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Until my most recent episode when it became clear that my psychiatrist was going t have to write bipolar disorder, my psychiatrist was putting down dysthymic disorder.  I can see it being the case, but hadn’t heard of it before being combined with bipolar disorder.  Anyone else have it as a combo or know more about it?

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My doc thinks the dysthymia is the result of "sub-syndromal" symptoms of bipolar meanin they're there but not enough to count as a full blown episode 

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I doubt that your dr is diagnosing you w/both dysthymia and bipolar disorder at this point.  It’s much more likely that your dx has shifted from dysthymia to bipolar, as new/different symptoms emerged.  

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I agree you probably have s change in diagnosis, it’s basically what happened to me. I think I had poorly treated depression because I wasn’t be medicated for bipolar, the real issue. Maybe you will do better with new meds, too. 

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Absolutely, from dozens of ADs tried, to lamotrigine plus abilify. For me, it was life changing. Prior to that I was just told I’d probably be depressed forever. It’s almost worth dealing with the bipolar diagnosis which I hate since I am so much better. 

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That is a very good combo for BP...nice work by the doc to work with you and get it all (somewhat) settled 

@dancesintherain many bipolars are never symptom free and low level depression is definetly not super rare...I'm usually a bit on the crappy/lethargic side despite meds and therapy

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So I've changed psychiatrists since then, but as of my last bill from that psychiatrist, he kept both diagnoses...there was the billing code for dysthymic disorder and a billing code for bipolar disorder.  That said, what you said makes sense.  My med approach isn't drastically different in classes used (it was always mood stabilizer, AAP, and anti-anxiety), but it took four hospitalizations in the past 18 months.  One was for lithium toxicity, so that doesn't really count.  But two were for mania and one was for a mixed state. 

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I was diagnosed with dysthymia before they realized I was bipolar spectrum. I've heard that even when technically in baseline, bipolar patients can have symptoms like anhedonia, trouble concentrating, etc that can look like minor depression but not be bad enough for an episode. Hell knows I've experienced it.

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May I ask what happened to warrant the change in diagnosis?

 

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My pdoc said that he writes the “mildest” diagnosis on forms that go to insurance until there’s a reason that he can’t anymore.  I had the dysthymia diagnosis for a while, even though his opinion was that I probably also (?) had bipolar disorder.  When I was hospitalized, it couldn’t be hidden.

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Okaaayyy...I guess this is a case of “So long as you’re receiving the treatment you need, your diagnosis doesn’t matter,” but I still find it odd.

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On 1/23/2018 at 12:47 PM, dancesintherain said:

My pdoc said that he writes the “mildest” diagnosis on forms that go to insurance until there’s a reason that he can’t anymore.  I had the dysthymia diagnosis for a while, even though his opinion was that I probably also (?) had bipolar disorder.  When I was hospitalized, it couldn’t be hidden.

Since we might re-enter the era where you can be denied insurance for pre-existing conditions, this is pretty pragmatic on your pdoc's part.  

A bipolar diagnosis technically precludes you from dysthymia as a diagnosis, from a DSM standpoint, but the DSM is limited and that doesn't mean you can't have a long term dysthymic episode.

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