Q:  Could This Look Like BP II?

Dx with BP2 in Dec, 2000..but July while in counseling a psychologist  questiond my dx bc i show no signs of a manic side or hyomanic side or as y ou described  high energy state..having a neuropsych evail for reasons not named again this was questioned if the dx was correct..

my question is Can Dysthmia occur with boughts of Majore depression added to that anzeity(moderate to severe), look like Bipolar Two??

My pdoc will not listen to what Im asking and I have sence made an appt or a second opinion and reevaluation.  Depression causes insomnia which caues irritibility which causes anger and  arguements..Does this  sound possible is my question??

Thank you.
DC

Dear DC -- 
Sounds like you're right on the dividing line between something that might be called "bipolar" and something that is better thought of as depression.   You could see several different doctors and get several different opinions, but I'd guess they'd all locate you right near this dividing line.  Of course there is no such line, but in our diagnostic system there is; and one group of diagnosticians might put you on one side, another on the other.  Pretty soon I would guess it's going to come down to deciding which to emphasize re: guiding treatment.  If you've already had some trials of antidepressants, and they either don't work; or work for a while and then stop working; or particularly if they seem to make the anxiety or the insomnia worse -- then it might be time to try the mood stabilizer route.  Some people think lamotrigine is a mood stabilizer with sufficient antidepressant activity to "go both ways", i.e. work for either diagnostic emphasis (recurrent depression or "soft bipolar").  I think it's a little early to be sure; it's also early to look at thyroid as a treatment option, but at least that one seems to have a low side effect risk if you don't get hyperthyroid.  Read about that option here.  

Depression-insomnia-irritability-anger; hmm, some people would call that menopausal if you were between 40 and 50 or so -- and female.  Anyway, "is that possible?" Sure.  You're the example of it, I gather.  Doesn't really change the above analysis though, in my opinion: i.e. it still leaves you right on that dividing line that doesn't exist.  Sorry if that's too obscure.  My guess would be that you'll eventually figure out what works best (including in terms of what perspective to adopt) by trial and error from here.  

Dr. Phelps