Hello I believe I can help you with your concern of possibly being wrongly diagnosed
May I ask why you believe that you have been wrongly diagnosed and what symptoms you are currently experiencing?
Okay, I am sorry that you have been experiencing those symptoms. Well typically depakote is used to treat seizures (as seen in epilepsy) and to treat bipolar disorder (as it is very effective in helping relieve symptoms of both the manic and depressive phases). Rarely is it used to treat just major depressive disorder. Can I ask have you ever experienced the opposite of depression, like you were on top of the world, had racing thoughts, felt your were talking really fast, etc...
I definitely agree with you that sometimes bipolar disorder can be misdiagnosed as depression because the manic symptoms are often overlooked, the symptoms typically only present themselves for a couple weeks on average so they can be missed, and the medications can mask any bipolar symptoms. It sounds like that you have definitely experienced some symptoms that are commonly associated with mania. I went to a conference a few years back that discussed the comorbidity of depression, anxiety, and bipolar symptoms with individuals that have been diagnosed with epilepsy. Studies show that with individuals diagnosed with epilepsy are 6 times more likely to have symptoms of bipolar disorder,so I think the likelihood of bipolar disorder is definitely a strong possibility as you have suggested. In addition, depression and anxiety symptoms are also more prevalent as well, so I think your concern of your symptoms and a possible misdiagnosis is valid. I will attach the article here for you to read as well
One medication that I have seen help both the mood symtpoms and is also an anti-seizure medication is Lamictal.
The side effects are typically not as serious as the ones with Depakote, in case you wanted to try that as I believe you do not like the side effects of depakote.
I understand your frustration, but I think one reason why your psychiatrist doe not want you to stop the medicine is because the self-harm behavior, and suicidal/homicidal thoughts may return again and I think psychiatrist does not want to put you through that
You mentioned that you see a psychologist, you can ask to do a personality assessment (e.g. Personality Assessment Inventory (PAI) or Minnesota Multiphasic Personality Assessment (MMPI-2)) and this can provide objective evidence of manic behavior that may push your psychiatrist to agree that you have bipolar symptoms present.
i apologize i was having technical difficulties with my internet connection
i agree with everything you mentioned regarding depakote and the withdrawal effects and mania. unfortunately psychopharmacology is not an exact sciencevand there is a lot of trial and error. I would mention if lamictal is an option for you. Also you are right about the antipsychotic medication and you can ask if that will help the effectivness of the depakote. Risperdal had been shown to help the effectivness of depakote. And you can always ask for a second opinion from another physcian. This can provide you with a fresh perspective
Also are you on liquid depakote?
Okay sometimes liquid depakote is more effective, so you can also ask your psychiatrist about that.
Yeah unfortunately there may be a lot of trial and error and I know you feel like a guinea pig at time, but it may take some time to find the right medications for you and the right combination of medications
I think providing your physicians with options and new perspectives are a good way of approaching the situation
Every doctor I know will say to stay off the internet, but I think sometimes the internet can help a doctor see evidence that they did not think of. And sometimes doctors do not spend enough time with a patient or ask the right questions, and the patient may feel inclined to look on the internet for answers.
You can also print out that article I gave you and give it to your psychiatrist to read
Of course I can mention your symptoms and concerns to your psychiatrist, do you have an email address for him? Now due to medical privacy laws he will not be able to discuss your case with me, but I can give him information.
I can put it nicely in my email that you were just concerned about your symptoms and that sometimes you forget to mention these things in your appointments with him. Also professionals usually do not get offended when seeking a different opinion, they are just concerned about giving you the best treatment possible.
Sure I can call him later this afternoon around 1PM Pacific Standard Time
Yep I know what to do. Just some clarification questions, what is his name? And your name isXXXXX?
Oh wow, the number did not show up on the chat, i guess the website does not like phone numbers
Yes it did, okay I will make the call later in the afternoon. Most likely it will go to his voicemail, but I will still give the details of your concerns for him
Sure no problem, I will leave a message on the chat for you after I call
No problem, I am always happy to help
Sure, anytime. My goal is to help you
Do you have other symptoms that you have not mentioned yet?
Well can you describe to me the hallucinations that you feel you had?
Okay well I know you mentioned earlier that you thought these hallucinations could be a side effect of the Depakote, so that is always a possibility. Hearing music and sounds are not typical hallucinations of psychosis if that is your concern, typically auditory hallucinations are of voices speaking to you. The hearing of music and sounds could be caused by your medication or anxiety, or even both of them, but I would not be concerned of psychosis with those. The feeling of bugs crawling on you has been associated with your medication use, they are typically like tingling feelings like bugs. This side effect usually goes away in time. The bad smell is a common symptom of seizures and epilepsy, so I would not consider that a hallucination associated with psychosis. And lastly the people or things moving at the corner of you eye is called an illusion, it basically believing something is there when it is not...illusions are common and are experienced by everyone. A visual hallucination are usually right in front of you that you can see and no one else can see. For instance have you ever seen a beautiful mind with Russell Crowe, he had visual hallucinations of people right there in front of him that he could see straight away and not in the corner of your eye. I think a lot of these symptoms are associated with anxiety, possibly the anxiety of being misdiagnosed.
I think it is related to your anxiety, paranoia and anxiety often go hand in hand. Especially with everything you have been going through. I do not think that you have a psychosis based on your symptoms
I just left a message for Dr. Huang and expressed your concern over you possible bipolar symptoms and medications. I asked over the voicemail if he could reevaulate you and possibly provide you with more reassurance over your treatment plan.
The thing is I dont think you are traditionally hallucinating, I believe most of your symptoms are an illusion and associated with extreme stress and anxiety. Adding another medication would most likely cause more problems then make you better. To help with anxiety, there are anti-anxiety medications, and therapy can help you develop coping mechanisms that can manage the anxiety
I think that you have anxiety over the possibility of being misdiagnosed and that can lead to a type of hypochondriasis
Then I would encourage in therapy to ask for techniques to help with your anxiety, there a lot of them that can be very helpful
I do not think you are a hypochondriac, but I do think the anxiety over the uncertainty surrounding your mental health issues lead you to search for answers, which can lead to anxiety. The hypochondriasis is more of a symptom of your anxiety, not the cause of it. I do agree that you may want to stop looking at the internet for answers because it can turn into an obsession which is not healthy
Did you read the post I made when I said that I called Dr. Huang and left a voicemail?
I think your physicians are on the right track, as you said bipolar is often misdiagnosed for depression because the symptoms of mania have been presented yet or are often overlooked. I think because of your symptoms, I would give a stronger evaluation of bipolar disorder, and your physicians are aware that bipolar disorder should be considered, so that is a good thing. Also currently you are on a mood stabilizer and that is beneficial too, rather than just being on an anti-depressant.
So overall I think your physicians are doing a good job, but I would lean more towards bipolar disorder based on your symptoms right now. But the positive thing is that it appears from what you are telling me is that they are leaning that way too, just albeit more slowly.
Also on the voice-mail I was very kind and basically expressed your concerns and asked the doctor to reassure you and possibly reevaluate you if possible. I did not blame him or accuse him of anything, I was only making a suggestion to benefit you. I dont think he will take any offense to my message on your behalf.
Well i meant if I were your physicians I would lean to giving you a stronger evaluation for bipolar disorder that can be associated with you diagnosis of epilepsy. I would give a psychological assessment, like the PAI, I mentioned earlier to help me confirm that diagnosis.
My opinion is that I think you doctors will be diagnosing you with Bipolar Disorder soon, I think they are just taking a wait and see approach right now
Actually no, its a paper and pencil instrument we use that has over 300 statements that you have to answer. Then we put those answers on the paper in the computer to get the results. Then I spend time reviewing the results and interpreting them. Unfortunately none of this can be done over the internet, it has to be done in person.
What about your psychologist?
Actually usually only psychologists can perform those assessments, they are more qualified with them then a psychiatrist. You can call your psychologist and mention that you would like to take a personality assessment and they hopefully your psychologist will be able to help you with that.
The reason a psychiatrist does not give these instruments is because typically they are not trained in them, this is why it is important for a psychologist and a psychiatrist to work together to help and treat the patient
I think it will help too. If anything it will give more information to help you
The PAI is one type of personality assessments we have available (another common one is the MMPI-2 or the MCMI-III). These are used to help give psychologists objective information on particular symptoms. It has measure of depression, mania, schizophrenia, anxiety, hypochondriasis, and so many others. Elevations on each of these scales can help determine a diagnosis and best course of treatment. I encourage you to look these up on the internet to learn more about them, I believe some details of them are on wikipedia
Here is the PAI one
and lastly MCMI-III
There are others, but these are the most common ones that I have used and seen done
So basically these tests are tools that we use to help us, much like a blood test is a tool for a physician .
I think the results of the test can give your psychologist and psychiatrist a better idea of how to proceed next. I think it will add clarification to the symptoms you already mentioned.
I understand your frustration, but these processes do take and patience. I know that's not what you want to hear, but you do find the right treatment I can guarantee that you life will be immensely better.
*do take time and patience
Is there anything else I can help you with today?
I see that you are offline now, but if you have any other questions or concerns, please feel free to ask anytime and I will be sure to get back to you as soon as possible. I hope I provided you with excellent service today.
Hey I'm sorry I didn't response. dr huangs nurse called my mom and said dr huang got a call from some psychologist and she started yelling at my and I cut and ended up back in the hospital.
Hello I apologize for not getting back to sooner today, but I am usually online around 830 AM on weekdays. I am so sorry to hear that happened to you, would you like to discuss it further?
If you want..
Well you rated me with a bad service, I am not sure how I gave you a bad service since I spent 3 hours with you last Friday. But I want to help you and if you would like to discuss this further I am here
Because my mom found out I did this whole thing and she said that it was unnecessary when I am already seeing a psychologist and psychiatrist and told me to get my money back
Oh, well then we could have asked to help you get a refund
I would have assisted you with that
I have been in the hospital since yesterday. And then right when I got out my took my phone becsuse she said she can't trust me. I got my phone back because she needs to have contact with my because of my epilepsy. I'm sorry
I understand, I would have tried to help you get a refund if you needed it, but I see that posted something again this morning?
Yes I did post another question. I am a hypochondriac and I just need answers. But I dont know if you should help me anymore because I need to get my money back and if I do you won't want to help me anymore because that's the whole point of you helping me. To get money.
Alright I understand, would you like me to refer you to customer service to get a refund?
That would be the best way for you to get your money back
And one more thing could you just help me with the one question I asked so I can try to get a refund for that too
You would like a refund right away from that other question?
Or did you want to discuss the issue with me first and then ask for a refund?
Sure no problem, it will just take a couple minutes as I type this up
I just requested the refund for my question I asked. But could you help me with one more thing and then refund the answer I asked you?
Sure what is it?
Well like in the question I just asked. I really have the urge to hurt animals.
Oh okay, so I will go to that question and help you then
Does that work
Is this part of my depression and epilepsy? or of a whole other illness?
And I already refunded that question
Not sure, it could be more a part of depression I think, but lets discuss it further on that question, so that this does not interfere with your current refund request
I want both of the questions refunded can you help me with that
Sure, buts lets specifically go to the next question to help with that refund request
Oh someone answered you already with that question, so you can ask Elliot for a refund if you wish
Okay I will. Will you refund this question for me?
Yep as soon as I leave here
It may take some time for it to process, but it will go through