Psychiatrists often have a difficult time diagnosing bipolar disorder, as they tend to see patients when they are depressed rather than bouncing off walls. Additionally, certain symptoms may resemble ADD or schizophrenia or other illnesses. Bipolar also tends to come fully-loaded with symptoms of other mental illness, such as anxiety. Finally, even if a psychiatrist correctly diagnoses a patient with bipolar, there is substantial diagnostic confusion over exactly which type of bipolar a patient may manifest.
With this issue of Ask the Expert Patient, we have four questions from individuals wondering if their symptoms match the bipolar profile, and, if so, what kind of bipolar?
China writes:
I was diagnosed with bipolar in 2004 after I sought treatment for my increasing irritability and was prescribed Prozac. I don't remember too many details, only that I became more sad, angry, driven, erratic, after I started taking it and I felt extremely out of control. I've always had trouble sleeping regularly, but during this time I hardly slept at all. But I never needed to be hospitalized, I still went to work every day, and maintained my role as a mother and wife. I just was very unpleasant to be around. My doctor (whom I trust completely) gave me the diagnosis after I filled out a questionnaire in his office, and also based on the fact that my sister was diagnosed with it. The first few medications I took made me a zombie. My depression intensified. I started seeing a therapist, and eventually stopped all medications. I had felt so bad on the meds, that I thought I was back to normal, until I tried taking college courses and all the irritability, anxiety and sleeplessness came back. Finally a psychiatrist prescribed Lamictal, and Risperdal to help me sleep and control irritability. It took several months, but slowly I became more like my normal self. I've taken self-induced "medication holidays" because I forgot what I was like before and I guess partly to see if I still had it. It would always lead to an increase in symptoms.
I have also since been diagnosed with ADHD, but while that seemed to make a lot of since, it also created more difficulty accepting my bipolar diagnosis. My ADHD symptoms fit the classic profile, while my bipolar ones don't, or I don't think they do anyway. I was told by a psychiatrist that it was bipolar type I with some rapid cycling, but I've never had a classic manic episode (euphoria, grandiosity, calling friends in the middle of the night etc.) and almost always my "elevated moods" were (are) unpleasant. When I was charting my moods I couldn't decide if I was up or down because I knew I definitely didn't feel good! I finally learned about dysphoric mania. And the only severe episodes of depression I can remember were when I was already taking antipsychotics, so I thought if I have bipolar it seemed to be more like bipolar type II. A lot of my symptoms could be related to ADHD and bipolar,so I don't know which are which anymore! I guess I should talk more with my therapist but I'm seeing a different one now due to insurance, and it hasn't come up yet. When I went to my first one we mostly dealt with damage control. I'm struggling with anxiety depression (low feelings of self-worth), and guilt. Is there anyone else out there who is also having a hard time figuring out what they are going through too, or who can offer insight to my experiences?
