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TherapistMarryAnn, Therapist
Category: Mental Health
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Experience:  Over 20 years experience specializing in anxiety, depression, drug and alcohol, and relationship issues.
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Hi there, For the last 1-2 years, Ive noticed Ive been

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Hi there,

For the last 1-2 years, I've noticed I've been having extreme mood swings, which have gotten worse over the last few months.

I've noticed that I'll be on top of the world for weeks/months at a time, life is wonderful. I don't need much sleep during this time [I'll stay up until 2-3, sometimes 4 in the morning and then still get up early]. There have been times I'll be in bed at 1am, and wide awake/wired at 5am. I'll have tons of energy, I don't feel the need to eat much, I feel hyper and have a million things going on at once. I'm ridiculously productive, come up with tons of different plans for things to do, even business ideas to start... but don't follow through on any. I am TERRIBLE at finishing things I start during these periods. I'll be on the go all day and just feel full of energy. I suffer from restless leg syndrome every now and then, and there was one time recently I actually had that feeling in my hands/arms. I felt like I just had to keep moving them and fidgeting. It was really strange.

Then, randomly without warning, other days I will suddenly wake up feeling just unbearably low, feel like all I want to do is cry [which I do, fairly often], I will also sleep an unhealthy amount - I could go to bed at 10pm & easily sleep til 11am/12pm the next day, if not more. During this state, I just feel like everything in my world is crashing down. I feel like when I get in that low place, it's incredibly intense and I can't shake it - I also feel like during these times I almost look for things to be upset about. I usually wind up picking fights with my significant other during these times, I don't want to talk to anybody at all. I also feel like it takes every ounce of energy/strength in me just to get up and go for a 10 minute walk. I don't want to do anything.

I always brushed the mood swings off, I just figured 'oh I'm feeling down again' and thought it was normal. It's really a weird feeling, to be in such an extreme, empty, painful place... and then suddenly wake up a few weeks later feeling totally fine and happy again like nothing happened. I won't lie, it kinda scares me at times. Especially during the crying spells, I get really scared because I feel like I'm going crazy.

It recently got to a point where it started affecting my work, I had to call in sick because I could not stop crying. I've also broken down crying while at work, which is terribly embarrassing. I work in sales, and another thing I've noticed is that when I'm in the up/hyper frame of mind, my sales shoot through the roof. When I'm in the low periods, everything just tanks.

I started to see a counselor, who recommended I meet with a psychiatrist or doctor, because she felt it could be Bipolar Disorder that I have. I looked up my symptoms online, and frankly, I felt like I could definitely identify with pretty well everything I saw. I felt almost a sense of relief when I started reading up on the disorder. Also, although I've only noticed a pattern these last 1-2 years [ie: depressed for 3 weeks, up for 2, etc]...I do believe it goes all the way back to when I was in high school. Also, my mother has suffered from major depressive disorder, and it was even thought at one point that she may even have bipolar, but it was ruled out.

I saw my doctor the other day, explained everything, she said it's definitely Bipolar disorder... but she didn't tell me which type I could have. She then said because of the severity of my symptoms, she didn't want me to wait to see a psychiatrist, she wanted to start me on treatment right away. She prescribed me Cipralex, saying that she wanted to ease me into medications, see how it goes and then possibly add a mood stabilizer in 2 weeks. I take 10mg for 7 days, then 20mg.

My question is... I've read up on the medication and I read that a bipolar patient is usually prescribed BOTH an anti-depressant and a mood stabilizer... and that if the patient is taking ONLY an anti-depressant, it could lead to a manic/hypomanic episode.

Should I be concerned? Is it normal for a doctor to start a bipolar patient on only one medication at a time, just to see their my body reacts, before adding more? I'm sorry this is so long, but I wanted to share my symptoms and everything.

If you need any additional information, just let me know. Thanks so much for any insight you can offer.

Hello, I'd like to help you with your question.

You describe your symptoms very well. It sounds very much like you might have Bipolar disorder, possibly Type II. This type of Bipolar illness shows elevated states of mood called hypomanias. These states are disturbing as you describe but remain somewhat functional. And then you also experience significant periods of depression. You need at least one of those to qualify for Bipolar, Type II. Type I Bipolar only requires that you experience the extreme high. You can have depression, but it is usually not that severe and may not happen at all. And Cyclothymia is mild highs and mild lows.

Your doctor's concern for your symptoms is valid. But without knowing what type of Bipolar you have or even confirming that you do indeed have Bipolar, it is a hit or miss regarding your medications. The most prescribed medications for Bipolar is Lithium. Some people also take Depakote as an alternative. The medication your doctor put you on is an anti depressant, which is questionable to use with Bipolar. It is an SSRI, which is a selective serotonin reuptake inhibitor (SSRI). It works by preventing serotonin from being reabsorbed back into the nerve cells in the brain. This helps prolong the mood lightening effect of any serotonin that has been released by your brain. That helps alleviate your depression. This medication is mostly used for depression and anxiety though. It does not stabilize the mood swings experienced with Bipolar. You may want to ask your doctor again about the medication and the success that it has had with Bipolar. You may also want to get a second opinion.

You are doing the right thing by seeing a therapist and a psychiatrist. They will be able to provide you with a full evaluation and confirmation of your diagnosis. There are other things you can do to help yourself. Here are some links to help you:

Also, consider support groups either on line or in person. Talking to others who have the same symptoms as you can help you feel less alone and provide much needed support.

I hope this has helped you,

I hope you got all the information you needed today. Please let me know if you have any more questions.


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Customer: replied 4 years ago.
Hi Kate,

Thanks so much for your reply and opinion, I really appreciate it. I will definitely talk to my doctor again and possibly get a second opinion as well.

Not sure if you'd be able to answer this question, but I thought I'd ask anyway. As I mentioned, I've read that taking only an anti-depressant could cause me to go into a hypomanic state fairly quickly. My question is, I understand it can take anywhere from 2-6 weeks for me to feel the full effects of the Cipralex. If, for the sake of the question, I do indeed have Type II of the disorder.... when would I start experiencing the hypomanic episode should the Cipralex cause one? I understand it varies for everyone, depending on how they react to the medications...but I was just curious if I would start potentially experiencing things in the first week if it were to occur. Just so I know what to watch out for.

Again, I understand if you can't answer, just thought I'd ask anyway. I'm so confused why my doctor has put me on this medication, when I clearly explained everything to do with not only the depressed points, but also everything regarding the disruptive highs as well..and I explained it all just as I've explained it to you. I mean, even you said, I need at least one [either hypomania or depression] to qualify for Type II Bipolar and it seems I have both. But then again I'm definitely not a doctor so who knows haha. I definitely appreciate having your professional opinion on all of this.

I've bookmarked the links you sent me, thanks again.


You're welcome Amanda!


You are right. How fast you experience any hypomanic state, if you do indeed have one, depends on your metabolism, the cycle of your symptoms and other factors. While it is possible that you could experience an episode within a week, it does take the medication time to build in your system. So it's more likely that it would occur when the medication is fully active. But there is no way to tell for sure because of the differences in body chemistry.


I am also not clear why your doctor prescribed the medication. It's understandable that she wants to help. But it's important that you have a full evaluation to confirm your diagnosis first. That way, you do not experience any distressing side effects. A second opinion would let you know if it is ok to continue with this medication.


You are doing all the right things. And this will get worked out. Hang in there.



Customer: replied 4 years ago.
Thanks again Kate. My apologies it's taken a while to reply, I had to work.

One last question [again, thank you so much!].... do you think if I present all of the symptoms I've shared with you, along with any others I've noticed, with a psychiatrist, it would be fairly easy for them to reach a diagnosis? Or does it take a long time?

You're welcome!

Yes, I do think it will be easy to provide you with a diagnosis. From what you told me, your symptoms seem very clear cut. Any therapist or psychiatrist who sees them should be able to confirm what your diagnosis might be. It should only take an hour or two. They need to take a full evaluation and look all your symptoms and history to be sure they have the right diagnosis. Once you have that, they can provide you the best treatment options.


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