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Blue Opal

Blue Opal

Well-known member
Joined
Oct 28, 2020
Messages
255
Location
The Netherlands
Hello everybody,

I am a 41 year old female from the Netherlands. I am new to this forum and hope you guys can help me with a question about bipolar disorder. Sorry in advance if my English isn't very good.
I was diagnosed with Bipolar I disorder 18 months ago.
I am also diagnosed with Avoidant personality disorder with dependant and borderline traits.
My problems started about 16 years ago with what was then diagnosed as social anxiety and depression. Since then I've been depressed off and on, mostly not too severely.
12 years ago I had a psychotic break during a holliday in Egypt, following five nights of complete insomnia. I was admitted to the psychiatric hospital in Cairo and recovered quickly. My psychiatrist and psychologist (in the Netherlands) thought this so-called micro-psychosis was caused by extreme stress and my personality disorder (the BPD part in particular). Six months later I had another micro-psychotic episode due to stress and insomnia, which was followed by what I later recognized as a (hypo)manic episode of about two weeks.
During the first psychosis I was on mirtazapine (anti-depressant), during the second I had just started taking fluoxetine (anti-depressant). I stopped the anti-depressants and started taking Seroquel (100 mg).
Still, my psychiatrist did not diagnose bipolar disorder because they thought it was caused by my personality disorder - it was, according to them, just how I responded to stress.
After that followed years of low grade depression, diagnosed as dysthymia (persistant depressive disorder) and a lot of different therapies for my personality disorder.
Through the years the Seroquel was increased to 200 mg and later to 300 mg because of episodes of stress, that caused severe insomnia and some weird dissociative symptoms that I also had prior to the two micro-psychotic episodes.

A little over 18 months ago I tried to taper off the Seroquel, which resulted in insomnia and severe depression. The Seroquel was eventually increased back to 300 mg, but that didn't help, so after a few months my (new) psychiatrist and I decided to start with Lithium. By then she had diagnosed me with bipolar disorder after hearing my story.

So now, after this long introduction I want to ask you a question. Do you think I have bipolar disorder, or were my psychotic episodes and hypomanic episode purely due to stress, the use of antidepressants and my personality disorder?
My psychiatrist said: When someone responds to antidepressants with (hypo)mania and even psychosis, that is indicative that they have bipolar disorder. Is that true?
Because I haven't had a (hypo)manic episode in 13 years and because I've merely been depressed (dysthymic, sometimes with short episodes of more severe depression), I wonder if I really have bipolar disorder. I read on this forum and on the internet that people with BD never really go without episodes, even when on medication.
The weird thing though about my depression is that I usually sleep too much, bun when I am more severely depressed, I tend to get insomnia and some agitation (a feeling of restlessness that is very uncomfortable). That is the only thing that may point a little towards some slight (dysphoric) hypomania - I read that hypomania can also be quite negative. I never in those 13 years experienced more energy or the lack of need for sleep, I always desperately wanted to sleep but couldn't.

Sorry this is such a long post. I really hope someone can answer my question. To find out if I have bipolar disorder I want to taper off Seroquel and when (if...) I have successfully done that, maybe even try to stop taking lithium as well, to see what I am like without my medication. I have been taking Seroquel for so long now that I can't even imagine what I would be like without it.
Thanks for reading.
 
jajingna

jajingna

Well-known member
Joined
Jul 31, 2020
Messages
2,956
Location
Canada
Hi, welcome here. Nobody here can diagnose you. I don't know much about bipolar. Seems like doctors get it wrong sometimes.
Do you think I have bipolar disorder, or were my psychotic episodes and hypomanic episode purely due to stress, the use of antidepressants and my personality disorder?
 
HLon99

HLon99

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Joined
Apr 15, 2020
Messages
428
Location
London, UK
Honestly, I couldn't say, maybe its worth getting a second medical opinion. I do know that when people respond to antidepressants with hypomania/psychosis, they usually do investigate the possibility of bipolar disorder, but sometimes in may just be drug induced mania. This can sometimes even occur with other medications such as corticosteroids.

BPD is known to cause periods of stress-induced psychosis, but you claimed that you only had traits of it, rather than the full disorder, if I understand correctly. So its a bit of a tricky case, it might be cyclothymia or bipolar II, but I struggle to believe that you have Bipolar I considering you say you haven't had a Manic episode in 13 years. The sleep disturbances that you experience are normal, I went through the same thing when I was depressed. I would suggest that you stick with the medication for now, see how the Lithium goes, if it helps then great, and its therefore more probable that you do have bipolar. If not, I suggest that you get a second opinion
 
Blue Opal

Blue Opal

Well-known member
Joined
Oct 28, 2020
Messages
255
Location
The Netherlands
Thank you both for your replies.

@HLon99: I don't have BPD anymore, but I used to. Forgot to mention that. I now still have a few traits but not the full disorder.
I am doing better on the lithium. At first when I started taking it, after a month I felt good. I mean, really NORMAL, and I haven't felt like that since I was 14. Then after three months I felt mildly depressed again. Recently the lithium was upped again because I was more depressed and started to experience sleeping problems again. I now feel better (and sleep much better, almost too much), but am still slightly depressed. I think that's just my base level mood.
The thing about getting a 2nd opinion is: I've had many different therapists and psychiatrists over the years. None of them diagnosed me with bipolar disorder, only the current one. I was always diagnosed with dysthymia, which I do think better fits my issues. Also, in my family there is no history of bipolar, whereas both my mother and my sister have depression.
Maybe it was "only" drug induced mania/psychosis indeed.
Anyway, thanks for your thoughts on this, I appreciate it.
 
HLon99

HLon99

Well-known member
Joined
Apr 15, 2020
Messages
428
Location
London, UK
Thank you both for your replies.

@HLon99: I don't have BPD anymore, but I used to. Forgot to mention that. I now still have a few traits but not the full disorder.
I am doing better on the lithium. At first when I started taking it, after a month I felt good. I mean, really NORMAL, and I haven't felt like that since I was 14. Then after three months I felt mildly depressed again. Recently the lithium was upped again because I was more depressed and started to experience sleeping problems again. I now feel better (and sleep much better, almost too much), but am still slightly depressed. I think that's just my base level mood.
The thing about getting a 2nd opinion is: I've had many different therapists and psychiatrists over the years. None of them diagnosed me with bipolar disorder, only the current one. I was always diagnosed with dysthymia, which I do think better fits my issues. Also, in my family there is no history of bipolar, whereas both my mother and my sister have depression.
Maybe it was "only" drug induced mania/psychosis indeed.
Anyway, thanks for your thoughts on this, I appreciate it.
You're very welcome and your english is very good by the way. I'm glad you are doing better on the lithium. If you have been through a lot of psychiatrists already, then perhaps its best to stick to one and work with them consistently to get to the bottom of this. Whilst having a first-degree relative suffer from Bipolar disorder does increase you chances of having it, its not necessarily a precursor, I'm bipolar and none of my immediate family members suffer bipolar. My great aunt had schizophrenia and my dad used to suffer from PTSD and now probably has undiagnosed dysthymia and possible OCPD but that's about it.

Given the fact that you did experience hypomania and even psychosis, in my (non-professional) opinion I do not think that dysthymia explains this, I think that there is something else at play. Dysthymia also tends to respond to traditional antidepressants and therapy pretty well, whilst Lithium is only reserved for Bipolar and treatment resistant Major Depressive Disorder. Stick with your current treatment plan, don't get to bogged down in definitions and diagnosis as often times there is a lot of overlap in symptoms of affective disorders and continue working with you pdoc and hopefully in time you will get some clear answers.
 
Blue Opal

Blue Opal

Well-known member
Joined
Oct 28, 2020
Messages
255
Location
The Netherlands
@HLon99: Thanks for your compliment on my English and your message.
I do intend to stick to this therapist and the psychiatrist.

I am definitely different from my mother and sister because they function relatively well on antidepressants, when I clearly did not. They also never experienced hypomania or psychosis.
My father was never diagnosed with anything but we all suspect him to be at least a little narcissistic or borderline. He also had some bouts of depression, but on the other hand he seems to have periods where he is almost manic in his energy and goal directed behavior. He is very impulsive too, and he has a very irritable mood all the time, is quick to anger. I believe my grandfather was like that too. So that is probably where I get my bipolar tendencies from.

I still really would like to try and taper off the Seroquel and I am going to ask my psychiatrist's opinion on that.
 
Blue Opal

Blue Opal

Well-known member
Joined
Oct 28, 2020
Messages
255
Location
The Netherlands
Hello all,

I just spoke to my psychiatrist on the phone and told her about my doubts regarding my diagnosis of bipolar disorder. I told her I had those doubts because my only (hypo)manic/psychotic episodes may have been caused by antidepressants.
She said that in her studies she had learned that when something like that happens, it means this person has bipolar disorder. She said that if I wasn't bipolar, that wouldn't have happened.
She also said it could also be schizoaffective disorder, but I looked that up and ruled it out for myself. I don't have (had) longer lasting periods of psychosis without a mood episode.
My psychiatrist said: "It doesn't really matter what we call it, and it is not easy to label it because you've been on Seroquel for so long. But you definitely have depression and you've experienced psychoses and hypomania. So I would call it bipolar disorder with psychotic features."
If I really want to be sure of my diagnosis, I should stop taking my medication and see what happens, but she really doesn't think that is wise. I agree.
We did agree to try and slowly lower the dose of Seroquel, starting in january because of the upcoming hollidays. Those are always a stressful tilme for me.

I have read a lot about bipolar disorder on this website: Diagnosis in the Mood Spectrum – Psych

It speaks of a bipolar spectrum instead of a yes/no diagnosis. There is a lot of info, especially helpful if you're in doubt about your diagnosis. It took my doubts away.

You can also fill out the Bipolatity Index: https://www.moodtreatmentcenter.com/bipolarityindex.pdf

50 or up means bipolar disorder is highly likely. I scored 65.

Thanks for reading, have a good day everyone!
 
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