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Psychologist Wants to Diagnose It As Bipolar!!

Yesterday my husband and I finally went to a dr for an ADHD diagnosis (I say finally because he finally agreed). But it did not go well. The lady we saw says she thinks he has Bipolar…based on racing thoughts, not being able to focus and hyperactivity (which she says is mania). And whenever we expressed doubts she referred back to Bipolar and then referred us to her manager (the main dr in the practice) for further examination and a final word on a diagnosis. Well when my husband hear the work “Bipolar” he basically shutdown and heard nothing else and doesn’t want to go back. I can’t say I blame him. My mother is Bipolar and I’ve lived with that most of my life and I don’t see similarities at all (although I do know that every individual is different). It makes me very angry that she basically blew this for us. It would’ve been one thing is she said that many times ADHD is misdiagnosed and she just wants to rule out all possibilities, but she was pretty stuck on Bipolar and when she handed my husbands chart to the lady at the front desk, it said “Bipolar” on it. He is very angry and thinks its a waste of time and money to proceed because no one gets him or his situation. I don’t want to push him, but I want him/us to get help and that can’t happen without a diagnosis.

Replies

I feel your frustration. After over a decade of seeing doctors and being treated for different primary diagnoses, a psychiatrist did a trial of ADHD medication, which for the first time in my history of treatment that I noticed a profound improvement in, not only symptoms, but my overall mindset and clarity. But immediately preceding this, I had been diagnosed with Bipolar. It didn’t seem to fit, although I learned that the symptoms of Bipolar and ADHD are very similar, and difficult to distinguish. My moods shift rapidly, I have racing thoughts, easily irritable, hyperactive or underactive (I’ve noticed a pattern of this depending on the time of day). I did not like the Bipolar medications I was given for periods of agitation/anxiety (such as risperdal and seroquel), as they made me so out of it, lack of energy, which made me feel more so depressed. I did find a mild benefit from Lamotrigine/Lamictal as it seemed to prevent me from very low moods. However, it didn’t seem to target my main day-to-day struggles.

I suppose I’m trying to get at: I know it must be difficult, but it may take some time, and doing trial medication to reveal to doctors what could really be going on. It was only after nothing seemed to work medication-wise, and regular visits to a talk-therapist that I had a comprehensive psychological evaluation done (includes lots of tests, executive functions… maybe different things depending on the clinic), in which the psychologist noted ADHD. The medication I am now on for ADHD controls the symptoms I had that were labeled Bipolar, although I know some doctors are wary of putting someone with possible Bipolar on stimulant medications due to the possible exacerbation of Bipolar symptoms. Maybe this is one way to tell the difference between the two. I don’t know if your husband has problematic mood swings, but this is definitely a feature of ADHD.

Well that was long, but I empathize with your struggle. I hope he does stick in there, because it can take some time, trials, and perhaps switching doctors.

Posted by BritJ on Mar 25, 2014 at 11:59pm

BritJ: I think we might be twins, right down to the lamictal being the only somewhat helpful bipolar med I took and it only helping with one thing—getting rid of those lowest of lows.

After analyzing/observing my twin boys (and comparing them to my known ADHD husband) I decided that my medical education was somewhat lacking (I’m a PA), and I needed to learn more about ADHD.  That’s when I realized exactly what parts of that “type II bipolar, rapid-cycling” diagnosis had been misinterpreted/misexplained so many years prior.  For one thing: how does one truly differentiate where exactly “rapid thoughts” end and “racing thoughts” begin?  If someone could build a machine that would track the speed of thoughts and then determine exactly how fast they need to be to qualify for “racing” that person would save a lot of people from going down that ugly road of ADHD being diagnosed as bipolar…(and my gaining 63 pounds while on Depakote).

OP: I don’t blame your husband for freaking out and not wanting to go back there again.  My advice is DO NOT go back there again; get a second opinion from someone else who is not completely closed minded, and do some more research and lots of thinking & preparation before you go. 

Here’s why I give that advice: When I had my AHA moment after reading about all the various different presentations of ADHD in kids, adults, boys, girls, high IQ, low IQ, etc it was clear as day to me all the little things that had been observed & reported by me as being one thing, had then been interpreted through only the filter of Does This Qualify As Bipolar Type II (since it was back at a time when mental health practitioners were much less aware of Adult ADHD in general and many mental health practitioners were completely ignorant), then diagnosed as such because neither I nor my mental health provider even considered ADHD for one nanosecond.

A couple more providers down the line later, I walk into my current shrink’s office with an “official diagnosis” stamped on my forehead and we continue to view it through only that same filter for a few more years.  When I presented him with my AHA moment (and new diagnosis) I was a little bit scared he’d think I was just that bipolar nut-case who is technically a PA but who is clearly a bit delusional now thinking she really has ADHD.  So, of course, I did my homework WELL before I went.  I was pleasantly surprised to find out that it didn’t take much for him to 100% concur that my new diagnosis was correct.  I was mortified when there was nothing I could possibly say to convince him that his new “official diagnosis” was 100% wrong (bipolar type II and co-morbid ADHD).  But that didn’t stop me from returning to that exact same subject every 3 months and dumping every single minute factoid I’d come across or thought of in the interim on his desk, so to speak.  After a number of visits he finally relented that everything I had now added to this discussion could, in fact, indicate that it was only ADHD all along.  He/we had gone through my chart with a fine-toothed comb by then.  I thought I had “won” until he said, “There’s only one thing that makes me know for sure you are bipolar, and it is the way you talk.  I’ve been around a lot of bipolar people over the past X years and ONLY people who are bipolar talk like you do.”

I could immediately now clearly “see” what the REAL problem was—he was now misinterpreting my passionate debates as being “pressured speech.”

I, as a physician assistant, had been fighting tooth and nail to get that erroneous bipolar diagnosis dropped from “my patient’s” file, and I was becoming increasingly frustrated, not to mention increasingly impatient, at the length and depth and breadth of our continued academic debate over something that I, as the only person who has actually ever been inside my own head, knew for sure I was right about.

So I left that appointment with a new homework assignment.  I had 3 months to remind myself over and over again DAILY that I didn’t care how long this debate was going to drag on, and I had to actually believe it; if it took me the next year to fully “educate” him on all the nuances of Adult ADHD then so be it, but I was going to win this intellectual challenge—eventually.  In the process, I figured I’d simply have to flex my ADHD muscles, and learn how to become vastly less impatient…and remember to never, ever interrupt him…or change gears mid-sentence…or loose my train of thought…or throw in some random factoid…or go all motor-mouth over a topic of interest…Oh, God, this was going to be a HUGE challenge!

And only God remembers how long it actually took me to show him that I can “sound bipolar” if I’m excited or anxious (or pissed off) while running on auto-pilot or I can “sound” normal as long as I am calm, centered, and paying full attention the whole entire time to nothing but that.  And it was probably better if I ended up being unable to pay attention or recall much of the actual content of our debates (since all of my focus was going to be on minding my manners and trying to “sound completely normal”) because replaying some of the occasional asinine things he said which only seemed to prove how little he knew about adult ADHD later on in my head would only get me more irritated with him, thereby decreasing my chances at achieving that calm demeanor at some future visit.

Eventually my effort was rewarded in that he agreed to very slowly titrate my bipolar meds down to zero and “watch me like a hawk.”  Over a year later, now off all mood-stabilizers and taking only Vyvanse, he finally conceded the debate, and was even big enough to admit that he SAW bipolar all those years because of nothing but the filter of me having a pre-existing diagnosis which he simply never even thought to question himself.

In an ideal world I might change doctors to one who knows more about ADHD and is not clear on the other side of town.  But as long as he and I continue to live in the same town I’m going to continue to walk into his office every three months for my Vyvanse prescription to be his constant visual reminder of how ADHD can present in adults—potentially a lot like bipolar unless you are willing to go through their history with a fine-toothed comb and remember to take off your blinders.

Posted by BC on Mar 26, 2014 at 8:59am

I’ve heard that if you use the word “racing” to describe thoughts, psychologists will jump to bipolar.

Try to convince your husband to go to someone else and this time use different words. It sounds so stupid, I know, but apparently it works this way.

Posted by LLB827 on Mar 28, 2014 at 1:55am

Ask for a second opinion.  You are entitled to that, and while there are some similarities between ADHD and bipolarism, they are by no means the same.  A proper diagnosis can take a long time; this is the brain we’re talking about, they are all unique, and doctors are just beginning to realize how much they know and how much more they don’t know.  Keep at it!

Posted by CombatTVgirl on Apr 03, 2014 at 11:30pm

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