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Hi everyone ...

I've been reading like mad for a month or two, but not sure about posting.

In December of this year, I sought help for anxiety/panic issues that had gotten really out of hand. The pdoc I started seeing put me on a Lexapro, with Clonzepam PRN for panic attacks, and after getting through about a month of ugly side effects, things looked good. Prior to this, I had never seen a pdoc or been on any meds.

Long story short, since getting up to dose on the Lex, I have been cycling between hyopmania and this wierd agitated/atypical depression. I didn't realize this until about two weeks ago, when the agitation (a totally new and unpleasant mood for me) made me think that something more than my normal moodiness was going on (I had sort of thought that maybe what turned out to be hypomania was just me minus the anxiety, which, FABULOUS! Productive, happy, having sex with my husband constantly, out every night - I'll take it!). I sat down and made a timeline, wrote out symptoms, looked them up, and realized that I was clear-cut cycling between the two.

So I went back to my pdoc, for my third visit, and within 20 minutes he slapped me with a Biplor II diagnosis (based on my current symptoms and family history), gave me a starter pack of Lamictal, and told me to check in a month. He was fairly dismissive of my concerns, namely that I felt like going from my first ever SSRI to mood stabalizers was a pretty big jump. I was pretty shell shocked, but recovered enough to realize that was more or less unprofessional, and that I would need to find a new pdoc post-haste. I am not starting the Lamicta, or making any changes, until I find another pdoc to consult with. In the meantime, I am just trying to keep my moods under control and do the best I can.

I'm not even sure what I'm looking for with this post. I guess just some feedback on what I'm dealing with. I'm not unwilling to accept a BPII diagnosis, but I'm also not willing to have it happen so hastily, I guess. At this point, I don't know what to think. Any advice or thoughts would be much appreciated.

;)

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First of all, go you for being so diligent about observing and recording your moods!! ;) And for doing so much research on your own. That's fantastic work and you should be proud. Your doctor, whoever it may wind up being, should be very grateful to you for doing that. It's invaluable.

I think it's great you will find another doctor. No use being with one you don't trust. It can be hard finding the right doc and/or therapist. Hang in there.

What you described sounds like it could be hypomania...let's face it, hypomanias and manias often feel nice. We want them to be the norm. *shrug* I wish I had some wisdom to impart, but I'm still struggling with a lot of these issues myself. I think it's important that--from what I gather, anyway--you didn't have mood swings until you began treatment with Lexapro. Or maybe you only became aware of them after that. Either way, be sure to tell the doc about it. You mention a "normal moodiness"--after doing the research you've done, do you still consider it normal moodiness, or does it seem more suspect? Does it interfere with your daily life as much as the panic/anxiety did?

Antidepressants with no mood stabilzer treatment can trigger manias in the bipolar, so I'm not sure it's worth staying on Lexapro if it might send you into hypomania or mania. (Full disclosure: I am bipolar and currently on an an antidepressant and no mood stabilizer, and I'm still depressed. Each case is different.) Agitation and unpleasant feelings (for instance, racing thoughts so fast they hurt) can be symptoms of mania, too. It's not all fun. Did your doctor tell you to taper off lexapro?

Sorry I can't offer more. Wait a bit, though, the people on this board are smart, experienced, and compassionate, and I bet you'll learn something helpful once they start posting responses. I certainly have!

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Is there an issue here with a BP diagnosis specifically or are you just uncomfortable with how it was diagnosed?

The problem is, hypomanic episodes can mimic anxiety and anxiety often overlaps with bipolar. But you also say you have moodiness. I don't know that your doctor only took into account what you had told him that day when he diagnosed you. If you had seen him three times, he also had all of the other information you have provided him with to use. Not to say that three appointments is just the right amount of time to be diagnosed. Sometimes people get a diagnosis after one appointment and it turns out that it "fits" or sometimes people never seem to get one out of their doctor.

As for mood stabilizers... if a doctor suspects that you are bipolar, they aren't going to leave you just on an anti-depressant. It's just not a good idea. It can send you into hypomania. and not always the good kinds. There are bad kinds too- where you gets anxious and agitated and it's not a happy fun time.

Whether you want to keep seeing this guy or not is obviously your call. If you don't feel comfortable with a doctor don't see them. Do not stay with them, because it will just be screwing yourself over. But I don't think his behavior was necessarily unprofessional. [as described here] Next time you go see a doctor, make sure you are asserting your viewpoints and concerns and don't leave the room until you feel ok. And don't take something if you aren't going to take it. Ask why they are giving you a specific diagnosis. They are working for you.

You don't really describe your anxiety and panic issues. Or if they seemed to be periodic or what- no one here could really offer an opinion as to "yes, that sounds BPish" or not. [but you hint around having moods.] To diagnose someone with bipolar they need to have had hypomania or mania NOT induced by medication [as well as depression]. If yours was induced by medication it doesn't make a whole lot of sense if he is just basing it on THAT. But he may be looking at other things that you described to him and that seemed to be the final straw.

Family history, personal history both play a part in diagnosis.

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I hate to disagree with you, but I think you need to look at this from a different perspective.

Receiving a dx of bipolar is always shocking. None of us want to be mentally ill and really there is no hierarchy of 'badness', but still, anyone will recognize that bipolar disorder is serious and not easy to live with or treat. Denial is common for any bad news, but with bipolar disorder it is a hallmark of the illness. The doctors call it "Lack of insight to illness" and every text mentions it. It is a major reason why over 50% of bipolars are not med compliant at times. The ironic thing is that often the more ill we are, the more we are unable to recognize the situation. The good news is that the more one understands about the illness and comes to trust their pdoc and gains confidence in their medications, the better one is able to maintain stability and comply with treatment.

Is this diagnosis hasty? Perhaps, but considering that you already have an unsuccessful history of treatment with AD's, you are established with this pdoc who has had time to observe your behavior, moods and reactions to meds, and that you provided a detailed self observed pattern of mood changes, it seems pretty reasonable to make a dx of bipolar disorder and attempt to treat it! Given all the facts above, it isn't hard for your pdoc to reach this conclusion. He's treated hundreds of bipolars and recognizes the symptoms. How many have you known? If you think this dx is hasty, what would you have him do? You already know your present meds aren't working. Do you want to keep doing more of the same? "Crazy is doing the same thing over and expecting different results". Bipolar meds aren't dramatically different than any other MI meds, nor particularly harsher. So why not?

Now in order to make this a little easier to stomach, this doesn't mean this BP diagnosis is set in stone. Really, psychiatric dx is more art than science and our collaboration with the pdoc is a journey of discovery. One doctor suggested looking at it this way: "Maybe you aren't sure about the diagnosis and the meds. Why don't we consider this an experiment to test our hypothesis of you being bipolar. I'm not saying you have to take these meds forever, just promise that you will work with me, take the meds and we will re-evaluate how you are doing in four months". It's a matter of perspective.

Should you change pdocs? You should have already known in your heart whether this pdoc was competent and professional before this incident. His delivery and manner of relating the info to you does not come across as unreasonable, especially keeping in mind the bit about lack of insight (e.g. most bipolars tend to argue they aren't ill). I have had my pdoc stop a session and say "Look I can't do anything about stigma. Do you want my help or not?". It wasn't what I wanted to hear but it was the hard truth, and comes back to the point that you must want to get well, and work with the docs.

If you haven't alread done so, I most strongly recommend you get a copy of Miklowitz's Bipolar Disorder Survival Guide, the best book out their in my opinion.

Dr. Jim Phelps has a website dedicated to Bipolar II http://www.psycheducation.org

This dx isn't the end of the world. Rather, this will hopefully be the beginning of a much better life, and hopefully we can answer the other questions that you will have.

best, a.m.

p.s. I'll give you the secret BP handshake later. Welcome to the club. ;)

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AM, I can't tell you how much your post helped me. Thank you.

I am sticking to my decision to find a new pdoc. I DID have doubts about this doc during my 2 prior sessions with him, but I needed help and had a great deal of anxiety (heh) about trying to find a new doctor. Without going on and on about it, I am uncomfortable with his manner, felt like my questions and concerns were not taken seriously or really addressed (questions about meds and symptoms), and I felt like that despite asking clear questions and standing up for myself.

My biggest point of discomfort with the dx is that prior to being on the AD's, my moods (and I do have moods, I have always gone through phases of being irritable and unhappy and others of being enthusastic and full of plans) NEVER impacted my life. Were mood swings present? Sure, but they were easily self managed. It just seems strange and huge to me that all of a sudden I'm BPII after a life in which mental health has never been an issue for me (until the anxiety problems started).

The other thing - am I Bipolar II right now? Yes. Yes, yes, yes, and right now I'm getting more and more into this strange agitated hypomania that's getting harder and harder to stay on top of. BUT. This started when the AD's started. I've NEVER experienced this before.

Is it possible for AD's to trigger this in someone who is not bipolar? If not, I guess I have my answer ;)

I'm really not trying to be in denial. I've read Dr. Phelps site and understand what I'm looking at. I just need a doc I trust, who has spent more than one hour total with me and actually asked some questions about my life and helped me evaluate what I experienced BEFORE these crazy AD's got a hold of me. Until then, I'm just trying to manage these increasingly not managable moods.

I appreciate all your responses. They are helping me think things through more clearly.

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Yes, it is possible for AD's to trigger bipolar episodes. The key word is trigger, NOT cause. You've got to have the underlying physical/genetic setup to be triggered or exacerbated.

It is possible to go many years before bipolar disorder becomes acute enough to disrupt your life enough to need treatment. I went 43 years before breaking down and seeking help from a pdoc. This is easier to understand when you consider the "Kindling theory" wherein the longer bipolar disorder goes untreated, the worse it becomes. Dr. Phelps has a couple charts that show the natural progression and how it becomes worse.

Understand that mania/hypomania/mixed state episodes are urgent conditions the warrant calling your pdoc. You should expect to either be given a med change/adjustment or be seen within a few days. Just like a siezure, one should not allow these episodes to run uncontrolled because of the danger of harming yourself and because of the kindling theory.

hope this helps.

a.m.

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dragonfli-

i'm solidly with AM on this one. remember, bipolar disorder causes organic damage to your brain. in time, what is called the "kindling effect" comes into play, making every successive episode worse than the last. i've been bipolar for years, but it slapped me HARD in my senior year of college 7 years ago (i'm 28 now), and i had to be treated more aggressively.

considering your mood charting, the clear symptoms (such as heightened sexual desire), and a family history, you are a prime candidate for the BP2 DX. overt, heightened sexuality is NOT a symptom of anxiety, so that is one area where they're not overlapping. you need to consider all those areas. you're good at tracking and journaling, so make lists of all of your hypo/manic symptoms and then anxiety symptoms, and see where they overlap and don't. chances are strong that your pdoc is right.

that being said, it IS important for you to trust your pdoc and have sufficient time with him or her. however, remember that every pdoc is rushed and every pdoc will do that to you. it is a very rare pdoc who won't be like that. ask all of us- our pdocs see us and treat us in rapid order, just like a gp. if you want to have more quality time with your health care provider, so what i do and go to a pnurse. i call him a pdoc because he knows every bit as much as what he's doing as a pdoc (after many degrees and so much experience), but he's actually a highly trained nurse practitioner. he spends half an hour with me at a time, and i feel like i need that time. regular pdocs never spent the time with me i thought i needed, and i went through many pdocs before settling on a nurse finally.

you haven't built much of a relationship yet with your pdoc, so it would be an easy transition to a new one. but think long and hard about it. do you really think you'll get better treatment elsewhere? maybe go to a few free consultations with a few other pdocs and ask them how much time they spend prior to DX and that kind of thing. get comfy.

as for the DX itself, it is very h ighly likely to be correct from what you've described. it is a ton of bricks for some people to get the BP DX. being on mood stabilizers can be scary if you don't understand what they do. it isn't necessary that the moods destroy y our life before you get help- actually, the point is to prevent the moods from wrecking your life. lamictal works mostly on depression and also hits the hypo/manic symptoms. it works so well for me that i haven't felt any substantial fluxuations in the whole time i've been on lamictal, which has been years.

relax about it. the worst that could happen is that you try it and it doesn't work. if it works, you've found your miracle. you can stop the brain degeneration and live a much better life.

consider what you're doing to your physical and mental self if you go untreated. and consider the merits vs. problems of taking something to balance your moods. you'll most likely benefit from lamictal or a drug like it.

as for taking an AD, you may want to ask about a non-SSRI. some people get hit more with the hypo/manic symptoms on an SSRI than something like Wellbutrin. i take wellbutrin and lamictal both and never have manic symptoms, and i'm someone who used to frequently. since lamictal i've been mania free. i don't have them like i used to, and i'm so happy for it.

i'd ask for a different AD and focus on titrating up the lamictal. at least give it a go and keep an open mind. a BP DX doesn't mean the end of life as you know it. with the right medical help, you can life a much happier life than life untreated.

best of luck!

loon

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Yes, it is possible for AD's to trigger bipolar episodes. The key word is trigger, NOT cause. You've got to have the underlying physical/genetic setup to be triggered or exacerbated.

There is a reason the dsm requires an episode to happen that is NOT caused by medication [or condition]. Medications do all kinds of things to us and to diagnose someone on the basis of medication induced mood episode alone would be irresponsible. Though the majority of the time other factors come into play and that is not what the diagnosis is based upon. It is possible for medication to induce a manic episode in anyone just as it is possible for medication to induce a depressive episode in anyone [or general mood unpredictability], as rare and unlikely as it may seem. Strong chemicals can do strange things.

I just want to clarify that. Just because you have had a hypo/manic episode induced by medication, it doesn't make you bipolar. But also keep in mind just because it was med induced, neither does it rule out the possibility.

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