T vs Pdoc diagnosis

i went to pdoc yesterday. She dx'd me with Bipolar 2 about 5 years ago and never changed. T and I have always thought this was wrong. T dx'd me with Major Depressive Disorder and PTSD which is more what I thought it was and since T sees me more.. We do not believe I have had manic episodes and what may be seen as manic episodes is me trying to hard to put a happy face on and maybe going overboard.. It has always bothered me (don't know why) to have the Bipolar dx.. So yesterday I finally brought up the subject with pdoc. She told me she had Bipolar 2 but she disagrees with it now. She said what appears to be mania is often anxiety but not the typical anxiety but rather PTSD driven. She believes it is MDD recurrent. I told her what T dx'd me with and she agreed and changed it in the computer then. Not sure why but this seems like a big relief to have it changed. I hated the bipolar label.

Course then we discussed medications which T and pdoc always agree on but I have a hard time with it. Fortunately they are both very supportive and work with me.

Most people would rather have depression as a diagnosis instead of bipolar because there is a lot more negative/dangerous stigma around bipolar.

So it's not surprising that you feel relieved to have something with less stigma around it.

Also, having all the professionals agree on the same thing makes everything seem more stable and valid, right?

That's a sign of a good pdoc who is willing to reassess and go to plan B so to speak. One of the reasons I love my pdoc has been his willingness to have me go for a 2nd opinion, willingness to listen to me and collaborate in my treatment, etc. They aren't all like that.

It a very important distinction because it can make a huge difference in terms of what meds are safe to take when you're depressed. Sounds like a very good pdoc for being willing to reconsider and admit that psychiatric diagnosis can be tricky.

I agree no one wants the bipolar label. I think it's a whole new kettle of fish compared to depression, anxiety, ptsd.

Thank you everybody for understanding where I am coming from. T and pdoc both understand but other than that nobody in my "real life" understands including my husband who who is amazingly supportive and tries to understand but really doesn't.

I would be "ok" if I truly had bipolar in spite of the stigma. However, I just never felt it was correct. Fortunately, neither did T. I am very fortunate to have providers who are willing to listen and work with me.

I think the more relevant question is whether a diagnosis is serving the patient or the system. Not saying that there is no such thing as depression or post-traumatic stress, but saddling one with a formal precise diagnosis that can become a crippling encumbrance and stays with you for life, is a different kettle of fish. Especially when most of these disorders have no factual basis and are mostly used to justify prescribing of dangerous drugs.

If a professional told me I have Bipolar 2 or MDD, I would ask for the evidence used to arrive at that diagnosis and just why these labels are necessary.

Having a correct bipolar diagnosis is essential though because treatment with the wrong meds (for instance, treating bipolar disorder with AD's because it is being mistaken for major depressive disorder) can be disastrous, causing mania and rapid cycling. Mistaking depression as bipolar disorder is not as much of a med issue except that a person might end up taking unnecessary meds that way.

I would go with the diagnosis from the person you talk to the most and see more often. For example I see my psychiatrist once a month for about 5 minutes but a therapist is for one hour and more often.

Depends on the diagnostic competency and experience of the therapist though. My T would not have made a bipolar diagnosis alone, and he's a PhD with extensive experience in assessment. He wanted more than one eye on my status, including the eye of my pdoc who had much more info pertaining to my response to various meds. And even my pdoc sent me for a thorough psych eval before he felt sure of his diagnosis. The more eyes on a client, from various perspectives, the better, particularly in cases that may be complicated or where co-morbid diagnoses may be at work.

[QUOTE=ensconce;4580596]I would go with the diagnosis from the person you talk to the most and see more often. For example I see my psychiatrist once a month for about 5 minutes but a therapist is for one

The faculty of l pdoc and I work for has larger dx of bipolar than the national level. I think they use bipolar as the starting point

Frankly I think there's some professionals out there that wouldn't recognize PTSD if it walked into their office and did a jig in front of them. It actually is frightening how often trauma is ignored or downplayed and the patient is diagnosed with something else. I remember telling my pdoc at 20 that I was afraid of the world, had panic attacks and couldn't sleep (in addition to wanting to die) and got a lovely bipolar label which kept me from getting prescribed desperately needed anti depressants because of a fear of mania. Even though I was never manic in my life. Meanwhile my anxiety was ignored and I developed an eating disorder and started cutting. It wasn't until years later when I left my Podunk hometown that they realized I had PTSD, recurrent major depression and generalized anxiety disorder on top of that.

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Actually I think there is solid evidence that AD's are a primary cause of bipolar, and the rampant use of AD's in the modern era has taken what was once a rare disorder and made it common.

And I have read that the drug cocktails used to treat bipolar are causing outcomes similar to those seen in schizophrenia patients on drug cocktails, including cognitive decline, poor social functioning, diabetes, obesity, and more.

I believe the term for all this is "iatrogenic illness".

I would love to see your sources to share with the bipolar forum. Doesn't explain those who showed symptoms before ever having taken any medications, which is a large portion of us.

Robert Whitaker's book "Anatomy of an Epidemic". Well written, well organized, heavily cited.

Regarding those who develop depression or mania before ever having taken meds, he stresses over and over a critical finding -- the dramatic increase in the use of psych meds appears to have changed many conditions from episodic to chronic.

I am interested in peer-reviewed scientific studies about the causation of bipolar disorder.

I learned a lot at psycheducation.org. For me, causation of bp is genetic and can be "ignited" according to environment. Also, it can skip a generation so siblings with a diagnosis is heavily considered in making one's diagnosis. My brother, sister and I are all on the bp spectrum and were raised in an emotionally abusive home within a family legacy of both physical and verbal abuse, alcoholism, depression, anxiety etc. This website discusses the functioning of the bp brain and covers the GKSA enzyme that bp brains have, that other "typical" brains don't have. No one knows what it is, but it's there. Also, as genes are inherited, new evidence shows that one not only inherits the genes but the particular stress that gene endured. What is so baffling about bp is that the many inherited genes can attach to the chromosomes in innumerable ways, making bp elusive to pinpoint, compare, or even understand as clearly as other mental disorders. All of this really only came to light in 2008 after an intense research study of several years was released. Thus, the "Spectrum" is born, replacing categorizations such as cyclothymia etc. which are now outdated terms. There are some great pics and explanations of the spectrum on this website. Basically, it covers BPII and Spectrum BP, as BP I was already better understood and found to share the similar genes that disorders such as schizophrenia have, which causes delusions. My sister is BP I and suffers from extreme delusions and breaks with reality. I'm Spectrum and do not. Also, on this website is a BP "quiz" that I've found to be the most accurate thus far in "seeing" myself; I fit the BPII profile to NOS like a glove. This website saved me last year when I was first "diagnosed" with Spectrum BP (my Pdoc is progressive and doesn't like to pinpoint where I'm at on the Spectrum; the website discusses this approach). Anyway, it taught me a lot and I've felt so much better-knowledge is power. I hope it helps you as it has me

Actually, I have no questions about causation of bipolar disorder. I have a good understanding of the current understanding of causation. I, too, have a familial history of mental illness. Love psyched.org by the way. His book is excellent.

My apologies for the thread going off-course by the way.

Re: genetics, as always Gabor Mate has something brilliant to say:

"While there may genetic predispositions towards depression and addiction, a predisposition is not the same as a predetermination. A predisposition increases the risk of something occurring but it cannot by itself cause it to happen. The key factor is the environment. Genes are activated or turned off by the environment, including in cases of suicide, as brilliant Canadian studies have shown. Nobody is born doomed to depression, and nobody is born with low self-esteem. If Robin Williams became a depressive and was driven to seek validation in the laughter and applause of others, what he called the 'please love me syndrome,' it was not due to his genes. ...And let us understand that the prevention of mental illness begins in the crib, in how we hold and attend to our children."

BudFox, I don't know why you have such an agenda to somehow prove bipolar disorder is some med-created atrocity and that the known studies and science on the matter are bunk, but enough is enough. I never said bipolar was genetically predetermined; that was your take on things I guess. As far as your last statement . . . you don't know much about my "crib."

I was replying to Blue Swan's post about genetics. The "crib" line was actually part of the Gabor Mate quote but I messed up the formatting (fixed now).

One of the Pdocs I work with often states that somebody with Bipolar who is severely depressed often exhibits signs of psychosis and schizophrenia. In fact that is one of the ways they can tell if a person is bipolar vs. schizophrenic.