Thursday, September 25, 2008 Scott B asks

Q: A little confused about meds and diagnoses...

About 10 years ago I was diagnosed with major depressive disorder with psychotic features and put on an anti-depressant and an anti-psychotic. While the drugs themselves have changed a number of times, I've always taken the same kind of drugs until about 4 years ago when my doctor added a mood stabilizer. My diagnosis, however, did not change when the mood stabilizer was added.

Now, my therapist and doctor are not only considering changing my primary diagnosis from major depressive disorder to Bipolar I, but they also feel they should add Borderline Personality Disorder as a secondary diagnosis (I'm not a cutter, and you don't have to be to have that diagnosis).

I don't feel that my symptoms have changed, but they do seem to be more intense. I'm sure, though, that's because I finally decided to get sober and stop sabotaging my treatment and life.

My confusion is this - why didn't my diagnoses change when the mood stabilizer was added? Please understand, I totally trust my MH professionals, and I'm not questioning them at all. Or should I be? Can I also expect a change in medication or dosage?

Has anyone else had an experience like this?

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Answers (3)

John McManamy, Health Guide

9/30/08 8:29pm

Hi, Scott. I'm guessing you haven't had great success with your meds. Hence the reason to add a mood stabilizer, and consider two new diagnoses.

I'm guessing that your pdoc may have noticed that your depressions are recurrent - ie they come and go - as oppsed to chronic, which can linger for years. Think of recurrent depressions as having the same dynamic as bipolar - you are cycling, but maybe not up as high as someone with bipolar. In this case, the mood stabilizer may smooth out your cycle. This would justify you being on a bipolar med even if you are not technically bipolar.

Another possibility - your pdoc may have noticed subtle mania symptoms, perhaps not the sex, drugs, and rock 'n roll that we associate with mania. More like irritability and road rage features. Add these to your psychotic features (which also occur in mania) and we can see why your pdoc may be thinking bipolar. A positive reaction to a mood stabilizer may confirm his/her hunch, in which case your provisional diagnosis may become official.

As for borderline, we don't know the biological causes, but a number of experts theorize that it arises from oversensitivity to stressful situations, or reacting to normal events as if they were stressful. This is way people close to those with borderline refer to their dealings as "walking on eggshells." They literally get their heads snapped off for no apparent reason.

Again, the mood stabilizer may help with the stress.

All this may or may not apply to you. But it is food for thought, and you need to be discussing it with your pdoc.

Narelle

9/25/08 8:41pm

I was diagnosed with major depression for 8 years after having my one and only child. When I was manic or hypomanic I never went to the doctor, that's when I thought I was doing fine (the antidepressants they were prescribing we making me feel ULTRA great as they were shoting me through the roof). Then i'd get increasingly agitated, confused, racing thoughts, fear and would go back to doc only to have antidepressant changed or dose put up. Only in the last few years have they been suspecting mood issues (and Borderline was the latest diagnosis until I saw new Dr who has said that's rubbish and that i'm Bipolar - more likely 1 than 2 and with mixed states as well. You may well have a change in meds, or a change on dosage etc - but hang in there, meds are only one part of the equation and need to begin to build up "mental hygeine" as my Dr calls it. That's where taking some responsibility for mood and eating properly and exercising etc etc etc comes into it. I find it is essential to have a pretty strict routine for sleep and for life in general in order to live with this - otherwise I stop being midful of my mood and off I go....meds can only take me so far.

Take care and good luck.

Narelle

9/25/08 8:43pm

Please excuse my atrocious typing - used to having a spell checker!

Q: A little confused about meds and diagnoses...

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