Polypharmacy is pretty common in Bipolar. The only thing I would look at is whether your treatment is following any specific guidelines or if the psychiatrist is just throwing medications at symptoms willy nilly. For example, what was tried before Celexa was added? Generally, antidepressants can cause mood instability in Bipolar or they just don't work effectively against depression. That isn't to say they never work - I take an antidepressant - but they are not supposed to be an initial treatment for Bipolar depression.
I was on just antidepressants from my primary doctor for years before I saw my psychiatrist and they would work for a bit then I would fall back into a deep depression again. Celexa was the one I was on before and when I paired it with a mood stabilizer I found it worked better. I still have paranoid delusions even with the combination of the ssri and mood stabilizer so I was prescribed abilify. Thank you for your perspective I will definitely figure out a way to ask about a guideline.
I am also curious what he has said about your delusions. Generally delusions outside of a mood to episode would = schizoaffective Disorder. Are you currently in a depressive episode?
It wouldn't change your diagnosis because one of the criteria of a manic episode is, "The episode is not attributable to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or another medical condition.".
Depends on the symptom. My psychotic symptoms usually respond very quickly to medications - probably within 3-4 days. My depressive symptoms can take weeks to months to respond.
I can't think of a depressive episode that had ever been triggered by a life event. I mean, I have been bummed out by something that had happened in my life, but I didn't have a depressive episode because of it. My depressive episodes seem to be pretty random.
Have you explored the possibility of having a comorbid condition with Bipolar Disorder? BPD and ADHD both can mess with emotional regulation, and self-harm is common with both due to impulsivity paired with the dysregulation.
my team wants to hold off on diagnosing me with a personality disorder of any kind because im so young. they think it’s a big disorder to slap on a young person
I 100% agree. I don't like the idea of diagnosing anyone with a personality disorder under 25, although awareness around the traits is probably still a good idea. Sounds like you have a solid team.
It is difficult to tell, because even without treatment, people with Borderline Personality disorder often go into long term remission as they age. So you might have had it back then, but it sounds like you certainly do not have it anymore.
Thanks for the comment. I’m more so concerned with why my mom (she controls the family) thinks the 2015 diagnosis is…more credible…than the diagnoses of three different psychiatrists in the past 8 years. I think I worded this post weird.
I wonder if your mother is able to justify the state of her relationship with you by attributing it to your BPD diagnosis. Maybe if she accepts that you never had BPD, she will have to face the fact that the deterioration of her relationship with you is, in part, due to her actions. That might be a lot for her to accept and so instead she just continues to believe that the troubles between you are due to your mental illness, specifically BPD.
ADHD medication has increased my quality of life immeasurably. It also supports my Bipolar management by supporting my ability to adhere to structure and routines. The lifestyle modifications that are best for Bipolar are so tough if you have ADHD, so treating it can be essential for a lot of people. Treating my ADHD also eliminated my anxiety diagnosis. Turns out my anxiety could be attributed to ADHD struggles all along, and when I treated my ADHD I no longer experienced symptoms of anxiety.
It was awhile back but somewhere around 375-425 mg. My current psychiatrist would only go up to 200 mg unless the person also has epilepsy. He wasn't impressed with that high of a dose.
Do you know what is the difference between akathisia and mixed state? (Not medically; I mean in terms of how they feel). When I was searching for my symptoms, I identified more with akathisia but my dr thinks I had a mixed state. (I was severely agitated, couldn’t sit still, wanted to kms, bursting out of my skin, restless, zero sleep and appetite, constant pacing etc, plus terror/despair/doom/dissociation).
Akathisia is generally a completely physical feeling, although in can coincide with mood changes. Abilify gives me very dark anxiety along with akathisia, but I usually get the akathisia first before the anxiety sets in. So I guess what I am saying is that akathisia itself has nothing to do with the mood, it is purely physical, but that you can still have a mood episode at the same time as akathisia, or you could have had just a mixed episode.
Yeah that’s the problem; my symptoms fit both. Can akathisia present itself in absence of any medication? I did start to have these symptoms before I started taking anything.
I would feel the same way. My psychiatrist leans into the fact that I over-research everything. Like for the last medication, he gave me the name of it and said, "Read up on it and chat with your pharmacist, and we can discuss the possibility of trying it at your next appointment.". Honestly, I trust the guy to make the best choices for me, but I trust him even more because he respects me enough to let me feel like my opinions and feelings matter.
My depression tends to hit like that - sudden, zero warning, seemingly no trigger. Luckily, if you are on the right medication for you, it should lessen the length and severity of your episode. In this case, it sounds like your meds did their job!
Honestly, I have always had this "symptom". I always thought it was perfectly normal until it went away when I started a solid medication regimen. It comes back if I miss a couple of doses or if I am under a lot of physical and emotional stress.
It’s pretty common. For me it’s not a decrease in the amount of sleep I get, but I go to bed at much later times. When I’m depressed, I go to bed at like 11 or 12. But if I’m manic I go to bed at like 4 in the morning. Still get the same amount of sleep just different times
Yes!!! I put on my mood tracker "Circadian Rhythm shift" as a sign of impending mania. When I didn't have a full-time job, my 10 pm bedtime would suddenly shift to two or three am.
The one I got the most was "Too much of a disparity between her intelligence and her emotional maturity". I know this isn't a diagnosis, but so many professionals said it to my parents when I was a teen that it is almost laughable.
I wouldn't self diagnose, but I also wouldn't let my psychiatrist dodge the question. Be ready to ask the question in a few different ways: "Do you have a current diagnosis listed on my chart? What is it?" "I noticed that these medications are frequently used to treat Bipolar disorder. Do you think I have Bipolar disorder?" "Based on my current symptomology and how I have responded to the medications, what condition do you think I have?" "What are you referring to my condition as a "mood disorder". What about my presentation prevents you from identifying my condition as specifically depression or specifically bipolar?"
Polypharmacy is pretty common in Bipolar. The only thing I would look at is whether your treatment is following any specific guidelines or if the psychiatrist is just throwing medications at symptoms willy nilly. For example, what was tried before Celexa was added? Generally, antidepressants can cause mood instability in Bipolar or they just don't work effectively against depression. That isn't to say they never work - I take an antidepressant - but they are not supposed to be an initial treatment for Bipolar depression.
I was on just antidepressants from my primary doctor for years before I saw my psychiatrist and they would work for a bit then I would fall back into a deep depression again. Celexa was the one I was on before and when I paired it with a mood stabilizer I found it worked better. I still have paranoid delusions even with the combination of the ssri and mood stabilizer so I was prescribed abilify. Thank you for your perspective I will definitely figure out a way to ask about a guideline.
I am also curious what he has said about your delusions. Generally delusions outside of a mood to episode would = schizoaffective Disorder. Are you currently in a depressive episode?
It wouldn't change your diagnosis because one of the criteria of a manic episode is, "The episode is not attributable to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or another medical condition.".
Depends on the symptom. My psychotic symptoms usually respond very quickly to medications - probably within 3-4 days. My depressive symptoms can take weeks to months to respond.
I can't think of a depressive episode that had ever been triggered by a life event. I mean, I have been bummed out by something that had happened in my life, but I didn't have a depressive episode because of it. My depressive episodes seem to be pretty random.
of course, i understand manía isn’t a one sized fits all kind of deal. i just mis understood your previous answer. thank you guys for educating me
Have you explored the possibility of having a comorbid condition with Bipolar Disorder? BPD and ADHD both can mess with emotional regulation, and self-harm is common with both due to impulsivity paired with the dysregulation.
my team wants to hold off on diagnosing me with a personality disorder of any kind because im so young. they think it’s a big disorder to slap on a young person
I 100% agree. I don't like the idea of diagnosing anyone with a personality disorder under 25, although awareness around the traits is probably still a good idea. Sounds like you have a solid team.
It is difficult to tell, because even without treatment, people with Borderline Personality disorder often go into long term remission as they age. So you might have had it back then, but it sounds like you certainly do not have it anymore.
Thanks for the comment. I’m more so concerned with why my mom (she controls the family) thinks the 2015 diagnosis is…more credible…than the diagnoses of three different psychiatrists in the past 8 years. I think I worded this post weird.
I wonder if your mother is able to justify the state of her relationship with you by attributing it to your BPD diagnosis. Maybe if she accepts that you never had BPD, she will have to face the fact that the deterioration of her relationship with you is, in part, due to her actions. That might be a lot for her to accept and so instead she just continues to believe that the troubles between you are due to your mental illness, specifically BPD.
ADHD medication has increased my quality of life immeasurably. It also supports my Bipolar management by supporting my ability to adhere to structure and routines. The lifestyle modifications that are best for Bipolar are so tough if you have ADHD, so treating it can be essential for a lot of people. Treating my ADHD also eliminated my anxiety diagnosis. Turns out my anxiety could be attributed to ADHD struggles all along, and when I treated my ADHD I no longer experienced symptoms of anxiety.
I'm torn.
How much were you on? I’m on 150mg and don’t notice any cognitive decline
It was awhile back but somewhere around 375-425 mg. My current psychiatrist would only go up to 200 mg unless the person also has epilepsy. He wasn't impressed with that high of a dose.
Your current psychiatrist is right. Maybe lower dose won’t cause it? Lamotrigine is very helpful for many bipolar
I found it helped with the depression, but not much else.
Do you know what is the difference between akathisia and mixed state? (Not medically; I mean in terms of how they feel). When I was searching for my symptoms, I identified more with akathisia but my dr thinks I had a mixed state. (I was severely agitated, couldn’t sit still, wanted to kms, bursting out of my skin, restless, zero sleep and appetite, constant pacing etc, plus terror/despair/doom/dissociation).
Akathisia is generally a completely physical feeling, although in can coincide with mood changes. Abilify gives me very dark anxiety along with akathisia, but I usually get the akathisia first before the anxiety sets in. So I guess what I am saying is that akathisia itself has nothing to do with the mood, it is purely physical, but that you can still have a mood episode at the same time as akathisia, or you could have had just a mixed episode.
Yeah that’s the problem; my symptoms fit both. Can akathisia present itself in absence of any medication? I did start to have these symptoms before I started taking anything.
I think akathisia is specific as a medication side effect. Sounds more like a mixed episode to me.
I would feel the same way. My psychiatrist leans into the fact that I over-research everything. Like for the last medication, he gave me the name of it and said, "Read up on it and chat with your pharmacist, and we can discuss the possibility of trying it at your next appointment.". Honestly, I trust the guy to make the best choices for me, but I trust him even more because he respects me enough to let me feel like my opinions and feelings matter.
Nope, I would just find a new therapist.
My depression tends to hit like that - sudden, zero warning, seemingly no trigger. Luckily, if you are on the right medication for you, it should lessen the length and severity of your episode. In this case, it sounds like your meds did their job!
I love your tips, but they aren't necessarily evidence based for the whole population.
I have always been like this, and then certain medications made it far worse. I have no tips, but I can relate and it truly does suck.
Honestly, I have always had this "symptom". I always thought it was perfectly normal until it went away when I started a solid medication regimen. It comes back if I miss a couple of doses or if I am under a lot of physical and emotional stress.
It’s pretty common. For me it’s not a decrease in the amount of sleep I get, but I go to bed at much later times. When I’m depressed, I go to bed at like 11 or 12. But if I’m manic I go to bed at like 4 in the morning. Still get the same amount of sleep just different times
Yes!!! I put on my mood tracker "Circadian Rhythm shift" as a sign of impending mania. When I didn't have a full-time job, my 10 pm bedtime would suddenly shift to two or three am.
Sort of.
The one I got the most was "Too much of a disparity between her intelligence and her emotional maturity". I know this isn't a diagnosis, but so many professionals said it to my parents when I was a teen that it is almost laughable.
how does co-occurring adhd affect bipolar symptoms?
I wouldn't self diagnose, but I also wouldn't let my psychiatrist dodge the question. Be ready to ask the question in a few different ways: "Do you have a current diagnosis listed on my chart? What is it?" "I noticed that these medications are frequently used to treat Bipolar disorder. Do you think I have Bipolar disorder?" "Based on my current symptomology and how I have responded to the medications, what condition do you think I have?" "What are you referring to my condition as a "mood disorder". What about my presentation prevents you from identifying my condition as specifically depression or specifically bipolar?"