33- the same age my sister was when she died.
Hm. A lot of bipolar symptoms tend to present themselves in one’s early to mid-twenties. That’s the most common age for things to start up (though there are plenty of teenage cases and younger). Bi-polar disorder can also “mature” in some individuals, so they may get a broader spectrum of symptoms later. But early to mid-20s is when the fun usually starts in adults.
Come to think of it… a lot of mental illnesses start to present in the early to mid-20s.
As for “depression becoming manic-depression,” it’s not something I’ve seen discussed in the literature.
But that’s exactly what happened to me. I had my first major depressive episode at age 8. It lasted until I was about 13. I had them every four years after that, but they weren’t as bad.
Then, when I was 24, I came out of a two-year long depression and into a hypomanic episode. That was something totally new for me (and it felt fabulous). The hypomania lasted about six months…and then the most horrible depression of my life set in. It lasted three years. Then I swung into a fully manic episode.
I’ve had mixed episodes scattered in there since I was about 17, with increasing frequency and severity.
So definitely, in my case, what started out looking like a recurrent depressive disorder turned into what looked sort of like bipolar II, and then into a more classic case of bipolar I.
My doctors have told me there are various theories out there to explain this:
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I was always going to be a bipolar person–since onset of that disorder is usually in the early 20s or so–but just happened to have some depressions beforehand.
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My major depressive disorder turned into bipolar disorder, and the bipolar disorder got more and more severe, possibly because I didn’t get treatment until I was 25 (and didn’t get correct treatment until I was 27).
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The current definitions of “major depressive disorder,” “bipolar I disorder,” and “bipolar II disorder” are deceptive because they make it look like all cases will fit neatly into one box or another. Instead, the disorders people have and how those disorders progress may be very different from person to person.
I think there’s probably some truth in all of those explanations.
And Jesus Christ…but don’t go getting any ideas. You need to stick around awhile. 
To answer an earlier question:
Some manic depressives do have more mania or more depression.
Eats_Crayons says she has more mania, so she’d be typed as an Md (lots of mania, a little depression that’s usually not very severe).
I’m definitely an mD (couple of manic/hypomaic episodes, but lots of severe depression).
There are mds and MDs, too. Not sure what the percentages work out to–how many Mds, how many mDs, etc.–because my Goodwin and Jamison is currently in storage.
That would be as I alluded above. Untreated, a bipolar disorder can “mature” into a more severe form. Going from bipolar II to bipolar I etc.
Symptoms can really vary at the start unless you’re lucky enough to fall into a more obvious pattern, which is what can make it such a pain in the butt to daignose. In that respect I’m pretty lucky that I was relatively “textbook”. I’d had depressive episodes as a teen but nothing unusual for normal, adolescent, hormonal, blue funks.
But at 19 I had a mixed episode that was initially attributed to some kind fo stress-induced nervous breakdown. So I took a year off of university. But then I had smatterings of more mixed episodes and then at 22 I had a loooong lasting mixed episode and assorted other mixed episodes until I was 24 – it took awhile to figure out what was going on.
I had a lousy, lousy episode that lasted two years from 26-28. Finally it was pretty clear because they were able to consider a fuller history over time. When they looked at the big picture there was a pretty clear portrait.
Oh, yeah man! Eats_Crayons, M.D.
I can start hanging out with Dr_Paprika and Dr Mercotan himself. Get me a white coat, a stethoscope, and one of those shiny forehead disks…
Woo-hoo! And I’ll write prescriptions! Yeah, baby!
One of the hardest things for me to come to terms with is that, if I want to stay healthy, I will never, ever be able to experience hypomania again.
Mania and hypomania are, for bipolar people, inevitably followed by depression. My depressions are long and severe. I have to stay on lithium to avoid them.
To know I will never feel hypomania again, though…it’s something I am working through a grief process over. It’s that powerful.
For me, it’s more the logic leaps I make…that really aren’t so logical.
This is very true for me in both mania and mixed states. I get mixed a lot, and it’s hard on relationships when you’re belligerent and rageful. 
In the end, being on lithium and being healthy is better, but there are some things I will really miss.
Eats_Crayons, what meds do you take? (if you don’t mind my asking)
I get curious about what works for different people, for personal and professional reasons.
I just wanted to chime in again with hearty agreement to the advice Beltane is getting from Q.N. Jones.
If you have the disability available, TAKE IT. Mr. Lisacurl spent most of 2000 out on partial disability and FMLA leave recovering from a manic episode. He actually went back to work full-time in his last week of FMLA leave. I honestly do not think he would have recovered if he hadn’t been able to spend all his time on recovery.
His episode was exacerbated by extreme dystonic reactions to both Seroquel and Risperdal. (First Seroquel, then Risperdal - he wasn’t taking both simultaneously.) Once he got on a combo of Depakote and lithium, things have been great.
Ah, this is the kicker – and it’s the reason it took until I was 27 to properly diagnose me. I can go extended periods of time and be okay without medication. Or seemingly so (see “Spock” below). However that’s changing so I’m being reassessed next month to put me on a medication regimen. Very, very low doses of lithium have been proposed and at this time seem most likely.
The background: At the time, I was living in an “underserviced area”. Our provincial govenrment had shut down the two largest psychiatric facilities and the burden on community healthcare professionals was near-impossible to cope with. So I was put on a waiting list so long that I moved to a different city before I got to see a psychiatrist. So, without a proper diagnosis to get access me proper medication, I had to resort to therapy as an alternative. No real choice in the matter. But the results were interesting.
I was working with a therapist VERY reguarly (two times a week minimum) for almost three years to develop strategies to deal with the episodes and to keep tabs on me. It didn’t really solve the issue but it meant I could still function, and behave myself well-enough to maintain a job. We developed strategies of checks and balances so it’s like having a sub-routine constantly running in the background weighing every emotion for “legitimacy” or not. Legitimate emotions would be allowed, f–ked up stuff would be actively ignored. Ultimately it turned me in to Zen Master Yoda. Remarkably, the coping techniques alone seemed fairly effective at keeping things in check. Therapist puffed up with pride, doctor thought “Oo, that’s neat”, so everyone was content to let me continue on to see how long I could maintain an even keel without resorting to pharmaceuticals. (Kinda made me feel like a guinea pig, actually).
However, as I said I will be switching to a medication regimen because, although I’ve been lucky, and for a few years now have had only minor issues it’s simply not safe for me to continue being unmedicated because I risk maturing into a more serious condition.
As I said in an above post, I’m not prone to depressive cycles. Just… “off”. So I’m calm, I remain unphazed in times of crisis – like Spock. That is why I can appear to manage well for extended periods of time without medication – because everything is really unusually subdued. This is not the calm of a healthy mind, however, it’s an apathetic form of depression.
So I was a mixed mess for a solid two years, it took three years of VERY regular therapy to create a maintenance program that kinda worked (I mean, I really can’t complain all things considered). But it is NOT a recommended strategy and I will definitely be going on medication this spring.
It certainly would be thoroughly inadequate if I had a more severe form of BPD. I want lithium, dammit!
There was actually an interesting thread awhle back (two years ago) called What’s Next Tri-Pola?. Note, it is a Pit thread and starts off kinda nasty, but if you bear with it and follow along it actually turns into a really interesting and informative thread. Somewhere, I think on page two, I describe what my episodes were like when I was trying to hold down a job and try to keep myself together while I wan’t on medicaiotn. Arg. That was really not a fun time, lemme tell ya.
lisacurl that’s the one thing that has always worried me about the prospects of starting a medication regimen. I’ve heard horror stories about unexpected reactions to medications and I dread the idea of experiencing a new episode as a result of starting amood stabilizer that produces and unexpected result.
I did dialectical-behavioral therapy (which is basically crisis management) with that goal in mind. That was before they found a med regimen that worked for me.
It’s usually a great choice for someone who is primarily manic.
Well I will be off of the boards for a while, my Pychiatrist is putting me in the Mental hospital.
I know this is not what you wanted (would anyone?), but I am so glad you are going to follow your doctor’s advice on this. It’s the best place to be if you need your meds adjusted.
Take care, friend. We’ll be here when you get back.
Don’t worry Belt, it’s a good way for them to monitor your moods objectively. Then they can also be sure you don’t have any drastic reactions to medications and whatnot. It’s a very safe place to be.
Good luck and be well! We’re rooting for you!
Wow, a thread I can post to knowing full well I know what I’m talking about.
I was treated for depression on and off for almost 15 years starting at age 16. For over a decade that’s what they thought it was. At age 23 they thought it may be more panic- or anxiety-disorder. Then they thought it was a social phobia deal. None of them got it right and in prescribing Xanax, Zoloft, Lexipro, ad nauseum with nothing helping, I just gave up for a few years. It was too frustrating.
In another thread a few months ago I mentioned I had seen a therapist whom actually took a few hours to look for the problem. He made a few notes, sent them to a psychiatrist to evaluate me, and finally all three consulted with my family doc. They decided based on symptoms it was both bipolar and ADD.
For the ADD I was started at 40mg Strattera, and moved to 60 mg. It may be raised tomorrow to 80mg when I see the shrink again. It is a miracle drug in my book! I can actually get shit done now and not be confused on what I was going to do next or what order it had to be done in.
For the bipolar, I wanted to avoid the side effects (especially sexual and liver monitoring) and was put on 450mg of Trileptal. It’s an anti-seizure med but has shown great results in bipolar disorder. Whatever it was made for or what else it helps, it’s been almost 3 months since I’ve even noticed a swing either way, where it was about every 2 weeks before… I’m sure I’ve had some in a way, but they were so bad before that normal swings may not be noticed.
All in all, I can hold a job and look forward to it, I don’t have suicidal thoughts every few weeks, my wife can finally follow me in a conversation (I’d jump between 8 different topics in one 15 minute talk.) I’d also talk so fast nobody could understand what I was saying.
Both drugs I’ve mentioned are very expensive ($200=/month for each) but with insurance I can thankfully afford them. Unfortunately, they aren’t avail in generic yet. Best of luck on finding something that works.
I honestly feel like I’ve been given a whole new life. One I want to, and can, enjoy.
I was kind of the boob when my therapist said “bipolar”. Firstly I thought “No way, I can manage for months (and lately years) without any noticeable difficulties. Or at least anything that I would consider unusual.”
Then secondly, I thought “besides, I know someone who’s bipolar and I just don’t ever feel as bad as that.”
Of course I don’t feel that crappy! Most of the time I’m hypomanic. I feel pretty grand. And it’s amazing how “not bad” the mixed episodes seem when you’re remembering them rather than experiencing them.
Shortly therafter, I had a really bad mixed episode.
“Note to self,” I said, “yes, actually I do feel that bad.”
Therapy was still always my first choice (even though from what I read, I knew that it would like be inadequate). I practically had a phobia about medication, until a freind of mine on medication for OCD said. “Oh, dont’ worry. I doesn’t actually change you. The disorder will still be there, the medication doesn’t take it away. It makes it manageable.” Which I found tremendously reassuring.
It seems to me that part of the problem is that most of us are conditioned to believe that people with mental illnesses are totally incoherent, totally insane, and totally unable to function in society. They’re CRAZY, and we can all spot them easily because they’re NUTJOBS that would definitely stand out in a crowd, as obvious as if they were glowing neon or something.
So it’s really hard to accept it when your doctor tells ordinary old average you, with a regular job and some successes and a reasonably happy life, that you’ve got a mental illness.
Then, when you finally accept it could be true, and try telling your family and friends what is wrong with you, the response is often, “Uh-uh! Couldn’t be! 'Cause you have a job! And a degree! And friends! And a life! And you’re smart! Bipolar people are CRAZY NUTJOBS, ranting raving lunatics, who can’t take care of themselves or function in society. You’re not that bad!”
This phenomenon is a big part of why I decided to go into the mental health profession.