Talk:Bipolar II disorder

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STRONGLY DISAGREE to any merger of this article to Bipolar disorder as not being a sound direction to move in -----> unless the Bipolar disorder article sets out immediately to describe the disorder as a spectrum of disorders with links thru-out directing readers to articles of specific interest. None of the sub-articles should redirect to any of the other articles - unless the title of Bipolar disorder itself redirect to the Spectrum article so the entire point gets across quickly and directly.

Additionally, I am strongly of the opinion that the disambiguation page be deleted as it only leads to confusion and fragmentation of psychiatry's current understanding of this inherited disorder.

Below, I have copied my response from the Bipolar_spectrum Talk page. Actually, there is, necessarily, going to be a multiple of articles that must necessarily arrow out from the Bipolar spectrum disorders article as starting with the spectrum article is the only way to adequately deal with Bipolar. I might suggest that, if anything, Bipolar disorder actually be a description of the spectrum, covering the history of recognition of the disorder's breadth over time, as well as a general covering of treatments. Each sub-type of the spectrum of bipolar disorders, as well as an article about the treatment of them, and even, perhaps, an article about the difficulties in differential diagnosis, plus the confusing overlay of the many co-diagnoses that are so often found in Bipolar patients.

As someone with generations of Bipolar I and Bipolar II in friends and family, married to a psychiatrist for 20 years and having worked closely with doctors treating the disorders for 5 years, plus having closely and continuously kept up with ongoing research studies, I feel kinda qualified to comment on this.

Bipolar spectrum deals with everything as follows:

what doctors call Depression, but which lasts for decades, a lifetime - and is not connected to any loss or source of sadness - it just is.

Actually, in all the bipolar spectrum, even tho mania is what one hears most about, depression is the over-riding, most prevalent state of emotion.

Agitated depression and vegetative depressions are found in abundance. If you treat an agitated depression, seeing the only "symptom" which is free-floating overwhelming anxiety, with valium, the next day your patient will be suicidally depressed - even tho the anxiety will have, of course, disappeared.

Bipolar I is the only disorder originally recognized as such and was officially labeled Manic-Depression. Little or no attention was given to the depression, but the readily recognized Manic Symptoms, ranging from rapid speech reflecting the racing brain, grandiose (and ludicrous) plans to become very wealthy, spending money like there was no tomorrow, maxing out credit cards, by outrageous behavior very out of the usual for the patient and sometimes extreme sexual promiscuity or sexual encounters far from the usual norm for the patient. As the mania progressed, uncontrollable speech, delusions and psychosis could develop. Involuntary hospitalization was the only possible treatment. This degree of the disorder is referred to Hyper-Mania.

Lithium was the first and for a long time was the only medication available to control the mania, but did nothing for the depression since the tricyclics weren't around yet. Which was most unfortunate, for patients can go for years without a manic break, yet still have problems with irritability, social dysfunction and a heightened risk of suicide. Bipolars at any point on the spectrum are routinely denied life insurance.

Treatment begins with Lithium, progresses to Depakote (both of these require relatively frequent blood tests so toxicity does not develop), then to anti-psychotics if the other treatments fail or have too many side effects. Of course, antipsychotics have their own side effects, especially tremendous weight gain in the new-generation "safer" ones.

In Bipolar II, a more recently recongnized form on the bipolar spectrum, has manias most with a stretch of a few days or more of elevated enthusiastic very happy mood with tons of energy used in a very goal-directed productive manner ---- but they will not need any sleep, tho as the days go by, a periodic nap of 3 hours at the most. I have had therapists tell me that their idea employee would be this type of patient (as long as the Hypo-Mania lasted).

A patient may have even as little as 5 or fewer such episodes in their entire lives, yet years of depressive problems at other times. Or they may be Rapid Cyclers with several episodes of greater or lesser degree of being "upbeat" a year, Ultra Rapid Cyclers and even the now recognized Ultra-Ultra Rapid Cyclers that may cycle several times a week or even during a single day. And they generally are kept continuously antidepressants. But the tale-tell characteristic of these patients is IMPULSIVENESS which leads to problems in all facets of their education, employment, friendships and more intimate relationships.

Depending upon circumstances in their lives at the time, they may enter a period of extreme irritability, frequent emotional outbursts, whether of torrents of tears or yelling rages. Impulsiveness alternates with the inability to get organized enough to plan, execute plans and they can become unable to be gainfully employed.

For Bipolar IIs, Lamictal, a relatively new anticonvulsant, is the drug of choice, the first one to try, because it controls impulsiveness and helps the patient direct their own life towards goals and follow thru to a successful conclusion, plus it has an anti-depressant effect. The antidepressants most often prescribed are an old tricyclic called desipramine and the atypical Wellbutrin (also marketed to stop smoking).

In short, the bipolar spectrum of disorders is impossible to deal with in one article. This particular article should be expanded to point out that someone diagnosed with a bipolar illness is much more likely to have ADD/ADHD, Borderline PD and other PDs, dual diagnosis (which means co-existing with drug & alcohol abuse as the patient attempts to "self-medicate"). And there are more.

In recent MRI studies, those with bipolar illness have been found to have specific brain differences from the general population. The reason anti-convulsants are thought to be effective has evolved from a theory that the impulsiveness originates in the too-rapid firing of certain brain cells, over-riding the brain structures vital in normal inhibitory effects... Bipolar requires smaller doses than in persons with epilepsy. Spotted Owl (talk) 01:09, 5 February 2008 (UTC)

Spotted Owl (talk) 09:24, 10 February 2008 (UTC)