[TheSeaCat]

I went to therapy yesterday after work, I didn't feel like attending my usual Monday session and he dropped the news that he doesn't think I am any sort of Bipolar. He thinks I have a bad case of Generalized Anxiety Disorder, PTSD, and Treatment Resistant Depression since the only thing that has worked for my depression is Seroquel. He says I don't cycle like someone with Bipolar. He says while you shop you haven't wracked yourself into debt, I do talk fast but everyone on my father's side of the family does talk fast.

I honestly don't know how I feel, I know it's a subjective diagnosis and my doctor has my diagnosis as Mood Disorder NOS, he thinks that since I had such a bad reaction to antidepressants that it was probably Bipolar but he's never officially diagnosised me with it either. The only person that has diagnosised me as Bipolar 2 was my first therapist and she was sure of her diagnosis.

I don't have a Pdoc and the one PsychNP I saw basically shoved Latuda in my hand and left the room, she didn't even ask questions and the other PsychNP I saw before her asked if I was moody and shoved Lamictal at me and told me to stop taking the Effexor, she didn't tell me to taper or anything. Then the next day I had a panic attack and saw her again and she shoved Zyprexa at me.

My PA friend doesn't see the signs of Bipolar either, he's really steamed that nobody told me to tapper the Effexor and refused to take me off a medication that made me gain 20 pounds in 2 weeks, he thinks the Zyprexa is the reason I now have Metabolic Syndrome and how she acted towards me is not how anyone should diagnosis Bipolar. He wishes I would have reported the first NP to her supervising physician.

I honestly don't know how I feel about this, anyone have advice?

[Wild Coyote]

I think BPII is often misunderstood.
To complicate things more, as I understand things (from 2 different pdocs), treatment resistant depression is often BPII.

The fact that you have not overspent does not mean you would not have BPII.
I am not impulsive and do not overspend.

Do you think your therapist might misunderstand BPII?

What do you think? Do you think you might be BPII or no?

This question comes up often. It's an important question.

I hope you can get this sorted to your satisfaction.


WC

[TheSeaCat]

Thank you Wild! My therapist is Bipolar 1 so that might be clouding his judgment as well since he is probably thinking of his own experiences. He also brought up the fact I've never been IP.

I think I probably am Bipolar 2, I think when I see him tomorrow I might ask to see the DSM and try and figure out if he's letting his own issues get in the way of a proper diagnosis. I really like him so this isn't really a deal breaker I just left his office feeling more confused than ever. I believe his other diagnosis's this just feels strange.

[Wild Coyote]

I am glad it's not a deal breaker. It's helpful, in my opinion, to work on clarification together.

One of the sites I and others here often recommend: PsychEducation | Treating the Mood Spectrum

Good luck working with your providers to sort things out.

This is a great question, by the way.


WC

[bizi]

What were your bad reactions to antidepressants?
any of them make you hypo?
bizi

[TheSeaCat]

Originally Posted by bizi

What were your bad reactions to antidepressants?
any of them make you hypo?
bizi

I was on Prozac for a good month before work started stressing to the point where every day I was having a panic attack over something said or done.

Effexor: I was constantly hot all the time to the point I was sleeping with a fan on high and jumbo ice packs on my back. It also made me super irritable and I really didn't sleep a lot on it, hardly at all really. I also went right back to having horrible panic attacks even more frequent than on the Prozac. I was miserable on both medications. I think Effexor made me severely Hypo.

There was one day on Seroquel that I had a super good day at work with no anxiety and I was more bubbly and focused more on work then the next day I woke up depressed and severely irritable everyone annoyed me this day, I was also fired this day too. I think this was probably a hypo crash and I didn't recognize the symptoms since I was so new to Bipolar. Being fired also sent me into a depressed tailspin where I spent all day in bed and not wanting to do anything. Ever since I've been on 200mg I'm okay, there is no hypo and there is no depression.

[TheSeaCat]

Originally Posted by Wild Coyote

I am glad it's not a deal breaker. It's helpful, in my opinion, to work on clarification together.

One of the sites I and others here often recommend: PsychEducation | Treating the Mood Spectrum

Good luck working with your providers to sort things out.

This is a great question, by the way.


WC

Thank you for the link that will probably be very helpful to discuss with the therapist.

I don't know why IP has anything to do with bipolar diagnoses. I've never been to IP before and plan to keep it that way.

I have hallucinations and delusions often, but me not going to IP doesn't mean I don't hsve psychosis, for example. IP is just a safe space, and not everybody needs it. There are people dx'd with schziophrenia who've never been to IP.

[Guiness187055]

You don't have to have full on bouts of mania to be bipolar 2

[MickeyCheeky]

((((TheSeaCat)))) I'm sorry you're struggling. If you have doubts about your diagnosis, you can try to do some online tests perhaps? Maybe you can bring the results to your therapist or to your doctor and discuss it with them. Do you think that could work?

TheSeaCat, I imagine that is confusing!

Is it possible to get another opinion from a psychiatrist? Or if from another therapist, a clinical psychologist with a PhD?

Over the years, I have noticed reading that peoples' hypomanic episodes seem to be presented in various ways. There is no cookie cutter presentation. A hypomanic or manic person does not need to be a hyperspender or gambler or drug/alcohol abuser, etc., but may present some other type of symptoms dominately in the list or in the "impulsive" or "self-medicating" categories. I have bipolar type 1 and hyperspending has never been a major issue for me, but impulsive actions in public, sometimes to the point of almost having police called has. Or other similar symptoms.

According to the DSM-5, if a pure elevated episode results in psychiatric hospitalization, the episode is considered full blown manic. I've never heard of hypomanias resulting in hospitalization unless maybe if they were mixed, with severe depression dominate, or maybe a drug/alcohol issue involved.

I imagine guaging hypomania vs. non-hypomanic charged behavior or anxious behavior can be difficult for some mental healthcare professionals, especially if they don't directly witness the "mood elevation" or have experience seeing it in others (not just themselves). I will say that full blown manic episodes are almost always undeniable. They are very severe.

[yellow_fleurs]

TheSeaCat, I am sure this is all very confusing and frustrating for you! Sorry you are going through this. As others mentioned, I wonder if you can get another opinion--I was thinking it might help to find someone who specializes in mood/anxiety disorders, either a psychologist or psychiatrist? I saw a specialist and he was still perplexed by what was going on with me for awhile before reaching the conclusion that it was bipolar (although he still has me listed as an unspecified type) so I am sure it would have been even more confusing for someone without the expertise. I didn't present in an exactly classic way and he thought my mixed episode was just an increase in anxiety at first. I don't know the background of your therapist, so maybe he is a specialist, too. I am new to my therapist so she just has me down as major depression and anxiety and says she hasn't known me long enough to know if I have bipolar so guess I will see if she agrees.

Has your therapist known you long? I wonder if he could change his mind when he gets to know you better. I am sure it is difficult when there are multiple diagnoses at play to figure out what is causing what! I hope you get some answers so that you can get the best treatment for you <3

[tecomsin]

Originally Posted by TheSeaCat

Thank you Wild! My therapist is Bipolar 1 so that might be clouding his judgment as well since he is probably thinking of his own experiences. He also brought up the fact I've never been IP.

I think I probably am Bipolar 2, I think when I see him tomorrow I might ask to see the DSM and try and figure out if he's letting his own issues get in the way of a proper diagnosis. I really like him so this isn't really a deal breaker I just left his office feeling more confused than ever. I believe his other diagnosis's this just feels strange.

It might be helpful to have a conversation with your therapist about how you feel about his diagnosis. Because of the lack of precision in the diagnostic system there are going to be people who are hard to classify one way or another and they will be diagnosed differently by different people.

I would try to just focus on which symptoms are troubling to you and deal with fixing those. It sounds like Seroquel helps you also with anxiety. Is that right? At the end of the day, its about finding the right mix of meds (or no meds) for each person, rather than the specific diagnosis.

Even in Bipolar 1, with it's unmistakable manias. This can also be diagnosed as Schizoaffective Disorder, if the delusions persist outside of mood disordered periods. For people with psychotic manias, the psychosis can start to extend outside of the manic periods so I think people can go from Bipolar I to SchizoAffective over the course of time.

There's a lot of overlap between bipolar II and treatment resistant depression, as WC already mentioned, but I don't know that much about it. Some people think of bipolar on a 'spectrum' and some more as a cut and dry issue.

[jaysmotogp]

My pdoc didnt tell me but he suspected i was BP2 for quite a while. It wasnt until i went full hypo when starting an AP for the first time(with no mood stabilizer) that he then said it was definitive. He probably shouldnt have done that but heh whatever...
I didnt do anything real extreme during that time but i was incredibly productive at work, had pretty grandious plans, and did spend quite a bit too. Not a ton, but a lot.

[Blueberrybook]

Do you have any way to get evaluated by a pdoc?

I was mis-diagnosed with major depression for 10 years (treatment with the wrong meds, which I think worsened things), then panic disorder/PTSD, anorexia, take a break to have a baby, see new doc. I have seen this pdoc for 10 years, and she is retiring soon. I decided to get copies of my medical records from the clinic. My 1st appt. is 2 months post-partum (OB told me to line up this appt. in the third trimester).

Thankfully, she wanted to do her own diagnosis and not listen to previous doctors. First, she diagnosed me with the obvious: post-partum depression but on the intake sheet, she had written bipolar? Then, around 6 months later my diagnosis became bipolar? and I was put on Abilify. Then bipolar type? She settled finally on BPII until I had a major manic episode in her office. Then, I was diagnosed as BPI. So even one doctor can change the diagnosis over the years. My experience was a 10 year period, and she did diagnose me with the all the stuff the previous pdocs got right: panic disorder, ED, PTSD, it was just a question of which mood disorder. She never did think major depression on any of the forms, but those pdocs in the beginning could have at least diagnosed bipolar from the clues of spending sprees, hypersexuality (if you talk about masturbation as part of it), lack of sleep. They didn't ask all the questions or ask them in the right way to get to the bipolar diagnosis. Bipolar also hadn't fully manifested in me just then; it really got a lot worse when I was 25, 26, but I'd see a new pdoc, they'd never re-evaluate.

And my new pdoc decided I had ADHD, but he didn't pull it out of thin air like I thought. I had to go carefully over my old pdoc's summation sheet to him and saw something to the effect no diagnosed ADHD but possible symptoms, watch for it, BP better controlled. Talk about some hard doctor handwriting to read, hers tops my list. I can read parts, sometimes others with close examination, some parts not at all.

I am sorry you are in this weird position. If only mental illness were as easy to diagnose as the flu or something, but so many disorders share so many traits. It really does suck.

[~Christina]

I think some providers have there own views on the DSM. maybe you T is clouded by his own diagnosis

Does a label matter ? Yes in a way it does to think you have xyz and mentally take that lane but then you are told no would be confusing.

Be proactive and get your questions answered and if he isn’t willingly to really sit back and look at things , maybe getting another opinion or T altogether might be the best thing.

For now ? Just work on the symptoms your having trouble with.

[Victoria'smom]

1. You don't have to be hospitalized. My first hospitalization was about 10 yrs after I was diagnosed and the reason I was hospitalized was lack of ability for proper out patient treatment.

2. You do not have to have spending sprees

It's not all about consequences. My leg starts shaking, confused, very anxious, hypergraphy, I bake, most of my mania symptoms are in my head. If you weren't my family (living with me) you wouldn't know most of the time.

I've had 2 T's sit there and tell me I'm not bipolar and not recognize my symptoms. This was very difficult for me as med compliance is not something I'm known to do. Please find a pdoc/pnurse and therapist that will work together to give you consistent treatment. Honestly I'd run from that therapist because s/he didn't consult my dr before telling me.

[still_crazy]

you just have to do what works. i wouldn't stick with this team of "experts," especially this therapist, but...that's up to you and obviously insurance coverage can be an issue, too.

maybe just go to a family doctor and tell your problems and see what they have to say? non-psych doctors can often handle things better than psych docs, and its easier on the wallet. true story.

[TheSeaCat]

Woah I'm gone for the entire day and miss a party.

Thank you all for the comments I really do appreciate all the help. I feel like there is a lot and I have no idea how to multi quote.

I don't have access to any Pdoc they just don't exist in my area and if they do they don't accept insurance it's pay as you go, my family doc came up with this combo and it works, probably not what a pdoc wants but it works. I refuse to ever go back to those two psychNP's the refuse to ever diagnosis and just put me on something so that I would leave their office; at least my current doc listens before making an adjustment.

I get to therapy this morning and he admits he was wrong about saying that I wasn't Bipolar. I thought for sure it was not going to be that easy. He admitted he was putting bias in the way about his own issues with the disease. He actually let me look at the DSM and made me take another screening test and compared it to the one at the first visit, my medications are keeping me very stable and it confused him. I'll give him a pass on this issue.

I do have all the classic signs of Bipolar 2 the issue at my former job really solidified it for him. He admits he needs to read more about Bipolar 2. He can at least admit he was wrong so that's a plus in my book.

Thank you all for your comments and the wonderful advice it was very helpful addressing things with the therapist.

[tecomsin]

It sounds like a good outcome, except for the part about not having access to a pdoc. What were the classic signs of BPII that you had?

The reason i ask is I am wondering if I were actually bipolar II before having my first mania in my 40s and getting the diagnosis of bipolar 1.

I do think diagnoses can change over time too, just to make things even more complicated than they already are.

[downandlonely]

My mom was diagnosed with major depression for over 10 years. Then around menopause, something changed for her, and she was diagnosed with bipolar II. She doesn't have bipolar 1 or psychosis, because she has never really gone into full blown mania. The "up' side for her involves extreme irritability and uncontrollable shaking. It does not make her happy. So bipolar II is very different from bipolar I.

[TheSeaCat]

Originally Posted by tecomsin

It sounds like a good outcome, except for the part about not having access to a pdoc. What were the classic signs of BPII that you had?

The reason i ask is I am wondering if I were actually bipolar II before having my first mania in my 40s and getting the diagnosis of bipolar 1.

I do think diagnoses can change over time too, just to make things even more complicated than they already are.

I've fully come to accept that I will not have a pdoc and I'm cool with it. I'm lucky I have a chill primary doc that understands my issues. I know he wishes I would try another psychNP but after the last two my trust doesn't exist; so I'll stick with someone I trust completely.

I talk really fast, granted we think that is probably a family trait since everyone of my father's side talks really fast.

I have flighty thoughts from time to time, it's a lot better with the medication but these thoughts made me also have a diagnosis of ADHD as a child to keep me focused instead of having daily squirrel moments. I still have squirrel moments but it's not that bad and I haven't been on any ADHD medication since I graduated high school.

I had an awful time on SSRI's/SNRI's that only an Anti psychotic could cure that depression it was terrible depression, my mother has had battled depression since her two battles of cancer and her inability to do anything without help. I thought I knew depression, but when it hit me it was unlike anything I've ever experienced. I physically didn't want to do anything, I was sleeping until four in the afternoon and taking a nap on the couch, I just had like no will to go on. I was in that state for about two and a half months and the moment he upped my Seroquel from 100 to 200 it was a night and day difference, I wanted to enjoy life again, I wanted to work again, I had all these wants in my head because the medication had fixed the depression.

On the low dose of Seroquel I did have hypo tendencies I went to work one day and felt great, no anxiety, no depression, like old me before a diagnosis. I was more bubbly with coworkers and patients, I was certainly more talkative than usual, I'm usually more of the silent judgey type. The next day I went to silent my alarm clock and the depression came back and I was extremely irritable looking back I wish I would have called out this day and saw my doctor for a med increase but I was dumb and still new to the illness that I went to work full irritable. It didn't end well for me and I fell even further into the depressive cycle, every once in a while I would get mixed and want to things, but physically couldn't because of the depression.

I've finally found the right dosage because I finally feel like old me again.

[UpDownAround]

I am not hung up on the labels. Not currently seeing T, but she saw me two or three times during a long hypomanic episode, as did my pdoc at the time. Lamictal has flattened me out pretty well. My pdoc left and I see someone else at her former practice now that has never seem me hypomanic or more than slightly depressed (at which time she bumped my lamictal). She has commented that if she didn't trust Ann's judgement she would want to re-evaluate. It's kind of weird - the pros know there is no cure, only symptomatic relief, yet when they get that working pretty well they start having doubts about the diagnosis. What is especially strange about that is that they warn us not to do that' the cycle of stopping meds because things are going well, crashing and gettin back on meds is rampant with bipolar (especially bipolar 2).

[tecomsin]

I also did the thing of stopping meds and crashing into a hospitalization. More times than I care to remember. For me the main thing is to take an AP every day.

Lamictal didn't prevent manias and I couldn't take lithium at a sufficiently high dose to have an effect. I would get uncontrollable tremors and couldn't use my hands to eat or drink.

Fortunately I found an AP that doesnt' seem to cause me too many side effects. I would start to get symptoms of TD on olanzapine that took months to go away after stopping. I was also pre-diabetic on olanzapine.

I also took carbamezapine for awhile but it knocked me out. Seroquel was a nightmare, also to get off of it was extremely difficult for me. I ended up having these awful upper abdominal pains that no one could explain but went away once I got off it.

We all have different reactions to these meds which are also in many ways poisons and do damage to the body over a long course of time. Because of side effects I was reluctant to stay on an AP permanently but after my last tragic episode I had enough of those kinds of problems and also learned about rexulti here and decided to try it.

[Moose72]

Originally Posted by tecomsin

It might be helpful to have a conversation with your therapist about how you feel about his diagnosis. Because of the lack of precision in the diagnostic system there are going to be people who are hard to classify one way or another and they will be diagnosed differently by different people.

I would try to just focus on which symptoms are troubling to you and deal with fixing those. It sounds like Seroquel helps you also with anxiety. Is that right? At the end of the day, its about finding the right mix of meds (or no meds) for each person, rather than the specific diagnosis.

Even in Bipolar 1, with it's unmistakable manias. This can also be diagnosed as Schizoaffective Disorder, if the delusions persist outside of mood disordered periods. For people with psychotic manias, the psychosis can start to extend outside of the manic periods so I think people can go from Bipolar I to SchizoAffective over the course of time.

There's a lot of overlap between bipolar II and treatment resistant depression, as WC already mentioned, but I don't know that much about it. Some people think of bipolar on a 'spectrum' and some more as a cut and dry issue.

That is good way to put it about sza and bp1. I am now sza but i still identify with the bipolar diagnosis as well.