Did T identify Bipolar?

My new T and I have discussed my diagnoses, but he doesn't know me well enough yet to make definite conclusions. Plus he's psychodynamic and doesn't really use them for treatment.

I know I have emotional problems, but it's possible I also have Bipolar I. How do you know if you have both? Has your T recognized it, or did it come from seeing a PDoc? My insurance doesn't cover mental health, so my T and I have to figure this out.

I'm only asking about Bipolar I, not Bipolar II, because it's more definitive.
When T and I talked about this last, he also said that he finds that people diagnosed with Bipolar I usually have emotional triggers just the same (he's been practicing for over 30 years). That really surprised me, but he is even considered an expert on diagnosing; is known for his expertise in questionable or difficult to diagnose people. But he's not a PDoc, so he obviously can't prescribe. Last T was a PDoc, which was helpful for this sort of thing, but it also complicated things in my treatment.

Thanks for sharing any experiences you had with this issue.

I think keeping mood charts can be helpful in figuring out if you have ups and downs, how long they last, if there are triggers, etc. Have you tried that? I'd say one of the distinctive features of Bipolar I is the length of the manic episodes.

I'm not sure what you mean. Isn't your T a mental health provider?

If your T will not base his treatment plan on a diagnosis, how will having one help him or you? What would you like to get out of having a diagnosis?

you sound a lot like me. I am not sure where bipolar ends and emotional/psychological problems begin. It makes it very confusing for myself, T and Pdoc. I have thought for a long time that my pdoc thinks it is all my background and trauma issues but the drugs she prescribed were ones that I looked up and found to be for bipolar. It really confuses me whether she has made the diagnosis or not at this point. I was hypomanic last time I saw her and there was one exchange about bipolar when I asked if this hypomania meant I had bipolar, she responded with "yes, I see this as a progression of the mood disorder, that we talked about when I prescribed Latuda"...very frustrating session, I never remember talking about it when she prescribed Latuda.

Also, you are right the psychodynamic Ts don't seem to need/care about diagnosis.

The psychiatrists here charge soo much for a visit, I could not afford them and therapy. I guess what I meant to say is that I pay cash for all mental health services and would ask my primary care provider to prescribe psychiatric meds if my T thinks I have bipolar. I would ask him to call her or her to call him.

Yes, I thought so too. Thanks for the mood tracking suggestion. But if you are having a long mood episode from bipolar, isn't it still possible to have the other mood issues simultaneously?

I've had what seems like a bipolar depression for some time now and have already tried antidepressants (which always made me feel worse). I don't feel sad, just lack of energy and motivation. Focus and concentration problems. Family members have had formal Bipolar I diagnosis, which makes me suspect it more strongly.

I will talk to T more about this but just wanted to see if others had experience with this issue.

Yes.

That sounds like a good plan. Some PCPs are more comfortable than others with prescribing psych meds.

Be sure to tell your PCP that if you go to him/her for prescribing. It can be helpful to bring your mood charts for several months with you to the appointment.

Thanks Sunrise. I am afraid my internist will say that she won't prescribe me meds for bipolar. She has prescribed me 2 antidepressants in the past.

Yes-I saw your thread Renie and started to reply, then realized I had nothing useful to say. I have forgotten entire sessions too but it was from total dissociation.

Every time I see people with bipolar and other diagnoses in their signature, there are lists of medications that follow. My BP symptoms are limited to hypomania too. I also have OCD, GAD, PTSD, dissociation, depersonalization, borderline traits, dysthymia and more if I think hard. It seems everyone who has multiple issues like this takes bipolar I meds. Maybe I've been in denial about this. I already have cognitive problems and health conditions and am worried about taking a psychiatric mixture.

I've also had allergic reactions to half of the meds I've tried in the past. ADD medications have been the most helpful over the years, and I never even had ADD as a child. I don't think my internist would prescribe ADD meds. They are really conservative with those types of meds where I live. I feel like i'm treated as a suspected drug-seeker just asking for Ambien to help me sleep.

I don't think you are in denial but I have this vision with all these balloons. Each with a different symptom and a bunch of buckets below. So now I see you grabbing the balloons and trying to stuff them in the appropriate bucket. But sometimes the same symptom belongs in multiple buckets and often they float out. Very hard to keep them in the buckets without something holding them down. A DSM maybe?

The point I'm making is they are labels that grow and change every couple of years. There are meds that are used for bipolar but I can't think of any that are used exclusively for bipolar. They only treat symptoms anyway. So what symptoms are you most interested in controlling through meds?

One thing I can caution about antidepressants is they can cause mood switching. Your hypomania may have been caused by the ad's. Some people will tell you that's a "sign" but that is just illogical, IMO. That's why I stress looking more at symptoms and what really matters to control right now vs what changes in your lifestyle you can make to help long term.

Sent from my iPad using Tapatalk

I have not yet read everything in this thread, so excuse me if I repeat things.

My T and I discussed the possibility of me having bipolar disorder at one point (I have severe depression and anxiety and my father had bipolar II). We eventually decided that it was the PTSD and ADHD symptoms that were mimicking aspects of bipolar. But in the process, we had to sort through symptoms and what they may mean.

Bipolar I symptoms include:
- severe depression (possibly with psychosis)
- rapid changes in mood (going from severely depressed to manic within days)
- mania
- fast talking
- extreme anxiety
- restlessness
- extreme creativity
- psychosis or paranoia
- mental confusion due to thoughts moving too fast in your head
- feeling like you don't need sleep
- feeling like you can't stop talking
- flight of ideas
- starting many projects at once
- grandiose thoughts or inflated self-esteem
- increased libido
- dangerous or risky behavior
- high impulsiveness, possibly creating many long-term difficulties (lots of debt due to shopping, getting physically hurt due to risks, gambling debt, etc...)
- mixed mania, which can appear in two ways: 1) being both depressed and manic at the same time (such as being very restless and energized yet severely depressed) or 2) extreme anxiety and paranoia mixed with depression (the flight of ideas and high energy mixed with the negative thoughts of depression)

Bipolar II symptoms include:
- milder forms of above
- no psychosis
- no mixed mania (or if present, it is the "anxious" version with no paranoia)
- an ability to "reign" the symptoms in
- feeling like you are on top of the world or will be successful in everything you do
- inflated self-esteem without "super human" characteristics
- rapid changes in mood
- needing less sleep
- increased creativity
- feeling very happy or "light"
- having a lot of energy and feeling like you could go on forever
- increased libido
- feeling extremely lucky
- risk-taking behaviors, but not so much that you are out of control
- very "bubbly"

haha-great illustration; it sounds like I need a venn diagram! I am agreeing with you it seems more about treating the symptoms rather than the diagnosis. My T said it's worth a bipolar med trial, but I am attempting to make a decision. I actually had several hypomanic episodes when I wasn't taking antidepressants and agree with you AD hypomania doesn't mean one has/doesn't have BP. You really know your stuff Michanne.

Thanks for this list-I haven't read any in a while, and it really made me open my eyes. I've had several from both I and II. I think it's the cognitive problems that make me think about BP I, esp. "mental confusion due to thoughts moving too fast in your head". I noticed several of these symptoms used to coincide with panic attacks. I was always afraid I had schitzoaffective disorder.

Do you take ADD meds? Or if you don't mind, what do you take if any?
I was trying to avoid meds, thinking I could make it with just therapy. Therapy really helps, but I think I need more than that right now. Yeah, I know I sound really messed up. Probably will be in therapy the rest of my life.

I know it takes some people years to get a BP I diagnosis. Now I can see why. My DID symptoms are what confuse me the most, although my sister noticed the greatest change in me after an adult trauma, then shortly thereafter I had an acute onset of PTSD. The PTSD seemed the easiest to tweak out of all of this though.

edit-will spend the whole next session talking to T about this.

Glad it helps!

I take Wellbutrin XL for depression, but it also mildly helps the ADHD. Because of the risks of bipolar (I'm still young, and so could eventually develop bipolar disorder) and because I have reacted badly to antidepressants in the past, it's why I take this one (Wellbutrin is an "atypical antidepressant" and doesn't fit into the normal SSRI category).

I also take propranolol (brand name Inderal) for my anxiety. It's a blood pressure medication that is not addictive and works to stop the adrenaline in my body from affecting me. Basically, it calms my body down but doesn't stop my mind from spinning around. It is teaching me to get control of my thoughts before they cause anxiety and panic attacks. It is considered a really great medication for PTSD.

I don't have Bipolar, but my Pdoc works in a similar way to your T, from what you've written, in that he does work more from a point of view of treating symptoms rather than diagnostic labels. That being said he has diagnosed me with Depression with Psychotic features, and my treatment for that is different to the treatment I receive for my other issues, which are more emotional/personality based. It's why I'm treated with a combination of meds and psychotherapy - there is just some things the meds can't treat, and vice versa. But overall as long as your symptoms are being treated adequately and you feel like you're making progress, having one diagnosis or another is just labelling that doesn't necessarily affect outcome at the end of the day.

I do know how you feel though, because I had one psychotic episode outside of a depressed state, and wondered if that meant I was Schizoaffective, and my Pdoc said if that was the case he'd consider me to be 'High Function Schizaffective with retained insight'. I ended up driving him mad, I'm sure, for the next few months as I kept wanting to know what the difference between Schizoaffective and MDD with Psychotic Fx was, and which one did I have, exactly. I thought if only I could know exactly what was wrong with me I could somehow research ways to fix my brain and make myself better. In the end I had to accept that really one diagnosis over another doesn't always change the way things are treated. If you feel you are being adequately treated in all areas of your mental/emotional health, then how much does having a label of Bipolar 1 or 2 really matter?

You all have been extremely helpful. I also posted in the Bipolar forum and got some really helpful information there.

HazelGirl, I'm sorry Your signature wasn't in the text when I was replying, but obviously the meds you are taking are right there. It sounds like you are on the right track!

Haha I'm sure I do the same with my T and last T and Pdoc. Maybe there is an element of wanting to fix myself too.

Because then I can force myself to pursue adequate med trials. I hate taking any medications. My siblings, father, and grandmother have all had full-blown psychosis, so I do have a concern about getting worse and getting the right treatment.

Borderline, bipolar, or both? Frame your diagnosis on the patient history Careful attention to conceptual distinctions may reduce the risk of misdiagnosis

http://www.currentpsychiatry.com/ind...1010&tx_ttnews[tt_news]=178050

This article also helped tremendously. The history is a key issue; the problem is, you don't have as much of a history until you get older!

My last therapy was about the relationship/attachment, which is treatment I needed, but I feel like I worked through all of those issues and don't need that anymore. The topics that come up consistently in my current therapy seem mostly related to bipolar symptoms rather than emotional issues pertaining to life events. For example, I feel distress about having the cognitive problems and fatigue/lack of energy, but not distressed by other things in my life. I am also beginning to see that my in my last T, we focused too much on borderline/attachment stuff and minimized my need for med treatment.

I also realized that the ADD meds helped over the last couple years, for one, because I always said they made me feel "normal". I am now thinking that is because I was mostly in a hypomanic phase for a few year prior, and the ADD meds can be energizing. Before I got PTSD, I never had focus or concentration issues. Bipolar can be triggered by PTSD. I never had consistent PD traits, so I've been attributing personality changes to DID.

These realizations all came from my current therapy. It's all coming together now.

edit I can't get the article link to work.
Google "current psychiatry Borderline, bipolar, or both Frame your diagnosis on the patient history" and it should come up. Sorry.

I sort of relate to where you're coming from, which is why I'm glad I have a Pdoc who can separate out the medication needing side of things, from the therapy/emotional needing side - if that makes sense. Like he knows what has to be treated with meds, and what can be treated or helped with talk therapy instead.

Do your possible Bipolar symptoms feel different to your Borderline/Attachment/Emotional type issues? The reason I ask is because, as I've explained to my Pdoc, I can tell the difference between my emotional issues, which feel more like part of the product of my psychological and sociological environment, and my psychotic type symptoms, which feel like they're coming from my a misfiring in my brain. There's a clear difference between the way I feel or perceive my symptoms when it comes to my diagnosis, so I was wondering if that was perhaps the same for you?

It can depend on your thought processes, your intellectual style. I'm very analytical. I can distinguish some easily but not others. What complicates things is being in a very exploratory type of therapy. I mean-was having sex with my bf 5 times a day for a substantial length of time a result of hypomania or being a neglected baby? IDK The relationship ones would be more difficult to delineate than the other ones like racing thoughts, flow of creativity. But when exploring those things, they can be erroneously attributed to emotional issues that are coincidental. It didn't help that I have a lifetime of "major events" that could coincide with symptoms. But even if the symptoms were not there, I would have had the same life events. It doesn't have to have a cause-effect relationship, but it's easy to connect the dots anyway.

Thanks for all your input.