Is bipolar mis/overdiagnosed?
May 20, 2005 2:18 PM   Subscribe

In your personal experience, do you think it's possible (or even common) to be mistakenly diagnosed as bipolar?

I've spent the past few years--first on lexapro, now on effexor xr-- coping with what I believed was life-long depression/anxiety, and these diagnoses/prescriptions were given by my primary care physician. I finally decided that I would benefit from talking to a psychiatrist about the medication, and would seek some form of talk therapy.

The psychiatrist told me, based on what I told her about my behaviours and my lifestyle while on the meds (some sexual promiscuity/compulsion), that not only were these drugs the wrong class of medication for me, but that it was likely that I might be bipolar and that I could possibly benefit from Lamictal.

I told her that I was familiar with all the flavours of bipolar disorder but that I didn't consider myself at all bipolar and had never experienced any real manic episodes. I am meeting with her again in a week to talk about weaning off the Effexor and trying something else (though not necessarily Lamictal). Part of me thinks I should get a second opinion. But another part of me is (perhaps foolishly) hoping that this could explain the years of feeling torpid, lazy, uninspired, easily distracted/discouraged.

Are any MeFites willing to share their experiences, either as bipolar or being mistakenly diagnosed as such? Am I right to be circumspect? I've read all the other AskMe bipolar threads but haven't found an answer to this particular question. Thank you.
posted by anonymous to Health & Fitness (29 answers total) 1 user marked this as a favorite
I absolutely believe it's possible and common. I've been diagnosed as bipolar and I think it's horsehit. I tried meds twice and hated it both times. Almost threw myself off a bridge while on Wellbutrin and after that said fuck it.

Now, Instead of taking meds to straighten myself out I take responsibility for my own actions and recognize that I'm the only person that controls my thoughts/feelings/beliefs. Instead of looking for excuses for my behavior, I look for reasons for my behavior and then I make a conscious effort to change my behavior. Prior to accepting responsibility for the way my life was going I spent most winters as an anti-social hermit, much of that time in bed bemoaning my existence, and "why oh whying" about my lot in life. The pills didn't help and I mostly got mad at myself for "needing" them. I didn't throw myself off of a bridge (Oct 2003) because, get this: I didn't know who would look after my dog! After recognizing how ridiculous everything in my life had become I threw the pills off the bridge instead (figuratively), and started thinking and then acting instead of reacting and then thinking. It's made a world of difference.

I presently feel better than I have in almost 12 years and am accomplishing more than I have in the same period of time. I'm certainly not disputing that some people need meds or are bipolar but I, without a doubt, feel that doctors love to dish out the meds as a first resort rather than a last.
posted by dobbs at 2:49 PM on May 20, 2005

dobbs, I think doctors would rather err on the side of caution.

Anonymous- naturally it's possible that it's a misdiagnosis, but the doctor could be right just as well. Get a second opinion and then a third opinion if they vary- just know that the side effects don't happen to everyone, and it's worth a shot as long as you're under observation.
posted by BuddhaInABucket at 2:59 PM on May 20, 2005

Keep in mind that people who truly are bipolar often have a very difficult time accepting that. However, it can be misdiagnosed. As BiaB says, the solution is to get a second opinion from a qualified psychiatrist, not to chuck the whole thing altogether.
Good luck.
posted by LittleMissCranky at 3:24 PM on May 20, 2005

A medical diagnosis is a human act. All human acts are subject to failure. Of course it's possible. Get a second (or third) opinion and decide for yourself among them.
posted by xmutex at 3:25 PM on May 20, 2005

I take Lamictal after originally being on just paxil. They way my psych explained it to me is that it's from bipolar people who are more on the depressed side, but done ocassional manic episodes. I've only been on it around 6 months, so I don't know if it's helped regulate my mood or not. So hard to tell with these things.
posted by corpse at 3:29 PM on May 20, 2005

And never just take the meds, talk therapy has been nothing but wonderful for me. It helps me with so many aspects of my life.
posted by corpse at 3:31 PM on May 20, 2005

Yes, it's possible. No, it's not particularly uncommon to go through a few psych diagnoses, particularly if you are not textbook [insert diagnosis here.]
posted by desuetude at 3:31 PM on May 20, 2005

I had an overenthusiastic therapist once, she was super-helpful. At one point she had me fill out a mood-log to track how I was feeling. She was suspecting bipolar and the log helped her figure out it wasn't so. She seemed to think the log method was widely used. Just a thought.
posted by copperbleu at 3:33 PM on May 20, 2005

My longtime depression (20+ years, off and on) occasionally comes with a side of Hyper! Enthusiastic! Plus Anxiety!, which did cause a couple of doctors to initally wonder if I might be bipolar. But I, too, have never really had the full-on compulsive behavior that tends to occur with real bipolar disorder, and so I was pretty leery of that as a tentative diagnosis myself.

As it turned out most recently (about 4 years ago), I was just on too high a dose of my antidepressant (Serzone), which can cause hypomanic-like symptoms such as presssurized speech, distractibility, racing thoughts, etc. We brought the dosage down to a much lower maintenence level and the hypomanic symptoms faded pretty quickly (about a month, I think). Could your dose of Effexor possibly be causing a similar side effect for you?

Also: how's your thyroid function? Both hyper- and hypothyroidism can cause chronic mood disturbances (or exacerbate underlying ones), but can sometimes go undiagnosed for years. Getting a blood test to check your TSH (thyroid-stimulating hormone) could be very helpful, presuming your doc hasn't already considered this.
posted by scody at 3:36 PM on May 20, 2005 [2 favorites]

Here are links to the DSM-IV entries for Bipolar I and Bipolar II. Without a manic episode, you're clearly not Bipolar I, but that (of itself) doesn't rule out Bipolar II.

Anyway, there's huge overlap in the symptoms of various mental disorders, as they're defined. There's plenty of misdiagnosis in this world. Ditto the advice that you seek out a second opinion.
posted by Zed_Lopez at 3:45 PM on May 20, 2005

One of my friends was treated for depression (not very successfully) for years until she got a diagnosis of bipolar II--a sort of bipolar that's only got a very small amound of mania. She's on Lamictal now and in considerably better shape--she still has substantial problems with inertia, but she isn't miserable/suicidal.

As for your more general question, I think anything mental and most physical things have a pretty high chance of misdiagnosis.

Here's some qigong and supplements that I've found help me with inertia-flavored depression. The results haven't been dramatic so far, but they're definitely happening.
posted by Nancy Lebovitz at 4:06 PM on May 20, 2005

I would also think it is extremely reasonable and safer to seek a second opinion.

I recently started a med that I which very confident in its potential and ended up with high fevers close to 104, due to an extremely low blood cell count caused by the medication. The GP I met with was very skeptical about my shrink's decision to start me on this particular med. Not that his diagnosis is wrong automatically but that it is very common to have differring opinions on what your next step should be.
posted by scazza at 4:07 PM on May 20, 2005

Lamictal is sometimes prescribed for people who don't find SSRIs effective. I'd tried various kinds of SSRIs, then Wellbutrin, then Lexapro, and was not feeling significantly better. My doctor suggested Lamictal, and I was, like you, uncomfortable with the "bipolar" label, so I asked her to explain to me specifically how she was using the term, and if she thought that I was bipolar, and what that meant.

She explained that in current practice, "bipolar disorder" covers a range of what were previously considered one-off conditions (depression, mania, anxiety, ocd, etc) that are showing up in groups - so while one manifestation of bipolar disorder would be "manic depression", not all people who have "bipolar disorder" are manic or depressive. And that there are bipolar people who really have depression as their primary condition, and may not have significant other factors, but who respond well to medication of this sort.

For me, I found that after a few really good months of a mood stabilizer (Lamictal), I also needed to mix in a bit of mood elevator (using Cymbalta for that). Everyone's different - you need a smart doctor who is up on very current medical and pharmacological practices. And as difficult as it can be to try different things, sometimes you just have to. FWIW, I've had no side-effects whatsoever from Lamictal (though I definitely have them with other drugs, alas). Good luck.
posted by post_it_note at 4:13 PM on May 20, 2005

See Zed's links. There are specific criteria for bipolar.

And just a note, there's a phenomenon called Bipolar III, which causes mania post-antidepressants.

If your psychiatrist does think it's bipolar, he/she may be thinking some of your behaviors might classify as hypomanic episodes, which still fall under the category of bipolar (II).

And it's always okay to seek a second opinion. Your psychiatrist should be fine with it.
posted by gramcracker at 4:16 PM on May 20, 2005

I was on Effexor XR for a few months in 2003 followed by another couple months on Lexapro, and I definitely experienced some hypomania there. Kinda fun, but no way to live. I have had 1 diagnosed and at least 1 undiagnosed depressive episodes, and a handful of hypomanic weeks here and there both on and off of SSRI's (or SNRI's if you want to get technical about effexor). I don't think I am bipolar, or at least diagnosibly so, but it's something I do watch out for.

Keep in mind that any mental illness is a continuum. We all have mood swings, some of us have more than others, and some of us have severe enough mood swings to merit a diagnosis of a "disorder." I personally think that if I wanted, I might be able to get a doctor to diagnose me with Bipolar II, but really, I don't think I need to be medicated. I have my opinions on the overprescription of SSRI's and other psychotropic medications (and think there needs to be some research into the medicinal qualities of THC for depression); however, in some cases (including many bipolar cases), they are the best option. However, if you haven't ever had a "manic" episode (and get opinions on this from people you are close to, also, not just yourself. you may or may not be able to recognize them yourself.) I would say that getting a second opinion from a psychiatrist would be an excellent idea.

One more thing: Good luck with getting off Effexor. I quit cold turkey (I know, I know, not supposed to do that) and for about a month I would have these little one-second blinding flashes of dizziness*. Not pleasant, but not as bad as what I experienced after coming off of Lexapro: My orgasm was broken for almost a year. :( It's better now, though. :)

*Much like what the main character in Garden State describes to his neurologist, if you've seen that. (If you haven't, rent it. Or buy it. Best movie I've seen all year, and it hits home for those of us who've been psychotropically medicated.)
posted by salad spork at 4:18 PM on May 20, 2005

Misdiagnoses are common throughout medicine, so yes of course it's possible. Doctors look to fit symptoms into the nearest fitting diagnosis. Sometimes their first (second, third...) guess is wrong--for any number of reasons.

Maybe the doctor doesn't understand your symptoms well enough to make an accurate diagnosis.

Maybe your doctor isn't familiar enough with the nuances of other conditions outside his/her speciality that also have symptoms like yours.

Maybe you don't understand your symptoms well enough to give the doctor necessary clues (the mood log helps a lot with this. if you're female, also tie in your menstrual cycle. if seasonal affective disorder hasn't been categorically ruled out, tie in weather. if possible, also tie in meal info. yeah, it's a nuisance, but even just a week or two of data may give you and your doctor a much clearer picture of where to look for a source of your depression).

Maybe the doctor is lazy, or incompetent, or hopelessly under the sway of the drug rep who was pitching Lamictal five minutes before your session. Who knows?

The bottom line is that you know you best. If you feel that you're on the wrong track, then definitely either have a frank talk with the doctor about your reservations or go get a second opinion.

However, do remember that diagnosis and treatment are somewhat independent issues here. Just because a particular treatment isn't working doesn't mean the diagnosis is wrong. It could be just that you haven't found just the right med, or the right dosage level, or the right therapy, or the right combination of treatments. Or perhaps an untreated secondary disorder is clouding the picture.

Personal experience: it took many many years of vanilla "depression" diagnoses from various practioners before someone finally caught on to my hypomania and other tell-tale clues(thanks in part *cough* to a mood log...). Who goes to a doctor because they're feeling good and buzzed and hyper-productive? So of course they never got to see that, while I never conceptualized it as a "symptom" to report. Certainly not as mania, which is markedly different from hypomania. There are a lot of flavors of bipolar disorder that are not obvious, least of all to the person mired in it.

Finally, for now keep an open mind to the possibility that this diagnosis might be valid (whether or not you decide to try the Lamictal). Depression, anxiety, or (any flavor of mania) color one's judgement, so right now you may not be able to see what she's seeing. Start by asking your doctor to thoroughly explain her reasoning for the diagnosis. Ask your friends and family to be bluntly honest about whether her observations and assessment fit with your behavior. Do some more investigation of bipolar itself (for instance, call your local mental health association and ask if a couple folks with similar diagnoses would be willling to talk to you about their experiences). Does it really not fit the clinical descriptions OR subjective experience of bipolarity? Okay, then insist your doctor treat the actual symptoms you've got, not some convenient box she wants to fit you into. But do be sure this is the wrong track before dismissing potentially life-changing help.
posted by nakedcodemonkey at 6:31 PM on May 20, 2005

SSRIs are contraindicated in the presence of bipolar disease and could aggravate the conditions leading to some of your behaviors--share your concerns with the psychiatrist--why not wait 6-8 weeks for a second opinion--give the meds a try and evaluate as appropriate
posted by rmhsinc at 6:58 PM on May 20, 2005

I was mis-diagnosed as bipolar by one psychiatrist.

The back story: I've endured decades of depression, mostly chronic "dysthymia" with occasional but regular bouts of major depression. I got some relief for a few years thanks to Zoloft but it stopped working and I no longer respond to any of the SSRIs. In the past three years I've tried all sorts of meds, therapies, and had an extended hospital stay with multiple ECT sessions. All without success.

One of the dozens of pros I've seen in this period claimed that I didn't respond to anti-depressants because I'm not depressed, I'm bipolar. It was clear that he was prepared to attribute any symptom to bipolar disorder. He had a handy "fact sheet" all ready listing all the secret signs of bipolar disorder ("Were you a class clown? Have you ever been in a fight?", etc); probably 80% of the population exhibits at least one of the secret signs. He couldn't explain why I in fact had responded previously to an anti-depressant and why I have never exhibited any of the classic not-so-secret signs of bipolar disorder and why none of the dozens of other pros I've seen in my life had ever identified me as bipolar. (My mother was bipolar ("Aha!" cries Dr. Bipolar MD, "there's more evidence!") so I've had lots of experience with it.) His prescription: Lamictal. I did some research and found some studies in which Lamictal had been used to treat "refractory depression", which is my real diagnosis, with some success (as has been post_it_note's experience) so I was willing to humor him and give Lamictal a try. No relief. So I dropped Dr. Bipolar, MD and found another psychiatrist to guide me on my journey to the far corners of the psychopharmacological universe. Frankly, I could use a little hypomania right now but no such luck.

I belong to a support group for depression/bipolar and have heard similar stores from other members. The sad truth is that the success rate for treatment of depression is not nearly as good, over the long haul, as one might believe from popular media. The take-a-pill-and-it-goes-away-forever (or substitute the current talk/alternative therapy flavor-of-the-month for pill if you wish) scenario is rare or completely non-existant. So alternative diagnoses are inevitable: your depression isn't going away because it isn't depression.
posted by TimeFactor at 7:42 PM on May 20, 2005 [1 favorite]

The current medical opinion is not that BP disorder is overdiagnosed-- it's quite the opposite, in fact.

One of my close friends was diagnosed as ADHD in grade school. I went off to college, and came back a year later to find that he was suicidal and had to be institutionalized for a period. Suprise, suprise. He's actually bipolar.

Whatever the end diagnosis is, just remember that the only stigma is the one you decide to accept.
posted by LimePi at 11:42 PM on May 20, 2005 [1 favorite]

Boy, lotta crazies here on Metafilter (kidding, kidding, paroxetine, chronic dysthymia).

I would just second the suggestion to, if possible, keep talking therapy with a pro you work well with regardless of where you land. Medications are doing wonderful things, and I really believe a sustained low dose of paroxetine has done good things for me, but I also think that, even if the major component of whatever problem is chemical in origin (I realize I'm ignoring a big grey fuzzy line here but what are you going to do), you develop destructive and obstructive modes of thought in the context of any disorder that competent therapy can really help with.
posted by nanojath at 12:50 AM on May 21, 2005

I think you made a good choice seeing a psychiatrist instead of a GP, but even very competent psychiatrists can be mistaken in diagnosis and I think it is important that your remain active and questioning. I was diagnosed as manic depressive and on lithium for almost ten years. I was seriously nuts for about six months but it was not the lithium that stopped it but prolixin. Finally, about three years ago I was diagnosed with liver disease and they had to take me off both the lithium and the prolixin. I still suffer from clinical depression but a large dose of paxil helps me live a pretty decent life, albeit I am VERY aware when the paxil wears off. My current shrink thinks that I suffered from depressive psychosis, not manic depression, and I think she is right. I have a funny feeling that if paxil had been available when all this started, I might have never gone nuts. As far as the medications go, they don't really cure you, they just enable you to live a relatively normal life. One thing I would caution you about, though, is the following: Be careful who you discuss your demons with, for once you get labeled as a looney you would be amazed at the people who turn against you. There are even people out there who are more than willing to take advantage of the situation. Talk to your shrink, that is what you are paying him or her for. Anonymous posting works, too!
posted by phewbertie at 2:56 AM on May 21, 2005 [1 favorite]

Bipolar disorder is very commonly overused in diagnoses, especially in cases of personality disorder.

Almost everyone has some level of some form of what is called personality disorder, but things are treated in as far as they interfere with your life or those around you. (And I have yet to see how long the list of new ones will be in the newest DSM)
Believed to be caused by degrees of trauma and/or abuse experienced while developing a sense of self, I pointedly want to add neglect, emotional, perceived, and social/behavioral tutelage, as it is often ignored by both patient and doctor as trauma and abuse, but very common. Without a sense of security in stages of development and observing stable adults as patternable behavior, people develop a wide range of behaviors and thinking patterns to cope or avoid dealing with these issues.

Despite that, many of the same drugs will generally be used because they are treating the symptoms in as much as they are a problem to you or others.

Bipolar disorder is generally agreed to be hereditary, so if no one else in your family history has some form of "mood disorder," the chance is slimmer, but since usually only the most extreme cases were brought to anyone's attention and many people don't have contact with extended families or accurate histories, it's easy not to know. Also it generally manifests by one's late twenties, although differing levels of psychosis can be triggered by many different drugs.

How you react to certain drugs is a telling factor, as in the instance of people who experience dramatic resolution of symptoms from lithium. Because many people have intolerable side effects and/or other health issues, what was and is the commonly used "stabilizers" are anti-epileptic medications.

While you are figuring what works for your personal chemistry, your diagnosis may change and an objective individual who spends time with you on a regular basis, such as a therapist, will be more able to help you figure this out, as well as the doctor, as psychotherapists work with, if they are not, psychiatrists and can observe you over time in far more depth, in figuring your reasoning or helping you figure your reasoning.
Definitely get an overall check up to identify any other factors at play (nutritional, glandular, undiagnosed disease, etc.)

In that personailty disorders can present themselves with what is termed "extreme mood swings, impulsivity, dangerous behavior" and tend to become problematic in one's twenties as they have to sort different life challenges that they are unprepared for and confront issues to that end, when symptoms or behaviors don't resolve themselves and/or become more extreme, they will try the "bipolar option" in diagnosis and medications. As this is generally mood stabilizers and antidepressants, they may use the same drugs in either case, to give it a shot.
Antipsychotics are for when things become psychotic, as in not relating to the world around you perceptually, whether this is extreme thoughts (such as of a suicidal nature or to a like degree) or behaviors to whatever degree they are unmanageable. As Lamictal has like properties, that would be the reason it would be a first line drug of choice.

Antiepileptics lower the electrical activity in the brain. The older drugs one hears about in movies and books of psychiatric care "knock you out" because the point was to incapacitate you, now just to some to a degree and with as few side effects as possible. Slowing down the electrical activity can cut down on the level of impulsivity and give one time to think before they act and why they act. A therapist is there to assist one in this as well as observe you when you are on these classes of medication.

One identifiable trait of personality disorder one could ask oneself of is how overwhelmed do you feel by your emotional state. For instance, can how you feel about someone or something be completely colored by a single incident, in terms of good or bad, or like black or white thinking? While this is not atypical adolescent thinking, this is not considered rational in adulthood, because of the obvious consequences and lack of consideration for those consequences, short and long term.

What you are in for is work, because the best way to deal is to be informed, about yourself and your motivations and reasoning, developing them, defining your personal priorities, and how different drugs effect you. Any professional help is there for you to work with to solve problems, not to solve your problems.

Some people appreciate a certain emotional remove or less input, some people find it intolerable.
Some people manage themselves despite what may be considered mental illness just fine as far as anyone is concerned, some people exacerbate emotional and behavioral issues to a degree where they "need to be managed," and not being aware that you are, if you are, is a sign that you may need assistance.

As I have often seen depression and personality disorder misdiagnosed as bipolar, I would say it is easily the case, but neither one is an easier road depending how far you travel. Whether you are examining your level of perception or what your personal goals and beliefs and the reasoning behind them are, as much objective support, sound information, and a network of stable people (family, friends, groups) make the trip immeasureably less daunting.
posted by philida at 6:06 AM on May 21, 2005

Just wanted to chime in with my personal experience : I've taken Effexor for depression (Major Depressive Disorder - the kind that rears its head once every few years and makes life unliveable, not the chronic sort) and definitely experienced some hypomania during the first few weeks. I found that a lot easier to deal with than not being able to get out of bed, but that's just my experience.

I also have a lot of experience with Lamictal. I'm epileptic, and as with many bipolar drugs, Lamictal was first developed as an anti-convulsant. When I was on Lamictal, I was able to stop taking anti-depressants entirely and didn't have a Depressive Episode at all during the year I was on it. (I had my first episode at 18, my second at 20, my third at 21 - mostly if I was off antidepressants for a few months, one would crop up eventually) Many epileptics also suffer from some form of depression and Lamictal has been a god-send for some. It was for me, until I started suffering from insomnia at high doses (really really high doses). This was counteracted by adding Valium to my drug cocktail and worked out pretty ok until I developed a tolerance to Valium...

Anyway, Lamictal was wonderful for me and while most anti-convulsants have heavy heavy side effects, I didn't notice any on Lamictal until I was on a ridiculously high dose.

If traditional anti-depressants haven't worked for you, it's certainly worth a shot.
posted by grapefruitmoon at 6:55 AM on May 21, 2005

LimePi, is Bipolar disorder misdiagnosed? Generally you'd say that someone working for the "Bipolar Disorder Research Program" or the "Harvard Bipolar Research Program" (as do the authors of the paper you link to) would be the right person to ask; however, in psychopharmacology things get a little more complicated.

First, if any of us write down a list of our "symptoms" we'll be eligible for a whole host of DSM diagnoses. As Zed_Lopez pointed out, it's even possible to have "Bipolar Disorder" while only exhibiting depressive symptoms. This is one of the dangers of this "point-based" system for medical diagnosis - taken literally (which it generally is by psychiatrists), it often leads to irrational diagnoses and misprescription.

Next: because, given a range of symptoms, any of several different "disorders" could be diagnosed, a study like this isn't really very meaningful. It's core message is: these people who have previously diagnosed with depressive disorders, can also be diagnosed with bipolar disorders. They call it "misdiagnosis" in the study, but it's not - according to the rules of the game, everyone has every disorder for which they can put check marks in the right set of symptom boxes. This points to a very serious flaw in the whole system of diagnosis for mood and behavioral disorders.

Third: take this or leave it, but the authors of the study are primarily prescribing Valproic Acid, or Depakote. Their study? "[S]upported by a grant from Abbot Laboratories". Who make? Depakote. It's in the interest of the researchers, and their corporate backers, to say that bipolar disorder is underdiagnosed. It means more sales for the drug company, and more funding for the researchers.

This is all incredibly predictable, right down to the industry funding. So my take on your situation, anonymous, is this: do your research on the drugs you're being prescribed. If you decide to take them, don't be passive about the effect they're having on you. Take note of their effect on your mood and their other side effects. Don't take bullshit from your psychiatrist about "usual side-effects" - assess critically whether the benefits of the drug outweigh its negative aspects, in your mind. And don't let them tell you that mood swings caused by the drugs are in fact problems with you, and therefore reasons to keep taking them.

It's very hard to get psychiatric treatment that actually has making you better as its goal. I wish you the best.
posted by louigi at 8:34 AM on May 21, 2005 [1 favorite]

I don't know if I'd call it "misdiagnosed," but one shrink I saw a couple years ago thought I was a bit bipolar and I took Neurontin for a few months.

I think she suspected me of being bipolar because I was super, super moody, so much so that I couldn't make plans because I didn't know if I'd be in a good enough mood to carry them out. I know my doctor meant well, and was just going with what I told her; in retrospect, I think at that time I just wasn't able to verbalize how I felt and, therefore, I wasn't able to get the exact right amount/kind of help I needed.

Mis/overdiagnosis of bipolar probably has more to do with how the patient/client perceives their own symptoms and moods, than doctors being overly enthusiastic to make that particular diagnosis.
posted by elisabeth r at 8:36 AM on May 21, 2005

Wow, I've got the trendy mental illness! I'm on Effexor right now, but I don't know if it's working or not.
posted by Monochrome at 3:01 PM on May 21, 2005

1. Keep in mind every physiology is different. While some people here say Effexor made them close to manic, for me it treats my depression wonderfully. I used to be on Zoloft but it made me too numb... you could have told me my best friend had died and I wouldn't have been able to cry.

2. There is a difference between Axis I and Axis II diagnoses - Axis I are more clinical mental illnesses (bipolar, schizophrenia, etc) and Axis II are personality and developmental disorders.

3. Something I think is important: While it's entirely valid and a good idea to get a second opinion, try to spend some amount of time with one practitioner. The longer you are seeing one doctor, the more they get to know you and get a better picture of you and any disorders you may have. When I first started therapy 2 years ago, I was listed as having Adjustment Disorder (stress trying to deal with major life changes) until my therapist realized it was a more long-term problem and changed the diagnosis to BPD.

Finally, a link to some differentiation between Borderline Personality Disorder and Bipolar Disorder. Philida brought up personality disorders and the black-and-white thinking s(he) mentioned is a hallmark of BPD, and the sexual promiscuity/compulsion you mentioned is another sign. However, you have to meet at least 5 of the 9 criteria to be diagnosed Borderline.
posted by IndigoRain at 10:22 PM on May 21, 2005

An anecdote: I was diagnosed as bipolar last winter after years of depression and hypomania (I was in some serious denial about the latter). I talked about it with an acquaintence at one point (a gentleman who teaches psychiatry at a well-regarded med school), and he said that it usually takes 9 to 11 years for someone who is bipolar to be properly diagnosed. That makes me think that it is not particularly overdiagnosed.

Have you considered the possibility that you're cyclothymic? It's pretty difficult to diagnose, and since it's characterized more by hypomania, sexual impulsivity, and inability to keep romantic relationships going and so on instead of out-and-out mania, that might explain the fact that you've "never experienced any real manic episodes." It's in the spectrum of bipolar disorders, and is treated similarly. (nota bene: I am not a psychiatrist)

I'll second rmhsinc's comment about SSRIs. I was on Celexa for three years or so, and now that I know what to look for it's apparent that I had more hypomanic episodes while on that medication. I'm on Wellbutrin now... apparently it's the antidepressant least likely to tip someone who's bipolar into a manic state. If there's any chance whatsoever that you're bipolar, you should probably stay away from SSRIs. Effexor can possibly have the same effect as SSRIs in this case; you're supposed to let your doctor know if you have a history of mania or bipolar disorder before you start it.
posted by the_bone at 4:56 PM on May 23, 2005

I tried Lamictal a couple of years ago, and I couldn't handle it. It made me feel really physically weak (which the doctor ignored) and aggravated my asthma (which the doctor freaked out over, and caused him to yank the drug.)
posted by spinifex23 at 12:05 AM on November 7, 2005

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