The difference between a person with recurrent major depression - Major Depressive Disorder - and Bipolar Disorder, is that a bipolar person must have had at least one "high" episode which would include any one of:
- mania
- hypomania
- mixed mania

The episode must not have been induced by drugs, licit or illicit, and must not have an organic basis such as thyroid dysregulation.

For a doc to diagnose you, they will want to take a history of your experiences as well as know about family history of illness. However it is best for them to diagnose your symptoms when unmedicated.

I am wondering if you know that Cymbalta is a type of antidepressant and in some people, even not necessarily bipolar, can cause activating symptoms including racing thoughts. This and other antidepressants can actually cause a manic reaction, even if you are not bipolar.

I am also wondering if you are on any meds besides Cymbalta... If you are taking certain of the AED's, the med could cover manic or hypomanic symptoms. Many of these medications (not all) are used as "mood stabilizers" but with the exception of Lamictal, which works below baseline - i.e. on depression not mania, they work to treat mania and prevent manic episodes. Bipolars may still have breakthrough symptoms. But my point was, if you did have bipolar but were taking AED's they could certainly cover it up... at least most of the symptoms. The racing thoughts could be a breakthrough symptom...

OR

a reaction to the Cymbalta. When did the racing thoughts start? Did you have this going on before starting Cymbalta... were you taking another antidepressant then, also? Ever had them when NOT medicated?

Do you have family that is bipolar? (feel free not to answer)

Generally those with Major Depressive Disorder who have episodes of "atypical" or mixed depression (or agitated depression) are not considered bipolar... but this will vary based on the clinician, and the gravity of the symptoms. Major Depression is common in relatives of bipolars, however, they are more likely to have atypical features including activation (agitated depression). This is more and more being considered to be a "bipolar spectrum" disorder... or soft bipolar as Mari was saying.

Unfortunately psychiatry is an inexact science. The labels are just that. There are some individuals which have a fairly clear illness pattern that matches diagnostic guidelines well. Others do not have such a clear match. The purpose of guidelines and diagnostic labels is really to provide treatment and improve quality of life. So we must use the labels with parsimony and focus rather on the symptoms and corresponding treatments.

i hope this helps you some.



~ waves ~