Forms of Bipolar Disorder

[historyteach]

I found this short, interesting article on WebMD.com
While I knew there were multiple types of bipolar, namely 1 and 2, I didn't realize there were 5 types!

Bipolar Disorder: Forms of Bipolar Disorder

There are several types of bipolar disorder; all involve episodes of depression and mania to a degree.
Bipolar disorder is a lifelong illness. Episodes of mania and depression eventually can occur again, if you don't get treatment. A small percentage of people will continue to have symptoms, even after getting treatment.

Bipolar I disorder involves episodes of severe mood swings, from mania and depression.

Bipolar II disorder is a milder form, involving milder episodes of hypomania that alternate with depression.

Cyclothymic disorder describes even milder mood changes.

With mixed bipolar disorder, there is both mania and depression at the same time. "The person feels grandiose, with racing thoughts, all this energy -- but is also irritable, angry, moody, feeling bad," says Michael Aronson, MD, a clinical psychiatrist and consultant for WebMD. "This can be a dangerous mix."

Rapid-cycling bipolar disorder is characterized by four or more mood episodes that occur within a 12-month period. Some people experience multiple episodes within a single week, or even within a single day. Rapid cycling tends to develop later in the course of illness. Women are more likely than men to have rapid cycling. A rapid-cycling pattern increases risk for severe depression and suicide attempts.

Antidepressants are thought to trigger and prolong rapid cycling. However, that theory is controversial and is still being studied.

Knowledge is power. Understanding the different types of bipolar disorder may help people understand, and even accept a diagnoses, better.
To Knowledge!

Shalom!

[shutterbug]

Actually Teach...the article doesn't make it very clear, but they are not all seperate types of bipolar.

there is bipolar I and II. Either can be with rapid cycling. Either can also have mixed episodes.

I've skimmed past Cyclothymic disorder many times, but i don't recall it being a seperate "form" of bipolar disorder.

The biggest issue i take with this is in the first paragraph. It says, "A small percentage of people will continue to have symptoms, even after getting treatment."

that is simply just NOT true. Rather, the opposite is true....as a LARGE percentage of people will continue to have symptoms after seeking treatment! In fact, i'd be willing to say most all.

Moods can be stabalized yes...but it is a VERY difficult process to find the right combo of meds for each bipolar person. And even when a right combo is found....they can loose there efficacy over time (like Effexors seems to have many people who've reported that it just stopped working after a number of years).

And even when correctly medicated....symptoms are ALWAYS there...just usually very minute and aren't enough to cause disturbances in the individuals life. Here...it it just feels more like a natural and swinging of up and down.

[historyteach]

Thanks, Jenna, for this added information.
I do tip my hat to you, as I know you have much more information than I concerning this disorder, (and probably much more!)

But, (and this is just a question for comprehension, ok?), if mood is stabilized, and the symptoms that remain are minute and not enough to cause disturbances in the individual, isn't that, then, what the desired result is?

I mean, we all have ups and downs. Bipolar, like depression, cause extreems. Those extreems interfer with life functioning. That's where the issue lies.
If there were no "symptoms," that is to say, no ups and downs at all, we would be flat - affectiveless.
That surely isn't the goal of treatment, is it? Life without feelings would be unbearable, it seems to me.

Perhaps I just don't understand, but, I took that statement to mean that they continued to have symptoms that interfered with daily functioning. I know that's a true statement for major depressive disorder.

I do hear you, though, and totally agree that it's a continuum, rather than a distinct difference. Thanks for the clarification, here. And for sharing your knowledge so freely.

Shalom!

[shutterbug]

So this got me curious and as i'm up (and trying to stay so...so to not sleep thru an early assignment) i wanted to come back to this.

From one of the books i have called "Taming Bipolar" written by Lori Oliwenstein and published by Psychology Today.

It lists Bipolar I and II (and also III, but which doesn't officially exist and i suspect reasons for that so I won't elaborate), but also Cyclothymia.

It was Cyclothymia that i was thinking of when the above mentioned Cyclothymic disorder. As i had first thought when reading the above, it doesn't talk of cyclothymia as being a "disorder" out right...as in "bipolar disorder", but rather as you had read it Teach to be a TYPE of bipolar disorder.

The reason why i never have paid much attention to it is because of it's description in saying:

"And in as many as one in three cases, the mood swings will get wider and you'll wind up with bipolar I or II diagnosis. In fact, some clinicians think of cyclothymia as a precurser to bipolar disorder rather than one of its forms. Others think it's basically indistinguishable from bipolar II."

I agree that it is most likely a precurser or the same as bipolar II.

As to rapid cycling it says:

Rapid cycling isn't a "type" of bipolar disorder - if you have any of the diagnoses described earlier in this chapter, you can find yourself swinging from mania or hypomania to depression and back again. Rapid cycling, does, however, seem to pair itself most often with bipolar II.

It also seems that people who are rapidly cycling actually spend most of their time depressed. In Judd's "Archives of General Psychiatry today study, which followed 86 patients over a period of more than 13 years, he found that people with bipolar II spend 50.3 percent of their time battling symptoms of depression, both major and minor, but only 1.3 percent of their time dealing with the symptoms of hypomania.

it also goes onto say (which i find interesting as i didn't remember) that there's some evidence to suggest that THYROID problems might contribute to cycling and its speed. This particular screams at me as BOTH my paternal and maternal family lines have diabeties and my maternal side has Graves disease (my aunt who's issue is not blood sugar levels, but rather thyroid levels that affects so many things in the body and her son is most definetly bipolar...and only occationally treated for it. And she suspects her mother, my grandmother, to have died young from undiagnosed Graves disease).

[shutterbug]

I also wanted to share what the book lists in describing Bipolar i and Bipolar II.

Bipolar I
Bipolar I is manic-depression at its dubious best. If you get a diagnosis of bipolar I disorder, you've experienced at least one full-blown manic episode-- and likely at least one major depression as well. Although it's true that in nearly three-quarters of bipolar I cases, mania and depression will switch off in a somewhat orderly progression, there's really no rhyme or reason to the episodes: Depression might lead to mania, or mania to depression. They can be mixed in a single week or day or they can be seperated by months or even years.

Bipolar I is the most severe form of bipolar disorder. If you have bipolar I and don't treate it, you're likely to experience as many as four mood episodes a year. Untreated manias might last for a month or more -- an eternity spent in a world of frenzy. Untreated depressions can linger for months and months on end; some can even last for a year or more.

If your clinician diagnoses you with bipolar I, he or she will usually add a variety of modifiers such as delusions and hallucinations. If you're a woman, your doctor might also consider whether your symptoms were kicked off or restarted by giving birth.

Bipolar I affects more than 2 million people in the United States, or about 1 percent of the population. Despite the fact that it is the best-known and most easily recognized form of the disorder, it is not the most common forum. That particular dupious honor is reserved for bipolar II disorder.


Bipolar II
If you're bipolar II, you've never been out-and-out manic, but instead you have gone through at least one or more hypomanias (you don't go as "high" as full-blown mania) as well as at least one major depression.

It's tempting to talk about bipolar II as "less severe" than bipolar I. Cerainly, the symptoms of mania are less striking than they are in bipolar I, and if you're bipolar II, you're more likely to return to "normal" between hypomanic and depressive episodes. In fact, in a long-term study of bipolar Ii patients led by Lewis Judd, M.D., of the University of California, San Diego, the authors noted that although bipolar II patients spend a lot of their time with symptoms of depression, more often than not, those symptoms are relatively mild compared to those needed for a diagnosis of a major depressive episode.

But bipolar II has its own special brand of treachery. Those normal periods of time? They're shorter than in bipolar I. You're more likely to keep having episodes over time -- bipolar II has a more chronic course than bipolar I. You're also more likely to experinece rapid cycling. And because of the amount of time you spend depressed, if you have a diagnosis of bipolar II, you're more likely to commit suicide than someone who is bipolar I. this is a particularly devastating issue, because bipolar II disorder is two to three times more common than bipolar I.

"To paraphrase Kraepelin," wrote Judd and his collegues in their 2003 Archives of General Psychitary paper, "the nature of this deceptively 'milder' form of manic depressive illness is so chronic as to seem to fill the entire life."

[shutterbug]

Morning Teach...we seem to both be up in the weeee hours of the morning and both having forms of bipolar on our minds

You are right. The goal is not to end up flat, and "normal" moods is the goal of treatment, but what i was more wanting to point out is that it's not even close to being as simple as that statement of "only a small percentage of people will continue to have symptoms, even after getting treatment."

I had already written/typed out the above responses before your question...so the bolded area in that last sentance was not directed at this question, but that is how important i think that is for people to understand about bipolar disorder -- particularly bipolar II.

It is not easily treatable by any means. And like i mentioned above, even when a med combo is eventually found (that time usually taking on average 2 years on a med rollar coaster to 'find') then many find that within sometimes as soon as 2-3 years something has changed or stopped working and another med-merry-go-round is needed. To those of us who've gone thru the initial trial-and-error med process, changing meds after being stable for awhile is super scary and many (like myself) put it off as long as we can -- which also means we are obviously experinecing symptoms during that time too.

Med changes are such a scary thing to us because we can go from struggling to unable-to-function with the addition or deletion of one goofy little pill! And very quickly too....and the climb back up is not always as easy as reversing the change that caused the downward spiral.

Stable -- that is the word that i use to express my "goal" state of moods....stable. When stable, i can handle the normal everyday things that cause stress, grief, general saddness, whatever -- but when unstable....these things are no longer manageable to me like it is for people without a mood disorder. These normal everyday occurances truely throw my life in total upheaval on many fronts.

Teach, that statement of small percentage still having symptoms really stuck out to me because I am heading into my fourth year of "treatment" and i am NOT alone in my FIGHT to live my life successfully (i.e. still here, still working, still pushing on). I am not in the minority of bipolars, but the majority). And of course....this doesn't even take into account all those who initially seek treatment and give up way before ever finding a half-way decent med combo...and without understanding the disorder, they don't realize that even tho they may feel "normal" when they stop taking their meds....they may actually be in a hypomanic episode or only have leveled out for the time being. And without education of the illness...even when symptoms start hitting them again there are often things in life for them to blame it on (like a death or hard break-up) and they don't connect that....yes the circumstances suck...but this is WAY past normal responses to such life events and they don't see that a mental illness is actually doing most of the damage in their lives.

It is why so many people go their whole lives without being diagnosed or taking heed to the diagnosis...we get so USE to always struggling, that we often don't know it isn't normal.

This can be seen just as codependency can be viewed. Anyone who knows how that affects our lives and our choices can see that knowledge is really the only way "out" but that we will still always struggle with codie issues regardless -- it is that engrained in us. And in the same token as bipolar disorder, how many codenpendents continue wrecking their lives because of codependency that they don't know exists or do, but don't understand it enough to recognize it's forces in their lives on a daily basis? To me, someone saying only a small percentage of those treated for bipolar disorder continue to have symptoms is like saying...."only a small percentage of those who've read a codie book and go to occational Alanon meetings will ever have to deal with codependency at work in their lives ever again." It's just not that easy unfortunately.

It is a constant uphill battle against this disorder and one i will have for the rest of my life unless modern science comes up with something better (or else i am able and brave enough to take on ECT and find it works for my depressions).

Hugs and thanks for this thread Teach,
Jenna

[historyteach]

Wow! Good stuff, here, Jenna!

Curious here. Is it possible to go from Bipolar I to Bipolar II over time? I mean long periods of time, like 20 years or more?

Thanks for the imput. Much to consider here. Especially the fact that the supposed "milder" form of bipolar disorder II has a higher rate of mortality. I guess the unending nature of the short term highs and longer term lows have a cumulative effect. Even the strongest of us could think, "enough is enough; I'm tired."

Thanks for sharing, Jenna...

Shalom!

[shutterbug]

I don't know if it's possible to migrate from one from bipolar I to bipolar II over time. It is such a difficult illness for doctors to often even understand...and up until recently in our history...many bipolar I sufferers who also deal with halluctionations and delusions were actually diagnosed wrongly as being simply psychotic or some other non-mood related mental illness.

So i guess i'm trying to say that i don't think bipolar disorder has been understood enough, or for long enough, for there to be any real scientific data on that type of issue.

If you think you know someone who may have switched from bipolar I to bipolar II over 20 years, i'd be interested to hear about it. And i'd also want to know what makes the person think they were one over the other to begin with?

very interesting question.

[historyteach]

As usual, Jenna, you've given me much to consider again.
I have to "chew on the fat" a bit. You're connection to codependency really hit home for me.

Thanks...

Shalom!

[tryvia]

Originally Posted by historyteach

Curious here. Is it possible to go from Bipolar I to Bipolar II over time? I mean long periods of time, like 20 years or more?

See, now you've got me curious. I'm diagnosed bipolar II with mania that seems to be getting MORE severe (lack of insurance makes getting meds other than lithium an adventure :p), and that's a fairly well documented "Thing That Might Happen With Insufficient Treatment", but I've never heard of the reverse. The problem, I think, is that the only way to know whether you would be having a manic or hypomanic episode is to go off meds for it, and that's just a plain bad idea.

That said, I do have an appointment with a p-doc tomorrow and will ask, because it's a darn good question!