Is It Bipolar? If So, What Kind?

Ask the Expert Patient Health Guide
  • 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?

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    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?




    Hi, China. Your experience on the Prozac points toward bipolar. Many of us flip into mania when prescribed an antidepressant. A family history of bipolar is also a fairly reliable, thou not necessarily conclusive, diagnostic tie-breaker. The fact that the BP meds are also working also speaks volumes.


    As for bipolar I, you need not have "euphoric" manias to get this diagnosis. You mention your elevated moods were "unpleasant." This fits the bill for mixed states. Mixed states involve both depression and manic (or hypomanic) symptoms. I experience these, myself. The DSM, the diagnostic bible, however, only recognizes mixed states for bipolar I. The reality is bipolar IIs also experience mixed states, and this is likely to be corrected in the next edition of the DSM. You may be a bipolar II with mixed states, but your psychiatrist may have classified you as bipolar I for the sake of filling out forms and getting paid.

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    Re ADHD, bipolar usually comes loaded with other co-occurring illnesses. ADD is a frequent co-traveler with bipolar.


    Angie writes:


    I've been living with bipolar for over 10 yrs now, it has been hard for me, it was one of the main reasons my marriage ended, and a recent relationship in which i was for 9 months, we broke up a month new doc tells me i have mixed bipolar, and first he had told me i was a rapid cycler, i don't understand anymore, right now im in a manic phase, but a weird one, because although im barely sleeping and i am very active, i am extremely depressed and cry out of the blue for whatever reason, and i am getting severe panic attacks even while sleeping, i cant stand it, i am afraid i will never get better and learn to live with it, sometimes i just feel like giving up........right now im on lamictal, and geodon, and klonopin for panic attacks....any input?




    Hi, Angie. Please see my answer above regarding mixed states. I've been there. It's extremely terrifying having lots of energy and feeling miserable. Your first priority is to stick with the meds, even if the side effects are onerous. It's probably best to take time off. You need to get down from the mixed state in a quiet stress-free environment, not cope with it at work or elsewhere. Your next step is stability, but still not feeling right and with meds side effects. This is where you need to work with your psychiatrist in adjusting the cocktail so you can function. This may take time and patience. Please don't give up.


    Confused at 40 writes:


    Hello, I have been reading all the messages here for over an hour and though I have not been officially diagnosed with bipolar, I believe I am experiencing all the symptoms. My mother was diagnosed with bipolar and her brother was also diagnosed as well and ultimately committed suicide. I have destroyed most if not all of the relationships I have been in. I have also been in denial for so long about this and I am tired of being alone. I was diagnosed with Depressive episodes years ago and believe now that I was miss-diagnosed... Im not sure where to go from here.. I feel embarrassed to talk to my regular doctor about this for fear he will think I am just paranoid... All my life I have just ignored things, always afraid of what others will think... This is destroying every aspect of my life and the worst part is I believe my son also suffers from this disease. Im not really sure where to go from here? I do have to say this is the first time I have spoke out about this ever... I felt safe to do so here, any help would be greatly appreciated... Thank you


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    Hi, Confused. You have every reason to be concerned. Please book an appointment with a psychiatrist and tell him/her what you posted here. Your fear is keeping you in suffering. Overcome the fear, end the suffering.


    Tbachtem writes:


    I was recently diagnosed with bipolar disorder. It took doctors ten years of treating my symptoms separately to final get a doctor, the one I have now, to put them all together and figure out that I was bipolar I am curious to know if ten years is the norm, or if I just dealt with the wrong doctors. I even suspected that I had it even before my doctor confirmed it.




    Hi, Tbachtem. You hit the bullseye. Numerous studies have confirmed that going 10 years with a misdiagnosis after you've seen a medical professional is pretty much the norm. Unless you're bouncing off the walls when your doctor sees you, they tend to assume - based on your stories of misery - that you have unipolar depression.


    Ihopeat writes:


    To read posts by those who live with or deal with BPs-I think, yuck, what a bunch of pieces of poo we are. I don't see myself in the descriptions. Impulsive? Yes, I got a tattoo on a whim yesterday. Obsessive? Of course, to the point of sleepiness, irritability and aggressive behavior, though directed at myself. But my symptoms all seem to be directed internally-I'll injure myself, not others (well, hold on, honesty check, my self-injury does injure others). I guess what I'm saying is I don't see myself in these people who are BP and cheat, leave their families, steal, lie whatever........I try the old "observer" trick and see myself outside of myself......but am I just being delusional?




    Hi, Ihopeat. Let's change the question. Instead of asking yourself whether you may or may not have bipolar, instead ask yourself if any of the behaviors you describe, and any others, affect your ability to have meaningful employment, have friendships, stay in relationships, and feel at peace with yourself? A resounding yes indicates the wisdom in seeing a psychiatrist. Whether or not you have bipolar is a different issue. You may have something else entirely. The point is you have pointed out certain behaviors that you acknowledge need working on.




    Do you have questions about bipolar disorder? Every two weeks, I'll answer new questions and post the answers here, in our Ask the Expert Patient section.


    If you would like to ask a question about bipolar disorder or living with bipolar disorder, please write a SharePost and be sure to select "a question" in the drop-down menu next to "I want to create a SharePost that is a," which is Step 2 on the SharePost creation screen.

    Please keep in mind that I am not a physician. I cannot diagnose or give medical advice. This section is for sharing information and offering support as a nonphysician "Expert Patient."


Published On: October 28, 2007