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DrMichael-MD
DrMichael-MD, Psychiatrist
Category: Mental Health
Satisfied Customers: 6
Experience:  Board Certified psychiatrist with 25+ years diverse experience, specializing in Child & Adolescent Psychiatry.
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Question about possible bipolar I OKMH1001217

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Question about possible bipolar I diagnosis Hello, I have a question regarding diagnosis. My explaination will be long, so bear with me. I have a history of suicidality and depression since I was around the age of 11. At that time I began to contemplate ways to kill myself, made some very half-hearted attempts and was very depressed/isolated/hopeless. I would also go into frequent rages where I was consumed with anger and hatred and would act out on myself (hitting/cutting) or break things, scream. I also have a history of trauma, being molested by my father from 5-10, by a cousin for one year when I was 6-7 and my house was also physicall violent (father towards mother and brothers). During this time I was quite withdrawn, bullied, and learned to keep everything to myself or I would get in trouble. I remember staying up for days at a time reading, fantasizing, and making up pretend worlds in my mind. I don't really remember being tired. But I could have been staying up because I was afraid of my father coming in to my room. I dont' really know. When I was fourteen I was raped by a family member of my best friend, and finally made in to treatment because the case was seen in the courts. During that time I was placed on zoloft and did quite well, staying on it for maybe a year or so. In 2009 I had a complete melt down. I became very suicidal and depressed, completely withdrew and began to experience that same rage and anger again. I was very out of control. There were times where my thoughts were racing and unmarshalled, I was also very rumative. At times I would stay up, but it was not because I felt great and was euphoric, instead I was so aggrivated and angry I could not calm down. Absolutely anything would set me off and I vacillated between rage, suicidality and tears. Eventually I attempted suicide and this set off a chain of hospitalizations, ultimately culminating in 15ish (I stopped counting) hopsitaliztions, mainly due to suicidality, between 2009 and 2012). I was on SSDI and really struggled. Since then I have come a long way and am off SSDI and am working. Now, however, I find I am still cycling and I've noticed, over the past month, an increase in my anger, irriatability and aggression. The same old impulses are coming up. I'll go for a couple days like this, where I sleep less or not at all without a sleep aid. Then I go into deep depressions for a few days where I plan out my suicide and the only way I can stop myself is to cut to releive the pressure. I have tried a million meds. I have found that anti-depressants really don't work. With the exception of viibryd.Which I take now and I feel like helps me from reaching the bottom of the depression barrel. But I still have those swings in mood where I just want to lash out. I have tried mood stabilizers and anti-psychotics in the past and they did help. So, after all this my biggest question is what is going on with me? My therapist thinks some form of bipolar due to the rage and anger, some trouble around sleeping and the mood swings. The psychiatrist says bipolar I. However, I don't ever remember being euphoric, going days without sleep or not being able to get things done. I do struggle with some aspects of PTSD and found though that those problems (e.g. flashbacks) are much imporved. Based on my history would you suspect bipolar? ptsd presenting as bipolar? Or (as much as I don't want to put it) borderline? I'm just not sure what to believe. I feel like bipolar doesn't quite fit, but neither does a unipolar depressoin. Unless there is a very, very angry and aggravated deppression. Thanks for your thoughts!!

Hello! DrMichaelH here! I am a psychiatrist.

Let me see if I can help you figure out this Bipolar diagnosis.

Here are some tips.

The problem with trying to diagnosis someone as a certain type of Bipolar is everyone's mood swings are a bit different.

However, it does sound like you are suffering from mood swings and mood-stabilizers helped.

So the take-home is, don't get hung-up on the exact diagnosis,

because these are just approximations with the current

science. Is it Bipolar I, Bipolar II, Cyclothymia?, Borderline?

I consider Borderline Personality to be a sub-type of Bipolar with very rapid mood swings due to the person having an extra-sensitive nervous system.

Another VERY STRONG clue to if you have Bipolar is if there

is a family history (blood relative) of Bipolar Disorder or mood

swings, anger outbursts, alcoholism or anti-social behavior.

In fact, I will usually not diagnose a person with Bipolar

Disorder unless I get a family history of Bipolar.

Bipolar Disorder is very, very genetic.

Your situation is a little complicated because PTSD leads to

symptoms of anger (and so does Bipolar.) If the PTSD is

pretty well treated and dealt with, and you are still having

these mood swings, then you may have some variant of

Bipolar on top of it.

The clearest clue would be the family history.

That all said, if you have taken mood-stabilizers in the past

and they really helped the mood-swings and made you feel

better then that's the most important thing.

Another final important point: If you do have some varient of

Bipolar disorder, you cannot take an antidepressant alone

without a mood stabilizer because an antidepressant alone

will make you cycle worse.

I hope this long answer helped! Let me know if you need

further clarification on any of the points I've made.

I will send you good wishes and prayers to help your situation. :)
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