Bipolar 2 Disorder

[Meylis Delano Lawrence]

Hi Apophenia!
Could you tell me the difference between Bipolar disorder Depressive epidode with pshychosis and Schizoaffective disorder? Or are they the same thing? If one is experiencing BP depressive episode with psychosis can we say he is schizoaffective. If not, how can one distinguish the two?
P.S I heard schizoaffective disorder is hard to diagnose.

Yes, they push the newer ones, primarily for two reasons. One, the pharma salesmen push the new ones, and doctors tend to push what the pharma reps are pushing. The more important reason is that newer medications tend to have a lower "side effect profile"; what this means in a nutshell is they produce fewer side effects for a given effect averaged over a population, and therefore the odds of someone dropping out of the medication due to side effects is lower. That being said, everybody has their own favorite drugs they love to hate. Drugs come with side effects. There's no avoiding it. While it's important to be mindful and not remain on a drug that's not working and/or making you miserable, the flip side of this is that it takes time to adjust and evaluate medications, and most come with some side effect, minor or major; don't stick with bad medicine for no reason, but at the same time, don't run at the first sign of trouble: these things take time and patience. I've never found anything that works, but I know myself well enough to know that at times in my life, I simply wasn't giving medications a sufficient trial before dumping them for this or that reason. Other times I did. It's a difficult thing to judge in the moment. The one medication which was somewhat effective for me, because of dosage, came with serious side effects. I shook all the time, had great difficulty coordinating my movements, and ended up falling several times a day as a result. On the other side of the coin, I was free of depression and felt just plain "good" for the first time in my life. I had to discontinue the medication, but the thing is, I would have put up with all the bad — the falling, the dropping things, the shaking — just to feel that way on a regular basis. And with medication, mostly, you see the bad before you see the good. I can't offer any clean guides other than to suggest not being too quick too abandon ship.

I'm diagnosed as schizo-affective, which means that I display features of the affective disorders like BP2, and features of the thought disorders like schizophrenia. Up until 2008, I had been basically silent about the psychotic side of my experience and so from 1990-2008 I carried various diagnoses of bipolarism and PTSD. The bipolar side of my disorder tends to resemble BP2, though I have had full manic episodes (and at least one mixed episode). I'm going to try to avoid generalizing too much, but I'll speak from my own experience without putting qualifiers in at every other sentence. The clinical presentation of depression and bipolar disorders can be enormously complex, and so self-diagnosis is something best undertaken with caution. The "diagnostic criteria" you read and the summary descriptions you find may resemble actual cases, but there are also going to be plenty of cases that don't seem anything like the text book examples. (I tend to have an atypical presentation with everything.) Again, speaking from my personal experience, some things seem familiar, some raise question marks. In my experience, and I don't think I'm over-generalizing, many people with bipolar disorder have a common pattern of experience in which their manic symptoms and depressive symptoms are reactive towards each other. The usual pattern by which this plays out is a short "positive" episode, in which the symptoms of positive affect rise fairly sharply, immediately followed by a reversal into a negative affective period, and the negative period is usually deeper and longer than the positive period. That much seems to align with your experience. However if one looks at the criteria lists, most are suggesting that these positive and negative periods be of longer duration before they are diagnosed as either mania (or hypomania) or depression. This is where the variability of the clinical picture comes into play, and it's impossible for me or anyone without clinical expertise to say whether the shortness of your cycles is a meaningful difference or not. (There also at one time was a diagnosis of "cyclothymic personality disorder" in which a person's affective state regularly cycled between near-hypomania and near-depression regularly.) I too have relatively short cycles, primarily of the positive states, with hypomanias lasting only a few days to two weeks. I think, though, it's important to bear in mind that diagnoses aren't made simply for some abstract exercise of labeling what you have: diagnoses are made because people with similar symptoms (sydromes or disorders) are likely to show benefit or response to the same treatments. So the question becomes not, should one avoid the diagnosis of BP2 because of the ways in which it doesn't fit, but rather should one try the treatments that have helped people with similar symptoms, on the theory that some of those same treatments might be effective in relieving you of some of your symptoms.


Having rambled on too long, just one other personal note. Again, it's somewhat irrelevant and beside the point, but I guess everybody calibrates differently. I rarely have hypomanic episodes, and even more rarely full manic episodes, but I put the border into hypomania a little higher for myself personally. I generally don't consider myself "into" hypomania until I start showing the overt aggressiveness, hyper-sexuality, increased creativity, intelligence, word play, and a general sense that I'm no longer fully in control of my behavior. I'm probably niggling over a matter of no import, which I've already argued is truly beside the point, but I felt like mentioning it. Anyway. Best of luck.

Oh, and, yes, second opinions are always good. (or even third opinions; you need to be satisified)