an article by Joseph F. Goldberg M.D., a clinical associate professor of psychiatry at the Mount Sinai School of Medicine in New York, the following summary was highlighted as a "bottom line: "Ultra rapid cycling [bipolar disorder] has not been validated as a distinct clinical entitiy, and frequent mood swings should not be used as a criterion for diagnosing bipolar disorder."

In the diagnostic Bible, the DSM, a rapid cycling bipolar disorder is defined as an individual who has four episodes of depression or mania per year, not per hour.  Yet the "bipolar disorder is everywhere" crowd has insisted for decades that there was such a beast as an "ultra-rapid cycler."  Thus anyone who was moody, had a sudden mood change no matter how brief, or had  the unstable emotions characteristic of individuals with borderline personality disorder, was suddenly "bipolar" and in need of medication for his "bipolar spectrum disorder." 

"Psychotherapy? What's that?" they seem to say.

The supposed existence of rapid cycling was advanced as an argument against using anti-depressant medication in bipolar patients having a depressive episode, because the drugs allegedly induced it.  This argument was even picked up by Robert Whitaker, author of Anatomy of an Epidemic, as a possible reason to be cautious about using antidepressants in general.  An argument based on a phenomenon invented by some psychiatrists that does not even exist!

Funny how after having practiced for 35 years in two states, with a wide variety of clinical populations, and specializing in the treatment of borderline personality disorder, I have never seen rapid cycling, with the possible exception of one case in which sudden episodes of psychosis (not mood changes) would come and go without warning.  Maybe I've just been lucky.  Or rapid cycling could be so rare as to be nearly non-existant.

When I first saw the cover of Current Psychiatry under discussion, I must admit was prepared for the worst.  "Oh no, not again,"  I thought. At least, I figured, I would have more material for a new post with another scathing attack on the whole bipolar spectrum craze.

Then I read the article.  What a pleasant surprise.

Meanwhile, in other myths-about-bipolar-disorder news, a new small study seems to contradict a bit of current conventional wisdom about the disorder: A study published in the January issue of the Journal of Affective Disorders (Baldessarini et. al.,136, 2012 pp. 149–154reported: "Patients with bipolar I disorder show disease progression that is random or even 'chaotic.'"

After following 128 patients with bipolar I disorder for about six years to assess "inter-episode intervals (cycle length)," researchers found that "most current bipolar I disorder patients are unlikely to show progressive shortening of recurrence cycles."

In the past, the impression that bipolar patients had episodes more frequently as they got older, the authors believed, was a statistical artifact caused by a minority of patients with frequent recurrences!

As most of these subjects were being treated with medications, and were probably going on and off of them every so often as patients are wont to do, this is evidence that the treatments do not make bipolar disorder worse over time.

49 comments:

  1. It's good to see the other side of the issue.

    Current Psychiatry is edited by Dr Henry Nasrallah and Dr Joseph Goldberg, so I'm not so surprised to see it in this particular Journal.

    Jim Woods in Memphis

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  2. Though considered a "throw away," I'm consistently impressed with Current Psychiatry. I usually always read something clinically useful. That much can not be said for most journals.

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  3. I was diagnosed as bipolar type 1 many years ago. For me it has been a case of the intervals between episodes being longer. Also, the severity of the episodes have become less severe.
    I put these changes down to me having a strong desire to manage my disorder effectively. I have achieved this by much research into it. Using what I have learned about bipolar has given me back the ability to regain control of my life.

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    1. Thank you ray for your words. They will be inspiration for me for the next two minutes. I suffer from ULTRA rapid brain cycling bipolar 2 disorder. yes I'm doing further reasearch on my mental illness and refuse to continue to be a victim to this debilitating illness. Oh and to surprise you: I am a 32 ye old black divorced mom with a very inquisite mind and I'm tired of keeping quite about my mental struggles..

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    2. My situation is similar, same dx. I wish there was a way for us to talk, as I have the same dx and people do not understand this. I call it horror in my brain. I am very well educated and feel as though people think I am an idiot. I am tired of the stereotype and feeling that my dx must be a secret because of embarrassment and that I am not working because I am lazy.

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  4. My cognition is poor due to short term use of Risperdal and Geodon. Most of the positive parts of my personality and abilities have been destroyed. My reading comprehension is diminished, but I'm glad I can still read, so if my comment seems out of place I appologize.
    I don't know about rapid cycling but antidepressants absolutely cause mania. No doubt. I had never been manic before in my life before taking an antidepressant. After less than a week of taking lexapro- less than a WEEK!!!- I became manic off and on for MONTHS. Not to mention the muscle problems that started and breathing problems and all kinds of other things because this stuff interferes with the communication of the brain with itself and with the body. ALL OF THE PSYCH DRUGS DO.
    Sorry, but I am pissed. I'm probably going to have to commit suicide now, and I'll be just another dead uncounted psychiatry victim.
    Oh, I haven't read your book, but I suspect I'll agree with you on quite a lot.
    Thank you for reading my angry post and letting me vent some of my frustration and anguish at the horror and injustice of my situation.

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    1. I agree with u...after taking an antidepressant for depression when I was 16...I had a manic episode 4 months into treatment...since then I was taken off...my depression is still intense and repetitive...my mania continues and I get psychotic...I'm hardly normal...I feel eventually suicide is to come...and I don't think I'll ever recover

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  5. Anonymous,

    Antidepressants certainly can induce full-blown mania in some folks (and I'm not talking about the brief "mood swings" that seem to get that label nowadays).

    The question is whether or not that only happens in people who have manic-depressive disorder in the first place, since the first episode of mania can occur on its own later in life, and the first episode of depression often occurs first. We don't really know if mania induction can occur in others.

    Until we have a definitive lab test for the disorder, antidepressants always have that risk, particularly in those with a family history of real bipolar disorder.

    I cannot really know what or what was not caused by anti-psychotic medication in your case, since I'd need to know a whole lot about you in order to do that.

    I sure hope you are not really planning to hurt yourself.

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  6. I have a lot of changes in my bi-polar. I call it second to second. Really, I can be talking on the phone rationally for a few minutes then start crying for no reason. Then I'll stop resume the conversation. This happens through out most conversations, I'm a riot to talk to. I don't realize it until after the conversation. That is my story. Try living with me. My usual comment is hold on I'll be back in a minute.
    walk away. I am petrified of the ides of grou ps. I wan't to go back to work but that ain't going to happen. Oh well, I'll cope with what I have. I have NO short term memory at all. I write everything down in my journal and hope I get everything. I have a mini Schnauzer and we try to get by.

    Jaklyn

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  7. i am a wife of a rapid cycler,he was diagnosed 9 years ago with bipolar, but he has been having too much episodes last 3 years, recently he found his TSH high with borderline T4, probably due to lithium which he used several years alternating with other mood stablizers like lamictal, valproate.
    i have a question, does correcting his thyroid status by thyroxine supplements will solve the problem?

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    1. Hi Anonymous -

      I obviously can not say whether or not any of the following applies to your husband's psychiatric or medical issues, but your question is certainly worth looking into.

      Some potentially useful information:

      When lithium affects the thyroid, it is reversible. That means that when someone stops taking it, the thyroid level returns to normal in the absence of thyroid disease from another cause.

      Low thyroid levels from whatever cause can indeed cause psychiatric symptoms like depression in some people, and can be corrected with thyroid supplementation (and that includes in cases of lithium-induced low thyroid).

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  8. nice idea..thanks for sharing....

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  9. Hello I am actually diagnosed with Ultra Rapid Cycling Bi-Polar, by no less than four individual Psychiatrist's? I live in Great Britain and I can no longer work because of my swing cycle I suffer from as many as four cycles a day with the manic end being soul destroying because the process of trying to hang on to one train of thought becoming such it is impossible to function. I have a full time carer/wife 24-7. My low's are just as dramatic as the manic. I have a regular contact and with both my mental health nurse who visits me at home every couple of weeks. I have a number for a back up crisis team 24-7 and have very regular assessments by the psychiatrist. I do not here voices nor have any any other delusions that I am honestly aware of. I function at a good level and don't at others. I have been like this for many , many years I was originally diagnosed as just having bi-polar but mine has certainly gotten worse. I used to design and build power stations all over the world- now I am lucky if I can have an average day. I have never sent anything or read up on anything to do with my illness before today too scared I suppose of the jump on the band wagon this weeks fashionable illness of the stars is??? I found your ideas interesting but from this prospective maybe because you have never seen it it does not exist slightly off the mark. I should know I am the equivalent perhaps of your (no offence meant) personal yeti. Thanyou for your time.

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    1. Bless your heart, my son is the same its an all day every day cycle he is only 12 and has been battling this disease since he was only 3 I make sure he knows I love him so much I only wish for one day I could switch him places for he suffers so and I struggle knowing how to help he struggles terrible in school and beats up kids when they hit a trigger I am desperate for help! I cannot stand how doctors act like its not possible well it's an all day every. day thing here may God bless u!!!!

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  10. Hi Anonymous,

    Thanks for writing. Unfortunately, as you probably know there is no way I can comment about your particular case, which diagnoses you may or may not have, or what physical, environmental, and emotional factors may be contributing to your symptoms.

    What you describe sounds more like what we call "affective instability" that bipolar disorder, although it may be nothing of the sort.

    And of course there are people whose symptoms do not fit neatly into any psychiatric diagnostic category, psychiatric diagnoses being what they are.

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    1. I'm diagnosed with schizoaffective disorder, bipolar type.

      I went years without any proper diagnosis except "depression" ~ which really did not cover what I had. Until I went completely crazy in late 2010 and FINALLY they saw The Truth!

      The full-blown bipolarity only started a couple of years ago when I was 38. I woke up late one day so miserable it took over 4 hours to get it together to get out of bed, I was that depressed. Within 8 hours of this I was hearing voices and feeling very high. One particular day, a few days after this, I remember being manic and psychotic in the morning and evening yet depressed and psychotic in the afternoon. The full mood switch took maybe 4 hours and it felt to me like real depression (no anger or irritability) with extreme guilt feelings and my body so slowed down I was practically catatonic.

      There were also times when I felt high and low at exactly the same time (not just manic energy with depressed mood: I mean euphoric and depressed mood at exactly the same time, and euphoric mood and suicidal ideation and euphoric mood with extremely depressive thought patterns ... all at different times. The manic and depressed moods were intertwined for much of the time early in the episode. I have a book with the DSMIII criteria for mania which points out that elevated/etc mood "may alternate or intermingle with depressed mood" ~ which is exactly what happened to me. Yet the DSM in their wisdom saw fit to remove that wording from subsequent editions.

      After about 10 days of mania, depression, paranoia and hallucinations things improved a bit, but for the next 6 weeks I kept a mood diary that recorded both hypomanic euphoria and depression on the same days for many days on end. (eg I'd feel depressed for most of the day, but get a hypomanic blip for an hour or two in the afternoon ~ that type of pattern.

      Then suddenly I launched up into psychotic mania so strong I lost the ability to read completely, couldn't follow what people were saying to me, had racing thoughts and psychosis so extreme I ended up completely incoherent. My mood and energy levels went extremely high during this time. I have a history of drugs (have tried everything) and I was way way higher up than any drug has ever taken me. During this period I easily met the DSM criteria for a manic episode ~ I checked afterwards and there is no doubt in my mind that whatever else I might have been, I was most certainly manic.

      So I did eventually go into a full-on manic episode but surely the period preceding this, with days when I must surely have met the full diagnostic criteria for both mania and depression in the same 24 hours several times and those for depression and hypomania many times more were more than "affective instability"... surely?

      + this year I've had what my friend calls mania and I call hypomania for at least 3 1-2 week periods, interspersed by a lot of depression so I certainly DO meet the description of "rapid cycling" ~ 4 or more episodes in any 12 month period.

      Sorry if this is a bit of a jumble but I want to make sense of this so any replies anybody can make would be much appreciated.

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    2. Hi Gledwood,

      Of course I can't diagnose you or give you medical advice from a blog post, so I can only talk in generalities, but things you might ask your doctor to consider if any of them seem to be relevant:

      1. There is such thing as dysphoric mania, which is also called a mixed state by some, in which the patient looks manic and acts manic but feels very depressed. Rare, but I have definitely seen it. (Unfortunately, the definition of a mixed state in the DSM makes no sense because it is contradictory).

      2. Another issue is that, if the doctor does not have a bipolar patient on a mood stabilizer, or does not yet know if the patient will respond to the mood stabilizer he or she is on, then starting an antidepressant can cause a very rapid shift from depression to mania.

      3. Stimulants/cocaine can also cause a real bipolar patient to quickly switch into mania.

      4. Manic patients who are put on anti-psychotics like Seroquel can feel very drugged, while still retaining racing thoughts and pressured speech.

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  11. This is a really interesting blog. This is the first post I have read of yours, but I appreciate how easy it is to read for a layperson. I found this post because I was searching for rapid mood cycling.

    Most of what I find for rapid mood cycling is related to bipolar disorder. In college I had an episode where in the space of about 10 minutes or so I went from really happy to crying, to paranoid that there were monsters outside my window, to wanting to punch my boyfriend who was there with me. It scared me a lot because they did not feel like my emotions. Shortly after that I went to the campus mental health clinic and spoke with the psychologist there. He didn't speak very good English and only met me for about 30 minutes, but he said I had rapid mood cycling and prescribed Prozac. No one said anything about bipolar disorder.

    That was many years ago. I recently saw a therapist. When I told her about the Rapid Mood Cycling she seemed somewhat concerned and said that was was close to borderline personality disorder.

    So I am confused. I know you can't speak for what another doctor diagnostic, but do you know if the lexicon back in 2002 for rapid mood cycling meant bipolar or borderline personality disorder or something else?

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    1. Hi Gamermom,

      Back in 2002, just as today, "rapid mood cycling" among many (incompetent) psychiatrists meant "I am calling this bipolar disorder even though it does not come close to meeting the accepted duration criteria."

      However, a lot of therapists and other psychiatrists also knew then that the description was mostly being applied to misdiagnosed patients who had borderline personality disorder, among other possibilities.

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    2. Dr. Allen, I was dx with Rapid Cycling Bipolar II, I am have a college degree in Psychology and I have know since I was very young that I had these issues with severe mood changes and as I call them, "triggers, that set me off", no suicidal ideations and my sleep patterns are fine. I was not familiar with Rapid Cycling, as when I was in college it was not even a dx at that point. So I have been trying to read up on it and the more I read, the more I do believe I have been misdiagnosed. My symptoms seem more like borderline personality disorder. I dont have the funds to keep being assessed and with health insurance deductibles at an all time high, tx are difficult. I just take the meds that I have been prescribed by a Psychiatrist and hope that I stay stable enough not to offend everyone around me. I surround myself with highly intelligent people that are aware of my "personality issues" and they stay loyal, however, people with lower intelligence I do not tend to stay friends with long.. in addition, as I get older, it is getting worse. I must take my meds on time everyday or I am looking at 24 hours at a minimum of horrible mood swings, and then a crash of depression in bed for anywhere from 2-5 days. As I am aging, I just want a proper dx with as little meds as possible. I commented on gamermom, because her case seems similar :) Just need help or a good inpatient program, preferably in warm weather with a spa...just kidding, sometimes it really feels like I just want to get away, but I cant escape my own brain. By the way, when I get the way we just say, "I am about to pull a Marie Osmond" I am always reminded of the time that she just left and drove up the coast. I love my kids and would never leave them, but I really want to do this sometimes! But once again, my brain will still be with me and I know it is no cure! Desperately seeking any advice.

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    3. Hi Anonymous,

      Finding effective diagnosis and treatment has indeed become more difficult of late, due to several cultural forces pushing for quick fixes in both psychiatry and psychology. And it does get expensive interviewing different practitioners, especially if you are not sure what to look for.

      It isn't much, but check out my posts on good psychiatrists and good therapists at http://www.psychologytoday.com/blog/matter-personality/201204/how-recognize-bad-psychiatrist and

      http://www.psychologytoday.com/blog/matter-personality/201205/finding-good-psychotherapist

      I wish I could be of more help.

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  12. Today, I have been diagnosed with rapid cycling bipolar disorder. I am willing to indulge the idea that something about me is not quite "normal". In 1994 a psychiatrist told my mother I had a chemical imbalance I was 16 now 32.

    Today, I pleaded with my doctor please do not diagnose me with this disorder unless you are absolutely sure I have it, so after finding out that there are doctors out that don't even believe that the disorder exist, I am quit upset. I said to him can this be a reaction to all of the traumatic events that have offered in my life, my up bring/environment. He said no and prescribed Depakote the side effects of this medication seem to be worse than the disorder itself.

    I do have extremely severe mood swings! I have been promiscuous and engaged in risky behavior. I am educated and am well aware of the risk but
    chose to engaged in the behavior anyways. I can be extremely violent. Repetitious noise seems to bother me a lot. I do occasionally cry for no apparent reason.

    Thank You,

    Susie

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    1. Anonymous,

      Obviously I can't offer you a diagnosis in this forum, but if you had a traumatic upbringing, engaged in risky behavior clearly knowing it was risky, and seem to cry for no reason at all (I bet there is, in fact, a reason), then you owe it to yourself to get a second (or even a third) opinion if you can.

      And ask the doctor if your mood swings meet the duration criteria for manic and/or depressive episodes according to the current DSM standard.

      Depression - minimum two weeks straight, all day every day, no matter what is going on in your life. Mania - seven days, all day every day, no matter what is going on in your life. "Hypomania" - four days, all day every day. And all these moods states should be MARKEDLY different from the way you feel normally.

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  13. In 2004 I was diagnosed with menopausal depression. Went on psyche meds for 3 weeks was myself so I went off meds by 3months. Same month in 2005 I went down again and was diagnosed with bipolar disorder. I take Seroquel, an anti phyc, and Trileptal, an anticonvulsant. Both worked for me for 7 years. Now at 58 in 2012, the same month as 7 years ago, I went down into a bad depression. My doc upped my meds by 100 mgs each. First the Seroquel from 200mgs to 300mgs a day. After 5 weeks nothing still depression bad. Then she upped the Trileptal from 600mgs a day to 900mgs. After 2 1/2 weeks I have first after 2 days on the increase Trileptal and increased Seroquel I was good, more myself. Then went higher, too high by the 5th day. Then I went down again for 2 days then high more myself for 3 days. Then for 5 days I was low. Now for the past 2 days I am high but not more myself, uneasy high but not Manic high. Would you consider this rapid cycling? I am so confused and just want to be better, myself. The amazing thing is I knew exactly the day I was sick. And in 2005 I knew exactly the moment I was well again. I just turned to my husband and said I am myself again and stayed that way for 7 years on the meds. Mental illness is so confusing. Before I got sick I was an advocate for the Mentally Ill. I volunteered for 27 years at the local State Hospital. When this happened to me I totally started thinking, did I catch this? After all the education I received about how mental illness is like breaking your arm or having heart disease and giving all the speeches to that effect. When it happens to you it's a whole different ballgame.

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    1. Anonymous,

      Once again there is no way for me to make a diagnosis on you in this forum, but you do not describe anything that sounds like mania in your post.

      If your first mood episode really took place when you were menopausal, bipolar disorder would be very low on the likelihood scale.

      Major depression, recurrent would be consistent with what you describe, which, if that were the case, would be better treated with actual anti-depressants and not ant-ipsychotics like Seroquel, or anti-manic drugs like trileptal.

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    2. Thank you so much for taking the time to review my post. I truly appreciate it. I am def. going to get another opinion on my condition. I had what I would describe as a nervous breakdown during menopause. I could not eat or sleep for three weeks then I sought help. So now I will seek out new help. Thanks again.

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  14. EDITED
    Similar question: I go to a psychologist that says I have anxiety and am histrionic. I am wondering if I actually rapid cycle and he witnesses my ups and downs.
    I have previously been diagnosed with BD. It started when I d.c'd Prosac after taking it for many years. My Father was unquestionably Bipolar I with manic psychosis. My sister may be BD I too.
    Back to me. After going off Prosac I took Effexor. On Effexor I was all over the place. I was accused by young men 20 years younger than me of flirting (I wasn't) but I did hug and compliment freely and had overwhelming feelings of love for people. I can have so much charisma that I can feel that I draw people in, sometimes hypnotizing. During that time I had episode of talking and talking and talking; I was embarrassed afterwards and blamed it on drinking too much coffee. I fell in love with my therapist (no indiscretion but it was definitely 2 sided.) I was ultra sensitive and could cry hysterically. Subsequently, I was depressed for about a year. I tried Lithium, Lexapro and Lamictal but they were ineffective. A 3rd doctor precribed Levothyroxine to purposely induce hyperthyroidism. A below normal TSH pulled me out of the deep depression. I stayed on 400mg of Lamictal a day. About a year later I took Welbutrin for about three weeks then stopped because I felt flat. Another "weird" season was triggered that lasted a few months. I can remember having many shifting intense thoughts on my drive to work. I flirted unintentionally again which triggered a huge crush on a single doctor. He came onto me before until he realized I was married. I had a big personality and was told by my peers that I was the heart of my workplace. I would sometimes ride my bike for 4 hours at time. After about 4 mos I experienced depression again for a long time. I quit my job because of abuse/bulling from my boss. I lost my next job after 3 mos. Subsequently developed intense anxiety and was later diagnosed with PTSD. I couldn't hold down a job. I sabotaged the next job due to my anxiety quitting before being fired after working there 9 mos. By the suggestion of others I ended up in a psychologists office. He helped me have the courage finding another job but I again got fired after after 8 months. I was diagnosed with GAD, anxiety NOS, PTSD, major depression and histrionic traits by the psychologist. I seemed to ruin most of my medical doctor/patient relationships. I believe they see me as a hypochondriac. I have never told my psychologist this, there is a limit.




    Presently I am taking Lamictal 200mg, Prosac 40 mg and Adderall 30 mg. I still get quite depressed although sometimes feel "really good". I have so many creative projects started, it is comical. I am kind of a creative genius...really. I look at something and make it into something else. In general I am smart but not a genius...just extremely creative. My brother is an actual genius. I feel more normal now and can finally hold down a job, I don't cry all the time but can cry when I need to. I can concentrate and stay focused at work. I go back and forth feeling real good and energetic for about a week and then I'll get very depressed for a few days that I don't even want get out of bed, but I do. The mood changes usually last days. I can bear the depression because I know I will feel good again. My psychologist says there is no such thing as rapid cycling and he doesn't think I am bipolar. I am anxious, depressed and have histrionic traits. Comments?

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    1. Your case sounds very complicated, and if you came to see me it might take quite a while for me to sort all this out, so unfortunately I really can't say much about your case. Just a couple of points, though:

      1. People who have a parent with bipolar have an increased risk of having the disorder themselves. I've seen different numbers - something like between 8 and 20% - probably the lower.

      2. People with bipolar disorder can have their major mood episodes completely controlled, and still be unhappy campers, have a lot of anxiety, or have personality problems when they are in the euthymic (normal) state.

      3. If you do in fact have bipolar disorder, Adderall (or any other stimulant besides caffeine) is one of the worst things you can take, especially in the long run. It could conceivably be contributing to your low moods, especially when it wears off.

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  15. Thank you doctor for your answer.
    Yes, I think that I am treating the depression with the Adderall. I probably do have some ADD too. It really helps my work performance!
    Why is Adderall not a good choice? Isn't it safe if i am taking Lamictal along with it?
    I have thought of trying Welbutrin instead since it essentially increases the same two neurotransmitters-dopamine and norepinephrine.
    The Prosac works great on the anxiety.

    I have been taking adderral ER and piggy backing it with a short acting in the afternoon. And yes it does lift the depression 1/2 + of the time.

    Even though this is anonymous...I wanted to add... I always dress very modestly and have never had an affair.I have a great marriage. If I am thought to be histironic it's because of other things. I have a great relationship with my psychologist but I wish he didn't give me so many diagnoses. I think I just had a few very difficult years and everything was out of whack for a while. I am pretty normal now.

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    1. Adderall will help almost anyone's work performance, regardless of whether they have a mental disorder - that's why it's the most abused drug on college campuses. It also elevates anyone's mood at first.

      It can trigger a manic episode - lamictal may prevent that from happening, but that drug's mania prophylaxis in studies is highly unimpressive, so I'd hate to rely on it.

      The biggest problem is that when stimulants are used chronically they deplete a chemical called dopamine in the brain's pleasure centers, and that's not good for depression in the long run. It can also cause paranoia and hallucinations in some people.

      Personality traits can come and go depending on the circumstances, so I wouldn't get too hung up on how valid your histrionic label is.

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  16. Thank you very much...I will try to get off the Adderall. Maybe I'll just use them on the days that it is almost impossible to concentrate.

    Thank you also for the explanation of "personality traits". I think MD's and psychologist's have an enormous responsibility on how they communicate to their patient's. Their influence is especially powerful when their patient's emotionally weak. Label's can be dangerous! Personalities are changeable. would really like the option to change. Personally I have been an extrovert most of my life. In this season I am quite introverted and enjoying it immensely! It probably has something to do with the meds.
    Thanks again...I perceive that you are a careful diagnostican. I think that is very important in psychiatry...It's quite alot to take in when you are diagnosed with am mental illness.

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  17. Dear Doctor...I also take Adderall...

    What is your source regarding Adderall?

    "when stimulants are used chronically they deplete dopamine in the brain's pleasure centers? Can this be reversed if you stop the mediction? Or does your brain stop producing as much dopamine?

    "It can also cause paranoia and hallucinations in some people"...Are these possible long term side effects or while someone is on the medication.

    Does Adderall, and other stimulants affect our adrenal glands increasing cortisone? I ask this becuse since I have started taking it I seem to be aging very rapidly.

    Thank you for your expertise...

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    1. I heard about dopamine depletion in a presentation by the National Institute of Drug Abuse (NIDA). The guy was talking about street amphetamines, but someone in the audience asked him about the use of the drugs in kids creating that problem. All he could say was, "But they work so well!"

      The effect IS reversible when stimulants are stopped, but sometimes it can take months for a complete recovery.

      Paranoia and delusions are usually long term side effects but some people can become psychotic with short term use.

      I can't find anything about adrenal problems with stimulants except on anti-psychiatry sites, and I haven't heard anything about it clinically.

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  18. Thank you very much for taking time to answer my questions!

    Do you know if the paranoia/delusions/psychosis would stop if the medication/stimulant was discontinued?

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  19. I've always felt different, but never let anyone on to it. From a young age I felt so much more mature than my peers, while also seeming more in tune with the dynamics of my surroundings, especially those social. Being that nobody talks about what they do by themselves, or the process/speed/and unique organized way their brain works, I don't doubt the skeptics of bipolar or mood disorders. However, skepticism doesn't justify the refute of an illness that we don't yet know how many people are affected by. The "Golden Age" of psychology that followed behaviorism brought forth the technologies of brain imaging that have yet to be around for 25 years. At one point all of the most reliable scientists agreed that the earth was flat, California was an island, and that an atom was the smallest particle. What I'm getting at is that this isn't the first time science and skeptics have been wrong in their conclusions.
    I’m writing this to share with the psychiatrist I plan to see since I struggle to articulate how I think and feel in conversation. I cycle through hypomania, depression, and irritability very rapidly throughout everyday. However, my depression doesn’t make me debilitatingly sad, just numb. Partying, sports, hanging out with friends, and what I love to do most cease to physiologically arouse me when I’m down like this. Think of a time you forgot you had to do something important like feed your dog, meet someone for lunch, or you woke up 30 minutes late. You feel your heart race speed up and body move quicker in order to do what you need to. I can distinguish these feelings because when I’m hypomanic it can be triggered, but only when I’m hypomanic. I say “physiologically aroused” because no cascade of emotions are exerted when I realize I’ve have forgotten, or need to do something. This is how I can best distinguish when I’m depressed.

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  20. It’s impossible for me to bring myself to do anything no matter how much I rationalize I need to. During this mood I can only be by myself because I become easily irritable, which is the mood I least enjoy. Yet I’m never alone in my own thoughts when I’m by myself because I’ll only feel depressed. I wake up and instantly turn music on. Music doesn’t bring me to full hypomania but I thinks it acts as a constant that makes it easier to get moving. But because I’m so indecisive it’s usually Pandora playing on my computer. I listen to my phone on my speakers when I shower, am never without earbuds walking to and from class, and again turn Pandora on when I get home. I remember getting grounded when I was younger and my mom taking away my i-pod and me thinking it was the end of the world. I told her she could take away anything else for however long she wanted, but that I needed my music. Luckily she compromised. No way can I listen to music when I study though, too much going on. But if I’m not studying or listening to music when I’m alone I’m watching TV, which is what I usually do when I feel numb or am depressed. When I’m hit with depression it’s like my brain and body move in slow motion. I’ll be hit with it so quickly that at times that I’ll go from doing my make up, turn around to change a song, and turn back around to do my make up and just can’t move. Sometimes it’s because I forgot what I was doing, and I’ll stand there for a few seconds before realizing “oh yes I was doing my make-up”. Or I’ll turn around and doing my make-up is the last thing in the world I want to do. Because I’m hit with depression so rapidly, and suddenly there’s so many things that I start but never follow through with. From books, to plans I had made for the future, and never can I accomplish a goal I set for myself. It’s crushing feeling like I am so much bigger than what my brain and body allow me to exert and show. If I’m reading and go from hypomanic to depressed I can feel the change in my retention of memory, it’s like everything slows down. However the number of times I have read and been hypomanic is very few. Consequently reading is my biggest weakness. My mom has always left me notes to act as reminders because of how poor my memory is at times, but even the notes won't help unless I carry them with me. I can’t retain anything by reading, so schoolwork and studying have become tedious cycles of writing down what I need to know over and over again.

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  21. I’m much more quiet when depressed because my thoughts disappear so quickly that I forget what I’m saying when I try to carry a conversation, this is what embarrasses me the most. I’ve always been teased by my friends for telling the worst stories. It’s not that I’ll search for a name, or trip up over the details of what someone says, but up to 5-7 times a day I will completely black out in the middle of speaking and have absolutely no idea what I was talking about. I hate asking people to remind me what I was saying so most of the time I just blow it off like it “didn’t matter anyway” I usually say. Consequently I’m perceived as “loopy”, or an “airhead” I’ve been called a few times, but it doesn’t bother me. However, I feel like my intellect in underestimated, although with good reason for how I act at times, but I feel like I’m not always taken as seriously as I feel I am.
    My forgetfulness is crippling. I have dreadful memory retention when anything is told to me verbally, and I usually spiral into irritability when I have to listen to detailed instructions or plans that I’m being asked to follow through with. I don’t know how people are able to so easily recall where they leave their phone, keys, purse, or essential personal items. I don’t know if people see a mental image of where they set things down, but never can I remember where I put anything. The number of times I’ve lost my phone is out of control, but I usually find it soon after. In high school I always left it in the bathroom, but I’ve found it in the pantry before, and even in the freezer one time. I don’t know what to attribute my poor memory to but it’s like I work backwards when recalling something. Always trying to filter through so much to remember where I was going with what I was saying.
    Since my irritability is much harder to mask I am quick to remove myself from situations when I am hit with it. It’s usually triggered when I am let down feeling hypomanic, or disturbed when depressed, which is why I isolate myself in both of these moods. No matter how irritable I get though I have only ever “blown up” on my mom, and so many of my friends have said to me that they’ve never seen me mad or angry. (This is one of the biggest reasons I believe I have gone unseen as having any type of disorder.) I’ve come realize recently that my “stoner habits” are more of a way I’ve been self medicating myself. I usually smoke 4-6 times a day and most often when I’m alone because it’s the only way I can bring myself to do anything that triggers hypomania, which is the only state I can get myself out of the house in. I’ll usually smoke right when I wake up, and just before I leave the house. I can’t remember what contentment feels like because of how quickly I cycle through states. In the morning is when I switch between depression and hypomania most rapidly though.

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  22. If I’m not numb or irritable, I’m absolutely exhilarated(hypomanic). I move 10 times faster, talk more quickly, and feel on top of the world. The surges of adrenaline run like waves throughout my entire body that put me at ease because I know I am about to be in my most bliss mood. Walking and listening to music can sometimes trigger hypomania if there isn’t too much stress I’m under worrying about other things. Only if it’s sunny outside though. The adrenaline makes my thoughts race, and I feel I take in so much more of my surroundings because my perception shifts more rapidly when I’m in this state. Growing up I felt like I saw so many little things that others didn’t. Like the person trying to cover up picking their nose in class, or eating out of their desk when they shouldn’t. I’ve always known my mom has smoked off and on since I was young, but never let her on to know that I knew because she hides it and I hate confrontation. I’m struggling to articulate it even in text, but I feel like my occasional heightened sense of perception makes me pick up on more social cues that make it really easy for me to read people, while also giving me a leg up in masking my feelings and not letting on to people when something is wrong. The hypomania is most consistent when I’m with people though. When I’m with my friends although I want to move a million miles per hour I am always looking to please people. I’m never the one to stand up and make a decision, I go with the flow, and am only happiest when everyone else it too. ( Another reason why I think no one has mistaken me for having a disorder.) Confrontation spirals me into a mixed-state of depression and irritability so I do anything at all costs to avoid it. I’m definitely guilty of yielding the interests of others before my own just to avoid falling into depression, irritability, or both. The two of them is a toxic combination. I get very heightened anxiety to the point where if I’m sitting down both my my legs are viciously shaking. Or if I’m up, I can’t help but pace. The only thing to ease it is by trying to exert energy. But I really shouldn’t try to talk when I’m like this. I talk quicker than I do when I’m hypomanic, but make no sense at all. I just bounce between too many ideas, all the while usually apologizing and feeling guilty for something- even though I’m always told not to. I’m not debilitated by my feelings of guilt but I find a way to feel bad in so much I do, especially to people. Because of my poor memory I usually end up taking on too much or making plans I shouldn’t, which I then have to contemplate what ones to follow through with, and which to break. Any type of this cognitive dissonance, or decision making where I have too many conflicting choices also sends me into a mixed state of depression and irritability- but there really is no inbetween of my moods that cycle through hypomania, irritability, and depression.

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  23. When I’m hypomanic and drink though is what is most dangerous. Because all I want to do is go, go, go, nothing phases me, and I’ll going from drinking and having a great time, to then waking up in the morning. Luckily always in my own bed or with my friends. I drank in high school but had never experienced such blackouts until I came to college this past winter. I got a handle on them quickly though, and came to adapt to my new tolerance within a few weeks. When I’m not partying but just hanging out with friends I cycle through all three moods fairly quickly but I can’t stand to have attention drawn toward myself and because my depression doesn’t make me debilitatingly sad it’s easier to put a smile on a numb face, than a teary eyed one, so no one ever questions me for being sad, upset, or having anything wrong when I know I’m depressed. I rarely become irritable but like I said earlier it’s usually triggered after feeling let down when hypomanic, but I don’t stay irritable for too long however, depression always follows. Just the other day I was walking to campus, listening to music of course, and had plans to meet with friends and walk to a baseball game. When I got there though they had just left in their car and it was going to be a 15 minute walk for me. The societal perception of someone with bipolar disorder in this case would be to spiral into a raging fit, however the degree that I hate to be in the spotlight always stops me from ever having tantrums or really becoming angry at all. Instead it was like I was hit with a pile of bricks. I’ve grown up playing softball my whole life and the Ducks baseball team was playing in a game to determine if they would go to the college world series. However, like I said earlier, I usually become irritable when I’m let down when feeling hypomanic. So I got off the phone soon after my friend told me they left and decided I wasn’t going to the game, which I know is ridiculous, but then the depression set in. It was like it took me twice as long to walk home. But then I decided I wanted to go to the game when I heard it was only the second inning, and had a great time when I got there- it was like a complete 360 within seconds.
    I’ve hinted at reasons why I think people have never taken me as having a disorder but I think the biggest reason is because of my looks, and I say that in the most unconceited way. It’s like I won the genetic lottery or something. But I know it’s nothing more than just very symmetrical facial symmetry, and other biological attributions that people consider beautiful. If people didn’t take as much of an interest in me I know I wouldn’t get out nearly as much as I do. I do really well with first impressions usually because I feel hypomanic around people and so I love to talk. And although some people will tell me, I can still tell when people are surprised when I talk sometimes because of how well I can articulate myself and hold eye contact, which isn’t always expected from a pretty girl. Any job with an interview I’ve applied for I’ve gotten, one being a hostess at a very well known restaurant in San Diego. I didn’t find out until after I had started the position, but over 50 people applied for the job, and at the time being only 17 I was the youngest who had applied. As qualified as I felt I was still so surprised after finding out but never boasted to anyone about it- again, hate the attention. Because I am surprisingly most confident when meeting new people, and this is also when my hypomania reaches its peak, I excel in social situations, which I think most people think those with bipolar disorder are incapable of. As grateful as I am for how I look, more times than not I hate the attention it brings. I don’t know how to take a compliment. I know people say them to be nice but I get very anxious but usually stay hypomanic when people praise me that it’s the most uncomfortable feeling, and I usually try to get out of the situation before I am mistaken as rude.

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  24. Growing up I was always very athletic and loved sports. I was the ultimate tomboy, and would wear my uniforms to elementary school before I became more feminine. I wouldn’t consider myself the most athletic girl to ever walk the earth, but most of my friends describe me as the most athletic girl they know. I set the school record for the girls mile, and long jump at my elementary school in 6th grade. “Jog-a-Thon” was an event that was held to make money for our school, and every year since 1st grade until 5th grade that I participated I ran the most laps. We also had what was called “Run-for-life” which was an event aimed to get kids more active and we would all go to school early and run around a course. Again, every year I ran the most laps for girls in my grade. I played competitive soccer when I was younger but still love to juggle. During practice when I was 12 I got going and once I reached 500 my coach let me continue while everyone else practiced. I got to over 1,000 and was soooo excited because the club I played for had certain clubs pertaining to how to much kids juggled, ranging from 200, 500, and 1,000. Softball also came very natural to me growing up and I predominantly pitched until I was 13 because all of the other girls started passing me up in height. One time we had a carnival when I was around 12 and there was a competition of who could pitch the fastest. All of the girls in each age division lined up and I ended up throwing the fastest. Even though it was only 42 mph I beat all of the other girls by at least 5mph. Since I was 7 I was always chosen to play on the All-Star team over the summer, but when I was 12 I was asked by the 14 and under team to play and travel with them, and it was an awesome experience. I am extremely humble though because of the attention boasting brings, and as grateful as I am for my athletic abilities at times it causes me distress because of the spotlight it puts me in. Like I said earlier, I don’t consider myself the most athletic person ever but I am freakishly coordinated, more than any girl I know and better than most boys. I have very keen perception, and can catch anything that is thrown to me with a lot of grace. I have very good hand-eye coordination, which has made softball so easy for me. I am very good at estimating odds, and acting quickly when I play sports because I’m usually hypomanic, and there is nothing that puts a halt to the adrenaline that rushes through my body when I’m in this mood. I’ve always been fit but never super strong- my dad is always trying to push me to the gym more. However, how fast I can throw a softball is incredible. I really think it is attributed to how heightened my perception becomes and how much quicker I move when I’m hypomanic. Because softball is fairly slow paced I can find myself falling into depression in the dug out, our standing in the field if a timeout is called. However, again my depression doesn’t make me feel sad, it makes me feel nothing, so no one ever realizes when I’m hit with it.
    I can’t remember when I was younger exactly what my moods were like, however the sense of surrounding I have has always stayed constant, and really never grown since a young age. That’s why I say I considered myself more mature than peers. It’s been over the past year though that everything has become heightened to this degree. I have been trying to rationalize that I have more control over my state of mind, attitude, mood, or whatever you want to call it. But I don’t, and it’s taken me this long to realize it.

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  25. Wow that was long...It sounded like you really needed to talk. I can relate soooooo much even though I didn't read the whole thing. The depression, having to have the TV or music, a sermon,a book on tape or something to stimulate. With listening to something deep I get depressed. In social situations I'm happy and outgoing, feel deep empathy and compassion. I seem to be in tune with other's emotions and never want to hurt or see anyone hurt. I think of myself as dimmentional, seeing hearing and sensing many things at the same time. One thing that differs is that I have a great long term memory for detail. When I'm depressed or anxious I can't concentrate so I miss alot. Bless you...I am the one up above that takes Lamictal, Prozac and Adderall. The combination works well. I have been relatively normal lately...maybe a little depressed but I feel more mature and can be taken a little more seriously.
    I wonder about the fact that I am constantly creating and making things...a multitude of projects overlap and go unfinished but I do complete a lot of them. I just get excited about my new idea so I start it...then want a previous one completed. It's exhausting. I also go to thrift stores several times a week and buy various things...clothes that I dye or remaking into an awesome an outfit or I buy thing to decorate my house. It's like I have an iterior decorator for free...My kids are grown and I still buy and make over clothes for them or pick up thing for their apartment. It seems kind of hypomanic but I also do this when I'm depressed....the focus and creating help pull me out of depression...(all of this is while I'm on meds and even now that I feel relatively "normal" not extremes of depression or elation). I think I continue to go up and down but to a much less extreme. Actually to not fluctuate would be difficult. It would be like being a differnet person.
    altogether.
    I would love to hear a comment from the doctor :) We are just trying to figure out who we are...I've been going to a psychologist for a couple of years and he says I'm not bipolar. I have to tell him that I get depressed or feel good. He can't tell. I think it goes away when I have a session. I could be home on the couch, walking slow and dropping things then go to a session and feel and act fine. I guess we are all very different and don't fit into a box.
    all and all I can REALLY relate to you up above this! Did you get on medication? Did it help? I would not be well if I didn't take medication. God Bless!

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  26. I am correctly diagnosed Ultra-Rapid Cyclical Bipolar Disorder, and yes it does it exist, I'm living proof right here! I go literally between suicidal depressive episodes to the euphoria of full blown mania at time within a day of each other and the mixed episodes and agitation and absurd behavior in between them is what is the worst thing about it! Even on several medications, and I've been on different meds in these classes- tried everything literally, I still fully swing- they are just not as intense and most times I'm able to be self aware at points that I'm in the middle of a bad one and get help. So, I live with this monster 24/7, believe me- this monster DOES EXIST!

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  27. hi im a 50 year old man with a wife who has bi polar. she was told and been treated for this disorder for 15 years now. she has in my opion the worse kind raipid cycling type. she has good doctors in my opinion. and she takes the meds when she is to. /her moods change for 4 times a day maybe even more
    the extreme of the change is so much very hig to extreme lows. i have been married to her for over 30 years. and it some times becomes so difficult .so i know you may be thinking how to help her. thats not wut im asking. im asking how can i better deal with her and help myself. its not like i can get her a wheelchair ramp and problem is fixed . it goes so much deaper. she doesnt like dicusing her disabilty . and i think we should. not alot of ppl think about the familys that have this disabilty inside the home. her anger lv has gone up in the past few years toward the family. i beleave its because some ppl have pushed her aside. afraid of dealing with her and het disability. and some ppl i beleave just think its a lie or fake. because on some days she just normal person. . so fustrated ,want to help, but cant, if you have any ideas please share them im willing to listen thanks bob

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    1. Hi anonymous,

      Thanks for writing, but unfortunately I can not offer you any specific psychiatric advice in a blog post, nor am I able to confirm or refute whatever diagnosis she may have been given without my having evaluated her myself.

      Have you discussed seeing her together during her visits with her psychiatrist and/or therapist for suggestions or understanding? If not, I'd start there.

      Delete
  28. I have seen my elder brother coming out of bipolar disorder with the help of Paxil generic. He was in a miserable state due to this disorder. But, with the timely treatment with this drug and proper counseling, he has successfully managed to combat this illness and is living a near normal life today.

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  29. Hi I don't have any disorder but my boyfriend was diagnosed with ultra rapid cycling manic depression and his physc said he had never seen one like his before only read about it.... its horrible but unfortunately my bf is very smart and fools most to believe nothings wrong we had to call physc on phone during one so he could hear... its really hard wen he's good he's wonderful wen he has outbursts or rages its horrible I tend to kno wen its goin to be real bad cus he craves salt few days before but unfortunately every medicine he's ever took wears off... at times he knows wat hes doin other times I truely don't think he does its hard to manage... so I'm really jus asking if anyone has advice on dealing with it not being the one with it but not giving up on him... plz

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  30. I am Bi-polar and have been for forty years. I was misdiagnosed for thirty years. For the past ten years I've on the proper meds. I finally found my great doctor, but he retired six months ago. It crushed me. I felt like I had lost a family member. It was my safe place and he knew something about anything I brought up. The transfered me to another doc in the same office. Help! He and I clash and it's not my safe place. Hoe do I go about finding another. My meds don't cure me but my episodes not as bad. Suicide and rage were my big problems. Many people in my family are bi-polar. Could you point me in the right direction?

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    1. Have you discussed your dissatisfaction directly with the new doctor? If not, that would be the first thing to do. A good doc is receptive to patient complaints.

      I don't maintain a referral base in other cities, so unfortunately I can't suggest anyone if you want to go to a different office.

      Delete
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