Getting diagnosed with bipolar II
June 25, 2016 3:18 AM   Subscribe

I think I may have bipolar II. How do I get help?

I have been struggling with some very difficult lows in my mood over the past year, and my therapist, an LCSW, referred me to a psychiatrist after we discussed it pretty frankly at our last meeting. Feeling this low is not new to me, but I am in my early 30s and am tired of having long stretches of my life where I can't get out of bed in the morning and I feel worthless and empty despite a great career, a wonderful pet, and nice friends.

In the interim, I had a chance encounter with a friend who works as a psychologist at a psychiatric hospital. She mentioned a patient with bipolar I to me and I asked her what the difference was between I and II. When she described bipolar II, I had to nearly bite the inside of my check to stop myself from saying, "that's not just what life is like for most people?" She described me: stretches of depression punctuated by what she called hypomania: not full manic episodes, which is what I had always associated with the diagnosis, but periods where you are creative, don't sleep as much, feel euphoric, and you make impulsive, sometimes really bad, decisions.

I came home and read a bit about it and I am pretty sure that this describes me. Every single time I have gotten into a romantic relationship, I've had this same feeling the weeks leading up to it. Speedy, doing an amazing job at work, not sleeping as much, and then I usually go and meet a man and have sex with him very soon after meeting and start up with them, all the while continuing to do a great job in my daily life at work. And then the depression kicks in and things all get dark again, for years. Once I cheated on a boyfriend for no reason at all during a particularly weird speedy time in my life that I have not been able to understand even to this day. I don't know. I really think that I might have bipolar II. I have taken two SSRIs in the past with no great effect, other than that I feel like I am a tamped down version of myself.

I also have a lot of medical issues that are kept pretty well in control (not mental health) so I have lots of experience with doctors. I know that telling them what I think is wrong with me usually results in pushback and denial. But I really think this is a missing puzzle piece in my life, and I want to get to the bottom of it with this psychiatrist. To be honest I think I had a hypomanic episode about two weeks ago and I made some strange and usually uncharacteristic life choices that I am now trying to get used to.

If you have been diagnosed with bipolar II, how did that go? Did you suspect it at first and tell your doctor? Did they diagnose you without you knowing anything about it first? And is your life better now that you have a diagnosis? Or is this going to be a constant life struggle for me? I am in my 30s and I do not want to keep doing this with my life, having brief moments where I shine like a bright flame and do amazing or strange/stupid things followed by long periods of darkness. This isn't really what life is like for everyone?
posted by anonymous to Health & Fitness (11 answers total) 4 users marked this as a favorite
It took a long time for me to get to a bipolar II diagnosis. I think a lot of that was down to the fact that I'm in England and mental health resources are limited and primary care doctors generally seem less up to date on how bipolar diagnosis has changed in recent years. A huge barrier for me was a series of GPs essentially saying "I don't recognise the hypomania you're reporting as the bipolar mania I was taught to identify so you're not bipolar". My hypomania is generally super mild and it was never the symptom I was reporting in with (depression, always depression) so it took a long time to get picked up.

In the end I made a graph showing my mood from 2001-2014 (it was spiky as hell) and showed it to a sympathetic GP and she referred me for a psych evaluation (my second: the first also said I didn't have bipolar after talking to me on the phone for twenty minutes). It also took fucking some stuff up at work and needing to take time off to get the evaluation expedited, and I think the fact that things were obviously getting more severe then helped with getting diagnosed.

I've been taking lithium for a couple of years and it's okay. There are only three licensed drugs for bipolar depression in the UK; seroquel was awful (for me; intense thoughts of hurting myself and it didn't do anything for my mood) and I got a-rash-but-not-THE-rash twice while trying lamotrigine, which is apparently enough to mean I shouldn't take it again. So it's lithium or bust, and lithium is okay but not a miracle cure.

I'm not in my 30s yet so I can't speak for how this goes on as you get older, but in terms of "is your life better now that you have a diagnosis" - kinda yes and no but overall not hugely. I'm marginally more stable now than I have been for the last few years but the last few years have been particularly bad for cycling. I still feel low/meh a lot of the time, and kind of diminished as a person - like I'm never going to live up to the potential I had as a teenager because I'm a lot more broken and jaded and tired and negative as a person now than I might have been if I hadn't been undiagnosed/incorrectly medicated for around fifteen years. There hasn't been a magical sunshine moment where everything has felt better/more manageable as a result of the diagnosis or med changes.

Some of this might again be the UK treatment approach - very few of the doctors I've seen are interested in getting me anywhere beyond functional enough to go to work and do normal stuff. It doesn't seem to be an issue worth investigating that I still don't feel great a lot of the time, and I've semi given up on pursuing it more aggressively - I just swallow the lithium and ride out the cycling as best I can.

I'm coming to terms with the idea that the aim of treatment might be "make this more survivable" rather than "make me function like someone who doesn't have bipolar". My life is not terrible (good career, partner, etc.), but I also don't really enjoy being alive and would quite possibly choose not to be were it not for my loved ones. It's been hard and stressful and nowhere near rewarding enough to make up for that so far.

The one thing that's been really useful is therapy, and it sounds like you're on that already. It's doing a much better job of addressing/filling some of the holes in me than medication or a change of diagnosis did.
posted by terretu at 3:41 AM on June 25, 2016 [2 favorites]

I got my diagnosis in the hospital after a suicide attempt; I'd been incorrectly diagnosed with garden-variety depression for years. The diagnosis made a huge difference for me - not just being on the right meds (I'm in the US, so unlike terretu, I had a lot of options and went through several combinations before we found something that worked), but mostly because I'm a geek with an analytical brain, and so once my psychiatrist and I were able to tease out what my triggers were, what the beginning of a slide into depression/mania looked like for me, etc., I had this huge set of data that I could (and do!) use to make my life a more stable place. It took years of meds and therapy and check-ins, but I'm now med-free. (I do still see a psychiatrist just to be on the safe side.)

When you do meet with the psychiatrist, it may help to start with a description of what you've been experiencing, rather than a flat out "I think this may be bipolar II" - though your results either way will depend on the doctor.

Best of luck to you!
posted by okayokayigive at 4:12 AM on June 25, 2016 [2 favorites]

My inpatient therapist strongly suspected that I had some flavor of bipolar disorder when I was 15 years old, but it was not possible to officially diagnose anyone under 18 with bipolar anything in the early 90's. I'm not sure if this has changed. Regardless, I was placed on lithium as a teenager. After I stopped doing regular blood work due to loss of health insurance I also stopped taking lithium. Then I was on a series of crappy health insurance plans that gave me 3 psych visits a year, so I didn't pursue official diagnosis. When I was placed on disability I sort of muddled along without diagnosis or treatment until a suicide attempt landed me in a psych emergency room. At that point I got a referral to a psychiatrist who performed diagnostic testing and gave me a bipolar II diagnosis. She went with bipolar II because I only had one episode that might be described as true mania but was complicated by other factors--my age the time, which was 17, comorbid diagnoses including borderline personality disorder, and a general tendency to mostly be depressed with infrequent periods of increased activity, lack of sleep, etc.

I'm going to be brutally honest, here. Bipolar II is definitely treatable but it can be very difficult to settle on the right drug cocktail. I've been on three different mood stabilizers, benzos, every single flavor of antidepressants from SSRIs to tricyclics, and various antipsychotics in a vast array of combinations over a period of 20 years. For me, nothing has worked for more than 18 months and I am now officially treatment resistant. For bipolar II, the seizure medications as mood stabilizers (Lamictal, for example) seem to be the the thing--lithium is becoming a bit less commonly prescribed for BP-II. If those work for you, they are like magic in pill form. You will pretty much become a Normal Human Being once your dose is stabilized and it gives you tons of room to work on mood/trigger charting, CBT, mindfulness, all the things that help you manage the disorder. But if that medication stops working, as it did for me, there's not much else to turn to. For various reasons, I have rejected other medications that have tardive dyskinesia as a side effect and I have also rejected electroconvulsive shock therapy. That's on me--there are plenty of people with treatment resistant bipolar II who do elect to try those things and some do find that the relief is worth the side effects.

My question history will reveal that bipolar II has ruined my life and I fully expect it to kill me one day. However, I am not typical. If you search Ask you will find tons of stories of people with bipolar II who have found relief and made a great life for themselves after medication and working a successful therapeutic program. Having a great support network is super helpful.
posted by xyzzy at 4:52 AM on June 25, 2016 [1 favorite]

I was given a diagnosis of bipolar II when I was 32. For years I'd being treated for depression and anxiety - despite having periods of feeling high and distractable since I was a teen, and knowing I wasn't quite "right" during those times. The crunch point came when I was put on Sertraline and reacted to it badly, including some mild hallucinations. I reported to the GP (I'm based in the UK) and unfortunately there was a totally clueless locum on duty that day. She told me I couldn't possibly be bipolar because patients with bipolar disorder weren't capable of attending doctors' appointments alone. When I said I'd been hallucinating she asked if I was hearing voices. I said no, and she said she didn't see any reason to revisit my diagnosis. She also heavily implied I was concealing a recreational drugs habit that would account for my symptoms.

However: I went back when my regular GP was on duty, and he was much more sensible. He referred me to a psychiatrist for assessment. When I spoke to the psychiatrist I didn't say I thought it was bipolar, I just described my symptoms - although I did say that my grandmother was diagnosed with what was once manic depression, and my uncle on the same side was schizophrenic (bipolar and schizophrenia tend to show up in the same families). The psychiatrist took a detailed history and looked at my mood charts before giving me a bipolar diagnosis. She tried me on lamotrigine, then took me off when I got a rash. After that I went back on sertraline, but with a low dose of olanzapine to ward off hypomania. That was three years ago, and it's working well for me so far.

Diagnosis has improved my life. This combination of medication doesn't remove all my symptoms, but I'm functioning better than ever before and I feel I understand myself better too. It's such a relief to be stable.
posted by Ballad of Peckham Rye at 5:29 AM on June 25, 2016

I also have a lot of medical issues that are kept pretty well in control (not mental health) so I have lots of experience with doctors. I know that telling them what I think is wrong with me usually results in pushback and denial. But I really think this is a missing puzzle piece in my life, and I want to get to the bottom of it with this psychiatrist.

As okayokayigive said, the best way in general to do this is to talk about your symptoms, rather than a diagnosis. If it were me, when I met with the psychiatrist I'd start with the hypomanic symptoms, especially the ones negatively affecting your life (sexual impulsivity, lack of sleep), in order to put the possibility of Bipolar Disorder out there quickly and to make sure they don't focus exclusively on depression. It might also be helpful if you could figure out how long these episodes last, in general, and how often they occur.

With the therapist, I'd just bring it up pretty much as you did here.

Some of the struggle with getting Bipolar II Disorder diagnosed is that clients/patients often seek help for the depressive episodes but either like the hypomanic episodes and don't see them as a problem, so they don't bring them up in treatment, or don't realize the hypomanic episodes are unusual, so they don't bring them up in treatment. If you can bring up these symptoms with your psychiatrist and therapist, figuring out the right next steps will be much easier.
posted by lazuli at 9:52 AM on June 25, 2016

It took an episode of hypomania in my early 30s for psychiatrist to switch my diagnosis from depression (which it was for 15 years) to bipolar II. Frankly it was like opening a window and seeing the sun for the first time. Years of treatment for depression and anxiety (talk therapy, CBT, and drugs) had gotten me to a tolerable level but I still felt drained, unfocussed, and withdrawn. My doctor looked at all of my symptoms individually and put together a treatment plan that tackled one thing at a time. Make notes about how you've been over the past few months and bring those to your appointments. Track how it connects to any other medical issues you have, too. When I got the bipolar II diagnosis I also did a sleep study and found out that sleep apnea was another factor in my constant exhaustion.

Having the right diagnosis opened new treatment options and made me feel less isolated because there are a lot of us. Yeah it still sucks and there are side effects and I'm going to be on pills for the rest of my life, but I feel like I have a life now. Life isn't like this for everyone. People who don't have to deal with this really have no idea how fucking lucky they are and they usually do not understand the amount of effort it takes for some folks to get through it.

It helped that I responded well to the medications, but even with that it's taken years to get the right cocktail. Best resource I've found for learning about the drug is There's also research on how nutrition can help, specific vitamins and stuff.

Finding the right doctor is exhausting but 100% critical for success. Memail me if you want to talk about anything--I respect if you want to stay anonymous, too.
posted by mrcrow at 10:09 AM on June 25, 2016 [2 favorites]

FWIW, in case you, or anyone else reading, are in the UK and feel discouraged by terretu's crappy experience, I've had mental health discussions with GPs who did know exactly what Bipolar II was, so they are out there. I think/hope doctors' knowledge and receptiveness is improving, but it definitely varies between GPs.

If you find yourself totally up against a brick wall, it can be worth trying someone else. I've got more of an anxiety/depression flavour of issue, but I was fortunate that my regular, pleasant but uninspired GP was on holiday once when I was trying to find the right medication. I made an appointment with one of the other GPs at the practice and found she was much better.
posted by smock puppet at 10:38 AM on June 25, 2016

I'm in the UK too. I don't have an official bipolar II diagnosis but I was prescribed bipolar meds when nothing else worked to treat my depression. I don't know if I'm I or II but the meds fixed my depression and helped with a lot of my anxiety issues.
posted by Chenko at 11:33 AM on June 25, 2016

and I do not want to keep doing this with my life, having brief moments where I shine like a bright flame and do amazing or strange/stupid things followed by long periods of darkness. This isn't really what life is like for everyone?

Everyone, no. Many? Yes. Me? Yesno.

My diagnosis is slightly different but I also believe the Bipolar-whatever diagnosis is all part of a spectrum where treatment plans may be different for the I or II bit but all share similar characteristics.

I was diagnosed 25ish years ago and gotta be honest, my experience has been that finding a workable, useful medication support plan has been fairly shitty across the board for the majority of those years. It's daunting. So many meds were ineffective or had unbearable side effects. Also, it is worth mentioning that many people with the diagnosis find that things simmer down a little the older they get, which you also may find to be true down the line.

Meds, a solid psychiatrist, a trustworthy therapist, supportive loved ones, DBT groups, all have been helpful when used in conjunction with all the other pieces but it really does take the whole bunch to make it work.

Resist the inclination to self-diagnose by reading every possible globalnets story that contains the word 'bipolar'. Most of it is bullshit, much of it is inaccurate, and a high percentage is written by people who have self-diagnosed by reading every possible globalnets story that contains the word 'bipolar'. Now that you have established your symptom bread crumb trail, take that information to a reputable M H professional, lay it out and let them use all that specialized training to help figure out your next steps. Nthing crazymeds as a really useful tool.

I encourage you to be amazing during the times when you're firing on all cylinders plus a few extra, and be patient and brave when you're slogging through a rough patch. You are absolutely not worthless, friend.
posted by mcbeth at 1:02 PM on June 25, 2016 [2 favorites]

My partner's first BP diagnosis, after years of other misdiagnoses, came from his GP and he was so hypomanic that he dismissed it at the time and has literally no recollection of it now; only some email trails I have show that conversation ever happened.

He got diagnosed again a year or so later by a psychiatrist. In neither case was he seeking the diagnosis,

Things have been definitely up and down since, which he's described to me as being partly about a reluctance to accept the dx at first, largely for stigma reasons. In more recent years he's found more peace with the diagnosis and has found an array of supports that, all together, keep him doing mostly okay. I know he still misses some things that were part of his life when he was more hypomanic, that aren't anymore. Finding the right meds was a long and painful challenge, although that's fairly well sorted out now.

It seems from the outside that one of the biggest benefits of having the diagnosis was then starting to go to a support group for people with that diagnosis, which greatly lessened his isolation and helped him understand more about how his experience was like others'.

If there's someone in your life you trust to talk about this with, I wonder if you might find it useful to talk with them. I know when my partner first came home with that initial dx, I did some research and definitely went holy shit that is 100% him, due to some things he wasn't even consciously aware that he did. It might be useful or interesting to find out if someone with an outside view of you has noticed behaviors or patterns that back up what you feel, that you could then also take to a psychiatrist.
posted by Stacey at 8:52 PM on June 25, 2016

I'll lead with: unlike mcbeth, I tried Lamotrigine right out of the gate and it's worked amazingly well for me. Meds are such a crapshoot, but not every story is a horror story. Get a psychiatrist you look forward to seeing, who listens to you, because that's really the only way to play an active role in your meds. Self-care is huge. Therapy isn't so important for managing bipolar so much as it is coping with it. Managing it requires good sleep, good diet, consistent exercise, controlling/limiting caffeine intake.

I was diagnosed in 2013 after my GP referred me to the ER to expedite a psych referral. He'd given me an SSRI a few months earlier because we thought my several months of depression were, well, depression. The SSRI kicked me into an SSRI-induced hypomanic episode that bordered on mania. It lasted for a few months and by the time I got to him again I was in an agitated depression and thinking about suicide pretty much constantly.

I was referred to a total jackass psychiatrist who thought I had depression because I was depressed at our first visit, never mind my relaying the past few months to him. After I'd been seeing him for few months he went on vacation and left no emergency contact. I started another hypomanic episode (thankfully a cheerful one), had to go to a psych ER, then afterward I asked around and got myself on a ridiculously long waiting list for a fantastic psychiatrist I love to death.

When I'm hypomanic I'm energetic, productive, creative and hilarious. Then I go into an agitated depression where I have all that same energy but intensified and all I can think about is suicide and actually doing something about it. Then I totally crash and I'm still only thinking of death but at least I have no energy to act.

I haven't had a cycle since the trip to the psych ER 3 years ago. I recently crashed from a really high-energy period though, and I don't know if I'm having a small cycle or if it's just stress right now. I was extremely isolated when I was diagnosed, and hopefully now that I'm in a relationship I'll at least have a consistent connection with someone who knows me well enough to tell if I start staging a coup to be mayor of Bananatown again.
posted by good lorneing at 7:48 PM on June 26, 2016

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