[Confused115]

Hi everyone,

I'm not even sure if this is the right forum to post in. My question relates to my diagnosis, and it could have fit into 3+ forums, so moderators, please move it to wherever you think I'll receive the most helpful answers.

I was diagnosed with Unipolar depression (MDD) in 2006. In 2010, a diagnosis of Borderline PD (which I'd started suspecting I had in 2000) was added.

I've had to change a few psychiatrists since 2010 - for different reasons. Almost all of them knew each other however, and obviously as they do while making referrals, they would discuss my case with one another. They are all friends with one another, and hold each other in high esteem etc. All of them agreed on my diagnosis, which has been the same since 2010 (Borderline PD and MDD) - although the rating of which was primary and which was secondary differed.

A few weeks ago, I started suspecting that perhaps the unipolar mood disorder diagnosis was incorrect, and my actual mood disorder is a bipolar one (with hypomania, so bipolar II, my guess is mixed-state or whatever its called)

There were several reasons for this:

1. The last time I felt normal/euthymic was very very long ago. The elation/hyper-ness that started 14 years ago was not enough to get my parents to pay attention:

The first episode of a "mixed state" was in 2000. Around this time, I became quite different from my usual self. I became quite high and hyper, but mixed with this was high irritability and anger. This was also when the self-harm started.
But since it was so long ago, I have very little memory of what it's like to feel "normal". The state that I've been identifying as "feeling good" for the past 14 years, was probably not euthymia, but hypomania.

2. There was a gap of 6 years between the last time I was "normal" and the first time I saw a psychiatrist. My parents, and even I myself, didn't remember what my baseline/normal/euthymic state had been like:

The first time I saw a psychiatrist I'd been crying quite alot, primarily because it was final exam time and I wasn't doing at all well in school. At this time the self-harm was also quite frequent. He immediately diagnosed me with MDD and started me on antidepressants. What he didn't know was that at this time alongside the depression and self-harm I was also quite high and hyper.

3. After the introduction of anti-depressants, the hyper-ness increased (and so did the self-harm):

After I was started on SSRIs I appeared less depressed and "happier". This was actually a worsening of the "hypomanic" symptoms (my self-harm also increased). But he thought I was "recovering" and that this state was a state of euthymia for me. Since he had never seen me normal (the last time I had been "normal", i.e. not high and not low, was before 2000), he thought the increase in hyperactivity, laughing all the time, not caring that I was failing in school, etc., was my baseline state. It was not. The increase in self-harm he did not take note of.

4. I also have Borderline PD (a diagnosis I'm pretty certain is correct), and I know that the affective instability seen in borderline PD - swinging from high to low very frequently - can resemble the mood swings seen in mixed-state bipolar disorder, particularly if its rapid-cycling or ultradian..
So I know that in the presence of one, there is a probability that the other is missed.

5. The reckless/impulsive/"disinhibited" behaviours seen in borderline PD can also resemble those seen in the hypomanic phases of bipolar disorder - another reason why one disorder can be missed in the presence of the other.

6. There's also lots of other symptoms that I've experienced on and off during the past 14 years for sometimes weeks and sometimes months at a time. Except when I've been on antipsychotics. These include:
a. decreased need for sleep. Sleep reduces to about 50-60% of my usual need.

b. feeling high, happy, much more outgoing, active, energetic, talkative, alot more articulate and witty, focused, better concentration etc.

c. But at the same time, being EXTREMELY (even more than usual) irritable, and VERY angry (hidden from friends, very visible to family).

d. Going to excess in certain behaviours (spending, etc.)

e. not working hard at school because of a belief that I'd do well anyway "because I'm supersmart".

f. Self-harm is more frequent than usual.

g. If I'm taking antidepressants (not balanced by antipsychotics), all of these symptoms are triggered/intensified.

h. I start isolating myself from close family, but start going out more with friends etc.

I don't know what to do. Nobody listens when I tell them that I need help for the high/hyper/elated/'hypomanic' state. They think it's just me being non-depressed, but it's not, and the stuff I do in that state embarrasses me and gets me in trouble later.

I know that one's diagnosis affects one's treatment plan as well. Can someone please advise. From what I've written here do you guys think I'm right, or that they are?

Thanks.

[Mountainbard]

Hello Confused,

I'm glad you were able to share your story here. From what you described (very lucidly I might add) I think you're right. I too was diagnosed unipolar depressive, and put on antidepressants. After about a month they would put me into a hypomanic state, without fail. Then I'd go off them and the cycle would start all over.

For that reason and because of your description of your symptoms I think you are BP2, and the borderline simply exacerbates your problems w/hypomania.

Take it for what it's worth-- I'm no kind of doctor.

all the best,

Randy

[hvert]

Have you tried bringing what you wrote into one of your psychiatrists? You do lay it all out very clearly.

Whatever the diagnosis is, the main point is that the current treatment does not leave you in your preferred state. You sometimes have behaviors that you don't like - a competent psychiatrist should be willing to help you figure out how to address that. It's okay to trust that you know yourself well enough to know how you want to be.

[Confused115]

Originally Posted by Mountainbard

Hello Confused,

I'm glad you were able to share your story here. From what you described (very lucidly I might add) I think you're right. I too was diagnosed unipolar depressive, and put on antidepressants. After about a month they would put me into a hypomanic state, without fail. Then I'd go off them and the cycle would start all over.

For that reason and because of your description of your symptoms I think you are BP2, and the borderline simply exacerbates your problems w/hypomania.

Take it for what it's worth-- I'm no kind of doctor.

all the best,

Randy

Hi Randy, and thank you for the reply. I had the exact same experience with antidepressants. What solution did you reach with your meds then?

[Confused115]

Originally Posted by hvert

Have you tried bringing what you wrote into one of your psychiatrists? You do lay it all out very clearly.

Whatever the diagnosis is, the main point is that the current treatment does not leave you in your preferred state. You sometimes have behaviors that you don't like - a competent psychiatrist should be willing to help you figure out how to address that. It's okay to trust that you know yourself well enough to know how you want to be.

Hi Hvert, and thanks for the reply.

This uncertainty actually started only a couple weeks ago. I'm in the midst of switching psychiatrists, and I told all of this to the new guy (in pretty much the same format) in the first session. Today was my second appointment with him and he says he's leaning towards a diagnosis of unipolar depression as well...I was too tired (have gone off my meds cold turkey) to think to ask why.

I agree that a competent doctor should help me address my difficulties, whether emotional or behavioural.

However, in order to do that I first need to establish whether there are any loopholes in my own assessment of what's wrong, and if there aren't, I need to know arguments I can give to convince him that my assessment is correct.

[Mountainbard]

Originally Posted by Confused115

Hi Randy, and thank you for the reply. I had the exact same experience with antidepressants. What solution did you reach with your meds then?

Hola C-- Good question. I was gonna put that in my original reply, but I forgot. I'm on 300 mg Wellbutrin and 200 of lamotrigine a day-- been on those two since March. About 10 days ago we added in 2.5 mg of Abilify. So far so good.

[Confused115]

Originally Posted by Mountainbard

Hola C-- Good question. I was gonna put that in my original reply, but I forgot. I'm on 300 mg Wellbutrin and 200 of lamotrigine a day-- been on those two since March. About 10 days ago we added in 2.5 mg of Abilify. So far so good.

Oh ok. I've been on a mix of antidepressants and antipsychotics for the past 4 years (before that it was just antidepressants)...the addition of antipsychotics took away some of the exacerbation in elation caused by the antidepressants.. but came with their own set of problems. Glad your meds are working for you

[Mountainbard]

Originally Posted by Confused115

Oh ok. I've been on a mix of antidepressants and antipsychotics for the past 4 years (before that it was just antidepressants)...the addition of antipsychotics took away some of the exacerbation in elation caused by the antidepressants.. but came with their own set of problems. Glad your meds are working for you

Me too C. I was diagnosed in '99 with MPD and started on antidepressants, and over time had more and more pronounced exacerbation of my hypomanic episodes. It wasn't until this year that I was diagnosed BP2, and that diagnosis has really been a blessing. It's me all over, and now I have a real handle on the nature of illness I feel, for the first time in ages, like I can manage it and live a productive life.

[Crazy Hitch]

I think the two can share a select few symptoms.

I've seen 3 pdocs over the years and all said BP 1.

Recently during a crisis I was referred to a BPD screening centre. Saw a panel of 3 psychiatrists for three hours who are all in agreement of BP1 and BPD.

Wish other psychiatrists could have picked that up years ago.

Just goes to show they don't alwa get their diagnosis right.

[LastQuestion]

It might be worth getting a second opinion from a neuropsychologist. My understanding is that neuropsychologists are the most qualified to make a diagnosis when it comes to mental health.