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Forum Name: Psychiatric Topics

Question: Subthreshhold bipolar...


 AbsentLazarus - Sun Nov 09, 2008 10:10 pm

I experienced around 8-10 acute, subthreshhold manic or mixed episodes in a year, while depressed. The manic episodes where always acute -- within about a thirty minute time frame. The downhill transition takes about five minutes, a bit less comfortable. Heh. Delusions about seducing any woman in the world, being president, ***** like that. The feeling of motivation associated with it typically lasts a day afterward, with low-self esteem and sadness in tandem.

I was treated on buproprion, got better on 300, regressed severely back to my severely melancholic state at 450, came off, was better than initially having entered the psych's office.

I was curious as to the implications this would have for me in the future (is it likely I'll go on to develop the illness, etc). Also, I am not receiving treatment, and was wondering, upon what different basis psychiatrists choose not to treat depression or subthreshhold mania.

Yeah, any advice is useful. At the moment, I'm just curious, not really expecting any pragmatic or accurate (don't warn me please) advice.

Past family history;

Mothers side; grandmother smoker, grandfather alcoholic, mother dysthymic, mother smoker.

Father's side; grandmother panic disorder, HPD, depression, chronic and amazing amounts of drug abuse of any kind, possibly bipolar, grandfather ADHD melancholic clinical depression, sex addict, IQ 170+, meth addict, uncle cocaine addict, crack addict, etc. Father former smoker, severely inattentive, aunt cocaine user, alcoholic. Great uncle absurdly shy, committed suicide. Taciturn image. I could go on more. There is more. I'm impatient and looking for answers. More on request, then.
 Dr. E. Seigle - Mon Nov 10, 2008 7:41 pm

Hi AbsentLazarus,

There are many factors that enter into the decision as to when to treat a bipolar disorder. Some of these include: the amount of impairment or interference in your life, the risk for future problems if you are untreated (the disorder tends to worsen with time, and felt to progress more significantly if untreated), and how the disorder has manifested in your biological relatives (the history of suicide would make one more concerned). It is interesting that you were treated with only an antidepressant, as I understood it, since one would generally use a mood stabilizer first or in tandem with the antidepressant, if you were having manic or mixed episodes. These comprise just some of the relevant issues that you asked about. Good luck.

-Eliot Seigle MD
 AbsentLazarus - Mon Nov 10, 2008 8:01 pm

Is the rapid onset on descent of mania aberrant amongst the bipolar? Does it have any interesting implications?

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