Wednesday, February 2, 2011

Bipolar II? Early onset medstudentitis?

hypomania hy·po·ma·ni·a (hī'pə-mā'nē-ə, -mān'yə)

A mild form of mania, characterized by hyperactivity and euphoria.

The American Heritage Stedman's Medical Dictionary

I always assumed that if my mental health status had to be summarized by an ICD-9 code, that my diagnosis was major depressive disorder; after all, that's the conclusion that my healthcare providers always came to. Whenever bipolar disorder was considered (or maybe more accurately, bipolar I) it was always dismissed because I never had any kind of full-blown manic episode. I was just a high-functioning person who was depressed. The other night, though, I started reading about bipolar II disorder, which, by the DSM criteria, must include at least one major depressive episode and one episode of hypomania. I'm wondering if maybe bipolar II might be more accurate diagnostic framework to work from. After all, it opens the door to a lot of new medications that might be a hell of a lot more effective for me.

Based on what I've read, hypomania is mainly distinguished from mania by it's lack of psychotic features (hallucinations, delusions, etc.), and that the person experiencing the hypomania often maintains a high or improved level of functioning.

I don't know if I'm just being paranoid, but I started jotting down a list of hypomanic symptoms and personal examples that I could think of:

Decreased need for sleep; increased productivity: a huge chunk of my time as an undergrad consisted of never sleeping and working all the time. Then again, that can be normal, right? It's normal to be motivated and work hard for the things that you want. And it can be normal not to sleep if you're working hard. Then again, here is a post from the fall where at the end I describe my sleep deprived self as being "invincible." I'm also really not sure why I thought I would be able to pull off that insane schedule, other than the fact every time I had tried to stretch my limits in the past, it had worked. I was convinced that everything was just a battle of will.

Risky behavior: for no reason that I can really explain (clearly I knew better), I would repeatedly have unprotected sex (and eventually unintentionally became pregnant); I would regularly participate in an illicit activity that I won't go into detail about right now; I sometimes would spend significant amounts of money on an impulse; I would go joyriding (always alone).

Psychomotor agitation: there are a few things that I find myself doing but that I really have no desire to do: jigging my leg; scratching my scalp, sometimes until it bleeds; chewing on my hair. The hair thing is new, and equally disgusting, I think. I keep catching myself mid-act, stopping myself, and thinking: that's gross -- if I don't stop this I'm going to have to chop all my hair off.

It makes sense that bipolar II was never considered, because for the most part, I've never talked to anyone about this stuff. Why would I want to? It's all kind of odd, gross, stupid, or embarrassing.


  1. Interesting. We're in the psychiatry portion of neuro now, and just learned about bipolar the other day. The main reason I don't like psych is that there is so much overlap between diagnoses. I'd definitely talk to your doctor about it... it seems that the meds for it work well, though they aren't without side effects.

  2. Yeah, talk to your doctor. These things that are supposed to be odd or gross or embarrassing are just symptoms. They aren't really you, and if you think about it in a clinical way it might be easier to talk to professionals about it.

  3. Not odd or gross at all.

    I am a self-proclaimed hypo-manic.

    But diagnosing via the DSM is all about how much the ailment impairs your daily functioning.

    Also I concur with above comments. I'd seek the opinion of a professional who can do a full eval.

  4. I had assumed you hadn't talked about being bipolar because of the stigma associated with it (compared with depression, which everyone seems to have), but go back and read your posts from before your breakdown when you weren't sleeping. You're definitely agitated, but I think the no sleep thing was what tipped me off.

    Why didn't you ever mention this stuff to your psychiatrist in the past? Did you know that SSRIs can flip a person with bipolar into a manic episode? Also, have you thought about getting an IUD?

    I think it's really positive that you thought of this yourself. Good luck in sorting it out with your therapist. You may need to see a psychiatrist rather than a psychologist since the med regimen can be more complex with this disorder.

  5. C, MedCouple, DrPyschobabble: I did end up talking to my doctor about it briefly yesterday. Sometimes it helps to work things out in my head (or blog about them) before talking about it. It wasn't that I was planning not to talk to my a health provider about it, or that I was too embarrassed to, but it just it never seemed like it was relevant to bring up. I also wasn't seeing a therapist or a physician regularly throughout most of college, which was when a lot of this stuff seemed to be at its height.

    OMDG: Yeah, I really was clueless to this possibility, it was not a stigma thing (although the stigma thing kind of sucks). I had never read about bipolar II at all. I didn't even know it existed. I should spend more time reading, especially considering all the time I have now.

    In the past, I wasn't seeing a psychiatrist (or even a therapist), so there was really no one to mention the above stuff to. I'm still not seeing a psychiatrist, and my family physician is doing the prescribing. I think at this point, you're right, it probably makes sense to see a psychiatrist, too.

    And yeah, I did recently read that SSRIs can launch someone into a manic episode. I feel really strung out up on my current meds and can never sleep through the night, but I don't think it's gotten that bad, at least yet. I also sort of wonder if they might be worsening the suicidal ideation thing, since it has never been this big an issue.

    And the funny part, about a year ago, I told my GP that I wanted to get an IUD. I can't remember exactly how the conversation went, but it was something along the lines of "IUDs will mess you up. Maybe your husband should get a vasectomy." We talked about it, but then nothing happened. I can't blame him for not being psyched about the idea. And I think I'd be okay with my uterus getting a little messed up. Whatever keeps the babies out.

  6. Ack! Now granted, I don't know anything about your reproductive history, but your GP is 100% wrong about the IUD. 40 years ago they might have caused problems, and obviously they aren't right foe everyone, but it's not the same device. Do some research on your own. They are very popular in every developed country but this one.

    Keep us posted on the bipolar II thing! I'm so glad you seem to be making progress on this! Good luck with the psychiatrist!


  7. Hi MezzoMedical,
    I just found your blog from a link on OMDG's page and there is so much you are writing about that I can relate with!

    Just a small comment on this post- IUDs are awesome, but if you have a history of depression, DON'T use Mirena. They can mess you up emotionally (personal experience). The copper coil is effective and is really a brilliant form of birth control.
    All the best,

  8. Penelope,
    I'm going to check out your blog later tonight (after my toddler goes to bed and stops raiding the refrigerator for leftover apple crisp). Sometimes I wonder if my blog is getting too self-absorbed and too intimate.

    It's funny that you just mention IUDs, I actually called earlier to schedule an appointment, and had been debating copper vs. Mirena. I finally decided to go with copper for exactly the reason you mentioned! Anyway, I'm glad you chimed in. Now I really feel sure about it.

  9. Hi Mezzo,
    I struggle too with how much to share on my blog. While I'm sure I am identifiable to anyone who knows me, I like having some degree of anonymity on the web. I can tell you that I have read almost all of your blog and I can relate to so much you have written. I'm in my late 30's, but have experienced depression (and been evaluated for bipolar II) and worked in the healthcare system. I know how hard it is when all of these factors collide.

    By far, the most popular posts I've ever written have been about Mirena. I would say that since 2009, over 90% of hits to my site have been about Mirena and Depression. If you ever want to solidify your decision, have a look at the stories people have shared in the comments section.


  10. Does anyone else research like crazy? I have been reading on for hours...