I'm feeling a bit muddled up about my supposed diagnosis at the moment and was wondering if anyone could possibly share their experiences/knowlede with me? Basically, I would just like to try and gain a better understanding of the difference (diagnostically) between Bipolar ii, Cyclothymia and unipolar depression.
Having searched through various resources (ICD-10, DSM-IV, rcpsych, mind, rethink, NICE guidelines etc) I understand that cyclothymia comprises episodes of mild depression and hypomania over a period of two years or more. These episodes do not meet the criteria of either full blown mania or major depressive disoder.
Now here's where the confusion sets in. I was officially diagnosed with MDD sometime in 2008/9, and although my symptoms are far less severe these days, it didn't just disappear overnight, and at the time was in fact nothing short of hideous. I have never had a full blown manic episode but my mood has a tendency fluctuate, however it has always been subject to the whole "hypomania or happiness" hypothesis, which I share.
So, given that I have had an episode of MDD fairly recently, can I actually be diagnosed with cyclothymia? And what happens if slip back into another depressive episode now that I am apparently cyclothymic? Will I then automatically become Bipolar (ii)?!
Ok, I'm confusing myself even more now! Any replies and opinions would be greatly received.
I am not an expert but hum if your moods are far less severe at the moment then it sounds like cyclothmia is the right diagnosis to work with now even if in time you end up getting treated for bipolar ii.
My understanding on upgrading a diagnosis is that it can happen e.g. someone diagnosed with bipolar ii has a manic episode they would then have a change of diagnosis so if you had another depressive episode then your diagnosis may change at that point.
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I am not an expert but hum if your moods are far less severe at the moment then it sounds like cyclothmia is the right diagnosis to work with now even if in time you end up getting treated for bipolar ii.
My understanding on upgrading a diagnosis is that it can happen e.g. someone diagnosed with bipolar ii has a manic episode they would then have a change of diagnosis so if you had another depressive episode then your diagnosis may change at that point.
This is why I am confused. I have always been diagnosed with and treated for unipolar depression (although have always been honest about, and actively monitored my mood swings with my psych; until he left that was) and had thought that my depression lifting slowly as it has done mean't that I was getting better.
I will be honest - the way that my mood can randomly fluctuate does frustrate me and I struggle to ascertain whether it is purely happiness (which I am unfamiliar with thanks the depression) or if it is indeed hypomania. But, according to the diagnostic criteria, if you've had an episode of MDD, you cannot be diagnosed with cyclothymia.
I'm sure that diagnoses can jump from one to another, but I was diagnosed as cyclothymic by a locum psych whom I'd never seen before. He spoke to me for 15 minutes and had a glance through my (thick) notes. I can't help but worry. I saw my previous psych for around three years and he was so careful and respectful. Not once did he slap a label upon me, he was always more concerned about alleviating my symptoms, although obviously wasn't blind to any potential diagnoses.
I am currently in the same kind of situation. I have a history of MDD, but through some stupid mind training I did on myself when I was a teenages I no longer feel emotions (at all/ever). Due to this they are unsure where to put me as any variation in 'mood' is energy based with no emotional ties. As I currently present I would be Cyclothemic but my history suggests BPii.
The happiness/hypomania one is difficult, but for me there is a clear difference: when I'm manic, either mildly or severely, I sleep far less than usual, have boundless energy, spend too much money and often make impulsive decisions which I wouldn't make if I was just 'happy'. Also, sometimes, 'inappropriate' happiness (ie if something bad has happened but you feel fantastic!) is also a sign of a bipolar disorder.
Cyclothymia vs Bipolar 2: This distinction is made on the severity of your depression. Mild to moderately depressed = cyclothymia; severely depressed = bipolar 2.
Does that make sense? If you're really bothered then you should explain to your psych what you put above and see what he/she says, although some of them don't hand out diagnostic labels and might be unwilling to talk about it (although they should if you ask them to).
Hope that helps
xxx
There are, it has been said, two types of people in the world. There are those who, when presented with a glass that is exactly half full, say: 'This glass is half full'. And then there are those who say: 'This glass is half empty'.
The world belongs, however, to those who can look at the glass and say: 'What's up with this glass? Excuse me? Excuse me? This is my glass? I don't think so. My glass was full! And it was a bigger glass!
The happiness/hypomania one is difficult, but for me there is a clear difference: when I'm manic, either mildly or severely, I sleep far less than usual, have boundless energy, spend too much money and often make impulsive decisions which I wouldn't make if I was just 'happy'. Also, sometimes, 'inappropriate' happiness (ie if something bad has happened but you feel fantastic!) is also a sign of a bipolar disorder.
Cyclothymia vs Bipolar 2: This distinction is made on the severity of your depression. Mild to moderately depressed = cyclothymia; severely depressed = bipolar 2.
Does that make sense? If you're really bothered then you should explain to your psych what you put above and see what he/she says, although some of them don't hand out diagnostic labels and might be unwilling to talk about it (although they should if you ask them to).
Hope that helps
xxx
Good morning, thanks for your reply.
Yeah the hypomania/happiness thing is a tricky subject. When my mood is "up" I am confident, energetic, motivated, productive, I make people laugh, but can be a little obnoxious. It never gets out of control however, I still go to work etc. It's an unfamiliar feeling, but I can't quite work out if feels odd because I am simply not used to being happy and functioning well, or if it feels odd because it is in fact abnormal.
So, mild/moderate depression = cyclothymia, severe depression = bipolar ii. That seems to be the general consensus regarding diagnosis. I understand it, but at the same time I am confused by it! I can see how my current symptoms could be identified as cyclothymia, but then, I was diagnosed with severe MDD a couple of years ago (which I have battled to recover from) which kind of contradicts the diagnostic criteria for cyclothymia.
And why cyclothymia? Is it beyond the realms of possibility that this is all just a natural process of my personal recovery? i.e depression getting milder and having random periods of happiness and high functioning?
I am so confused. I have spoken to the psych that diagnosed me (during my first and only appointment with him) but he didn't seem to be too symapthetic regarding the issue. He was a locum and I think that he has moved on now anyway. I just wish that he'd just taken a little more time to get to know me and my history/symptoms before slapping a firm diagnosis on me. I have to live with this now whereas he just gets to move on to the next job and forget about me. I have lost a lot of confidence in psychiatry, which is a shame because my previous psych was an absolute gem.
Urgh, my brain is all tangled up now. Need to go for a walk and clear my head.
