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wookie

Difficulty in diagnosing bipolar

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Posted (edited)

Hello,

I was diagnosed bipolar 2 last year, and have gone through medication trials.

I believe I responded well to meds but a doctor at my family health  clinic thinks I am not bipolar.

The head doctor thinks I am possibly bipolar 2 with perhaps add/adhd.  My new psychiatrist thinks anxiety disorder and ptsd but no bipolar. Emergency doctor was concerned for bipolar 1 but I don't see it.  No mania.  Just agitated depression. I said that I prefer my psychiatrist treat me. Just don't want too many cooks in the kitchen

The bipolar meds (seroquel) seemed to work but gave me a rapid heart rate.

The lamictal seemed to work but also jacked up my heart rate.

The doctors think I'm sensitive emotionally to the meds and do well on smaller doses.  I am more physically sensitive to meds than emotionally.  This would work fine for me if my side effects didn't happen

Down to 100 mg of seroquel and my hr is lower.  I am doing ok.

It might just be ativan and meditation.  Current psych wants me off all meds.  Anxiolytics help me chill though and are necessary to get me through life.

Is this a common experience for people with  bipolar to experience shifting dx depending on the Doctor you see.

 

 

Edited by wookie
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I think bipolar can be hard to diagnose, particularly if you're someone who experiences a lot of depression as opposed to hypomania or mania. It took me basically thirty years to get a bipolar diagnosis, and about 16 years during which I was treated/assessed by a few psychiatrists. And once you get into agitated depression it's even trickier. I also think some psychiatrists are more open to the possibility of bipolar if you are experiencing mood episodes that don't strictly meet the time criteria in the DSMs. Conversely, some psychiatrists seem to jump to bipolar as a possibility too quickly. My niece went to a psychiatrist who within twenty minutes of meeting her pulled out the bipolar diagnosis, which I think had more to do with her proclivity to diagnose bipolar than anything my niece was exhibiting. Diagnoses can also change as new information becomes available. For instance, I never had a hypomanic episode until I suddenly did, and some of what I now see as mixed episodes were either subclinical or chalked up to anxiety or agitated depression. And there's so much overlap in psychiatric symptoms. MDD, bipolar, and ADHD can all cause attention issues. It's frustrating, for sure, when the doctors don't seem to know what's going on.

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7 hours ago, wookie said:

Hello,

I was diagnosed bipolar 2 last year, and have gone through medication trials.

I believe I responded well to meds but a doctor at my family health  clinic thinks I am not bipolar.

The head doctor thinks I am possibly bipolar 2 with perhaps add/adhd.  My new psychiatrist thinks anxiety disorder and ptsd but no bipolar. Emergency doctor was concerned for bipolar 1 but I don't see it.  No mania.  Just agitated depression. I said that I prefer my psychiatrist treat me. Just don't want too many cooks in the kitchen

The bipolar meds (seroquel) seemed to work but gave me a rapid heart rate.

The lamictal seemed to work but also jacked up my heart rate.

The doctors think I'm sensitive emotionally to the meds and do well on smaller doses.  I am more physically sensitive to meds than emotionally.  This would work fine for me if my side effects didn't happen

Down to 100 mg of seroquel and my hr is lower.  I am doing ok.

It might just be ativan and meditation.  Current psych wants me off all meds.  Anxiolytics help me chill though and are necessary to get me through life.

Is this a common experience for people with  bipolar to experience shifting dx depending on the Doctor you see.

 

 

Yes... I did Mood D/o nos to BP2 to BP 1 to BP+anxiety to BP NOS to now BP1. The guidlines, while trying to be specific, will naturally have room to interpret.  But why does your doc want you off all meds? 

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BP is hard to dx as UH stated, when depression is the main issue, that's all the doc will see. I doubt it would be common for someone to call up their doc and say "hey doc, i'm feeling fantastic, hell I bet i'm actually cured right now. No more depression, the world is beautiful and my mind is so clear and efficient".  Damn do i miss those, but no crash and no case of the stupids for a few weeks following it, is way more preferable.

My dx is now mood disorder, up from mdd + anxiety for two reasons. I once asked my therapist as to how to classify a mood for the mood tracker, as i wasn't sure if that counted as elevated. It was. Very clearly in fact. The clincher was a few visits ago, I was in a sort of up state, "not like myself" when i had a pdoc appt. He lamotrigined my ass that visit, Hopefully the rash goes away or stays benign. It has made a world of difference, even at low doses.

Otherwise? I'd probably be in TRD + anxiety territory still.

It's a spectrum of mood really. If your doc is not of that mindset, then you're either BP 2/NOS (and i think that either got removed or is elsewhere classified) or MDD (usually with anxiety and possibly atypical features). That grey area, i suppose is that nebulous mood disorder zone, where you might be, possibly subsyndromal and don't count for as BP in a by the book, DSM 5 dx.

Why off all meds? I hope this isn't a "give her an AD and see if she loses her shit..and we'll have  our answer" type or deal.

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Posted (edited)

Coming off meds.  My heart raced on seroquel and it was established that it was rapidly increasing my heart rate by my psychiatrist.  Same issue on Lamotrigine.  Don't know if it was the adding it to the seroquel that created a synergistic effect and affected my heart rate.

Lamotrigine seemed to be working but didn't play well with me and both my family doctors disagree with the bipolar dx and my new psychiatrist doesn't believe I have the disorder and he suggested coming off all meds.  New psych said he sees people on 300 mg of lamictal and my 25mg at the time was nothing.

Still on seroquel but lowering the dose slowly.

Edited by wookie

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4 minutes ago, wookie said:

Coming off meds.  My heart raced on seroquel and it was established that it was rapidly increasing my heart rate by my psychiatrist.  Same issue on Lamotrigine.  Don't know if it was the adding it to the seroquel that created a synergistic effect and affected my heart rate.

It worked but didn't play well with me and both my family doctors disagree with the bipolar dx and my new psychiatrist doesn't believe I have the disorder and he suggested coming off all meds.

Still on seroquel but lowering the dose slowly.

Has any antidepressant worked for you? Both Seroquel and lamictal are mood stabilizer s with a bias  towards antidepressant effects. It stabilizes from the bottom. It seems both are promising as monotherapy.  Perhaps that is what your pdoc is going for. A clean slate then another go around. I've never heard of geodon as a mood stabilizer but that could be a possibility. Or abilify? If we have some parallels in our symptoms, that is what my pdoc recommended as possible next steps.

 

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Posted (edited)
7 minutes ago, argh said:

Has any antidepressant worked for you? Both Seroquel and lamictal are mood stabilizer s with a bias  towards antidepressant effects. It stabilizes from the bottom. It seems both are promising as monotherapy.  Perhaps that is what your pdoc is going for. A clean slate then another go around. I've never heard of geodon as a mood stabilizer but that could be a possibility. Or abilify? If we have some parallels in our symptoms, that is what my pdoc recommended as possible next steps.

 

They have worked. I took 40mg of citalopram for 3 years with no ill affect.

Low doses lexapro have worked as well.

I might stay on low doses of seroquel.

Tried abilify for a few days and it was horribly activating.

Edited by wookie

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Most psychiatrists these days diagnose mental illnesses based on clusters of symptoms without necessarily isolating the root cause of the issue, often because the root cause isn't well understood. There could be multiple organic issues that cause similar symptoms to manifest. At the moment, there's no commonly used blood test/genetic test to isolate bipolar disorder, and I wouldn't be surprised if diagnostic categories change once there is something along these lines - who knows how many conditions cause us to experience manic/depressive symptoms.

It's quite possible that your symptoms could be divided into different clusters. As for the underlying cause of our illnesses? Most of us have no idea why we experience what we do, even those of us who don't have psychiatrists arguing over diagnoses. The most important thing is that our diagnoses in our files give us access to the treatments we need. 

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On 5/30/2019 at 12:57 AM, argh said:

BP is hard to dx as UH stated, when depression is the main issue, that's all the doc will see. I doubt it would be common for someone to call up their doc and say "hey doc, i'm feeling fantastic, hell I bet i'm actually cured right now. No more depression, the world is beautiful and my mind is so clear and efficient".  Damn do i miss those, but no crash and no case of the stupids for a few weeks following it, is way more preferable.

My dx is now mood disorder, up from mdd + anxiety for two reasons. I once asked my therapist as to how to classify a mood for the mood tracker, as i wasn't sure if that counted as elevated. It was. Very clearly in fact. The clincher was a few visits ago, I was in a sort of up state, "not like myself" when i had a pdoc appt. He lamotrigined my ass that visit, Hopefully the rash goes away or stays benign. It has made a world of difference, even at low doses.

Otherwise? I'd probably be in TRD + anxiety territory still.

It's a spectrum of mood really. If your doc is not of that mindset, then you're either BP 2/NOS (and i think that either got removed or is elsewhere classified) or MDD (usually with anxiety and possibly atypical features). That grey area, i suppose is that nebulous mood disorder zone, where you might be, possibly subsyndromal and don't count for as BP in a by the book, DSM 5 dx.

Why off all meds? I hope this isn't a "give her an AD and see if she loses her shit..and we'll have  our answer" type or deal.

I think hypomania can be poorly understood.  Dysphoria and anger seem to be hallmarks when things aren't well for me.  I am up and down at the same time.  Agitated, can't sleep, argumentative.  The world is going to shit.  I have no magical plans to save it.  I'd rather watch it burn.

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35 minutes ago, wookie said:

I think hypomania can be poorly understood.  Dysphoria and anger seem to be hallmarks when things aren't well for me.  I am up and down at the same time.  Agitated, can't sleep, argumentative.  The world is going to shit.  I have no magical plans to save it.  I'd rather watch it burn.

Id say most of my supposed maybe hypo has been dysphoric.

i either wasn’t  looking for it or thought it was a period of not depressed before when i had a true up moment. A pure up mood for me is relatively recent. Which doesnt make sense as im 35. 

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17 hours ago, argh said:

Id say most of my supposed maybe hypo has been dysphoric.

i either wasn’t  looking for it or thought it was a period of not depressed before when i had a true up moment. A pure up mood for me is relatively recent. Which doesnt make sense as im 35. 

I had an up phase (I think) in my early 20's.  That's it. I was happy at age 28 to 30 then depressed with a panic disorder by age 32

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8 hours ago, wookie said:

I had an up phase (I think) in my early 20's.  That's it. I was happy at age 28 to 30 then depressed with a panic disorder by age 32

were you untreated for a long time? i think that's what fucked me up and let it progress..or maybe it's always been there and i was in denial.

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On 5/31/2019 at 11:08 PM, argh said:

Id say most of my supposed maybe hypo has been dysphoric.

i either wasn’t  looking for it or thought it was a period of not depressed before when i had a true up moment. A pure up mood for me is relatively recent. Which doesnt make sense as im 35. 

My first (only) hypomanic episode was when I was 45. Prior to that some periodic dysphoric stuff I didn’t think counted.

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On 6/2/2019 at 1:11 AM, argh said:

were you untreated for a long time? i think that's what fucked me up and let it progress..or maybe it's always been there and i was in denial.

I was untreated for a long time. My first signs of trouble began in my teens (eating disorder, self harm, suicidal ideation, depression, reactionary psychosis /ptsd)

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My pdoc has wavered in my dx.  First MDD, then BP2, then "atypical depression," now it's back to BP2.  Every time we talk about it he seems to have completely forgotten what we talked about the prior visit.  But BP2 makes the most sense for me.

My course of illness has been really strange.  I first had depression when I was 15, lasted a couple months.  For the next 8 years or so I'd have period of depression every few months or so (or longer in between).  Then for 15 years nothing, no depression at all.  Then at 37 I just suddenly crashed and went from fine and dandy to dangerously suicidal within two months.  It came out of nowhere.  I then started treatment for the first time.  It was rough for the next year.  The depression was kicking my ass.  But things started to get better as we honed in on good treatment.  After that first year to treatment I went hypo for the first time.  I knew it for sure.  It happened a couple more times.  By this time I was rapid cycling, a week or two of depression, a week or two of remission, rinse repeat.  Then add in the hypo cycles.  My pdoc started me on lamotrigine and I've been lucky because it's been a miracle drug for me.  For almost a year I've been on it and I've been very stable.  What was getting to me before was the unpredictable instability more than anything.  I haven't been hypo (although a few times I felt like it came and fizzled, or it came an was very subtle) since, and I've only had a few episodes of depression.  I'm excited because the last time I was depressed I wasn't suicidal, and that is big step for me, so hopefully I don't have to worry about having people keep me safe when I get depressed.

All that said, my BP2 was very hard to diagnose.  The reason my pdoc wavered after I knew I went hypo was that it didn't last over a week.  DSM says 4 days so whatever.  My wife says looking back I may have been hypomanic in years past but we just didn't know that's what it was.

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Posted (edited)

It is so very hard to diagnose: hypomania can really be pleasant and look nothing like illness.

I went through a happy phase heading into my 20's that is hard to even tell if I was hypo, or euthymic.  Stressful event happens and everything slides downhill.  My depression was strange, and horribly paranoid afterwards.  

The doctor even said maybe you're a bit bipolar.  Then no one agreed.

Was a bit hypo when I tried topomax but was very even keel after adjusting to it.  Thought the up phase reminded me of my early 20s.  But when you're 20 being vivacious and happy is typical right?

On antidepressants I always felt not quite right and anxious.  Adding clonazepam seemed to keep me on even keel.

So hard to decide what is going on.  My doctors can't even decide.

Edited by wookie

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44 minutes ago, wookie said:

It is so very hard to diagnose: hypomania can really be pleasant and look nothing like illness.

I went through a happy phase heading into my 20's that is hard to even tell if I was hypo, or euthymic.  Stressful event happens and everything slides downhill.  My depression was strange, and horribly paranoid afterwards.  

The doctor even said maybe you're a bit bipolar.  Then no one agreed.

Was a bit hypo when I tried topomax but was very even keel after adjusting to it.  Thought the up phase reminded me of my early 20s.  But when you're 20 being vivacious and happy is typical right?

On antidepressants I always felt not quite right and anxious.  Adding clonazepam seemed to keep me on even keel.

So hard to decide what is going on.  My doctors can't even decide.

As much as I'm like damn it doc tell me, at the end of the day, it's down to treat the symptoms and you'll work your way to a root cause. Your past med reactions at least give you a hint.

It really is frustrating however. I'm always like "ok is this a really good mood or am i losing my shit?"

Are you off the seroquel? Since lamotrigine worked for you, perhaps once you're completely off seroquel, you can give that another shot?

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2 hours ago, argh said:

 

 

 

As much as I'm like damn it doc tell me, at the end of the day, it's down to treat the symptoms and you'll work your way to a root cause. Your past med reactions at least give you a hint.

It really is frustrating however. I'm always like "ok is this a really good mood or am i losing my shit?"

Are you off the seroquel? Since lamotrigine worked for you, perhaps once you're completely off seroquel, you can give that another shot?

I was thinking I might try the lamotrigine once off seroquel.  If does the tachycardia thing again without the seroquel on board I'll consider other options.

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I have seen the same pdoc for years.   Before seeing him I was diagnosed MDD by various doctors.  Most likely cus I only presented when depressed. 

When I started with my current pdoc I was diagnosed Bipolar NOS. Guess I didn’t fit the box and I had addiction issues at the time. I was told that was part of an NOS DX. 

Current diagnosis is bipolar 1 due to long manic episode. He has talked bipolar 2 and even unipolar.   

He does not like boxes.and rather keep the DX fluid based on symptoms. 

I hope you have found some relief.    I take seroquel and Lamictal as well.  And a few other things.

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Posted (edited)

MDD to BP (no idea what kind) to SZA to BP 'But you meet the criteria for SZA so I wouldn't argue with that'.  That's my progression.  With the odd PTSD/ED NOS/GAD/OCD etc thrown in depending on who is treating me

Edited by jarn

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