Had anyone heard about Bipolar Type 2 before CZJ?

[JustinBeaver]

Because I hadn't. (CZJ is Catherine Zeta Jones btw). Been reading a bit about it online and am curious. Since last August I have tried Sertraline (8 wks), Citalopram (6 weeks) Duloxetine (7 weeks) and have now been on Lofepramine for nearly 9 weeks AND DON"T FEEL ANY DIFFERENT. I haven't even had any bad side-effects - I was sat there waiting for nausea, increased-anxiety, dizziness etc. but the most I have felt is a bit of constipation and sometimes a bit of a dry mouth. I am seriously thinking that I am a freak in the way that these powerful drugs don't do anything to me at all for good or bad. But then I remember reading somewhere that anti-depressants aren't good for bi-polar disorder - but I've discounted having bi-polar because I don't get totally manic or delusional. Having read about Bi-polar 2 am starting to think that I have something more akin to this? Anyone got any thoughts or experience?

Well DSM IV says this: Bipolar II: Similar to Bipolar I Disorder, there are periods of highs as described above and often followed by periods of depression. Bipolar II Disorder, however is different in that the highs are hypo manic, rather than manic. In other words, they have similar symptoms but they are not severe enough to cause marked impairment in social or occupational functioning and typically do not require hospitalization in order to assure the safety of the person.

If you think that sounds a lot like you then the appropriate route is a psychiatrist via your GP.

I would observe though that you have not stuck with any anti-depressant long enough to see if they would actually work for you - why is that?

Yes, that's the definition I read Madmouse. Well I have been back and forth regularly when prescribed the ADs and when after 8 weeks of Sertraline (I think the dose was increased after the first month) I was still reporting zero effects the doctor thought I should try a similar AD within the same type ie. SSRI so I slowly weaned off Sertraline and onto Citalopram (with no withdrawal probs at all) - again the dose was increased after the initial month as I was reporting no effects and she deduced that after 3 and a half months of SSRIs they were obviously not the drug for me. We then moved onto SNRI duloxetine and she warned me that these had more of a problem when it came to withdrawal but I went with it anyway. Couldn't believe it when I felt nothing with these although I did at least get a little constipated which she though was an encouraging sign.

After 7 weeks I was exasperated and feeling very disheartened but in discussion with the doctor decided to give a Tricyclic AD a go to see if that would do anything. I actually got the prescription for these and then received some bad news and thought that I didn't want to rely on a drug to get through it so weaned myself off Duloxetine over a 2/3 week period, again no bad effects noted at all. After a month of being "clean" and still desperate for some help I started on Lofepramine and have now been on them for 9 weeks.

Madmouse - to me that sounds like I have given the ADs a good go - most of the advice says that you should give them at least 4-6 weeks to feel any change and during that period I have seen on here that people have all sorts of effects (some almost immediate) - not necessarily good effects but something that at least registers that the drugs are doing "something". It's not that there has been an effect such as a worsening of symptoms that I have baulked at - I have felt nothing. Do you think I should have stuck with the first AD for longer? I thought 2 months was quite a good shot?!

side effects are no indication at all of whether a drug works for you or not

and you have done all this in close collaboration with your GP and I am not a doctor so I hesitate to disagree. But I thought it was a more common approach to up the dose a few times over a 3 month period before deciding it doesn't work.

Do you get relatively mild highs? (hypomanic episodes)?

Did you take the maximum dose of any of those AD's for a reasonable length of time?

Failure to respond to AD's is not a sign of bipolar 2 - the symptoms of bipolar 2 are as described by madmouse. The reason that AD's are sometimes avoided in bipolar is because they can sometimes lead to a persons mood becoming too high.

Anti depressants can be used to treat bipolar but if used without a mood stabiliser they often cause highs. But for someone who has bipolar with a lot of depression episodes anti depressants are often given with a mood stabilser. So on its own that is not indicative of bipolar do you have any of the bipolar symptoms that come with a hypomanic episode? There are also numerous reasons as to why anti depressants may not work. If your GP cannot offer a treatment that works you need to ask for a referral to a pychiatrist who will be able to correctly diagnose and treat your symptoms.

I appreciate that just because I haven't responded to the ADs doesn't automatically mean I am bipolar - I just happened to have read about bipolar 2 and recognised some traits.

I suppose I was expecting more - I have procrastinated for so many years about even taking ADs because I wanted to be able to "do it myself". I then slowly came to the realisation that I couldn't do it myself (although I also had 3 years of therapy too) and that there was no "shame" in admitting that there was something chemical going on that drugs could maybe "fix". Perhaps I was expecting too much.

I was so fearful too of taking ADs because I had read about all the horrible side effects so it was with some trepidation that I took the first tablet. And then... to feel nothing... felt like a joke. I am struggling to remember precise dosages but have just had a rummage through the drugs cabinet - I started the Sertraline at 50mg a day and then doubled the dose to 100mg a day after a month with no discernible difference, because I then went straight onto Citalopram 20mg and still felt no difference after 6 weeks I think the Doctor said it would be a waste of time just upping the dose because the cumulative effect of both the Sertraline and Citalopram should have produced some effect by now if this type of drug that was going to work for me (SSRI).

I don't know - they obviously work so well for some people but not for me (at the moment). I am going to continue with the Lofepramine and will be seeing the doctor for another review in 4 weeks. I'm just worried about where we will go if this tricyclic doesn't work - will I move into "mood stabliser" territory.

I think I hide my depression too well. I don't socialise a great deal outside of my dh and children and can hold it together at the playground. I don't go out to work and have hours at home. The few occasions when I have someone round or go out somewhere are anxiety inducing but infrequent enough to deal with and put a "normal" face on. There are many people who would be terribly surprised to know that I am going through this. I even feel a fraud when I am sitting in front of the doctor. I do recognise that I get "highs" when I feel I can put the world to rights and wake up write pages and pages of plans and goals in a notebook and then the next day or week I read it back and cannot remotely recognise or conjure up the energy or the enthusiasm/positivity of the "other person" who wrote that stuff. I waver between thinking I have talent and creative energy and then crash into inertia and try and take to my bed at every opportunity (not many unfortunately!) And then I become alive at night and stay up till 2/3 in the morning even though I know I have to be up in the morning.

Sorry for going on at such length but I guess it's what this forum is for (am a cowardly namechanger btw)

Who is seeing to your mental health ATM is it a GP or a pychiatrist?

don't call yourself a coward for name changing - it's fine

If I was in your situation I would want to see a psychiatrist before making any further medication changes (Im assuming that treatment until now has been done by your GP?).

Thanks madmouse, crawling and catsareevil. Yes, I'm just under the GP at the moment. She handed me a leaflet about 2 months ago with the details of the local mental health team and apparently I can self-refer. I was put off by the mention of group therapy. I guess I was looking for an easy solution - to be under a psychiatrist feels heavy duty but that's just my own prejudice and unease showing its ugly face. What would it mean being under a psychiatrist? I'm genuinely nervous about it.

It would mean a closer look by a mental health expert at your symptoms, a proper diagnosis, more different meds to try...

GPs know a little bit of everything, they are no mental health experts.

A pychiatrist will spend a few meetings (or as long as it takes) understanding what the problem is and how to treat the symtoms. Then he/she will arrange for the best treatment (which could be medication, therapy, CBT, or group therapy there are loads more) sometimes you will need a few treatments and then they assign any other support you may need once they have assertained that the treatment is working you will be discharged FWIW I have seen many pychiatrists and never had group therapy.

It is nothing to be scared off it is like any other medical problem e.g I had a problem following my DC2s birth so was refered to a gyni who said I needed physio after physio was sure my bits were fixed I was discharged same thing really with a pychiatrist and you dont need to tell anyone that you are going if you dont want to. Please dont suffer in silence if you dont like going you will be free to walk away at any point if you dont like going.

I have bipolar. Or at least I seem to - nobody will give me a diagnosis (I suspect they have one, but won't give it to me for some odd reason, although I have had all sorts mentioned, it seems that bipolar is the one they are settling on). I think I have type 1 though.

The way I understand it (or at least ime) the reason anti ds don't work in bipolar is that they work too well, if that makes sense. They send you high, even more high than you would be normally on a high.

I don't think this is you (because I don't know you) but quite a lot of people seem to say they have bipolar when they seem to have a more straightforward depression that comes and goes. To me, for it to be bipolar, the highs have to be enough to negatively affect your life. although it would seem that this type two might be proving me wrong there.

I get mild highs, where I sleep less, spend more money, drink more, take risks, get a massive sex drive, inflated sense of my own importance and intelligence and so on - a pain, and destroys any chance I had of living a completely normal life, but managable, and bigger highs where I have hallucinations, can't stop pacing up and down, get full on delusions and am generally "lost" to real life. Mercifully those are very rare these days, and I have learned to recognise the warning signs. The highs are followed by lows where I kind of can't cope with life - I hide away, tend to stay in bed, only eat and drink if really encouraged and so on. The lows are easy compared to the highs though - people "get" depression, they don't have that scared look that people get when faced with mania.

My advice is to accept all the specialist help you can get. I am currently under a team called Early Intervention, although they have quite strict rules on who they will help. I'm sure there will be a team that does fit you though, and if you have anything more than a simple and temporary depression, a GP will struggle, just because they have so much to deal with. Early intervention have taken me from literally having no life to living an almost entirely normal life and being mostly in control.

I'm sorry, I think that sounded too harsh.

basically, yes, you do seem to have some of the symptoms, but beyond that, who knows? Take all help offered - god knows it is hard enough to get.

thanks butterpieandcheese - the description of your highs and lows offered me a great insight into the nature of being bipolar. You didn't sound harsh - you just sounded like you are dealing with something that doesn't allow the luxury of "wondering" whether you have "depression". Thanks for taking the time to contribute to this thread.

And crawling - thank you too. i suppose I should start taking this seriously.