Bipolar spectrum depression

[Cutiepie]

Hello,
I've posted in the past regarding my sons' bipolar problems, but this time I'm posting about myself.

While this forum was down I spiraled into some deep depression, the lowest I've ever been. It started in May, but it got out of control in July and August.

I finally got in to see a psychiatrist. To make a long story short, she looked at my family history (at least 5 immediate family members diagnosed and treated for bipolar), my past negative reactions to unipolar antidepressants (anger and jerking), and said she is fairly certainly that I have "Bipolar Spectrum Depression."

I had never heard of this before, so she explained that I most likely have many, but not necessarily all of the bipolar genes. So most of my life I have been subclinical. When the stressors in my life became too much, my bipolarness (for lack of a better phrase) emerged and some mild signs of mania were triggered by the unipolar antidepressants.

So she has started me on Lamictal. I've only been on it a week and don't feel any change yet, but I'm tolerating it okay. Just knowing something is being done makes me feel better.

During my lowest point I was also dealing with major menopause issues and was not on enough HRT. Since that was increased I'm doing better. So hopefully between the two I will get through this time.

Have you guys heard of BP Spectrum Depression? I've never experienced any manic episodes (other than previously mentioned) so I never would have guessed I was dealing with BPD in any way.

Also, I do get a low grade headache on the Lamictal. Should that go away as I adjust?

Take care,
Julie

[dyslimbic]

Unrecognized bipolarity in antidepressant-refractory depression


29 September 2006

Clinicians treating patients with depression who fail to respond to adequate antidepressant treatment over a long period of time should consider augmentation therapies and even a bipolar disorder diagnosis, study findings suggest.

Takeshi Inoue and colleagues from the University Graduate School of Medicine in Sapporo, Japan, found that a substantial proportion of patients with antidepressant-refractory depression actually have bipolar disorders.

Moreover, augmenting antidepressant treatment with lithium, L-thyroxine or dopamine receptor agonists proved effective for patients with either unipolar or bipolar antidepressant-refractory depression.

The researchers explored the long-term outcome of 26 antidepressant-refractory patients with depression who had been assessed and treated by the team in 1995.

Before being classified as not responding to treatment, the patients had received at least two tricylic or heterocyclic antidepressants, at a minimum of the equivalent of 150 mg of imipramine for 4 weeks.

In 1995, 21 of the participants were diagnosed with unipolar depression, while five were diagnosed with bipolar depression.

By 2002, five of the patients originally diagnosed with unipolar depression had their diagnosis changed to bipolar disorder. Thus, the 26 participants consisted of 10 bipolar patients and 16 unipolar depression patients.

Over an average follow-up of 5.7 years, ranging from 1 to 7 years, 13 patients – eight bipolar and nine unipolar – achieved full remission and demonstrated high social functioning, defined as a score of 80 or higher on the Global Assessment of Functioning Scale.

The investigators note that a further four patients initially achieved full remission, but experienced subsequent recurrence of their symptoms. Thus, in total 17 of 26 patients achieved remission at least once during the follow-up period.

Augmentation therapies were effective for seven bipolar patients and nine unipolar patients. The addition of dopamine receptor agonists (bromocriptine or pergolide) to antidepressants was effective in nine of 13 patients. The combination of lithium and dopamine receptor agonists with antidepressants was effective in one patient and the combination of lithium and L-thyroxine with antidepressants was effective in two patients.

The findings indicate that "bipolarity plays an important role in the pathophysiology of a subgroup of patients with antidepressant-refractory depression," Inoue et al write in the Journal of Affective Disorders.

They suggest the use of augmentation therapies for patients with antidepressant-refractory depression both for bipolar and unipolar patients, noting that, in their study, no serious side effects or rapid cycling were observed with such treatment.



Source: J Affect Disord 2006; 95: 61–67

[bizi]

Hello,
I've posted in the past regarding my sons' bipolar problems, but this time I'm posting about myself.

While this forum was down I spiraled into some deep depression, the lowest I've ever been.

Also, I do get a low grade headache on the Lamictal. Should that go away as I adjust?

Take care,
Julie


Dear cutie pie,
I am sorry that you had to go thru such a depression.
our hormones can also cause us haovoc as you are finding out.
I wonder if they have checked your thyroid to see if there is anything else out of line.
The lamictal is usually started at a very low dose and slowly titrated up over the course of months to its theraputic level.
At least this is what my pdoc did.
I am at 200mg at night...this is my only bp med...I also take a sleeping pill at night ambien.
I am sorry about the headache.
take care and keep posting.
bizi

[Mari]

Hi Cutiepie,
You might have many of "soft signs" of bipolar:
http://www.psycheducation.org/depression/02_diagnosis.html#soft

That page is from one of the best bipolar sites on the web.
http://www.psycheducation.org/index.html

Google bipolar spectrum and you will find lots of stuff:
http://www.psycom.net/depression.central.lieber.html

[In recent years, clinical research has begun to validate the observations reported by experienced practitioners of clinical psychopharmacology - that a much larger group of patients demonstrate milder and/or atypical forms of episodic mood disturbances.

These patients are frequently resistant to standard antidepressant therapies, and sometimes their conditions are worsened by drug treatment with antidepressants. Efforts at clinical subtyping of the so-called soft bipolar spectrum are ongoing; up to this time such patients have fallen into the DSM-IV diagnostic category of Bipolar II Disorder, NOS (not otherwise specified).

If we include these patients with the three DSM-IV bipolar subtypes, the lifetime prevalence approaches 5% to 8 % of the general population. This is a far cry from the 1 % prevalence for manic depressive illness postulated by several large scale epidemiological surveys conducted by academic consortiums.

Also,
http://www.psycheducation.org/depression/BSDS.htm


Re Lamictal:
I've never been on it but perhaps you have to be at 100 or 200 mgs for a litte while before you notice a change.
My first guess is that the headache will go away. I certainly hope so.

Good luck.
Sorry you had a bad time recently. I hope that you trust your pdoc and feel good about her.
Mari

[Cutiepie]

Thanks for all of the replies and information. The articles are very enlightening and help me understand what is going on. I appreciate the time you took to look these up and share.

I am titrating up very slowly on the lamictal as I am very sensitive to medication. I guess I won't feel improvement for a while, but it's good to know that something is being done. I was glad to hear that lamictal can be a stand alone therapy. I am also on Ambien CR to help with sleep.

I do have a thyroid problem that is being treated. I also had premature ovarian failure and am in full menopause now. I have an endocrinologist for these problems. I think I'm finally getting these under control. No doubt they have contributed to my depression.

I like my pdoc. She is also the doctor who originally diagnosed and treated my son. She is very good at explaining things and is well respected by other doctors. I am seeing a separate psychologist for therapy.

I was encouraged to hear that my depression can go into remission. I don't want to live in this place permanently!

Thanks again for the support.

Best wishes,
Julie