Thank you for this concise and clear response--and without any sighs or groans, to boot!
So, if it is true that "the longer someone is well the longer they remain well," if one does in fact remain well (i.e., without any significant relapses of either severe depression or disabling mixed-ish episodes, in the case of Bipolar II), is it, at some point, conceivably possible to say that the disease is in some sense no longer a problem or even that a full recovery has occurred, and thus the patient no longer requires treatment with medicine? Or is that laughably wishful thinking, given that "the best predictor of good outcome is doing well for as long as possible" could simply indicate that the patient has done well precisely because he or she has been med compliant?
I do honestly apologize for my tendency toward theoretical questions. I had a doctor scold me once (really!) for "over intellectualizing," but I need to ask these kinds of questions in order to understand and to accept. It helps me, immeasurably.
This is probably one of those posts that will make you say, "Sigh. There's absolutely no way to answer this pointless question because there are far too many diffuse factors to consider." But obviously that won't prevent me from asking anyway.
Generally speaking and all other things being equal, is the prognosis for a patient with Bipolar I disorder worse than the prognosis for a patient with Bipolar II disorder? By prognosis I mean, what is the general outlook within each of these categories for the diagnosed person to have stability and success in life, and not to commit suicide or destroy life in some other way. Does the person with Bipolar I face significantly greater obstacles than the person with Bipolar II? Or is it completely dependent on how well each individual takes care of himself or herself, in terms treatment adherence, coping skills, etc.?
As a corollary question, I've sometimes heard people say, "It's only Bipolar II," with the suggestion that Bipolar II is not a particularly significant illness in comparison with Bipolar I, or that Bipolar II is just "bipolar lite." I'm trying to think of an analogy here . . . it would be like saying that Bipolar I is the equivalent of double pneumonia while Bipolar II is only a common upper respiratory infection. One is quite serious while the other one really is not. Is that true? Or not?
No respectable psychiatrist would make a diagnosis of a complex psychiatric disorder based on a patient's response to a medication, alone (or at least I WANT to believe that is true), but to what degree does medication response help to support or even confirm a suspected diagnosis, when considered alongside other symptoms?
I limped through several years of what doctors thought was "just" recurrent agitated depressions before a psychiatrist finally tried Depakote during a hospitalization several years ago. My response to that medication was so dramatically positive that, as my doctor told me later, it helped to bolster his suspicions that my mood and motor issues fell within the bipolar, rather than unipolar, spectrum. All I know is that when I took antidepressants alone, my mind seemed to grow more and more crowded, while the addition of a mood-stabilizer calmed things down almost immediately--and has, with adjustments, kept things calm for well over a decade. Is medication response, then, a strong(ish) indicator when it comes to the diagnosis of cases of bipolar disorder that are not clear-cut and textbook-tidy? Or is medication response fairly low on the list of things a doctor considers when settling on a likely diagnosis?
(I don't post often, but it always seems that when I do, I have a diagnosis-related question. Sorry for the redundancy--but I am fascinated about the process by which these complex diagnoses are teased out, though I'm sure I over-think such things anyway.)
I see from news reports that DSM 5 was at last released (this morning, I believe)!
As someone saddled with that problematic NOS label, owing to clear but sub-total manic features during my depressive episodes (or vice versa), I am quite curious to hear your impressions about how DSM 5 deals with the mixed episode problem--that is, the fact that a mixed episode has in the past been defined too narrowly. I believe I read somewhere that Bipolar Mixed will no longer be included as a separate diagnostic category. Is that in fact the case? What's the latest on how the psychiatric community will interpret the mixed features that are so common, whether in full-blown form or--more commonly--if present only to a lesser degree?
My PCP does not seem interested in the increasing number of these incidents at all, which is the source of my frustration because they have become burdensome. At least I feel justified now in my dismissal of her Lamictal idea.
I have taken Lamictal for ten years for Bipolar NOS, with no side effects of note. I am hoping that you can tell me if there is any link between Lamictal use and non-diabetic hypoglycemia, especially as a side effect that appears suddenly after many years of taking the drug.
During the past six months, I've been experiencing some rather unsettling episodes of hypoglycemia. A GTT shows that I definitely do not have diabetes, and I am of a very healthy weight, Nevertheless, instability with blood sugar seems to be worsening, decidedly. Most dramatically, I've recorded levels as low as 47 and 55 myself, using a highly-reliable home monitor. On another occasion, a blood draw at a doctor's office registered a glucose level of 52. My PCP is not concerned about this problem (and it IS becoming a sincere problem, especially in terms of driving); she has only advised that I eat more often. This answer frustrates me because I already do eat six small "meals" throughout the day, with both protein and carbs each time. When I mentioned the problem again at an appointment with her today, she said she thought the fluctuations in blood sugar was probably just due to Lamictal use.
I have to admit, I am somewhat nonplussed by her answer, given that it seems rather dismissive. But perhaps she is correct? Perhaps there IS in fact a link between anti-convulsants and non-diabetic hypoglycemia?