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  1. Also known as manic depressive illness, bipolar disorder is characterized by severe and disabling highs (mania) and lows (depression). Affecting 2.2 million Americans, this illness typically begins in adolescence or early adulthood and continues throughout life, with 80% of patients experiencing multiple manic episodes and 15% ending their lives in suicide. However, effective medical treatments are available, and new research is constantly expanding the range of possible treatment options. With proper treatment, most people with bipolar disorders are able to lead fulfilling and productive lives. Bipolar Disorder is distinguished from Major Depressive Disorder by the presence of manic or hypomanic episodes. It is distinguished from Schizoaffective Disorder by the absence of psychotic symtoms (such as delusions, halucinations) during periods of stable mood. Bipolar Disorder is really a spectrum of disorders. Bipolar I disorder is characterized by a history of at least one manic episode, and (usually) depressive episodes. Bipolar II disorder is characterized by hypomanic episodes alternating with depressive episodes. Cyclothymia is characterized by highs which fulfil some but not all criteria for hypomania and lows which fulfil some but not all criteria for depression. Manic Episode A. A distinct period of abnormally and persistently elevated, expansive or irritable mood, lasting for at least one week (or any duration if hospitalization is necessary). B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree: inflated self-esteem or grandiosity decreased need for sleep (e.g., feels rested after only 3 hours of sleep) more talkative than usual or pressure to keep talking flight of ideas or subjective experience that thoughts are racing distractibility (i.e., attention is easily drawn to unimportant or irrelevant external stimuli) increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments) C. The symptoms do not meet criteria for a Mixed Episode D. The mood disturbance is sufficiently severe to cause marked impairement in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism). Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder. http://www.bipolar.org/ Hypomanic episode A. A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood. B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree: inflated self-esteem or grandiosity decreased need for sleep (e.g., feels rested after only 3 hours of sleep) more talkative than usual or pressure to keep talking flight of ideas or subjective experience that thoughts are racing distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli) increase in goal-directed activity (either socially, at work or school, sexually) or psychomotor agitation excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments) C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic D. The disturbance in mood and the change in functioning are observable by others. E. The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features. F. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism). Note: Hypomanic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar II Disorder. Major Depressive Episode A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations. depressed mood or a loss of interest or pleasure in daily activities consistently for at least a 2 week period. This mood must represent a change from the person's normal mood; social, occupational, educational or other important functioning must also be negatively impaired by the change in mood. A major depressive episode is also characterized by the presence of a majority of these symptoms: depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, this can be irritable mood. markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observations made by others) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: in children, consider failure to make expected weight gains. insomnia or hypersomnia nearly every day psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) fatigue or loss of energy nearly every day feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide B. The symptoms do not meet criteria for a mixed episode. C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism). E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor dysfunction. http://www.stanford.edu/
  2. hello without giving an excess of background story, i've been diagnosed with "depression" for a while. the last time it got really bad was a few months ago when i was in russia, when i barely ate, had really bad insomnia (sometimes not sleeping at all) and began to feel as though i was already dead or a ghost or had begun to be out of phase with the rest of the world somehow (although i don't think these were delusions - just sort of "feelings"). i would think of suicide a lot and come close to attempting a few times. anyway i went to the doctor in russia and they prescribed me trazodone and phenzepam (sleeping tablet) which seemed to make my mood swing worse between suicidality and sort of frantic agitation (i bought 3 coats out shopping once even though i didn't really need any of them) and eventually i decided to go back to the UK where i actually live. that day that i decided to do that i suddenly felt my mood swing up again and i went out by myself, drank and took some of my tablets recreationally and was generally very excitable and euphoric. when i got back it was 2am but i wasn't tired despite hardly sleeping the night before and having had lots of CNS depressants and was thinking about going out again, but my room mate got annoyed and i got annoyed with her and so i woke up everyone in the hotel we were in by banging on all the doors and shouting. then i started to pack my stuff and booked a flight for the next day. someone unfortunately called the russian paramedics and they decided to tranquilise me. anyway long story short i was back in the UK. still sort of suicidal and depressed and irritable and slightly on the paranoid side ("everyone wants me to die" etc... but again, i would say this expressing a sort of feeling, i don't think it was a delusion because i would be vaguely aware of the silliness of the idea. sort of.) but things worked out over the next few weeks apart from a few blips (one of those blips being a botched suicide attempt but still). now the last three weeks. OKAY. a week ago, after a two-week depression, i woke up thursday morning having gone to bed at about 2 at about 6.30 am. very unlike me. the days before had been the worst for the depression so far, staying in bed all day, sleeping to avoid crying, suicidal thoughts etc. but i woke up in the morning and after a few mins of grogginess, the fog sort of cleared and i felt very awake. i felt more energized than usual, more excitable, just BETTER. i went out to do stuff, to find stuff to do. i searched out people to speak to. i sat with my friend and some of his friends i'd never met before. they found me a bit odd, as i would cycle between hyper, irritated and depressed every 10 or so minutes. laughing excessively at my own jokes, going off on little rant tangents about people who'd wronged me, picking discussions with people, accusing random people of discussing me. etc etc. but at any rate, i felt increasingly that irritability and rage began to define my mood at the time. in the end i called my ex, who refuses to speak to me anymore since january because of my verbal anger outbursts (:(), i was really agitated and upset because i'd seen he was planning a birthday party. so i asked if i could go. he said "er no". but i didn't have any verbal outbursts i was quite controlled imo. anyway the phone call ended and i was even more agitated and confused and angry, pacing around the room planning to go to his house or his friend's house just because i needed something to do with myself. so i called my other friend and he convinced me to go to the hospital instead. at the hospital after a looooong wait they gave me a sleeping tablet and told me to come back the next day. they irritated me too. i noticed, as i'm sure they did, that i was very talkative. you don't realise how talkative you actually are and how much you feel the need to talk until someone is there having a conversation with you. so i went back the next day. i woke up at 8.30 having gone to bed at about 1 or something. better. i felt still somewhat sedated from the zopiclone when i got to the hospital. sort of quietly sad. the psychiatrist i saw wanted me to try sertraline. this made me feel annoyed for some reason. i don't like SSRIs, although i've taken citalopram before. i felt no one had provided me with a satisfactory explanation as to why i should take an SSRI. anyway i decided to make a big scene about it. so a manager came and spoke to me and i argued with him and was hostile etc (who wouldn't be at some random who'd just said i need therapy and i have a personality disorder as a weapon to get me to be meek??????) anyway then i waited for a consultant. i began to feel more euphoric again rather than irritable. i was still overtalkative when i met the consultant. he said i was hypomanic and gave me quetiapine. this is when it gets a bit more complicated because what is the quetiapine and what is the POSSIBLE hypomania? i was told to take 300mg the first night and 600mg after. 300mg knocked me out for 12 hours a night and made me basically useless, i couldn't do anything. so i decided to just take 300mg rather than 600 as i feared that would be even worse. in the evenings i could feel the effects wearing off and i'd feel MUCH better - i don't know if it was normal better or hypomanic better though! i have no idea anymore :( after two nights of this i decided that too was intolerable, so on monday evening i decided i wouldn't take it. i stayed up until 2 as usual and woke up 4 or 5 hours later, feeling driven and euphoric, getting lots of stuff done in one day. that night again i decided not to take it, slept for 4 hours again. during this time i made only one or two reckless purchases - i bought a couple of tickets for nights out, one of which is tonight, assuming i would go to them when i most likely wouldn't have. i also bought a bag to hold my vinyl (and the vinyl itself i think i bought at this time). i decided to get into glitch, techno and breakbeat and spent a lot of time downloading (this didn't cost me anything though....). i also tried to get into contact with a few men i hadn't spoken to. however while my mind would rush through the day, and even when i went to sleep it felt like i wasn't sleeping because songs and thoughts would whizz through my head, it was like i was awake the whole time still, my body still felt it. when i woke up the second day i could sort of feel that my body was tired but my mind wasn't, my eyes would sting a bit but i'd go on anyway. and sometimes any muscle aches would disappear with a new burst of a pervading sense of euphoria. a couple of other things i would associate with this time - the eyes of anyone looking into the camera in advertisement posters etc would take on an uncanny sort of significance, direct orders (like for traffic) would as well. not a direct, concrete significance, i would just feel a certain "uncanny" feeling. also i would eat fast. it's odd because as i don't have any work or a job or anything i tend to feel i lack things to do, but now i would always have something to do. anyway that afternoon i felt i'd "come down" a bit so to speak, and i went back home, my body feeling heavier, and had a nap for an hour or two, although still with the sense that id been sort of awake the whole time. i thought i was back to normal but again i could feel the irritability and sense of purpose rising when my mother rang me about something (which on the other hand could be perfectly normal!) i decided to take the medicine. it knocked me out again, but the next day the euphoria seemed to break through it, so that i felt sort of sedated and muted but also i cleaned my room, did the laundry, cooked etc, completed with a sense of wellbeing and pleasant gorgeousness. that evening i prepared to go out, but i felt rather down, oddly, for the first time. i decided to take 600mg as i was supposed to. NEVER DOING THAT AGAIN. i slept for 16 hours and was useless for another 2. no euphoria but i think that was over anyway. what makes me think that i wasn't hypomanic - the sense that my body still felt it missed the sleep even if my mind wouldn't switch off, i didn't have any TOTALLY unrealistic plans or make HUGE dents in my bank account. i'm not sure what to do. i can't tolerate the quetiapine it's absolutely awful. what do i do? because the quetiapine sort of interfered when i was in the middle of it, does that change the nature of things? did it cause the stuff that happened on tuesday and wednesday? because overall you might say i had thurs+fri+mon(evening)+tues+wed = 5 days of hypomania = "hypomanic episode". but, like, really? REALLY?! i find this difficult to believe. i found it more difficult to believe before tbh but i guess with the thing that happened in russia etc... it's hard to know what would be "me" and what would be "illness". also REALLY/!?!?!?!?!
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