Demystifying The Bipolar Spectrum: What Is It and Why Is It Important?

[@KevinTspirit]

Great information I'm just finding 1 year after the post LOL. Grew up in domestic violence and at some point just "checked out" of life, but was able to at least finish school. Life ramped up quickly in my 20's, didn't like being around my mom too much because she and my grandmother were "moody". Fast forward to living in Mexico for 9 years of wildness and very low lows, multiple careers, and finally health failure. Last year, 2022, I received my Bipolar 1, GAD, and PTSD diagnoses while going through disability process. Yes, I'm your original example in a body.

[@navidmohammmadpour3751]

As a healthcare professional (Nurse) I have learned more from your videos contents than I did during my mental health class/clinical rotations. I have classic TRD (treatment resistant depression) and currently waiting for my health insurance provider to reimburse me for VNS implant. I just wanted to thank you for being a patient care advocate, and for taking time to make these informative videos.

[@ShrinksInSneakers]

No worries I appreciate the support, please subscribe and spread the word we are creating some new ways of thinking about psychiatry and mental illness

[@catalystcomet]

Would you be willing to do a video concerning not only the treatment, but the symptoms of a comorbidity of ADHD and bipolar? There are so few videos concerning what those interacting symptoms can look like, and none of them are very good. They focus on the overlap instead of focusing on how the symptoms would interact with one another. Personally, I thought I was rapid cycling for years, but I only just realized that what I thought was mania was actually hyperfixation. I would really appreciate it if you decided to make that video, I know so many people would. Thank you.

[@courtenaywells140]

Thanks for this. I can't believe there is still professional pushback about recognizing a SPECTRUM approach to depression. If autism and development and really everything human is on a spectrum, why should depression be considered polar opposites? I have treated many patients who have severe depression and hypo-hypomania but don't exactly fit bipolar 2... and when we added a mood stabilizer, the effect was like magic. The ongoing question is, what is the diagnosis for this patient in DSM 5 or ICD-10???

[@NatureHeadSupreme]

Yes, keep posting. Thank you.

[@clintparsons3989]

You said 70-80% of the type they are depressed. Did you mean time in general or did you mean 70-80% of the time they have episodes, they are depressive episodes? Hope that question made sense.

[@ShrinksInSneakers]

We are talking about episodes, the predominant mood experience is depression. Even the manic episodes are not as much fun as we might think and often develop into dysphoria the longer they remain untreated. Hope that clears things up

[@kalalgutierrez5844]

Dr.Rossi, please...do tell me. What is the best medication for Schizophrenia?. You are totally right about Lybalvi, and it has not worked to help my loved one with His Schizophrenia. Respirodone actually worked better, for almost three years, after it stopped doing its Job. Should we try Respirodone again? It's been about a year now.

[@ashleyzeleznik5388]

Do you do evaluations over the computer? I’m in humboldt country and we don’t have any mood disorder specialists here.

[@sellersplus7960]

KEEP UP THE GREAT CONTENT 😎

[@ShrinksInSneakers]

I appreciate the support, spread the word about what we are doing here

[@sanalsingh]

What are some off label medicines for OCD other than SSRIs and clomipramine? According to what i have read, it may be Venlafaxine, duloxetine and mirtazapine but not sure. Can you tell me effective off labels for OCD according to effectiveness please?

[@clairek-s8918]

I have schizoaffective disorder bipolar type. Can a person have a mixed episode with that diagnosis?

[@bradstout5107]

This is helpful. I underwent TMS therapy for depression and whoops, had a first and only manic episode. Been depressed since childhood but dysphoric episodes. Nobody knew.

[@ShrinksInSneakers]

It’s one of the potential risks but very rare. Honestly it’s a blessing to know that bipolar is the diagnosis as most spend time on medications that only make their mood worse such as SSRIs. Best of luck with treatment, if you haven’t subscribed to the channel please do and spread the word about what we are doing here

[@michaelharned8741]

I have gotten better with age I am 63 now and haven’t had a big episode for a long time

[@ctobolsk]

Yeah, I’m 51 and haven’t had an episode in 20 years

[@ronnie-lynn]

My Doctors are exploring "other unspecified bipolar and related disorders" I’m just exhausted. Diagnosed and treated for depression age 13. Diagnosed with Anxiety age 21. Diagnosed with OCD age 36. Diagnosed with ADHD age 37. Still struggling with sleep and being moody & irritable. Also suffer with a chronic pain disorder and Chronic headaches & Migraines. Now im confused. Have I been misdiagnosed my entire life?? I truly hope if so im taken off some of the many medications im currently on. They took me off 2 antidepressants last spring (Wellbutrin & sertraline) still currently on Dexadrine, guanfacine and Buspar. It’s Psychiatrist Also wands me to take 50mg Lyrica as well but I think it’s useless. Recently came off Lamotrigine as it caused a rash and skin sensitivity.

[@Kingboo1081]

Getting strong skater vibes from you! 😝🤩 love your videos.

[@wesleymccollum9437]

Does Covid trigger manic episodes and psychosis in individuals with bipolar or preexisting psychotic disorders?

[@AP-nx6xo]

Have you had much success with Vraylar. It just came to Canada In April 2022.

[@MrDcrules]

Great video! I've been on SSRIs for 25 years for severe OCD, depression, anxiety, PTSD with very marginal benefits. I've had a fairly constant level of "jitteriness" with these agents. I wonder if that represents the akathisia from SSRIs or some kind of mixed depression. Its an interesting question... thank you.

[@ShrinksInSneakers]

No problem thanks for watching and commenting

[@texassunshine074]

My manic episodes can be two/three days and up to two weeks, just depends on the the stressors in my life.

[@anand11111]

Hi Dr. Rossi, would you be able to do a topic on sports psychiatry (and related to psychology) please?!

[@ShrinksInSneakers]

Wrote an entire book chapter on it, so yes we can cover sports psychiatry. If you haven't subscribed to the channel please do and spread the word about what we are doing here.

[@anand11111]

@@ShrinksInSneakers where could we access the book from? Subscribed and will look out for the video on it. Thanks!!!

[@angelavila174]

I have two questions for you. Have you had pts who get upset once you tell them they may be bipolar? I am a psych nurse practitioner and have had this happen before. Due to this, when referring to the bipolar spectrum, I refer to it as “mood disorder spectrum” and pts seem to accept this wording of the diagnosis better. I was wondering if you would be able to explain a bit further on the key differences between bipolar with mixed features vs cyclothymia. Thank you for all you do.

[@ShrinksInSneakers]

I do a lot of inpatient work and people get upset all the time. When you are forced into the hospital it's not the most pleasant experience. I think there is a lot of stigma and a lack of trust in psychiatric diagnosis. However, bipolar is one I'm 100% sure is valid. There are many other disorders that are questionable but I think Bipolar, schizophrenia, are some of the most biological and well established. My approach to clearly explain to the patient why that is the diagnosis and how I arrived at it, this seems to ease many patient's minds. Some people will still be unwilling but usually as time goes on they see the course of illness plays out and eventually come around but usually by that time the damage has been done. For the second questions it sounds like a topic for a video

[@Inside_A_Tardis]

Hello, congrats on your work! Is it possible that chronic agitation, impatience and anxiety with subsequent chronic depressive symptoms can be treated with amitryptiline - perphenazine- escitalopram combo? I myself have been in this utterly anxious state for 20 years since a teenager, tried 2nd generation antipsychotics, SSRI's, SNRI's, Trazodone but to no avail. Only certain is that I do not have type 1 bipolar. More likely atypical bipolar my new psychiatrist says. The only thing that saved me since January 2022 is a combination of :Amitriptyline 25mg 2 times a day, perphenazine 4mg 3 times a day and escitalopram 10mg once a day. My progress is at least 80% better. Is this regimen sustainable in the long run for my anxiety-bipolar spectrum in your opinion? Thank you in advance.

[@andrzejtk]

Maybe try high dose of Levothyroxine. After struggling for more than 20 years, triple diagnosis, at least 20 different medications (nothing was helping!) I'm almost asymptomatic after just few months! of treatment. This litteraly saved my life. Do the research online on PubMed, YT etc. on Levothyroxine and BD. Most of doctors don't know this and even the world class experts still don't understand how does it work, but it helps (especially with so called treatment resistant BD). I've done special genetic test of my thyroid and it turned out that is not functioning properly (due to some "faulty" genes inherited from my mum) , hence we use the hormones and they changed everything. Would be great if the doctor would mention this in his video and also that BD almost never comes alone! It's often comorbid with other disorders/autism etc. If you need any more information, please feel free to drop me an email or message, I will send the links. It's super complex and here is not the place to explain it in details. Although I would recommend anyone struggling trying this unusual treatment.

[@wesleymccollum9437]

I have a cousin who was abused by his mother and he was on a lot of psych meds at the age of 5. His mother had severe munchausen by proxy. He was healthy and now he has bipolar disorder. Does early use of psychotropic drugs cause bipolar or schizophrenia later on after the brain is developing?

[@MrDcrules]

If someone clearly has OCD/anxiety/depression, which are treated often by SSRIs, what do you do if those SSRIs don't seem to help and the patient may have a hyperthymic temperament? Can you treat the OCD secondarily via the atypicals minus the SSRIs? thanks!

[@ShrinksInSneakers]

If there are clear manic symptoms even if they do not meet criteria for bipolar disorder in my mind they matter. If those symptoms are made worse by the presence of an SSRI or SNRI then it may be worth tapering off the antidepressant and using an atypical. One of the problems with DSM is we do not assign a heirarchy to diagnosis. It's always possible that what looks like three distinct disorders is say bipolar disorder inapropriately treated with antidepressants for example. Would treating OCD with an atypical be the standard of care in most cases no, but if you suspect mixed depression or bipolar illness it might be worth a shot and maybe the OCD improves as the other symptoms get better.

[@MrDcrules]

@@ShrinksInSneakers thank you again. Another option is try to successfully add one of the atypicals--Abilify, Rexulti, Vraylar--to the SSRI, right?

[@dianasims6583]

I have been diagnosed to be bipolar. This happened after I was hospitalized for a psychotic episode. I experienced the suicide of my brother and the trauma created the first psychotic break. I was 42. I only experience the manic highs. I have never been depressed. Is this common ?

[@ShrinksInSneakers]

Not very common but can happen. The defintion of bipolar I disorder only requires the presence of at least one manic episode. There is no requirement for depressive episodes although they are usually more common and can be more debilitating but it will deepened and mania with psychotic features that lands someone in the hospital can be just as serious as depression with suicidal ideation. Hope this helps if you haven't subscribed to the channel please do and spread the word about what we are doing here

[@carlharmeling512]

Hey, it’s me again, I really like your presentations. But what lay people like myself will benefit from is an illustration of clinical symptoms that can be observed by friends and family. Seems you are presenting to professionals not really lay people who are usually the first line of defense for serious mental illness.

[@Jervisdude]

Spectrum is bs. Bipolar mania and agitation can be indistinguishable. I have an anxious depression. Depression makes be become anxious and anxiety wears me out and makes me depressed. Depression is depression but anxiety can be anxiety or hypomania, or agitation/restlessness. Further, if one had a hypomania episode when they were 16 years old (if that was even what they had) and they had major depressive episodes throughout their lives, at the age of 80 years Old they would STILL be considered bipolar. Such nonsense. Between 16 and 80 years of age, you have someone that heeds treatment for depression only.

[@clintparsons3989]

My old psych said I was type 1 because I spent like 20 grand on an aquarium once. I don't think that was full-blown mania. I have mixed episodes and doubt I even have it sometimes, I call myself 1.5. my grandmother is super bipolar, without any doubt type 1. She takes lithium and haloperidol. My treat grandmother was bipolar I suspect, she'd have episodes where she would turn into a complete bitch and do things like presch on the sidewalk during episodes lol.

[@ShrinksInSneakers]

As we can see the presentation of bipolar disorder can vary a lot. The treatment also varies but one thing remains true in all cases antidepressants are not good. I hope the video was helpful, let me know if there is a topic you want to see

[@ronnie-lynn]

@@ShrinksInSneakerswhich is so interesting, a close friend of mine she takes lithium and 200 mg sertraline. BP 1 unsure why they have her on SSRI Got further in the video, in some patients it’s used as a third line treatment. Makes sense. If someone often cycles through severe depressive episodes!!