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Bipolar II Diagnosis Uncertainty/Confusion/Concern

I

inky

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So, my therapist has diagnosed me with Bipolar II, but after talking it through, we aren't 100% sure that's what it is. I know that a diagnosis isn't really what's important, and it isn't a matter of labeling mental illnesses or anything, but it kind of bothers me that there's so much uncertainty.

I guess my biggest question is whether or not mood instabilities are measured on an objective scale, or if they're more subjective. I know that I have episodes of feeling a lot more confident and talkative and outgoing. But I've spent so much of the past seven years in depression that I can't tell if those episodes would be considered hypomania or if they're just a "normal person's" good mood. My therapist seems to imply that if it's above my normal, then it's hypomania, but one of the psychiatrists I've talked to seem to say that it was measured on an objective scale.

I also know that antidepressants alone are known to cause a lot of issues with bipolar, but I don't think I've experienced that except for with one prescription. But I've also read that it's only a correlation and not a necessary symptom for diagnosing bipolar II.

I also wanted to ask about this really weird thing I've started experiencing. It's a little hard to explain, but a few times, I've felt mentally energized, like I have a lot of emotion/energy, and that could either put me into an extreme depression or an extremely good mood. I feel really great and absolutely horrible both at the same time, like I could start laughing or crying at any second. Has anyone else experienced something like this? And is it a sign of Bipolar II, or is it not associated with anything in particular?

I just have a lot of concerns about it. It's really frustrating to feel as if I can't be diagnosed because the symptoms I show don't match with anything already known. I've spent over a year now trying to find the right doctors and treatment. It's so exhausting, especially when things go wrong or you just keep running into dead ends. I want to make progress and finally start healing.
 
mar

mar

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Yes, it's very frustrating and exhausting...
I don't think there is much objectivity in diagnosis...
At least that's the conclusion I've arrived at after a long time...
One can try to piece together some kind of narrative for yourself from
all the input from therapists and doctors, and your own knowledge...
Sorry I don't have clear answers...
 
T

Traveler5

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Like most people here, I'm not a doctor. But in my opinion, it sounds like BP2 symptoms with some periodic rapid cycling. Whether or not it's actual BP2 I don't know. Like you, I really question my BP2 diagnosis even though I've had three doctors tell me it is. I don't feel I have all the symptoms nor are they all extreme enough (some are fairly faint) to diagnose BP2. What I probably have is Cyclothymia. But I do have many "indicators" (not necessarily symptoms) that are directly tied to BP2. To throw a wrench into things, I also have ADHD and I know that ADHD and BP2 share a lot of the same symptoms. I feel for you. For me it's frustrating to not know, one way or the other, what my specific diagnosis is. I know what the doctors say but I don't know if they are correct. I really hope you can get it figured out. Perhaps get and second or third opinion. Delve deeper with them to get a correct diagnosis. I did not do this with the three doctors and wish I had. All the best to you.
 
T

Traveler5

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I just re-read your post and it looks like you have spoken with more than one doctor. Like me, I guess we both need to talk with a doctor who knows and understands what we're going through and we can trust what they have to say and feel good about it.
 
Wishbone

Wishbone

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Just a quick question for all of you North America based guys. I see a lot of mention of 'therapists' diagnosing conditions. Are you guys using this term intermittently with psychiatrists or are these people - the therapists - able to diagnose illnesses over there? It's not the first time I've seen it on here and it's confusing me.

As for the weird thing: are you taking any medications at the minute?
 
mar

mar

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In my case (USA) therapists have given diagnosis...
But sometimes they put down a different diagnosis for insurance claims...
(Maybe some diagnosis' are easier to get accepted for insurance claims...)
Sometimes the diagnosis from the therapist is different from the psychiatrist...
There isn't not much agreement or coordination...
At least from my experience...
 
T

Traveler5

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For me, I would define a "therapist" as someone who has an advanced degree, whether a master's degree or a doctorate, in the field of psychology but is not a medical doctor. He/she would be able to make a diagnosis but not be able to prescribe medications. You would normally go to this person to receive help and guidance (therapy) in dealing with your psychiatric condition.

A psychiatrist can also diagnose but does not necessarily offer therapy. He/she is a medical doctor, who specialized in human behavior/psychology, and who can prescribe psychiatric medications. Normally you would go to a psychiatrist first then go to a therapist for ongoing therapy.

I currently take Risperdal and Lamictal for BP2 symptoms. They were prescribed by a psychiatrist.
 
Wishbone

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Yeah that's what I would assume too, I just keep seeing therapist and diagnosis and its throwing me off. Sounds like it's actually pretty much what we have it's just the wording.
 
I

inky

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I just re-read your post and it looks like you have spoken with more than one doctor. Like me, I guess we both need to talk with a doctor who knows and understands what we're going through and we can trust what they have to say and feel good about it.
Thanks for the comments. It's encouraging to know I'm not alone, especially since I've kind of been stuck in an environment with people who don't struggle with mental health as much as I do. I have seen several doctors, way more than I would like, and am in the process of searching for a new one. On top of everything, I have severe social anxiety, so I end up not being comfortable enough to communicate well with a doctor that doesn't make me feel very at ease to begin with. I could be wrong, but I was under the impression that cyclothymia only went as low as mild-moderate depression. I know I go much farther than that and am fairly often severely depressed. I might be wrong, though.
 
I

inky

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For me, I would define a "therapist" as someone who has an advanced degree, whether a master's degree or a doctorate, in the field of psychology but is not a medical doctor. He/she would be able to make a diagnosis but not be able to prescribe medications. You would normally go to this person to receive help and guidance (therapy) in dealing with your psychiatric condition.

A psychiatrist can also diagnose but does not necessarily offer therapy. He/she is a medical doctor, who specialized in human behavior/psychology, and who can prescribe psychiatric medications. Normally you would go to a psychiatrist first then go to a therapist for ongoing therapy.

I currently take Risperdal and Lamictal for BP2 symptoms. They were prescribed by a psychiatrist.
This is how I've always understood it. A psychologist really only addresses medication while a therapist is usually seen more often and provides guidance and help apart from medication.
Does Lamictal work for you? I was prescribed that by a previous doctor, but ended up not taking it because I wasn't sure I felt comfortable after reading about it. I've heard there are some risks with skin-problems as well as possible pregnancy complications. Have you had any issues with it? And do you think it's worth taking?
 
T

Traveler5

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In my case (USA) therapists have given diagnosis...
Sometimes the diagnosis from the therapist is different from the psychiatrist...
This is true and obviously confusing to the patient but fortunately, their diagnosis is the same most of the time. From my experience, I usually trust the psychiatrist's opinion more than the therapist in a diagnosis. It comes down to who you agree with more. For me, if the diagnosis is different, I find a therapist who agrees with the psychiatrist.
 
I

inky

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Just a quick question for all of you North America based guys. I see a lot of mention of 'therapists' diagnosing conditions. Are you guys using this term intermittently with psychiatrists or are these people - the therapists - able to diagnose illnesses over there? It's not the first time I've seen it on here and it's confusing me.

As for the weird thing: are you taking any medications at the minute?
I always understood it the way Traveler5 explained. Psychiatrists are mostly just concerned with medication while therapistd provide help apart from that. Both can give diagnoses, but only the psychiatrist can prescribe medicine. In my case, I'm often more inclined to go with the therapist's diagnosis, simply because I feel as though she's likely to be more accurate after six months of weekly sessions while the psychiatrists I've seen only ask very general questions for a few minutes and judge based on that.

As for medicine, yes. I am currently taking welbutrin and prozac daily, as well as Atarax for anxiety. I don't think either of the antidepressants are working the way they're meant to, another reason I'm led to believe I have something more than MDD. However, I did only start experiencing this after I began taking the prozac.
 
T

Traveler5

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This is how I've always understood it. A psychologist really only addresses medication while a therapist is usually seen more often and provides guidance and help apart from medication.
Does Lamictal work for you? I was prescribed that by a previous doctor, but ended up not taking it because I wasn't sure I felt comfortable after reading about it. I've heard there are some risks with skin-problems as well as possible pregnancy complications. Have you had any issues with it? And do you think it's worth taking?
Lamictal works very well for me. It targets BP depression where a regular SSRI antidepressant is not usually effective in BP and can even aggravate Hypomania/Mania symptoms. Lamictal is also known for not having very many side effects. One that is listed and I deal with is hair loss. I have never heard of or personally dealt with any skin issues. I highly recommend Lamictal. It evens me out and I'm nowhere near being as depressed as I was before taking it.
 
Wishbone

Wishbone

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I always understood it the way Traveler5 explained. Psychiatrists are mostly just concerned with medication while therapistd provide help apart from that. Both can give diagnoses, but only the psychiatrist can prescribe medicine. In my case, I'm often more inclined to go with the therapist's diagnosis, simply because I feel as though she's likely to be more accurate after six months of weekly sessions while the psychiatrists I've seen only ask very general questions for a few minutes and judge based on that.

As for medicine, yes. I am currently taking welbutrin and prozac daily, as well as Atarax for anxiety. I don't think either of the antidepressants are working the way they're meant to, another reason I'm led to believe I have something more than MDD. However, I did only start experiencing this after I began taking the prozac.
The diagnosis part sounds plausible enough but I'd trust the psychiatrist over a therapist simply because they've had more training. Okay so the assessment part isn't the best, it will likely be a long time until it is, but even after months people can still be barking up the wrong tree. Over here there are team meetings to discuss you, I'm sure you have something similar (although it does sound a bit more disjointed in that you can choose to go another way it seems) so that the psychiatrist is getting feedback from the team, therapists etc.
As for meds. Two antidepressants you would expect something to show, and this 'weird' thing that you described does sound like low level 'mixed' features. At its worst this is mania and severe depression hitting you together - hell, basically. Watch for that getting worse if dosages of AD's are increased. For me, you're better off with the Lamotrigine but I'm not doc.

I have never heard of or personally dealt with any skin issues.
Oh nothing to worry about, just a potentially fatal skin disease that you should have been monitored for when starting it. You don't know whether to laugh or cry sometimes do you!
 
P

Paul396

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Lamictal works very well for me. It targets BP depression where a regular SSRI antidepressant is not usually effective in BP and can even aggravate Hypomania/Mania symptoms. Lamictal is also known for not having very many side effects. One that is listed and I deal with is hair loss. I have never heard of or personally dealt with any skin issues. I highly recommend Lamictal. It evens me out and I'm nowhere near being as depressed as I was before taking it.
Thank you for this. I have been very nervous since i started taking lamictal 4 days ago.
 
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