[archipelago]

I'm really curious about what people think or have experienced who have a bipolar diagnosis and have reactions to meds. I had long standing depression and also PTSD. A few years ago--so decades into treatment--I had a manic episode that was triggered by overmedication, especially with anti-depressants. When the meds were removed, the mania stopped, but my shrink now thinks of me as Bipolar I and is very cautious about meds for depression, which is still very serious.

The problem is that even if this does happen to people with Bipolar, the DSM says that a mania caused by meds doesn't qualify as Bipolar I, but it is a substance induced mania instead.

I have argued with my shrink futilely about this and it always ends with me getting upset, frustrated, and angry. I still want to be able to convince him that he has made the wrong diagnosis, especially since it affects the kinds of medications he thinks are appropriate.

Bipolar I is considered severe, rare, largely genetic, and life long, while major depression is not. If I truly had Bipolar I, surely there would be more to go on than this one instance. I would have had a spontaneous manic episode. Something would have turned up before I was 50. Something would show in my family's history. I would have had other manic episodes while treated for depression. None are the case. Also since that episode, I have been on anti-depressants 3 times without any difficulties. And I have not been on any mood stabilizers or anti-psychotics for most of it. Doesn't this seem to be proof enough?

[Nammu]

DSM 5 now says that medication induced mania is now a reason to use bipolar Dx. I too spent a long time disagreeing with my T and Pdoc but why? What matters is the treatment and having the bipolar Dx makes it likely your docs will avoid or use AD cautiously.

[kaliope]

your argument sounds solid but I understand the otherside of it as well. I don't understand why they are saying it has to be bipolar 1 and not II though.. the different classes of AD's will or will not trigger the manic episodes. Zoloft triggered the biggest manic episode with psychosis I have ever had after being on it only a couple weeks but I can take wellbutrin no problem. my pdoc has me as bipolar II yet I thought I fit the classification of I. it all confuses me..........take care.

[archipelago]

DSM IV was really clear about it not being bipolar if med induced. DSM 5 says it is substance induced bipolar but doesn't say it is Bipolar I, which is more serious. There are two main reasons, besides just wanting to be understood properly, that I would argue against this diagnosis and for Major Depression. One is that he is hyper cautious about the possibility of mania, when only one has ever happened and I'm over 50. Therefore he under treats depression, which he is less fearful of. But I suffer more from severe depression in an ongoing almost lifetime way that is sometimes suicidal. A short manic episode induced by overdoing meds seems a tiny thing in comparison. And we have used anti-depressants since then with no bad effects so you'd think he'd stop worrying as if I really did have Bipolar I.

The other is that I was hospitalized during that mania when I was not a danger to myself or others, nor was I gravely disabled. People do feel that they have a right to hospitalize someone in a manic episode, even though that is technically illegal, and for me was traumatizing. I had just been assaulted by my husband and went to an ER to get checked out after getting a hotel. My shrink encouraged me to go, but he wanted me there so that he could have me put on a hold. As a result I got no care for my two sprained knees and no counseling for assault. Had I not had a Bipolar I diagnosis they would not have been able to justify a hold.

[wiretwister]

I have mixed feelings I too was inpatient after a med induced (ad) manic episode. dxed as bipolar ll and put on mood meds. Was on depakote and had a very depressed life, after switching to lamictal my life has completely turned around. I felt i was misdiganosed and very resentful of the forced inpatient. Now a year and a half later my family says i am the best i have ever been, looking back i see bp traits for years prior to being dxed. For me being treated has been a blessing and i have found peace with it,,I hope the best for you whatever path you follow.

[archipelago]

I'm glad it has worked out for you so well. Also sorry for your experience though it's clear that you do understand why I am resistant.

For me, I have never had any signs of being up. Ever. Even the brief manic episode was more irritable, which was hard to separate out from the fact that I was assault so had lots of reasons to be behaving differently since I do have a severe case of PTSD.

Bipolar is 80% genetic and relatively rare with only a 1% prevalence rate. I think it is over diagnosed. It makes sense that someone who is overmedicated would have a reaction, and it would also make sense that the person need not be predisposed toward bipolar, that it could happen to anyone who is overmedicated.

Since it alters both what medications are in the picture and possible involuntary hospitalizations with that on your record, it is a significant life changing problem. Once after this diagnosis was recorded, I was hospitalized for having an infestation of fleas. I was at a hotel, noticed itching and redness at my ankles, thought it was chiggers and asked the clerk where the nearest clinic was. Somehow there was a misunderstanding that I was talking about spiders being in my room (I had to explain what chiggers were) so the cops came and as I waited heard them joking about "tri-polar" and "spiderwpman." It was humiliating and expensive because of course the psych unit did not admit me but I had to pay for a long cab ride back to the hotel, where I was basically asked to leave.

[TheWell]

I have a diagnosis of atypical Bipolar. I get mixed manic on certain meds. My doc even said that most doctors wouldn't diagnose it as bipolar.

My mania is totally the irritable type. I don't get the good feeling over the top mania.

[archipelago]

I didn't realize that there was an atypical bipolar. Why would you go with that diagnosis if your doctor says most wouldn't diagnose it as bipolar? Is there a benefit?

I guess I see so many ways in which this diagnosis produces harm that I can't see why someone would accept it if there are other explanations.

[TheWell]

Because it doesn't really matter to me. I would only be worried about it if my insurance didn't cover something I needed covered. So far I've been very fortunate with getting covered for everything I need. As far as I see it the only people that care what my diagnosis is are all in the same building anyway - my therapist and my PDoc.

There is definitely atypical bipolar. It's also called dysphoric bipolar. My p-doc refers to the hypomania I've been experiencing this past year as "negative mania", meaning I feel extremely anxious/agitated/irritable/fearful.

I had a terrible reaction (a dysphoric mania) from too high a dose of Zoloft.

[archipelago]

I guess because I have such severe depression and the diagnosis interferes with treatment for that I see it as important. I also went for almost two decades without it and got my depression treated completely differently. Also I didn't experience involuntary hospitalizations that I consider both traumatic and illegal. It seems that it is taken for granted that you can be hospitalized for episodes with bipolar even if you don't legally match what is required to take your rights away. This doesn't happen with the diagnosis of depression. So to me there is a huge sets of risks involved. Also I want to feel understood by my shrink. If he doesn't really attend to my depression since he's more afraid of mania, that is not good for me.

[LastQuestion]

Find another psychiatrist if you are convinced he is no longer willing to listen.

[BipolaRNurse]

I became manic and psychotic on Wellbutrin. Horrible reaction---I was threatening to kill people, screaming and shouting at the top of my lungs. I scared people. Had no idea at the time that I was bipolar. Found out right after this. At the time my pdoc figured it was just a bad reaction to the WB and diagnosed me bipolar NOS, but it wasn't too long before we both figured out I really was bipolar for sure. Now that I've been diagnosed BP 1, I don't imagine it'll change, my pdoc is very conservative about labeling people and it took well over a year for him to make the final diagnosis. It doesn't really matter, the treatment is the same and he treats the person, not the label.

[CozyMellie]

When I was in high school I was constantly in Drs. offices for migraines. I would get depression from time to time but this was long before my BP and mood swings appeared. During senior year and first year of college, doctor put me on Topamax which was experimental at the time for migraines. I was on it for a year and it totally messed me up - I looked and felt awful all the time. I went from overachieving and passionate to being complete disinterested in everything and everyone. The doctor would increase the dosage each time I saw him thinking it would work but my migraines never went away. I swear during that time, Topamax did something to me...like it triggered the onset of my BP. I was never the same after that. Who knows if it really triggered the onset of my BP but I am convinced it did something to my brain permanently.

[C0Nspiritus]

Originally Posted by archipelago

I'm really curious about what people think or have experienced who have a bipolar diagnosis and have reactions to meds. I had long standing depression and also PTSD. A few years ago--so decades into treatment--I had a manic episode that was triggered by overmedication, especially with anti-depressants. When the meds were removed, the mania stopped, but my shrink now thinks of me as Bipolar I and is very cautious about meds for depression, which is still very serious.

The problem is that even if this does happen to people with Bipolar, the DSM says that a mania caused by meds doesn't qualify as Bipolar I, but it is a substance induced mania instead.

I have argued with my shrink futilely about this and it always ends with me getting upset, frustrated, and angry. I still want to be able to convince him that he has made the wrong diagnosis, especially since it affects the kinds of medications he thinks are appropriate.

Bipolar I is considered severe, rare, largely genetic, and life long, while major depression is not. If I truly had Bipolar I, surely there would be more to go on than this one instance. I would have had a spontaneous manic episode. Something would have turned up before I was 50. Something would show in my family's history. I would have had other manic episodes while treated for depression. None are the case. Also since that episode, I have been on anti-depressants 3 times without any difficulties. And I have not been on any mood stabilizers or anti-psychotics for most of it. Doesn't this seem to be proof enough?

I am very sorry you are having such a bad time. Ask your Doctor this question, "Other than your opinion Doctor, what is your empirical evidence of your diagnosis other than the information I give you?" Your Doctor has no empirical evidence and can only go by what you tell him/her.

Please feel better!

[archipelago]

I haven't had a reaction to Wellbutrin and I'm on the maximum dose of 450mg alongside a stimulant Provigil. If I were truly bipolar you would think this would trigger mania, but it is just barely lifting my depression.

In some ways I agree the diagnosis doesn't matter and is a label. But the thing is because of the fear of mania, the treatment is different in terms of meds and possible hospitalization.

I had to become extremely depressed to the point of almost giving up before my shrink allowed me a chance to take such a strongly activating combination of meds. And it is working for my depression and not causing any signs of mania. That one short reaction was the only time my whole life that I have had those symptoms or anything close to them and I'm over 50.