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Tdoc and pdoc do not agree on diagnosis


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Saw my tdoc today. Didn't come out blubbering, which is nice.

She doesn't think I'm BP, pdoc does. Not that it matters what "title" I'm stuck with (I'm not entirely convinced that MDD and BP are different disorders), so long as treatment works. Speaking of, can my treatment be affected by their disagreement? I hope that's not a stupid question.

I don't know why I feel uneasy about this.

EDIT: It just occurred to me that my current anxiety issues might be explain my uneasiness...

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It doesn't really matter what your diagnosis is, as long as the treatment is working - so you've got that correctly. Your treatment shouldn't be affected by the differing diagnoses. I had one tdoc say she didn't think I was bp and it pissed me off. It's not the tdoc's job to dx you is it? Maybe for insurance reasons they have to put some number down. Dunno.

Maybe you're anxious because it's human nature to categorize people and things and you were used to your Dx and now someone has put doubts in your mind. Which is annoying because it shakes up your world for a bit. Where do I belong? Is this person doubting my illness? Is my pdoc (or tdoc) crap because they disagree? What other concerns do you have about a changed dx?

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I think you hit a lot of it. I am human, and I categorize things. It does shake me up.

They both seem to take turns diagnosing me. I'm not sure whose job it actually is.

I got to thinking about it, and I think that it shakes me up a bit because during my med-induced hypomania fun I was like, "I've been through this before. This is familiar." I'm sort of in maintenance mode, and I hadn't been seeing my tdoc a lot during that time. Now I guess I sort of feel like, "What, you don't believe me?"

I'm not sure how much she and pdoc communicate about these sorts of things...

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Probably time to ask each of them why each supports his/her own specific diagnosis. Then look for the overlap. The other thing that occurs to me: is it possible that they agree that there are two (or whatever) diagnoses, but that each is treating a different one? This happens fairly often.

Aren't they in the same office? They should be talking about this at case review.

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Thank you for the suggestions. I think I'm going to make an appointment with my pdoc within the next few days. I see tdoc in two weeks.

Tdoc said that she is treating me for depression and anxiety, pdoc said that he was treating me for BP I. I suppose the overlap is the depression. Great.

I didn't think about case meetings. Heh, it's kind of weird to think that a group of people sit around and talk about my treatment. I wonder how often they have those.

I'm half wondering if at this point, assuming I don't have BP disorder, the medication I'm on is treating side effects from previous medications. Is that possible?

I haven't been in a severe depressive state since September or October (to lazy to look it up at the moment). If I don't have BP, would it be possible to go off of medication?

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uh, no. MDD is a recurring or periodic illness. every bout you have increases the risk of another one in the future. *some* people have one episode and never have another. usually, these are well-adjusted people who have some kind of situational stressor that kicks off MDD. they use the meds to help them climb far enough out of the pit for their usual coping mechanisms to kick in & they're ok.

that does not describe our members, unfortunately. we don't see very many of that kind of simple, easily resolved MI.

moral of the story: no, you probably won't be able to go off meds.

also, depression plus anxiety looks a hell of a lot like BP. they can be very very very hard to tell apart.

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uh, no. MDD is a recurring or periodic illness. every bout you have increases the risk of another one in the future. *some* people have one episode and never have another. usually, these are well-adjusted people who have some kind of situational stressor that kicks off MDD. they use the meds to help them climb far enough out of the pit for their usual coping mechanisms to kick in & they're ok.

that does not describe our members, unfortunately. we don't see very many of that kind of simple, easily resolved MI.

moral of the story: no, you probably won't be able to go off meds.

also, depression plus anxiety looks a hell of a lot like BP. they can be very very very hard to tell apart.

I think what prompted my med question was me wondering whether or not the depressive symptoms that I experienced were the result of something situational. If so, well, I'm out of my hole o' despair at the moment. I've had a few blips, but its possible that those could be explained by medications I've been on.

I think I might call my pdoc.

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In general I would say that your Pdoc diagnosis trumps the therapist, unless perhaps if your therapist is a PhD in psychology. MD's are considered to have more extensive training and overall higher qualifications than a therapist up to the MA/MS level. That doesn't mean they are always correct, and ideally both should review cases periodically to discuss their impressions.

Depression is the most common symptom for bipolar disorder, with some studies reporting patients to be depressed up to 53% of the time. As mentioned before, the dx is not the most important thing, but rather successful treatment of symptoms. My pdoc had me as "tentative bipolar" for over year and a half. If you are taking the meds and doing well now, then I suggest "Dont'a touch'a nothing". Enjoy the good times. ;)

best, a.m.

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Yeah, I got to thinking about this, and I'm not going to worry about it. My anxiety level is a little high at the moment, and I think it's making me freak out about stupid stuff. I will talk to my pdoc eventually, but I think it's just going to be about what to do with the nasty anxiety.

Thank you for listening to my freak-out, all

- jen (Whose is experiencing a great deal of clarity with the help of Benadryl)

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