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Doc is lower lithium dosage...what to expect?


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#1 cupcake

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Posted 24 April 2010 - 10:18 AM

Hi! I have been taking 900 mg's of Lithium as Escalith ER for about 8 months. It's doing me no good, I don't even have side effects except a pesky little rash and some water retention. I've been able to lose weight rather well actually since starting it because I have no appetite. Every lithium level I've had has come back below a therapeutic level (.4 if I remember right maybe lower) and I started it when I was pregnant so they never raised it but it was the safest thing to put me on at the time.

My doctor wants me to drop my dosage by 300 mg's to 600 and I'm not comfortable doing such a drastic drop (well IMO drastic). I want to combine my 450 and 300 pills for a 750 mg dosage which would only be dropping it be 150 mgs. Then I want to keep this dosage for 2 weeks then go ahead and drop down to 600 mgs.

Since hypothyroidism runs in both sides of my family were going to discontinue the lithium but I'm afraid my doc will want me to drop too drastically. She even got me to cold turkey my Ativan after 3 months usage and put me in the middle of hell until I reinstated and I managed to come up with a reasonable taper schedule on my own and I've been benzo free for 6 weeks now...still having minimal withdrawal symptoms..Another question will slowly tapering the Lithium cause me problems with my benzo withdrawal symptoms? My doc would say no because she told me I wasn't in withdrawals from the Ativan, that it was all in my head hahah!

So I have a LIthium taper schedule I would like to run past folks that have experience with it..as I know no one that has tapered. Everyone I know just cold turkeyed and they swear they had no problems. These dosages will be taken at bedtime as ususal.

750 mgs X2weeks
600 mgs X2 weeks
450 mgs X2 weeks
300 mgs X2 weeks d.c or
150 mgs X2 weeks d.c
If my doctor will give me the 150 mgs pills I will taper on down to that and just quit from there. If not will it be ok to stop after 300 mgs for 2 weeks or will I need to cut my pills in half..might make my tummy upset but I can deal. Doc says I can cut them in half but I tried that once when she wanted me to taper before the birth of my baby and it made me feel weird but it was just for about 1/2 hour.

I want to avoid having any symptoms especially after going through ativan withdrawal...of course it would probably be laughable compared to what I went through there :-) Anyway does this schedule seem reasonable or should I hold the dosages for 3 or 4 weeks? Or could I hold them for 1 week being as they are only 150 mgs drops? I tried dropping my dose before the birth by half and I had some anxiety issues there that resolved immediately after raising my dose...psychological? Maybe but I know I had anxiety 2-3 days after dropping my dose.

Thanks so much for your input and suggestions!
~Cupcake~


#2 Cetkat

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Posted 24 April 2010 - 11:02 AM

First off, cutting the pills in half is fine & any stomach upset can be helped by drinking milk.

Secondly, cold turkey is usually just fine. If you're uncomfortable with that, titrating down makes perfect sense, and I don't know why your pdoc would have a problem with that - it's not like the the amount of added time would really make any difference in developing or not developing a Thyroid problem. I'm Hypothyroid myself. It's something that can develop from Lithium over time, but since it runs in your family, it's far more likely (if you even get it) that it came from that, not the Lithium. I don't know if taking Lithium would make you more susceptible to developing this, but I really doubt it.

As for the schedule, I would only stay at the doses for 1 week rather than 2. One, your pdoc will be more likely to support that, and two, I highly doubt you'll get any increased side effects that way (if you get them at all).

_ . _ . _ . _ . _ . _ . _ . _ . _ . _ . _ . _ . _ . _ . _ . _ . _ . _ . _ . _ . _ . _ . _ . _ . _ . _

Dx: Major Depression w/ Dysthymia and Panic Disorder, ADHD, Fibromyalgia
Pdoc's Theory Dx: Bipolar NOS (recently re-theorized by current pdoc)
Rx : Strattera 80mg, Armour Thyroid 60mg (1 gr), Nadolol prn, Xanax prn, Methocarbamol 750mg prn
EXRx : Zoloft, Seroquel, Wellbutrin, Prozac, Lithium, Lamictal, Remeron, Lexapro, Abilify, Zyprexa, Geodon, Cymbalta, Paxil, Sonata, Lunesta, Effexor, Metadate, Risperdal, BuSpar, Ambien, Invega, Tegretol, Nortriptyline, Desipramine, Deplin, Neurontin, Concerta, Trazodone, Mirapex, Amitriptyline, Saphris, Prestiq

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#3 suzz

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Posted 24 April 2010 - 11:50 AM

I did cold turkey and it was miserable. I had to as I had a crisis with it and forgot to hydrate when I was sick. I drank water every waking moment as it takes a few days to have it completely gone. I was put on Lamictal after that and it worked well enough I don't have to take an AD.
Slow and steady is the key..I can't imagine your doctor isn't stepping you down.
I also developed hypothyroid because of it..but it is easily treated if you end up staying on it.
Your kidney function should be monitored...I had damage to my kidneys and should have been switched to something else before it got to the stage I am in.
Blessings, Sue

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#4 bpladybug

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Posted 24 April 2010 - 12:55 PM

Hi! I have been taking 900 mg's of Lithium as Escalith ER for about 8 months. It's doing me no good, I don't even have side effects except a pesky little rash and some water retention. I've been able to lose weight rather well actually since starting it because I have no appetite. Every lithium level I've had has come back below a therapeutic level (.4 if I remember right maybe lower) and I started it when I was pregnant so they never raised it but it was the safest thing to put me on at the time.

My doctor wants me to drop my dosage by 300 mg's to 600 and I'm not comfortable doing such a drastic drop (well IMO drastic). I want to combine my 450 and 300 pills for a 750 mg dosage which would only be dropping it be 150 mgs. Then I want to keep this dosage for 2 weeks then go ahead and drop down to 600 mgs.


So I have a LIthium taper schedule I would like to run past folks that have experience with it..as I know no one that has tapered. Everyone I know just cold turkeyed and they swear they had no problems. These dosages will be taken at bedtime as ususal.

750 mgs X2weeks
600 mgs X2 weeks
450 mgs X2 weeks
300 mgs X2 weeks d.c or
150 mgs X2 weeks d.c
If my doctor will give me the 150 mgs pills I will taper on down to that and just quit from there. If not will it be ok to stop after 300 mgs for 2 weeks or will I need to cut my pills in half..might make my tummy upset but I can deal. Doc says I can cut them in half but I tried that once when she wanted me to taper before the birth of my baby and it made me feel weird but it was just for about 1/2 hour.

I want to avoid having any symptoms especially after going through ativan withdrawal...of course it would probably be laughable compared to what I went through there :-) Anyway does this schedule seem reasonable or should I hold the dosages for 3 or 4 weeks? Or could I hold them for 1 week being as they are only 150 mgs drops? I tried dropping my dose before the birth by half and I had some anxiety issues there that resolved immediately after raising my dose...psychological? Maybe but I know I had anxiety 2-3 days after dropping my dose.

Thanks so much for your input and suggestions!
~Cupcake~


When I titrate up or down on my Lithium I do it 150 mgs at a time. I actually insist on that because the slow gentle change keeps m mind more stable. I think two weeks at each level is good. That is what I would do. Too fast a change can destabilize me.

How unfortunaate that it has not helped you! And odd that you never got above 0.4 . Could that be why it has not helped. You are not having many side effects. Maybe you could talk with your doctor about going higher - moving up to 1200 mgs and see if that brings you into a therapeutic level. It could be successful for you once you are at a therapeutic dose.

You are not going to have the type of withdrawals that we do with a benzo. It is not an addictive substance like activan, valium, xanax. So don't worry about that.

Good luck with this, Ladybug

Edited by bpladybug, 24 April 2010 - 12:56 PM.

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'Mania is a dangerous Mistress.' BPLadybug

Bipolar 1
Treatment: 900 mgs Lithium, 900 mgs Neurontin, 400 mgs Seroquel, Xanax prn, Temazepam, fish oil, vitamins, Vit. D 5, 000 IU, exercize, some talk therapy and CBT Therapy. Exercize helps as does the Light Box; 30 mins every morning. I also have physical health challenges.


#5 cupcake

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Posted 24 April 2010 - 01:04 PM


Hi! I have been taking 900 mg's of Lithium as Escalith ER for about 8 months. It's doing me no good, I don't even have side effects except a pesky little rash and some water retention. I've been able to lose weight rather well actually since starting it because I have no appetite. Every lithium level I've had has come back below a therapeutic level (.4 if I remember right maybe lower) and I started it when I was pregnant so they never raised it but it was the safest thing to put me on at the time.

My doctor wants me to drop my dosage by 300 mg's to 600 and I'm not comfortable doing such a drastic drop (well IMO drastic). I want to combine my 450 and 300 pills for a 750 mg dosage which would only be dropping it be 150 mgs. Then I want to keep this dosage for 2 weeks then go ahead and drop down to 600 mgs.


So I have a LIthium taper schedule I would like to run past folks that have experience with it..as I know no one that has tapered. Everyone I know just cold turkeyed and they swear they had no problems. These dosages will be taken at bedtime as ususal.

750 mgs X2weeks
600 mgs X2 weeks
450 mgs X2 weeks
300 mgs X2 weeks d.c or
150 mgs X2 weeks d.c
If my doctor will give me the 150 mgs pills I will taper on down to that and just quit from there. If not will it be ok to stop after 300 mgs for 2 weeks or will I need to cut my pills in half..might make my tummy upset but I can deal. Doc says I can cut them in half but I tried that once when she wanted me to taper before the birth of my baby and it made me feel weird but it was just for about 1/2 hour.

I want to avoid having any symptoms especially after going through ativan withdrawal...of course it would probably be laughable compared to what I went through there :-) Anyway does this schedule seem reasonable or should I hold the dosages for 3 or 4 weeks? Or could I hold them for 1 week being as they are only 150 mgs drops? I tried dropping my dose before the birth by half and I had some anxiety issues there that resolved immediately after raising my dose...psychological? Maybe but I know I had anxiety 2-3 days after dropping my dose.

Thanks so much for your input and suggestions!
~Cupcake~


When I titrate up or down on my Lithium I do it 150 mgs at a time. I actually insist on that because the slow gentle change keeps m mind more stable. I think two weeks at each level is good. That is what I would do. Too fast a change can destabilize me.

How unfortunaate that it has not helped you! And odd that you never got above 0.4 . Could that be why it has not helped. You are not having many side effects. Maybe you could talk with your doctor about going higher - moving up to 1200 mgs and see if that brings you into a therapeutic level. It could be successful for you once you are at a therapeutic dose.

You are not going to have the type of withdrawals that we do with a benzo. It is not an addictive substance like activan, valium, xanax. So don't worry about that.

Good luck with this, Ladybug



Hi! When my doc started me on it she put me on 300 mg's first, then I was hospitalized because I went nuts after I found out I was pregnant because I was devastated, then the resident psych doc put me on 900 mg's. I still had manic lows until my baby was born and that was the end of the bad ones...now it's just moodiness.

I'm not interested in staying on LIthium anymore anyway because I freak out too much about the potential for getting toxic. I've actually been thinking about Lamictal but I'm not depressed. I don't want to be on something that's gonna make my thinking foggy because I have 4 kids running around now.

I wouldn't mind staying on a very low dose lithium, I've heard it can actually be beneficial for our brain.

#6 AirMarshall

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Posted 24 April 2010 - 01:19 PM

I can quite lithium cold turkey with absolutely no side effects, unlike any other med I've had.

It is very wise to taper though since quitting lithium rapidly has a reputation for causing rebound mania within a few weeks. (ask me).

I'm not sure why your doctor never upped your dosage to higher levels, unless your personal resistance is the reason. Lithium is generally pretty easy to manage and there is no practical reason to be worried about toxicity.

Lamictal is an effective drug. It probably more often used as an adjunct to another stronger mood stabilizer but still many use it alone. It often takes a bit of fiddling to find the right dosage. Like lithium there is no direct correlation between dosage and effective blood level. Each person is different.

Good luck. a.m.

[edit] p.s. Lamictal is a subtle drug. Not documented in the PI sheets but reported by many members and as I experienced it can make you feel variously irritable (maybe bitchy is a better word) ragey, restless during the first week or so. I would go throug it again if necessary. Lamictal can take a number of weeks to build up to full effect. I saw improvements each week for about 3 months. a.m.

Edited by AirMarshall, 24 April 2010 - 01:25 PM.

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#7 cupcake

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Posted 24 April 2010 - 02:47 PM

I can quite lithium cold turkey with absolutely no side effects, unlike any other med I've had.

It is very wise to taper though since quitting lithium rapidly has a reputation for causing rebound mania within a few weeks. (ask me).

I'm not sure why your doctor never upped your dosage to higher levels, unless your personal resistance is the reason. Lithium is generally pretty easy to manage and there is no practical reason to be worried about toxicity.

Lamictal is an effective drug. It probably more often used as an adjunct to another stronger mood stabilizer but still many use it alone. It often takes a bit of fiddling to find the right dosage. Like lithium there is no direct correlation between dosage and effective blood level. Each person is different.

Good luck. a.m.

[edit] p.s. Lamictal is a subtle drug. Not documented in the PI sheets but reported by many members and as I experienced it can make you feel variously irritable (maybe bitchy is a better word) ragey, restless during the first week or so. I would go throug it again if necessary. Lamictal can take a number of weeks to build up to full effect. I saw improvements each week for about 3 months. a.m.




Thanks! She would have raised my dose or had me on something else by now if I were able to get into see her, or if I had called her with some problems regarding my mood, which my mood is excellent except for the Ativan withdrawals I'm still subtly dealing with.

I haven't been back to her for about 5 months...she left her practice to take a long vacation for about a year but her nurse was unable to call in my meds without a dr. present (the law) so she came back to another practice and its just been a while to get me in..I called her and told her I wanted to taper the Lithium over the phone so she called in the 300 mgs for me.

I think I'm going to go naked as far as drugs are concerned for a bit and see how bipolar symptoms go. I didn't go to her to get help with the bipolar (didn't know I was though people have told me I ) but for panic attacks and she wanted to treat me for bipolar disorder instead. She said she knew I was bipolar by just looking at me because I'm covered in tattoos and piercings and had multicolored hair I don't see how that could be a basis for diagnosis but I'm not a doctor. My symptoms were rather minimal except for around PMS time and then I was the devil. So maybe I'm not really bipolar in a sense...though my husband would disagree with me.

#8 AirMarshall

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Posted 24 April 2010 - 05:18 PM

Kinda like epileptics are only epileptic during a seizure, eh? ;)

Ok. You are still welcome on the boards on or off the meds!

best, a.m.

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#9 SashaSue

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Posted 24 April 2010 - 06:08 PM

Um, if your mood is excellent, why do you say the lithium isn't working for you?
Dx: Bipolar I, ADHD<br />
Rx: Seroquel, 800mg, Lamictal, 150mg, Effexor, 325mg, Wellbutrin, 450, Dexedrine ER, 60mg

#10 cupcake

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Posted 24 April 2010 - 06:46 PM

Um, if your mood is excellent, why do you say the lithium isn't working for you?


It didn't make any change whatsoever when I started taking it. My mood is excellent because I'm happy to be benzo free and I have a new baby.

#11 cupcake

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Posted 24 April 2010 - 06:49 PM

Kinda like epileptics are only epileptic during a seizure, eh? :)

Ok. You are still welcome on the boards on or off the meds!

best, a.m.


Hahah yeah but not to that degree. Someone told me once she thought everyone had bipolar moments ;) I just had more moments than most people.

#12 cupcake

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Posted 03 May 2010 - 01:22 PM


Kinda like epileptics are only epileptic during a seizure, eh? :)

Ok. You are still welcome on the boards on or off the meds!

best, a.m.


Hahah yeah but not to that degree. Someone told me once she thought everyone had bipolar moments ;) I just had more moments than most people.



I'm on day 4 after my first reduction of 150 mg's and I'm doing great, no manic ups or downs. I'm going to hold these doses for about 10 days before lowering to the next. Hopefully by June I will be med free.

#13 6un6silent6

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Posted 03 July 2010 - 12:43 PM


Um, if your mood is excellent, why do you say the lithium isn't working for you?


It didn't make any change whatsoever when I started taking it. My mood is excellent because I'm happy to be benzo free and I have a new baby.


Interesting anecdote, a good friend of mine is also bipolar and she was medicated to the hilt (Lithium, Risperdal, Mitziprine, Xanax, Effexor) and she had to come off of all of it when she had a baby. After the baby was born she was medication free for about 3 years and doing great with no relapse. I believe she's now back on a low-dose of Lithium for her moods and Klonopin for her anxiety, but I'm curious as to whether child birth can affect neuro-chemistry as 3 years is a long time to go med/symptom free.
dx: BP II -Rapid Cycling, Anxiety/OCD
rx: Lithium 900mg, Topamax 100mg, Clonazepam or Lorazepam .5mg PRN, Ambien 10mg PRN

#14 bpladybug

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Posted 04 July 2010 - 12:46 AM

Hi! I have been taking 900 mg's of Lithium as Escalith ER for about 8 months. It's doing me no good, I don't even have side effects except a pesky little rash and some water retention. I've been able to lose weight rather well actually since starting it because I have no appetite. Every lithium level I've had has come back below a therapeutic level (.4 if I remember right maybe lower) and I started it when I was pregnant so they never raised it but it was the safest thing to put me on at the time.

My doctor wants me to drop my dosage by 300 mg's to 600 and I'm not comfortable doing such a drastic drop (well IMO drastic). I want to combine my 450 and 300 pills for a 750 mg dosage which would only be dropping it be 150 mgs. Then I want to keep this dosage for 2 weeks then go ahead and drop down to 600 mgs.

Since hypothyroidism runs in both sides of my family were going to discontinue the lithium but I'm afraid my doc will want me to drop too drastically. She even got me to cold turkey my Ativan after 3 months usage and put me in the middle of hell until I reinstated and I managed to come up with a reasonable taper schedule on my own and I've been benzo free for 6 weeks now...still having minimal withdrawal symptoms..Another question will slowly tapering the Lithium cause me problems with my benzo withdrawal symptoms? My doc would say no because she told me I wasn't in withdrawals from the Ativan, that it was all in my head hahah!

So I have a LIthium taper schedule I would like to run past folks that have experience with it..as I know no one that has tapered. Everyone I know just cold turkeyed and they swear they had no problems. These dosages will be taken at bedtime as ususal.

750 mgs X2weeks
600 mgs X2 weeks
450 mgs X2 weeks
300 mgs X2 weeks d.c or
150 mgs X2 weeks d.c
If my doctor will give me the 150 mgs pills I will taper on down to that and just quit from there. If not will it be ok to stop after 300 mgs for 2 weeks or will I need to cut my pills in half..might make my tummy upset but I can deal. Doc says I can cut them in half but I tried that once when she wanted me to taper before the birth of my baby and it made me feel weird but it was just for about 1/2 hour.

I want to avoid having any symptoms especially after going through ativan withdrawal...of course it would probably be laughable compared to what I went through there :-) Anyway does this schedule seem reasonable or should I hold the dosages for 3 or 4 weeks? Or could I hold them for 1 week being as they are only 150 mgs drops? I tried dropping my dose before the birth by half and I had some anxiety issues there that resolved immediately after raising my dose...psychological? Maybe but I know I had anxiety 2-3 days after dropping my dose.

Thanks so much for your input and suggestions!
~Cupcake~


This is exactly how I increase and decrease my Lithium. From 900 to 600 is a big change. 33% Just as from 300 to 600 is a big change. I always have a little bottle of 150 mgs on hand. If I start to push into hypomania I add the 150. I think you make perfect sense. We have to let out brain chemistry acclimate to a new dose. Slow is better.

ladybuglove.jpg


'Mania is a dangerous Mistress.' BPLadybug

Bipolar 1
Treatment: 900 mgs Lithium, 900 mgs Neurontin, 400 mgs Seroquel, Xanax prn, Temazepam, fish oil, vitamins, Vit. D 5, 000 IU, exercize, some talk therapy and CBT Therapy. Exercize helps as does the Light Box; 30 mins every morning. I also have physical health challenges.


#15 6un6silent6

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Posted 04 July 2010 - 12:58 AM

This is exactly how I increase and decrease my Lithium. From 900 to 600 is a big change. 33% Just as from 300 to 600 is a big change. I always have a little bottle of 150 mgs on hand. If I start to push into hypomania I add the 150. I think you make perfect sense. We have to let out brain chemistry acclimate to a new dose. Slow is better.


Sorry to butt in here, but that's a great idea to have some 150s on hand. Would be a good way for someone who is sensitive to the side effects to titrate up slowly. You were right about going from 600->900. Life is much different (in a good way) but I'm noticing more side effects (or at least a reoccurrence of them after being "good" on 600mg for 7 mo). I'll ask my Pdoc about getting a seperate rx for 150s in case I need to go up/down.
dx: BP II -Rapid Cycling, Anxiety/OCD
rx: Lithium 900mg, Topamax 100mg, Clonazepam or Lorazepam .5mg PRN, Ambien 10mg PRN

#16 OscillateWildly

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Posted 04 July 2010 - 12:59 AM


I can quite lithium cold turkey with absolutely no side effects, unlike any other med I've had.

It is very wise to taper though since quitting lithium rapidly has a reputation for causing rebound mania within a few weeks. (ask me).

I'm not sure why your doctor never upped your dosage to higher levels, unless your personal resistance is the reason. Lithium is generally pretty easy to manage and there is no practical reason to be worried about toxicity.

Lamictal is an effective drug. It probably more often used as an adjunct to another stronger mood stabilizer but still many use it alone. It often takes a bit of fiddling to find the right dosage. Like lithium there is no direct correlation between dosage and effective blood level. Each person is different.

Good luck. a.m.

[edit] p.s. Lamictal is a subtle drug. Not documented in the PI sheets but reported by many members and as I experienced it can make you feel variously irritable (maybe bitchy is a better word) ragey, restless during the first week or so. I would go throug it again if necessary. Lamictal can take a number of weeks to build up to full effect. I saw improvements each week for about 3 months. a.m.




Thanks! She would have raised my dose or had me on something else by now if I were able to get into see her, or if I had called her with some problems regarding my mood, which my mood is excellent except for the Ativan withdrawals I'm still subtly dealing with.

I haven't been back to her for about 5 months...she left her practice to take a long vacation for about a year but her nurse was unable to call in my meds without a dr. present (the law) so she came back to another practice and its just been a while to get me in..I called her and told her I wanted to taper the Lithium over the phone so she called in the 300 mgs for me.

I think I'm going to go naked as far as drugs are concerned for a bit and see how bipolar symptoms go. I didn't go to her to get help with the bipolar (didn't know I was though people have told me I ) but for panic attacks and she wanted to treat me for bipolar disorder instead. She said she knew I was bipolar by just looking at me because I'm covered in tattoos and piercings and had multicolored hair I don't see how that could be a basis for diagnosis but I'm not a doctor. My symptoms were rather minimal except for around PMS time and then I was the devil. So maybe I'm not really bipolar in a sense...though my husband would disagree with me.


If your only symptoms are during PMS time that really isn't consistent with bipolar at all.

Having an eccentric appearance doesn't make a person bipolar, if it is a stable personality trait. I always have bright colored clothes and makeup. I don't do this for a few weeks then start dressing like a pile of rags... I am always wearing artistic eccentric things. It is not at all a reliable indication to look at a person's appearance and say "you know they are bipolar" because they are artistic or edgy. That's actually fucking ridiculous as many people exist who are simply artistic and eccentric. I mean if this sort of appearance alternated with a subdued one, then yea, that's a sign.

I would assume your doctor had better reasons to think you were bipolar and you just don't know them, but after my experience with a REALLY bad doctor this december (who looked at me and "knew" what was wrong -- even though he was way off base and he refused to believe me when I told him his statements were not applicable to me and my case)... after the experience I had I now realize there actually are a lot of doctors out there, particularly psychiatrists, who are criminally painfully incompetent.

Also, most people think "bipolar" means "being moody and emotional". People don't know what bipolar disorder is. The fact your husband thinks you are bipolar is sorta meaningless, unless your husband has a medical education in the signs and symptoms of bipolar disorder. The average person on the street thinks "bipolar" means "emotional and reactive and moody" which describes a whole lot of normal people or even abnormal people who may be or may not be bipolar.

My advice... get a second opinion. Don't go on one opinion. This doctor sounds like she might be a bit crazy. If you have no mood problems other than PMS, that's not like bipolar.





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