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Doctors who immediately write you off as NOT bipolar


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Granted, I've only seen two psychiatrists, but both have immediately written me off as not bipolar, despite the fact that they know I have a family history of it. I think in my case it is not at all clear cut whether I am bipolar or not, but I wonder if perhaps some medical professionals are backlashing against the trendiness of the diagnosis.

Here were my psych "evaluations":

1st pdoc: Never asked if I had any symptoms despite knowledge of family history.

2nd pdoc: "Have you ever been manic? You would know because you would end up in the hospital or jail within 48 hours." I was frankly astounded by this pronouncement. Also asked me if I had ever been hypomanic--which he defined as something like "feeling elation and spending a lot of money." What the fucking fuck?

Granted, antidepressants have helped me greatly and I have never spun out of control--but to me that means nothing. Why?

My mother was greatly helped by Zoloft, which she was on for 7 years--before she was diagnosed with Bipolar II.

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Okay. I am not a doctor, ymmv, etc, but typically SSRIs alone make bipolar people completely freak out. Lexapro sent me over the edge in a major way. Like really in danger of hurting myself or others kind of way. SSRIs without mood stabilizers are generally no-nos for us.

Sam

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The first pdoc I saw after I got out of partial hospitalization said he didn't think I was bp because I didn't have frequent enough euphoric ups. He changed his mind after talking with the doc who saw me in partial (and who was conservative about diagnosing me - waited until it was clear I was having an actual euphoric hypomania inside of the hideously anxious and agitated ones I was cycling into and out of like clockwork, intermixed with periods of depression).

This doesn't get mentioned a lot, but not all bipolar patients flip out on antidepressants. It's between 20 and 40 percent that do. There's another pattern common to bipolar that involves repeated poop-out of antidepressants (this is what I get) and some who do fine on ADs. I saw a study recently involving using only SSRIs for BPII and finding good results, which makes me totally cringe because I know that doesn't always happen, but the people in that study didn't have the same triggering problem.

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The research I have done shows that ADs are a little more harmful than just in 20-40% of the population:

Ghaemi et al, 2003

*There are significant risks of mania and long-term worsening of illness with antidepressants.

*Antidepressants should generally be reserved for severe cases of acute bipolar depression and not routinely used in mild to moderate cases.

*Antidepressants should be discontinued after recovery from the depressive episode and maintained only in those who repeatedly relapse soon after antidepressant discontinuation.

One side of the AD=mania postualation

Anyway, we are splitting hairs. We can find plenty of internet info to back up each position. I think it may be premature to expect to be bipolar based on family history, and if things are going well on an AD, why fix what isn't broken?

Sam

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We threw bp around for a while...and when effexor obviously sent me up to the 95th floor in about 25 seconds flat there was no question.

Abilify is doing wonders for me...and I've only been on it for about a week.

I so value the fact that my pdoc will work with me...and trusts me to listen to my opinions when talking about my own body.

I'm sorry that you don't have such a relationship with your dr. I have never been in hospital or jail (thank goodness - and my heart goes out to those who have.)

My cocktail works great - no AD -

I hope you can find a way to iron things out..

A new doctor perhaps?

xoxo

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Sam - I'm not sure we're even in disagreement! ADs can be remarkably bad for some bipolars, but not necessarily for all. I'm mostly just trying to say that a lack of manic reaction to ADs doesn't necessarily indicate not bipolar.

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I had that happen a few months ago. I've mentioned this before on the boards, but it pisses me off, so I'm going to keep talking about it. Sorry if I bore anybody.

I was diagnosed with bipolar disorder six years ago. I've always agreed with the diagnosis. In January I wound up in the hospital for a few days because I was suicidal. The unit psychiatrist prescribed me Effexor XR and nothing else before I was discharged. He decided that I wasn't bipolar, despite that being the diagnosis in my file, without ever asking me any questions about my past history of hypomania and mania. I said I didn't think just Effexor was a good idea. He said it was. I figured I would try listening to the doctor and take the medication as prescribed. Hey, maybe I'd get hypomanic and it would be fun.

I did take the medication as prescribed. What happened was not fun at all. Still couldn't sleep but no longer tired, tons of energy but no focus or concentration, mood up down up down up down, irritable, irrational, and most of the time still suicidal. And so on, and so forth. In three weeks, I wound up in the hospital again; this time I was arrested first because I refused to go.

The doctor decided that because I did not improve on Effexor XR, this meant that I had no mood disorder whatsoever. He decided my behaviour of the past three weeks was due to borderline personality disorder and histrionic personality disorder and it was not possible that I was bipolar or that Effexor had any adverse effects upon me. (I won't bother arguing about that right now since this post is long enough already; I'll just say that I'm 100% positive I'm not histrionic, and that while it's not impossible that I have BPD -- I'd say "unlikely" rather than "impossible" -- if I am borderline, it is far from being my main "issue.") He did at least agree that I might as well stop taking the drug since it wasn't helping.

I have been remarkably stable since I stopped taking Effexor. I know I'll get depressed and hypomanic again sometime in the future. Now I also know beyond the shadow of a doubt that taking Effexor by itself will not improve matters for me.

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Why do you want to be bipolar? If your treatment is working, isn't that good news? Plus, do you really want mood stabilizers in your life? they can be real downers.

Family history also involves MDD with BP. They have similarities. and they do often appear in the same family. I wouldn't worry about it.

"Elation and spending" doesn't sound so "wtf" to me. Throw in hypersexuality and grandiosity and that's a brew i used to think was normal ;)

7

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My pdoc really had no choice but to DX me- both parents BP1- my childhood antics (at 7) were not normal, and in general, my behavior was out in no-where land.

There could be a misunderstanding of BP, even in the psychiatric community, that leads psychiatric professionals to either DX a non-BP as BP or do the reverse.

I think it comes down to education. And a lot of what the person feels like. And a lot of trial and error. If you treat a patient according to his/her symptoms and stop harping on a label, then that's a lot more productive than just trying to cookie cutter everyone. Even us BPers have such a variety of how our symptoms manifest! Even the way my family members manifest BP varies from person to person! My mom is almost unipolar manic and spends days and nights doing weirdo things (carving totem poles recently), my sister cuts and goes on sex sprees (at 17), and my dad was mostly depressed and just sat at the computer playing Neopets. Go figure. For me, I cycle rapidly and have major ups and major downs. I'm much more a classic BP than they are, but we're all BP1.

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Sam - I'm not sure we're even in disagreement! ADs can be remarkably bad for some bipolars, but not necessarily for all. I'm mostly just trying to say that a lack of manic reaction to ADs doesn't necessarily indicate not bipolar.

Yes, you are right. I just think that you have less of a chance of being bipolar if you tolerate SSRIs well.

7,

"Elation and spending" doesn't sound so "wtf" to me. Throw in hypersexuality and grandiosity and that's a brew i used to think was normal

My highs only last a few hours and I have the elation feeling. The others too, to some degree. Pretty much BP hallmarks, but certainly not exclusive ones.

Sam

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If you treat a patient according to his/her symptoms and stop harping on a label, then that's a lot more productive than just trying to cookie cutter everyone.

I agree. I'm only a little ticked off about that shrink that I mentioned misdiagnosing me for no particular reason after I already had what I felt was a correct diagnosis. What I was really upset about was that he didn't ask me pertinent questions about my symptoms, absolutely refused to listen to me when I tried to tell him about them, and did not actually bother to treat those symptoms.

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Sorry. I never said I wanted to be bipolar. I don't. Nor do I dislike my doctor. I was just trying to present the other side of the "people wanting to be bipolar" discussion. That because so many people apparently want to be bipolar, it might make doctors even more conservative about assigning a bipolar diagnosis. I used myself as an example. That's all.

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woah, people want to be bipolar??? HA!. wow, now that's screwed up.

As for your psych's reluctant diagnosis, ever thought about a second opinion?? I mean just go to a new doc, don't tell him your history, just see what he/she says.....

a wrong dx or no dx is possible as i'm sure a ton of people here can tell you. i rolled around in the depression arena for a long time....yet i am most certainly bipolar.

keep us updated, i feel ya! ;)

marisa

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To be fair to Doctors, identifying BD can be difficult. Outside of first episode psychosis or a grandiose manic phase which would be apparent to everyone who knows you, mania and hypo-mania are only definable compared to a baseline. How many doctors know you well enough to separte the ilness from your personality? The lack of insight that is contaminant with BD also works wrt doctors.

I would wager that many who are now diagnosed with BD at first had a hard time accepting it. Perhaps after some time (six months - 1 year) they became aware of how and when this illness had an effect on them before. That sort of "eureka" will also dawn on good doctors after they get to know you better (hopefully).

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Guest Guest

"Elation and spending" doesn't sound so "wtf" to me. Throw in hypersexuality and grandiosity and that's a brew i used to think was normal

My highs only last a few hours and I have the elation feeling. The others too, to some degree. Pretty much BP hallmarks, but certainly not exclusive ones.

Sam

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Hihihihihihihihihihihihihihi! Am I manic today? Maybe... I haven't yet been technically classified as "bipolar", but my pdocs have agreed that I've experienced manic episodes and have unnatural mood swings, and the first pdoc didn't hesitate to put me on Lamictal, my life-saver, and though it's lessened the swings and made life so much more manageable, I'm not "bipolar" because pdocs are reluctant to use that term. So, yes, I can relate. It used to matter because I felt a label was a requisite to getting the appropriate treatment, and I really just wanted to have my problems laid out in black-and-white, but it doesn't really matter anymore. I think it's shitty that they won't even consider it in your case and, as was metioned by someone else, I'd seek a second opinion if I were you. Reluctance to misdiagnose you is one thing, ignoring MI symptoms is another kettle of fish altogether.

There's another pattern common to bipolar that involves repeated poop-out of antidepressants (this is what I get) and some who do fine on ADs.

This is what I get, too. I've never experienced a manic episode from an SSRI, but Wellbutrin made me batshit and Pamelor wasn't much better.

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I was first diagnosed with depression and I took only SSRIs for several years. I still had problems because the whole illness wasn't being treated but anti-depressants GREATLY improved my life and I never went into a full blown mania. Mood stabilizers improved my life even more but if I had a choice between just SSRIs and nothing at all I'd definitely go for the SSRIs. Even with mood stabilizers I take two anti-depressants- without them I get depressed no matter what mood stabilizer I am on.

My point is that I tolerate SSRIs fairly well and I'm definitely bipolar.

Pdocs are just like any other kind of doc- there are good ones and bad ones and each come with their own prejudices. I had to go through several before I found one that correctly diagnosed me and managed to come up with a workable combination of meds.

If you look up the various diagnoses in the book you'll see that a lot of the symptoms overlap and since us psychos tend to come with several flavors of crazy, I can see why different docs come up with different diagnoses.

In the interest of full disclosure- I'm bipolar II and ADHD, taking Lamictal, Risperdal, Effexor XR, and Zoloft.

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On the subject of SSRIs, I was greatly helped by Seroxat (Paxil) for a couple of years. But Prozac sent me manic, which was the point at which I was diagnosed bp. So I guess, as with pretty much all these drugs, it's down to the individual what effects occur.....

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