View Full Version : Is it worth getting a second opinion?


Fuzzy12
01-02-13, 09:43 AM
First a bit of history for those who don't know me:

I've been depressed for the last 9 years. Beginning of last year I started taking anti depressants. I've tried three different anti-depressants at all possible dosages. Currently, I'm taking duloxetine 60mg. The anti depressants have helped with negative obsessive self talk but also made my mood swings worse. I'd go from feeling euphoric (and all the other hypomanic symptoms) to feeling suicidally depressed. I've always been very moody though, even before the depression started and before I started taking anti depressants. My GP suggested bipolar disorder. I saw a psychiatrist a few weeks ago who specialises in bipolar disorder and I was diagnosed with bipolar disorder type II.

I still doubt my diagnosis, mainly because it depends on the opinions and awareness of two highly subjective people, me and my psychiatrist. I keep wondering if I misrepresented my symptoms, if I exaggerated them or if I left out anything vital during the diagnosis. I do get hypomanic but to a rather mild extent (I believe). I'm definitely somewhere on the bipolar spectrum but I'm not sure if a diagnosis of bipolar II is warranted or if I really should start taking mood stabilisers.

The thing is, currently, I feel uncharacteristically normal. My mood is decent and fairly stable. I'm neither low nor high. I'm wondering if the anti depressants are sufficiently doing their job now. I think, the fact that I've tried three anti depressants and all at the maximum dosage without great results strengthened the case for bipolar disorder. But then, maybe I didn't give them enough time to work. I took each of them for a few months and everytime the anti-depressant effect reduced my GP either increased the dose or if the dose was already at the maximum changed my anti depressant. Maybe we've been too hasty. Maybe all I suffer from is really severe depression and slowly but gradually the anti depressants seem to be doing their job.

None of the psychiatrists I saw previously suspected bipolar disorder though I did tell them about my extreme mood swings.

But then I'm pretty sure my mother is bipolar (though she is diagnosed just with MDD) so it's likely that I have it too..at least to an extent.

My current stock of ADs will last for another month and before I start taking a mood stabiliser (lamotrigine) I have to undergo a battery of physical tests so I still have some time to decide.

If I really have bipolar disorder I'm willing to take the mood stabiliser but what if I don't? Maybe it's worth just trying them out but I'm worried about discontinuing my current anti depressant just when it's working fine.

Unmanagable
01-02-13, 10:20 AM
But is the AD really working fine?

Without having observed your symptoms while taking the mood stabilisers yet, you may find the ADs aren't as effective as you feel they now are.

Now that you have the diagnosis, I say go for it.

You'll drive yourself crazier every day until you answer all of the what ifs your mind keeps throwing at ya'.

Fuzzy12
01-02-13, 02:17 PM
But is the AD really working fine?

Without having observed your symptoms while taking the mood stabilisers yet, you may find the ADs aren't as effective as you feel they now are.

Now that you have the diagnosis, I say go for it.

You'll drive yourself crazier every day until you answer all of the what ifs your mind keeps throwing at ya'.

That's a very good point. Without trying mood stabilisers I really don't know if any further improvement is possible. I'm just worried about messing with something that works for me (at least currently..). Besides, if nothing else, I'm hugely curious about how I'll feel on a mood stabiliser. Thanks :)

crystal8080
01-02-13, 02:37 PM
I understand you are apprehensive about taking mood stabilisers. I think its too soon to ask for a second opinion. Give them a chance, you may be pleasantly surprised how much better they make you feel.

Its very common to deny having bipolar disorder. Have you heard of anosognosia? It happens. I'm sure you are just still trying to wrap your head around the idea, I know it took me a while. Hugs Fuzzy :)

saturday
01-02-13, 02:53 PM
Is it worth getting a second opinion?

Not until you try a mood stabilizer and are able to determine its effectiveness.

I'm definitely somewhere on the bipolar spectrum but I'm not sure if a diagnosis of bipolar II is warranted or if I really should start taking mood stabilisers.

Dont hyperfocus on the diagnosis. Treatment should be based on symptoms and not so much the name of your illness.

If I really have bipolar disorder I'm willing to take the mood stabilizer but what if I don't?

If you dont have bipolar and the mood stabilizers dont work then all you have to do is stop taking them.

Either way, bipolar spectrum or not, if the Lamotrigine helps then your one step further to being able to live life to your full ability.

Another possibility, if the mood stabilizer doesnt work consider taking an atypical antipsychotic drug like Abilify or one of the others. Mainy people benefit from adding atypical's to their regimen.

Fuzzy12
01-03-13, 08:19 AM
Thanks everyone for the inputs. :)

I understand you are apprehensive about taking mood stabilisers. I think its too soon to ask for a second opinion. Give them a chance, you may be pleasantly surprised how much better they make you feel.

Its very common to deny having bipolar disorder. Have you heard of anosognosia? It happens. I'm sure you are just still trying to wrap your head around the idea, I know it took me a while. Hugs Fuzzy :)

I had to look up the term. :o I think, I'm the exact opposite. I'm constantly hyper aware of my mental state and I'm afraid that this might be another reason why I did get diagnosed. Other people might not even notice the mood swings that I have or question them.

The psychiatrist kept asking me if my highs felt normal. I really don't know what normal is. How would I? How would anyone? All I can go by is the varying levels of my own mood and the descriptions of others, NTs i.e., of their moods. Based on that my highs don't feel normal but maybe that's just because I'm so aware of my mood swings. :scratch:

Another question of course is if I really am aware or do I just brood too much? I can't honestly say that I totally understand myself or my moods. I was hoping that the psychiatrist would help me figure out what is normal but I guess that's pretty difficult.

With my depression I know that it's not normal. My ADHD symptoms are not normal. I don't have the same confidence about my hypomanic episodes.

lamotrigine is supposed to help with depression so even if it works well treating the depression, it might not necessarily mean that I am bipolar. The thing is I don't mind. I mean, I don't mind the label. I'm not trying to get out of being labelled as bipolar. I just really want to understand what's going on in that crazy brain of mine. That's why the diagnosis and the labels for me are almost more important than treatment. :scratch:

tudorose
01-03-13, 08:57 AM
I think it must be pretty scary to be diagnosed with bipolar. In some ways ADHD seems like a 'safer' diagnosis (I really do see bipolar as much more severe and serious than ADHD). I would be scared if it was me. I think I'd be doubting it too but from everything you say I think the diagnosis might just be right.

I think if bipolar meds can give you some relief from the pain and anguish you've been suffering for so long then it's worth giving it a go. I mean it's really about getting some relief from it all.

ADHD meds don't give relief in that way. They just cause more anguish as you are suddenly lifted out of the blissful fog and into the harsh reality of life. To be honest I hate taking them but it's a necessary evil. I need a brain but they make feel like the world is going to come to an end unless I can channel that energy into something constructive.

I got 3 opinions for my ADHD (the psychiatrist was the third opinion) and even then I was doubtful at first. It took me a long time to come to terms with it.

You've been to see a bipolar specialist. I reckon he's have a better idea than most. Bipolar is a serious condition and not one to be diagnosed on a whim. He must have seen something in you that other people could not see. It's what he does so he'd be very familiar with it. If you'd gone to see any old psych then yeah I'd say get another opinion but you went to a specialist psych. If he misdiagnosed he's lose credibility so it's probably unlikely that he got it wrong.

Raye
01-03-13, 09:52 AM
IMO you should try the lamictal a.k.a lamotrigine. It is also used for hard to treat depression and I'm believing it works for me, when 20+ anti depressants over 12 years haven't worked at all.

If it doesn't work, there are other bi polar meds to consider talking with your doc about. Finding the right med combo is a difficult and long journey ( at least with me it was) but once you find something that clicks it's worth the wait. :grouphug::grouphug:

Fuzzy12
01-03-13, 10:36 AM
How come there doesn't have to be evidence of impairments caused by bipolar disorder for a diagnosis?

tudorose
01-03-13, 10:44 AM
How come there doesn't have to be evidence of impairments caused by bipolar disorder for a diagnosis?

Coz it's not about executive dysfunction. I know some really smart capable people with bipolar but they have unbelievable suffering because of the condition.

It's probably the anxiety and depression and mania that cause the drops in functioning rather than having a lack of functioning being the root cause (as I understand it - please correct me if I'm wrong).

crystal8080
01-03-13, 03:44 PM
How come there doesn't have to be evidence of impairments caused by bipolar disorder for a diagnosis?

Bipolar disorder is a mood disorder. There has to be evidence of mood dysregulation. That in itself causes impairments. You can admit that you have lows, how do those lows affect your life? How do your mood lows affect your relationships, work etc? Its impairing!

If the psychiatrist specializes in bipolar disorder he asked you questions to illicit responses, reactions, etc that he used as part of diagnosing you. It isn't all just face value asking you what you think and relying on your insight to make a diagnosis.

I think back to when I first met my pdoc, he was asking me about my childhood and I started getting teary and I said I'm sorry and tried not to cry then he started on most emphatically "well why not? its natural to cry!" or something like that and the way he said it made me react with dark irritability, I mean black. And I paused and snarled "Because I don't want to."
Scribble scribble scribble went his pen. He did other things like purposely interrupt me to see how I would react. Things like that. They do things to test you, and I'm with you I was (and am) hyper aware of myself but that is from anxiety.

keliza
01-12-13, 07:55 PM
The psychiatrist kept asking me if my highs felt normal. I really don't know what normal is. How would I? How would anyone? All I can go by is the varying levels of my own mood and the descriptions of others, NTs i.e., of their moods. Based on that my highs don't feel normal but maybe that's just because I'm so aware of my mood swings. :scratch:

You will when you get there. I was in my 20s before I even knew what a normal mood felt like. But when you're there, you'll know it. It doesn't smack you over the head the day you start taking the meds (by the way, Lamictal is an excellent antidepressant for either bipolar disorder or treatment-refractory depression, so either way I have high hopes for you with that drug). It will take time, a few weeks, but slowly you will become aware that things are just... better. You don't feel depressed and moody and tangled up inside all the time. The TVs in your head are quieter, or maybe even turned off. You'll probably sleep better. Euthymia is elusive and very difficult to pin down for very long, but it's a beautiful thing. You'll know it when you see it.

I'm really glad you're moving in the right direction with the medication. Do you have a therapist who you see regularly? Therapy and meds are both important components of overall wellness with bipolar disorder. Big hugs.

keliza
01-12-13, 07:58 PM
How come there doesn't have to be evidence of impairments caused by bipolar disorder for a diagnosis?

Because bipolar disorder doesn't impair executive functioning except during mood episodes, like major depressive episodes or manic episodes, or hypomanic episodes to a lesser extent sometimes. The disorder is episodic in nature. The episodes may last for a very, very long time, but they are just that, episodes. Impairment is not uncommon during episodes, because you're so tangled up in the mood episode that of course you're going to be a little cognitively impaired. But global impairments that impact a person even during euthymic episodes are generally minimal. It's not like ADHD, where the impairment is a constant, daily part of the disease. We're looking at spikes and dips, not a daily loss of functioning.

ebullient
01-21-13, 02:30 PM
Hello again :)

We have a very similar situation. I'm just a little further down the line, and hopefully your illness stops there.

I was depressed for a very long time (but I would have little periods where I'd feel a little better, so I wouldn't go to a doctor). When I did take an antidepressant it messed with my moods, but helped my depression. You asked:


How come there doesn't have to be evidence of impairments caused by bipolar disorder for a diagnosis?

Normally, they do. Well, for bipolar I they do. The reason I am diagnosed bipolar I right now is because I did something really stupid and it made them realize just how manic I was. I am mixed, so it would be years before they noticed how bad I really was - potentially - and I would probably be classified as bipolar II based on my symptoms...but it doesn't matter.

Any bipolar will make you probably go wonky with your moods when you take an anti depressant alone. That is probably why your GP sent you to a specialist, who should be caring for your mental illness anyhow. There are a million different ways medications interact, and if you can get to a good doctor- they are gold.

Now, here are the do's and dont's.
I really believe my doctor has changed my life. As a psychiatrist he doesn't do all of the little feelings, and one time prescribed me "psychotherapy". Go to a therapist, but trust your psychiatrist.

-Your psychiatrist cannot read your mind. All of what you said above? Your doubt about your diagnosis? About him? All of it, you need to tell him. They need to know where you are. No secrets. You won't get better if you have secrets. Try to remember when you feel up and when you feel down.
- Take every med, on time, every day. Have someone you are accountable to if you need to...something.
- You will periodically and often feel that in one way or another you aren't sick. This is the hardest part. It is the cruelest joke of the illness. It gets you every time. Write letters to yourself when you are well. Because you usually do the same things over and over, you can anticipate a lot of things, and you will only trust yourself in those moments and select people.
-Welcome to the world of trying to find bipolar meds. If you are bipolar II, it may be easier for you, but I kinda doubt it. For most bipolar people it takes over a year to find the right combo because of the cyclic nature of the illness, for some more than 10. So buckle in.
- Someone said that coming off a mood stabilizer above would be the worst that could happen. This is a good attitude, but you should know that these meds, when they work are God's very creations of mercy and give you your mind and sanity back. However, when you come off of them, and change from one to another it can be literal hell - incapacitating you for weeks sometimes. I'm not trying to be dramatic, but you should know that they can really screw with you in those times. But they've saved my life, and I think anyone who has a mental illness should unequivocally be on them because I believe in them that much.
uhmmm... oh yeah
Communicate like a son of a B about everything you like and dislike about every symptom you perceive you might have about a med. Communicate about everything.


Last but not least, get a second opinion if you want. If it will take your doubt away, there are worst things to indulge in.It's good to note though, that not all mental health professionals should be treated equally. I went to a psychologist when I was in my first high manic state. I was doing awful things, but I was able to put such a rational front. However, the emergency room knew when presented with the same evidence, and recommended I go to the hospital. Best thing that ever happened to me as far as my illness goes.
What I'm trying to say, is beware 'yes men' with bipolar.