Q: Does BP II Start Off w/Rapid Cycling? Suicidal on an
Alright, so, originally I was diagnosed as being ADHD with depression because of
a severe lack of impulsivity though I always seemed to be in a manic state and
the doctors monitored me, and I myself, for any other symptoms such as cycling
in case I was bipolar we could change the medication accordingly. That was
when I was fifteen.
Now, at twenty-one, we are coming to the conclussion that I am ADD and Bipolar.
The only thing is, naturally, meaning for my entire life thus far, I am
hypomanic. I'm afraid that they're going to put me on a mood stabilizer that
will keep me halfway between manic and depressive where, as my research on the
internet has found, most people usually are. But that's not me. When I have a
hypomanic episode I actualy feel like myself, feel "normal", if that even
So my question is, what should I ask my doctor about? Should I tell him that
and will he even care what I have to say? I'm really confused right now because
even in my normal state, I am suicidal, which is why I am now on Mirtazapine,
and I don't want them to lock me away.
Also, does Bipolar II, which is what I belive they are diagnosing me as, start
off with rapid cycling, because I have been cycling awfully quick as in only
staying depressed for about two weeks to a month and then going back to a
hypomanic state for about a week and a half. Is that usual?
Dear Ashley --
Some good, very important questions in there. Let's see if we can sort them out
one at a time.
First, let's take the rapid cycling issue. Yes,
bipolar disorder can definitely start that way.
Second, let's look at how your symptoms show up over
time: depression, enough to be on an antidepressant; hypomania "my entire life
thus far", or at least for a week and a half or so, before cycling into
depression; and finally, hypomania that in your experience is just getting up to
"normal". I'm going to guess from this set of descriptions that your hypomania
is never so dramatic or obvious that people would easily recognized you as
"bipolar", thus the diagnostic issues. And I'm going to guess that you spend a
lot of time depressed, from your description, at least, as you say, more than in
the hypomanic phase. And it sure sounds like the cycling is quite rapid these
Surprise, you're average. This experience, if I've
guessed right, is average for bipolar II (e.g.
Judd and colleagues' 2003 study): symptomatic at least half the time; when
symptomatic, depressed far more often than hypomanic; and rapid cycling (while
on an antidepressant, anyway).
Third issue: suicidal on an antidepressant (and not on
a mood stabilizer). That definitely should be discussed with your doctor pronto
(and while you're getting that going, here's a nifty
essay about suicide in case you
need it; of course, you should contact your doc' emergently if you're really at
risk of doing something now). Now you definitely need to discuss your mood
stabilizer options, which hold the possibility of treating your depression in a
way you've never seen before, with less risk to you if you really have bipolar
disorder (but DON'T stop your antidepressant now, that could make things worse,
they have to be tapered at minimum and some doc's would keep them in the picture
with a mood stabilizer). Lithium can actually protect you against
suicide, for example. And lamotrigine may be the best antidepressant out there
for someone like you, even though it's not recognized generally as an
"antidepressant" as such. And just stopping cycling, which any of the mood
stabilizers can do, can address depression by preventing it, which beats
trying to treat it, yes?
Fourth, should you tell your doctor that you're afraid
mood stabilizers will just make you feel "normal". If you and he are talking
fairly well (some tricks for
doctors, if you're not), definitely. He needs to know what your concerns
are, and might be able to decrease some of them. The goal is not to have any
symptoms, which ought to leave you "where everybody else is", and no side
effects either. About 30-50% of patients can get to that goal. If you're
worried about losing some of the "zing" of hypomania, well, you're average there
too. But virtually all of my patients come to recognize that losing some of
that zing is worth it for not having depression, or the cycling confusion of
wondering just how you're going to feel tomorrow.
Finally, what about the ADD part? Mood experts agree:
treat the bipolar part first. Often the "ADD" part is much less of an issue
after that, sometimes gone, or sometimes just not worth treating with
medications. And sometimes it's still worth treating, and then you just have to
watch to make sure the ADD treatment doesn't destabilize the bipolar part, which
some experts believe is a risk (and some don't). In any case, you treat the
bipolar part first. Good luck with that. If you haven't been there, you might
Bipolar II (diagnosis, treatment, useful details) of use.
Published May, 2004