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Milena

Diagnosis: how to distinguish bipolar from ptsd?

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I’ve a question for the hive mind.

I get different diagnoses depending on who I talk to.

I definitely have had serious early childhood adverse events, and have been retraumatized as a teen and adult. 

Symptoms: 

excessive worry and fear

Overreactive, esp about marriage 

Poor sleep

Inability to concentrate

When my symptoms are acute, which happens every couple of years, and always in summer, which happens to be an anniversary date, I get:

Feelings of rushing, or charged

Irritable & agitated

Emotionally labile (3 hour crying jags and I never cry)

Dissociation/derealization/depersonaliation

Paresthesias 

Self destructive behavior: sexual promiscuity, suicidal ideation

Intensely strong sense of fear, heart pounding

Intrusive alarming thoughts

Time shifts between past memories and present experience

Deep sadness

 

I have a history of recurrent depression. I have never felt euphoria.

I have persistent pain, and migraines.

 

Those who say I’m bipolar seem to worry about my paresthesias and rushed electric feelings.

Those who say it’s trauma seem convinced by intrusive thoughts & history.

 

it’s important because SSRIs are verboten if you are bipolar but good for trauma, and antipsychotics or lithium do nothing for trauma long term but are good for bipolar disease.

Has anyone had to navigate competing diagnoses? What did you do about meds?

 

 

 

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We're not doctors so we can't diagnose you. I will say, though, that it is entirely possible to have PTSD and bipolar at the same time. 

Who has given you which diagnosis? Two competing pdocs?

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Your pdocs should be the ones sorting that out. Both pdocs? 3rd opinion time?

but hey, can’t sleep, so 2cents time.

You could start with a mood stabilizer. If it helps any, possibly bipolar. Even if it’s not helping much, you have a lower risk of manic or hypomanic switching when taking an ssri, if you are on a mood stabilizer as well. Note that even people not bipolar at all can have hypomanic or manic switching on an ssri, just that the chance is much lower.

to sync’s point, you absolutely can have both ptsd and bipolar at the same time. 

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I have both. I have similar symptoms to what you described, including the weird rushing feeling, if I read that right. I have not been able to isolate which malady is causing which symptoms. For me, it seems that they work together in kind of a snowball of horror thing. 

I'm crazier than usual today so please take all this with a grain of salt. Literally had a PTSD trigger and also doing the BP thing today too.  I can't dx of course, just popping in to say yes, it is possible to have both, and that you are not alone. 

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SSRIs aren’t forbidden if you’re bipolar; they just have to be managed carefully, and are rarely used as monotherapy. In conjunction with an AAP and/or a mood stabilizer they’re effective and safe.

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Also you have to be careful about treating a diagnosis instead of treating the symptoms with an individualized plan. If there are intricacies like co-morbid conditions (like BP/PTSD) you have to be careful about restricting whole classes of medicines just because they are a little out of the scope of treating one illness, especially if they help the other 

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