Pdoc and Therapist disagree on diagnosis

Saw my therapist today. He's convinced that I just have recurring uni-polar depression and not any form of Bipolar.

I explained the impulsivity, sex, binging, spending, irrational decisions, inability to concentrate. I think I explained that I had a huge 'episode' of these behaviors 2 years ago, just a few weeks after I started anti-depresants for the first time.

I don't get some of the 'classic' bipolar symptoms. I have never been really 'high' or 'elated' or 'fast'. I just get really irritable and angry and can't make decisions well. I act out.

My moods change fast, within the day, not weeks or months at a time.

Pdoc (actually a psych nurse) wants me on Lamictal in addition to my Zoloft. We are working on getting insurance approval on my Lamictal.

What should I do? I did ask my therapist to talk to the psych nurse and work together on this. But who's "right"? And does it matter? Would the Lamictal hurt if I'm not Bipolar II?

I strongly think that I'm either Bipolar II or Borderline. But I'm not entirely sure. I don't know what to believe.

I have a good pdoc, so I always take his word over anyone else's. My therapist is smart, but she doesn't know as much as my pdoc does.

Good luck.

Razzleberry,

I have to agree with Conquistador...my therapist doesn't know as much about bipolar as my pdoc...that was the whole point of sending me to a pdoc in the first place.

I'm sorry you're so confused by all this and I know things are a bit rough for you right now. Sorry but all I can say is I hope things start to get better for you soon.

Well, I listen to my Pdoc on the diag, but thankfully my T agrees, so I don't have the same issue with that.
I AM, however, on both Lamictal and Zoloft and have found that the combination works very well for me. It's worth a shot if it works, right?

Good luck!
BJ

I did get insurance approval on the Lamictal, my psych nurse called in special to get it approved. They are paying 50% - still expensive, but better than nothing.

I am glad that you got the approval needed.
Were you thinking of a borderline diagnosis because of abandonment issues or do you self-injury?....may I ask?
I know that some of the symptoms over lap too.
bizi

Who cares?

You need to ask yourself why you are so obsessed with a diagnosis. It is not going to change your therapy and many meds overlap for many conditions. For example, many unipolar depressed people take mood stabilizers.

A label is just a label for insurance reasons. Your constant obsession with "why you want to be some label" should perhaps be a focus of your therapy.

Therapy is about growing and working to change your perspective about yourself and others, so that your life can be more fulfilling. A label is not going to change that.

Also, you can read into any diagnosis and make it fit you. That's why there is are experts in this area. They may differ on diagnsosis, diagnsosis change over time, etc. It does not matter.

Saying "I am Bipolar" or "I am Borderline" is not a badge of courage. And in many instances, it can be stimatizing.

I think that perhaps your therapist is only familiar with the clasic bipolar disorder, Bipolar type I.

Bipolar type II is sometimes harder to distinguish. I would trust your Pdoc and see how the meds help.

I like the lamictal and if you find it helps then you'll know for sure.

I am not using it as a 'badge of courage', only to get the correct treatment. If I had been accurately diagnosed 2 years ago, I may not be in this mess now. But I wasn't.

I think I had a medication-induced hypomania 2 years ago, when I started on meds for the first time in my life. At that point, I had no idea what symptoms to look for. But now, looking back, it seems clear to me that is what was going on.

I'm thinking Borderline because of relationship issues, the high impulsivity, and recurrent suicidal behavior. However, my reasons to doubt that are that I was never abused, and I do not self-injure. However, I do have self-destructive behavior that does not involve cutting.

Bipolar because of the strange erratic behavior I had 2 years ago....and again just recently. I don't think I'm classic bipolar I, but possibly II. Or just medication-induced, which doesn't actually fit a diagnosis.

Anyway...in some ways, you are right Riptide. It doesn't matter the diagnosis as long as I'm getting treatment. But it would sure be irresponsible for me to take 200 mg of Zoloft if I could be Bipolar, woudln't it?! And if I'm not making any strides with CBT, my therapist may want to try DBT. Just saying....while the label doesn't matter, the correct treatment does.

They are looking at a bipolar disorder that would describe medication induced symptoms .

Bipolar and Borderline have some very similar symptoms.

http://www.psycheducation.org/depression/borderline.htm

This is an interesting read. It is somewhat geared towards psychiatrists but is an interesting read nontheless.

How trained is your therapist? If he is a licensed psychologist, and has been seeing you for 2 years, I would trust him.
He has your best interest in mind, and has proven it I hope. The psych nurse only does one thing, and that's push meds. (Like if you go to a surgeon guess what? They'll recommend surgery.)

But if you feel the meds will help you, they will.

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Razzleberry said:
I am not using it as a 'badge of courage', only to get the correct treatment. If I had been accurately diagnosed 2 years ago, I may not be in this mess now. But I wasn't.

I think I had a medication-induced hypomania 2 years ago, when I started on meds for the first time in my life. At that point, I had no idea what symptoms to look for. But now, looking back, it seems clear to me that is what was going on.

I'm thinking Borderline because of relationship issues, the high impulsivity, and recurrent suicidal behavior. However, my reasons to doubt that are that I was never abused, and I do not self-injure. However, I do have self-destructive behavior that does not involve cutting.

Bipolar because of the strange erratic behavior I had 2 years ago....and again just recently. I don't think I'm classic bipolar I, but possibly II. Or just medication-induced, which doesn't actually fit a diagnosis.

Anyway...in some ways, you are right Riptide. It doesn't matter the diagnosis as long as I'm getting treatment. But it would sure be irresponsible for me to take 200 mg of Zoloft if I could be Bipolar, woudln't it?! And if I'm not making any strides with CBT, my therapist may want to try DBT. Just saying....while the label doesn't matter, the correct treatment does.

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If your doc prescribed the Zoloft, he/she know more about the diagnosis than you. And if you have a relationship with your p-doc, and if you were to experience dangerous hypomanic symptoms, you would call your p-doc. There is so much overlapping with drugs that just because you are on Lamictal does not mean you are Bipolar 2. Some Unipolar depressed people take all kinds of mood stabilizers. The question you should be asking "Is this med that p-doc suggests helping me? " Not "What is my diagnosis?"

Unless you are clearly Bipolar 1 or Schizophrenic or something where the exact type of medication is indicated, it is not "Take this for that." It is "Is this helping my symptoms?"

Studies after studies have shown that the therapy type does not matter. What matters is the therapeutic relationship between T and client.. Now clients may have a particular type of therapy they perfer like some hate CBT because it is short and not insightful, whereas others hate psychodynamic because it is long and in-depth.
But the truth is that the relationship provides the vehicle for change whether you are Borderline, Bipolar, OCD, Depressed, etc.

And DBT is mostly utilized for Borderlines who self-injure. DBT is a form of CBT that was developed to deal with the self-injury of Borderlines. It teaches skills to prevent the self-harm. The thoughts that are dealt with in DBT are similar to CBT.

Also, you can fit yourself into almost any diagnosis if you keep focusing on it. I would let the experts do their job.

hi razzleberry,
thank you for your reply.
I am anxious to hear how you like the lamictal if that is what you folks decide to try.
It has anti depressant qualities so that may be the only medication that you need.
It takes a long time to titrate up slowly.
I am not sure what self destructive issues you have but hopefully some one will help you figure out how to treat yourself well..... and change those behaviors.
bizi

Oh, just to clarify - I have not been in therapy for 2 years straight. I was in therapy 2 years ago, but had some issues...and stopped going for a while. I was okay for just over a year, but just recently started slipping again.

I have been going to this therapist for about a month, but only 3 sessions so far - some were every-other-week because of my busy schedule.

I have only been to the Psych Nurse (pdoc) once. She prescribed the Lamictal on our first appointment. It was actually my family doctor who prescribed the Zoloft, 2 weeks before I could get in to see the psych nurse (she was booked). She just continued what he gave me.

I've only taken 2 pills so far so obviously not seeing the effects yet! But yes, bizi, I'll let you know how it goes.

It does sound like you are reacting to the antidepressant....did your pdoc decrease this for you?
You know that this is not a quick fix...take baby steps in all of this, I hope that you are able to take care of yourself and do the things that you need to do to feel well.
bizi