Bipolar I Disorder versus Bipolar II Disorder

[prayerbear]

Miss ex-clean is being treated for OCD, bipolar II, and PTSD, and I am wondering with bipolar II, I am taking klonopin which makes me feel quite calm! How many people acutally get addicted to klonopin(I am taking the smalles dose to 1 gram a day)

Also, how do you know if with bipolar II you are in a very good mood or it is just hypomanic?
What is the most amount of medicine you have ever given anyone?

Is it accurate to say that with an OCD/bipolar II individual that the ups are considered manic and when I am down, I am very OCD?

 

[David Baxter PhD]

I am taking klonopin which makes me feel quite calm! How many people actually get addicted to klonopin (I am taking the smalles dose to 1 gram a day)

Klonipin (clonazepam) is a mild tranquilizer (benzopdiazepine). It is intended to make you feel less anxious, more calm. All benzodiazepines have some potential for addiction but at the low doses (you mean up to 1 mg, not 1 gram, by the way) you are taking, there is little danger as long as you stay within your doctor's orders as to dose.

Also, how do you know if with bipolar II you are in a very good mood or it is just hypomanic?

Hypomania is a little more than just a good mood. One of the ways to check is to solicit feedback from others who know you well.

What is the most amount of medicine you have ever given anyone?

In Canada, psychologists can not prescribe medications.

Is it accurate to say that with an OCD/bipolar II individual that the ups are considered manic and when I am down, I am very OCD?

No, it's not that simple, Your OCD symptoms are likely to become more intense or severe under stress or elevated anxiety. With bipolar, the other end of the manic/hypomanic dimension is depression rather than anxiety.

 

[stargazer]

Miss ex-clean is being treated for OCD, bipolar II, and PTSD, and I am wondering with bipolar II, I am taking klonopin which makes me feel quite calm! How many people acutally get addicted to klonopin(I am taking the smalles dose to 1 gram a day)

I'd like to address this from personal (not professional) experience, and maybe someone can fill in the gaps. My guess is that everyone's physiology is different as to the addictive potential of benzodiazepines. In my case, I was given klonopin in 1992, at first at a low dosage, yet prescribed to be taken regularly (the same dosage each day). I think the dosage was 1.5mg a day. (I was told this was a low dose.)

It wasn't very long before the same psychiatrist had me at 6mg a day, which I was told was the highest permissible dosage in the United States. (Later someone told me that higher dosages were all right for certain conditions). I asked the psychiatrist if I were "addicted," and she said, "no, but you are dependent." I was definitely habituated. I felt that if I were not to take it, something would somehow go wrong. If there was a foul-up and I didn't get a refill on time, I started feeling hyper, and there were uncomfortable changes in my breathing.

They later fired the psychiatrist. This is significant only because I think she mis-diagnosed a lot of people. She had me at Generalized Anxiety Disorder, then when they gave me to a new doctor, he diagnosed me bipolar, started to wean me off of the klonopin, and wanted to give me depakote. But I didn't believe him, and after I got down to 2.5mg a day of klonopin, I was so hyper I couldn't stand it anymore. I attributed all of this to klonopin addiction. So I went back up to 5mg a day, and eventually back to 6mg a day. I couldn't function without it.

I've discussed this all in earlier posts. I know the exact date when I stopped taking klonopin: May 10, 2004. Although I stopped cold turkey, this is not to be recommended. I could have had a seizure, but I didn't. The dosage from which I stopped at that time was 4mg a day. I'd recently been in the psych ward for 9 days because I was having a manic episode, and the doctor there took the dosage from 6mg down to 4mg. I slowly lost my Kaiser insurance during the episode, and I simply took the 4mg per day until I ran out and couldn't obtain any more.

There were other factors, but this is the gist. I basically thank God that I got off of this stuff, and it's been over three years now. I still have a prescription for valium, but I hardly ever take it, and I don't enjoy it when I do. The last time I took a valium was over 6 weeks ago. My experiences with klonopin have left me with a permanent aversion to benzodizepines.

This is my own subjective experience, but there are probably those who share similar experiences with these drugs, so I did feel compelled to share. Good luck to you.

 

[David Baxter PhD]

I wouldn't like to see anyone remaining on 6 mg of clonazepam or lorazepam for any extended period of time either, Stargazer.

However, people can and do remain on these medications for extended periods of time without suffering adverse side-effects and they are very effective in treating certain kinds of anxiety. The key factors to monitor are (1) the development of tolerance for the drug, where the patient finds that the dose needs to be increased stepwise over time in order to be effective; and (2) the development of excessive fatigue. In my experience, for most people this will not be an issue at doses in the range of 0.5 to 2.0 mg per day.

On the other hand, as with many other medications, abrupt discontinuation of benzodiazepines is not advisable. One is likely to experience a rebound (spike) in anxiety and insomnia for a period of time until the individual withdraws from the medication. Most or all of this can be avoided by gradually tapering off the medication under the supervision of your physician.

 

[stargazer]

That all makes sense with my personal subjective experience as well. I think that, had I still had medical insurance and a doctor at the time, the doctor would probably have set up a schedule for me to get off of the final 4mg/day klonopin more gradually. But because I lost my Kaiser health insurance shortly after being released from St. Joseph's, I didn't have that benefit.

Also, because I was having a manic episode at the time, I wasn't thinking quite clearly around the subject. It's somewhat remarkable that I didn't experience noticeable withdrawal symptoms after going off of 4mg/day "cold turkey," but let's put it this way: other people noticed stuff that I didn't notice, because I wasn't very in touch with my behaviour at the time.

Also, I hope I didn't discourage Miss Clean -- if you're fine at the lower dosage, I wouldn't worry about getting addicted. Also, I don't know a whole lot about OCD. I'm bipolar I, and that also might be a difference to be considered.

 

[prayerbear]

I sure won't go above the reccomended dose,and sorry Stargazer about that bad experience with that psychologist! The first time I took Klonopin, I felt REALLY GOOD!
I know what hypomanic is, but what is it like having to be hospitialized for being manic? If you are comfortable replying, my sister was bipolar I! She would get up on the roof and smile at lots of strange men and act hypersexual-scary.
Aren't the lows really low? Like major depressive disorder to the ninth degree? Don't all bipolar I dismiss taking meds when they are feeling really high?
OCD is major anxiety, along with a fear of losing control.

bye for now,
miss ex-clean,
(a recovering cleaning addict)

 

[stargazer]

If you are comfortable replying, my sister was bipolar I! She would get up on the roof and smile at lots of strange men and act hypersexual-scary.

I'm comfortable replying, but can't do so right now because I'm at work, and time is limited. I'll prepare something, though, and probably post it in a day or so. Hyper-sexuality was definitely involved, as well as hyper-reliogisity. It scared a lot of people, although I didn't think anything was wrong at the time.

OCD is major anxiety, along with a fear of losing control.

I understand. I have a friend who is OCD and has described some of his symptoms. I just don't have personal experience in that area.

 

[finetime]

this link mite help

YouTube - It's a Brain Thing: Bipolar Disorder Part 2 of 6

 

[stargazer]

I was directed back here by an email notification, and I haven't watched the YouTube yet, but I am surprised I wrote all the things that I did earlier in this thread. I can sure be long-winded.

I'm on new meds now, and I think I am writing fewer words and less often than usual, in general. I also find myself making fewer phone calls, and I think I am more content within myself. I don't feel as compelled to buzz people as often as I used to, or in an angry way that would sometimes come out of the blue.

I think the meds are fine, and I'm not experiencing periods of unusual agitation, anger, or severe mood swings. I'm getting a lot of work, I like my living situation, and life is good. I make it to my appointments regularly, and go to church every Sunday, and am generally more easy-going than earlier. My family relationships are a little more positive -- brother, sister, daughter (I don't know about stepdaughter.)

I think this mix of meds has a lot to do with it -- and yes, I am continuing to avoid benzodiazepines. Not good for me, though I'm sure they are beneficial to others, in the right dose.

 

[David Baxter PhD]

That's excellent news, stargazer. Thank you for the update. :2thumbs:

 

[stargazer]

Thanks, David. The only unpleasant side effect I've noticed from the meds is that my fingers shake a lot. Not sure why that is. But I feel healthy overall, mentally and physically.

 

[ladylore]

That is great news!

 

[stargazer]

Thanks, ladylore. Indeed it is.

 

[Halo]

That is so great to hear SG :2thumbs: I am really happy for you

 

[stargazer]

Thanks, Halo.

 

[sister-ray]

Im happy to hear all is well for you stargazer that is brillant news

 

[stargazer]

Thanks.

 

[finetime]

What is Bipolar II

Bipolar II is a psychological disorder that involves mood swings from depressed to hypomanic states. Unlike bipolar I, also called manic depression, bipolar II does not involve manic states. However, like bipolar I, the person afflicted suffers from varying degrees of mood. Bipolar II may create depression or anxiety so great that risk of suicide is increased over those who suffer from Bipolar I.

In order to properly diagnose Bipolar II, patients and their doctors must be able to recognize what constitutes hypomania. People in a hypomanic state may experience increased anxiety, sleeplessness, good mood, or irritability. The hypomanic state can last for four days or longer, and patients will note a significant difference in feelings from when they are in a depressed state.

Hypomania may also cause people to feel more talkative, result in inflated self-esteem, make people feel as though their thoughts are racing, and in some cases result in rash choices, such as indiscriminate sexual activity or inappropriate spending sprees. Often, the person who feels anxious or irritable and also has bouts of depression is diagnosed with anxiety disorder with depression, or merely anxiety disorder. As such, they do not receive the proper treatment, because if given an anti-depressant alone, the hypomanic state can progress to a manic state, or periods of rapid cycling of mood can occur and cause further emotional disturbance.What is Bipolar II?

Manic states differ from hypomania because perception of self is generally so deluded as to cause a person to act unsafely and take actions potentially permanently destructive to one’s relationships. Additionally, the manic person may be either paranoid or delusional. Those with mania may feel they are invincible. High manic states often require hospitalization to protect the patient from hurting himself or others.

Conversely, hypomanic patients may find themselves extremely productive and happy during hypomanic periods. This can further complicate diagnosis. If a patient is taking anti-depressants, hypomania may be thought of as a sign that the anti-depressants are working.

Ultimately, though, those with bipolar II find that anti-depressants alone do not provide relief, particularly since anti-depressants can aggravate the condition. Another hallmark of bipolar II is rapid cycling between depressed and hypomanic states. If this symptom is misdiagnosed, sedatives may be added to anti-depressants, further creating mood dysfunction.

The frequent misdiagnosis of bipolar II likely creates more risk of suicidal tendencies during depressed states. Patients legitimately trying to seek treatment may feel initial benefits from improper medication, but then bottom out when treatments no longer work. The fact that multiple medications may be tried before the correct diagnosis is made can fuel despair and depression.

Depression associated with either bipolar I or II is severe. In many cases, depression creates an inability to function normally. Patients suffering from major depression describe feeling as though things will never feel right again.

Severely depressed patients may not leave their homes or their beds. Appetite can significantly increase or decrease. Sleeping patterns may be disrupted, and people may sleep much longer than usual.

This type of depression does not respond to reason or talking it out, because it is of chemical origin. Though therapy can improve the way a person deals with depression, it cannot remove chemically based depression. Because of what seems an inescapable mood and a feeling that things will never improve, patients frequently contemplate and often attempt suicide.

Once accurate diagnosis is made, treatment consists of many of the same medications used to treat bipolar I. These medications typically include mood stabilizers like lithium or anticonvulsants like carbamazepine (tegretol?), and many people also benefit from a low dose of an antidepressant. Those with bipolar II rarely need antipsychotic medications since they are not prone to psychotic symptoms or behavior. Even with appropriate medication, it may take some time to stabilize a patient and find the right dosage. When patients have demonstrated suicidal tendencies, hospitalization may be necessary to provide a safe environment where medications can be adjusted accordingly.

When medication is combined with cognitive behavioral therapy, patients seem to respond more quickly and have the most success. Though bipolar II is not thought to be caused by traumatic events, such factors as a history of abuse can affect recovery. By approaching bipolar II with both therapy and medication, the patient is likely to recover fully.

With treatment, those with bipolar I or II can live healthy normal lives and attain success in work and relationships. Many anticonvulsant medications are related to a high incidence of birth defects, however. Patients who are on medication and considering a pregnancy should seek the advice of both their psychiatrist and obstetrician before becoming pregnant.
__________________

 

[David Baxter PhD]

finetime, the definition of Bipolar II you cite is somewhat misleading. Bipolar II may not include full blown manic states but it does include the presence of at least one hypomanic episode. Hypomania is like mania only less severe.

Here are the criteria from DSM-IV:

Diagnostic criteria for 296.89 Bipolar II Disorder

A. Presence (or history) of one or more Major Depressive Episodes.

B. Presence (or history) of at least one Hypomanic Episode.

C. There has never been a Manic Episode or a Mixed Episode.

D. The mood symptoms in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

E. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify current or most recent episode:

Hypomanic: if currently (or most recently) in a Hypomanic Episode
Depressed: if currently (or most recently) in a Major Depressive Episode​

Specify (for current or most recent Major Depressive Episode only if it is the most recent type of mood episode):

Severity/Psychotic/Remission Specifiers Note: Fifth-digit codes specified on p. 377 cannot be used here because the code for Bipolar II Disorder already uses the fifth digit.
Chronic
With Catatonic Features
With Melancholic Features
With Atypical Features
With Postpartum Onset​

Specify:

Longitudinal Course Specifiers (With and Without Interepisode Recovery)
With Seasonal Pattern (applies only to the pattern of Major Depressive Episodes)
With Rapid Cycling

 

[Always Changing]

Those with bipolar II rarely need antipsychotic medications since they are not prone to psychotic symptoms or behavior.

These days antipsychotic medication is being used in the treatment of bipolar ll and schizophrenia.
eg: Zyprexa, is an atypical antipsychotic which I am taking to stabilise my mood swings. Not on it long enough to say it is working, but I am hoping this proves to be the case.