Is it worth getting a fourth opinion?

Sorry for asking so many questions about this, but it's really bothering me. I don't think these meds are doing anything for me, and despite three doctors plus psych testing say I have bipolar, I am thoroughly convinced I do not. This is because I don't think I've ever had the extreme mood swings that are seen with the disorder, and those 'psychotic' symptoms I had were really just the result of not sleeping for a few days.

Should I go for a fourth opinion if I really don't think I have this thing?

I personally think you should because you feel so strongly about it.

Its your dime of course, but at three docs in agreement, I'd move on to treatment and see what happens. You manage to get treated for depression alone while bipolar and you have realistic odds of ending up hospitalized after doing a ton of damage to your life.

That's the thing. I was told I went manic from antidepressants, but strangely I don't really recall that ever happening. After being on meds for bipolar, I've never had the same level of mood swinging that I remember having before being diagnosed. But even then, I don't think those swings were very severe.

Have you communicated your concerns to your current pdoc?

BP can be different for everyone.
Were you diagnosed with BPI or BP II?

Do you have questions to ask here?

If you've asked your pdoc your questions and have expressed your concerns and remain truly unsure of the diagnosis, you can always get another opinion.
Will obtaining another opinion help you to settle with a diagnosis?

We all have to work with our doctors to find the medication combinations which work. The fact that the meds don't work doesn't invalidate the diagnosis. It sounds like you need help with meds, no matter the diagnosis?

How can you best come to terms with any diagnosis?
I agree with Jennifer, get another opinion if you feel doing so will help.


WC

I've brought this up with my therapist before, but she is 100% convinced I have BP1 and won't hear otherwise.

I might be able to get through to my pdoc, though. I believe he diagnosed me as BP NOS because he never saw me during a mood state.

Is there something you want to do that a doctor diagnosing you as BP is preventing. eg, I know I can't get a concealed carry permit in my state, I've heard some driving jobs have prohibitions, and acceptance for military service is much harder...

It just seems that if the meds are making the mood swings less intense, you're more or less on the right tract and just need to keep working with your doc to adjust them.

In your opinion, what caused the sleeplessness that caused the psychosis?

Three opinions is pretty solid. What if the fourth contradicts the other three? Do you just pick and choose?

No idea. I remember feeling really upbeat and energetic around the time that happened. Enough that I couldn't really sleep. Too much going on in my head.

No idea. I just figure the most recent assessment would be the most accurate.

The feelings you describe surrounding your sleeplessness sound pretty much spot on for some of my hypo/manic episodes.

Would it be considered hypomania even if those feelings lasted for only a few days, though?

I am not sure what it is here, but I had a sinking feeling the first time my checkout sheet was coded for bipolar, though I was more concerned about insurance in the future.

Maybe I'm of the minority, but I think a 4th opinion could be useful. If 251turnaround says EXACTLY what s/he disagrees with, there can be a good conversation with the psychologist and they could get down to the bottom of it.

If you do that same convo in therapy instead, (1) it might take multiple sessions to get through, (2) the therapist probably doesn't have the tools/skills to re-assess, as you need special training to do psychoanalysis, and (3) the amount of sessions it takes can cost the same amount as a new eval (depending on insurance).

And if the 4th one disagrees, then they disagree. But they may be able to create a better treatment plan that's more effective.

Four days is usually the minimum time frame for a hypomanic event, but it could be occurring (ramping up) for a few days that you don't really notice.

But, for reals, sleeplessness that leads to psychotic symptoms is not garden variety insomnia. It needs to be explained. I think that's why your doctors are set on bipolar.

If I recall, most insurance forms are worded like, "have you ever had a doctor tell you that you had condition XYZ." So a 2nd (or 4th) opinion doesn't really get you off the actuarial hook. You've still had a psychiatrist diagnose you with BP x at some point.

Huh. I was under the impression that hallucinations were a typical side effect of insomnia.

That said, I don't recall ever experiencing those symptoms after not sleeping since I went on an antipsychotic.

Typical insomnia (not caused by drugs, illnesses, etc.) is characterized by difficulty falling asleep, frequent waking and early waking. It's not a total lack of sleep or even the dramatically diminished sleep of hypomania and mania. Therefore, it doesn't really lead to psychosis.

I have booth sleeplessness from hypo/mania and infrequent insomnia during stable periods. I can tell the difference because when I'm stable but suffering from insomnia I'm tired during the day. When I'm hypo/manic and suffering from severely diminished sleep, I'm not sleepy during the day.

I think it is hard to get an independent evaluation once a person has a diagnosis of bipolar disorder because, unless you happen to show up for the evaluation in a manic or hypomanic state, the psychiatrist will not discount previous observations and just assume they have not seen you in all your mood states. According to many psychiatrists, people notoriously under-report manic or hypomanic symptoms so they will not take what you say about those times at face value anyway. At least that is what I have been told and also heard listening to talks on youtube...

I have had more than 10 psychiatrist evaluate me (including hospital admissions) and even still there are times when I don't believe the diagnosis. Sometimes this is because of the social stigma and negative self-evaluations that occur and sometimes it's because i think I have a different disorder like schizoaffective and sometimes it's because all of my psychotic episodes have been associated with long term daily cannabis use that has now ended..

But ask yourself, let's say the 4th psychiatrist also says you have bipolar. What would that change in your mind? Would you still have doubts?

Be cautious about any hallucinations with a possible diagnosis of bipolar. Also if AD don't help with depression (that is true in my case) then that also increases the likelihood that it's bipolar.

I think you brought up a good point. I'm not sure what exactly a fourth diagnosis would change. I would still doubt it after a while and probably go asking for a fifth.

That said, I've been on many ADs over the years and not one of them has seemed to help with my depression. One of them may have even caused me to go hypomanic. According to my therapist anyway.

As I recall, (with the exception of extreme sleep deprivation, or drug induced) hallucinations are a symptom of psychosis, which can have any number of causes. Anxiety attacks, bipolar disorder, schizophrenia, borderline personality disorder, etc.

I second others that said perhaps it might be good to seek treatment at this stage and give that a chance.

In contrast, 3 psychiatrists/psychologists agreed on my borderline diagnosis, and while I don't necessarily want to agree with it, they probably were right when I look back on it.

Why not just treat the symptoms and not worry about a label ?

I get being stuck on the diagnosis. The label shouldn't matter bc these are all just brain disorders that the AMA decided to name different things based upon rather subjective criteria printed in a manual that keeps changing. But. It still does matter for some reason.
At least it does for me so I can sympathize.

My current pdoc depolarized me- he disagreed with my last pdoc re the BP dx. So I am back to having MDD. Yet my symptoms haven't changed any. I think it depends on how you view BP- the spectrum model of mood disorders would view recurrent atypical depression to be closer To the BP side so mood stabilizers would prob help more than just ADs. If you view them as completely diff disorders than that wouldn't be the case.

I don't think a 4th opinion would hurt, and maybe it would give you some peace of mind. TBH I think a lot of modern psychiatry is complete bullshat and the whole labeling and over medicalization of emotions is out of control. But if gettinga certain label helps you find the right treatment than I suppose it is worthwhile. Good luck.

This is also how I feel about psychiatry. It is not up to the standard of the rest of medicine. (I'm not antipsychiatry btw just disappointed...)

There are no objective tests yet, it is people's opinions based on a long list of criteria. I also totally am against medicating children.

I'd also feel better about it if more people actually got better but that is not what has been my experience or what I see around. I don't see that many people get better.

I mean if you have cancer, doctors can do surgery, radiation, chemotherapy and have objective measures of increase in life expectancy and so on. There is nothing like that as far as I know in psychiatry and also almost all the studies that are done on medications effectiveness are short term and don't consider the long term side effects and whether or not they actually help long term.

Then you get big disagreements because there are no objective tests. I mean, for instance, the mass killer in Norway was first evaluated to be paranoid schizophrenic but after a public outcry another evaluation was done and it was decided he had NPD and AsPD. So his final diagnosis was a result of popular opinion that he should be held criminally responsible. bTW These are as different conditions as can possibly exist since schizophrenia can be medicated whilst those personality disorders can't.

If three doctors confirm a diagnosis there's a high likelihood that its the right one. That being said a diagnosis is just a name, if that name gets you the meds that make you feel better then I wouldn't worry about labels as much. Many doctors are starting to say, "We treat symptoms not mental illnesses". Worry about getting rid of the pesky symptoms that cause your life trouble and leave the label to the side to be remembered only when its really important. Also remember its an illness not a definition of who you are as a person. You may have it but you are not it.