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A Dual Diagnosis - Bipolar with PTSD - Seeking Advice

Discussion in 'Symptoms & Other Disorders' started by linasmom, Apr 29, 2009.

  1. linasmom

    linasmom New Member

    Hey guys,

    I know it's been awhile - I hope everyone is doing okay. I wanted to find out if anyone here, after being diagnosed with PTSD, has also been diagnosed with bipolar disorder AFTER their PTSD diagnosis.

    Here's the backstory - basically, nothing has changed for me. The last three weeks I was experiencing suicidal ideations every day. I couldn't get a therapist to call me back (I stopped seeing the one I was seeing earlier last year). My only option at this point was to go to the Psych ER because I knew something bad might happen if I waited another day. So - I go there, and they spend hours assessing me. Obviously, I told them that I have complex PTSD. However, the psychiatrist there diagnosed me as having bipolar disorder, as well. She explained several reason why - (one of them being that I hallucinated on Wellbutrin and it is supposedly well known that certain antidepressants "unmask" mania in bipolar disorder).

    So, anyway - I'm just not sure what to think. I mean, we all know that the symptoms of both bipolar and ptsd mirror each other. I just don't know what I should believe. The psychiatrist said she is not debating my PTSD diagnosis but that she believes I have bipolar, as well.

    She wrote me a script for Lithium and I've started taking it, along with Klonopin. (bye-bye xanax)

    Has anyone else experienced this, and if so, what became of it.
  2. linasmom

    linasmom New Member

    Oh, I should probably also clarify - This is my first time seeing an actual psychiatrist. My CPTSD diagnoses all came at the hands of therapists, not psychiatrists.
  3. cec

    cec New Member

    linasmom,

    Sorry for what your going through, no one needs another diagnosis. What's most important is do you feel it's right? I just want to draw your attention to the word "unmask" bipolar. I think if you research this, you will find three important facts:

    1. Antidepressants can cause a manic episode (therefore not unmask it) So if someone who is bipolar takes an antidepressant, that antidepressant can cause the person to go from a depressive episode to a hypomanic or even manic one.
    2."Certain other medications can produce a “high” that resembles mania. Appetite suppressants, for example, may trigger increased energy, decreased need for sleep and increased talkativeness. After stopping the medication, however, the person returns to his normal mood." Wellbutrin is an appetite suppressant. (When I was on wellbutrin, it gave me all the above)
    3. you cannot be diagnosed with bipolar if you have not had a manic episode. See DSM-IV

    I think you will find the above three facts well adopted by the psychiatric community.
    So, how is it possible that someone with complex ptsd can be diagnosed with bipolar while on Welbutrin? Should not the welbutrin be stopped to get an accurate baseline for the assessment? How can they say for certain what is pathological and what, if anything, is being driven by the Welbutrin? (and what about what the ptsd is contributing as you pointed out)

    Sorry, but I think I would get a second opinion.

    Cec
  4. linasmom

    linasmom New Member

    Cec,

    Thank you so much for responding. I have had a manic episode - in fact, quite a few in my lifetime. These manic episodes are a direct result of my impulsive personality - something I thought, again, was a reaction/symption of CPTSD. I've also "rapid cycled". However! I've been under the impression that mania is also a symptom of PTSD - do we not just call it "hyperarousal"? Maybe I'm confused. I guess I've been under the impression that my drastic mood swings were a direct result of my Complex PTSD.

    I am no longer on Wellbutrin, in fact, I quit taking the med immediately after experiencing the hallucinations. Up until yesterday, I haven't been on any meds in 6 months.

    The main question is: Do I feel it's right.

    Unfortunately, I don't know. I'm SO confused and frustrated and angry and just, exhausted. I dont' know who to trust anymore. I trusted my doctors to prescribe me medications taht would help me - and after taking almost every antidepressant on the market with no progress, I took myself off. I'm also most appreciative of the information regarding antideppressant withdrawal that was not provided to me when the prescriptions were written - but I digress.

    The answer is: I don't know.
  5. supergirl

    supergirl New Member

    I had BiPolar disorder before my PTSD Diagnosis. Manic events and hyperarousal are two different animals.

    Mania includes fast talking, inability to concentrate, hypersexuality, spending sprees, loss of impulse control, difficulty sleeping and/or staying asleep, irritability and impatience. For me the elevated mood is more than just "feeling good" it is feeling on top of the world. Like I am super woman, the life of the party, the "it" girl that everyone wants to be friends with. These are all classic charecteristics of mania and I have and them all.

    Hyeprarousal includes symptoms that stem from experiencing high levels of anxiety, such as having a difficult time falling or staying asleep, feeling more irritable or having outbursts of anger, having difficulty concentrating, feeling constantly "on guard" or like danger is lurking around every corner, and being "jumpy" or easily startled.

    Hope that helps,
    SG
  6. catjudo

    catjudo VIP Member Premium Member

    I was diagnosed with bipolar after my PTSD. I received the diagnosis similarly to the way you did...from a doctor at a psych hospital. The diagnosis followed me and subsequent doctors just assumed it was accurate and continued to treat me accordingly. I do not believe it is an accurate diagnosis. My current psychiatrist, who knows me pretty well as I've been seeing him for over seven years, also disagrees with the diagnosis. He strongly feels that bipolar is commonly misdiagnosed/over-diagnosed.

    Whether or not it is an accurate diagnosis for you is impossible for us to know. But I do think you owe it to yourself to get established with a psychiatrist that you trust and get a second opinion. On the surface it may seem to fit without the benefit of truly knowing you and understanding all of your symptoms. If you were to establish a relationship with one psychiatrist who is able to get to know you and the nuances of your symptoms, he may or may not concur with the diagnosis.
  7. Solara

    Solara VIP Member

    I was diagnosed with being bipolar BEFORE my PTSD Dx. My current Pdoc says he's not so sure. See, I haven't had true "mania" in the absence of an anti-depressant (even then it was mild hypo-mania). I have, however, been hyperaroused, which is typical of PTSD. I am still on my mood stabilizer because I have horrible problems with mood regulation.
  8. anthony

    anthony MyPTSD Admin Staff Member Premium Member

    I would seriously be discarding a bi-polar diagnosis in conjunction with PTSD unless the bi-polar was absolutely clear before trauma. Otherwise, the two simply have far too many similarities that are confused. If trauma is present, PTSD. If not, more likely bi-polar.
  9. catjudo

    catjudo VIP Member Premium Member

    I completely understand your position on this, Anthony, and like I said I tend to lean toward bipolar being misdiagnosed. However, one of the problems that comes into play is when a person's PTSD is a result of a trauma that occurred as a young child. Typically bipolar isn't diagnosed until late teens or early 20's (although I believe there is a growing trend of earlier diagnosis but I don't know how much I really trust the reliability of such situations). Just because someone has PTSD does not mean that they cannot have bipolar but the symptoms of the two become so inextricably mingled that it can be nearly impossible to sort them out. It definitely requires a psychiatrist that knows the individual well and has a good deal of experience treating both bipolar and PTSD.

    I'm not disagreeming with you, per se, just pointing out that it's not nearly so cut and dry.
  10. linasmom

    linasmom New Member

    cat- those are my exact feelings about it, as well. My first big trauma occurred when I was eight, and I started showings signs of CPTSD around 12 years of age. There's no way for me, or anyone for that matter, to ever truly know if I had bipolar disorder prior to the onset of my CPTSD.

    My therapist in Florida, who was fantastic, thought that my mother suffered from bipolar disorder - obviously, we can not take this as "fact" because my therapist never SAW my mother. But, this just adds another little layer to this issue. People whose parents suffer from bipolar disorder are 6 times more likely to develop the disorder themselves.

    Almost all of my "manic" episodes have occurred while I was not "under the influence". HOWEVER! I do not know if these "manic" episodes are actually caused from bipolar disorder or CPTSD. Impulsivity and Irritability are both symptoms of "mania" AND cptsd. If you look at the diagnostic requirements for bipolar disorder, irritability is a substitution in the manic field:


    1. A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual non depressed mood.
    2. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
    These reasons were given to me by the Psychiatrist. That's not to say I believe it. I'm just saying that I'm not going to fully dismiss the idea.

    This is so very complex and confusing for me right now.
  11. anthony

    anthony MyPTSD Admin Staff Member Premium Member

    Cat, I actually agree with you, and was trying to say something similar. Yes, you can have it, though 99.99% unlikely if it wasn't present prior to trauma. There are people here who where diagnosed Bi-Polar prior to PTSD, then PTSD after a traumatic event. Their lives are often quite hectic, more so than a person with just PTSD even. I totally agree with what you are saying, though I do not believe it to be the case here because it is now only one physicians opinion vs. the professional opinion of other physicians prior. If the overwhelming opinion was both, I would go with that. When one goes different from the others and is alone on their opinion, I would steer with the majority all the time as they are more often to be 99.99% correct.

    It is very common within the world of physicians to misdiagnose PTSD with Bi-Polar... it happens every day. I have spoken with some leading specialists on this from around the world to whom they advised me that unless Bi-Polar is diagnosed before trauma, it would be near impossible to actually give such a diagnosis in conjunction with PTSD because the two are simply far to identical. The consensus I believe is to treat for the worst, being PTSD, and if it is the lesser of only Bi-Polar, then that diagnosis would be downgraded and treated specifically at that time. I believe it to be quite rare though that a person would have both, being more it is misdiagnosed than actually correctly diagnosed.
  12. lilcuda1

    lilcuda1 New Member

    Bipolar???

    I was diagnosed PTSD 1.5 yrs ago then Bipolar about 8 months ago. This diagnosis is comfired by both my Psyciatrist & councelor. Stress triggers bipolar symptoms {deppression or mania} what is stress PTSD. Your right, from what I've learned they do mirror each other I call that feed, trigger and look alike. Both have like symptoms and for me either or can trigger the other. I stongly feel their right however. I have a great book Take Charge of Bipolar Disorder- a 4 step plan for you & you loved ones to manage the illness and create lasting stability by Julie A. Fast & John Preston, PsyD.

    How's the Litium going an what dose? I take 300mg am & 750mg pm I think it helps. I don't know much about the wellbutrin so can't help ya there.

    Most peolpe are misdiagnosed for years. Bipolar [DSM-IV} has more than just depression & mania{2 types} there are other common symptoms anxiety,anger & ADHD just a few. There are also different types of Bipolar I, II, III still all are affected by stress{PTSD}.

    write if you have any ? any time
    Thank You lilcuda1
  13. Ursa

    Ursa New Member

    A google research shows that PTSD promotes an anatomical change in the brain that can be seen through image exams. Looks like that there are 2 different kinds of bipolar disorder, in which one of them there is also an anatomical change in the brain (different from PTSD) and the other is related to the sensibility to melatonin. The bipolar kind III is not completely accepted because it is medication induced. In this case I personally think it is more like a colateral effect than a condition.

    If this is known, why the doctors are not using lab exams to make a distinction and/or co-diagnosis between the 2 conditions (PTSD and Bipolar Disorder) when necessary? Or did I get some wrong information?
  14. Solara

    Solara VIP Member

    Just because an antidepressant forces you "manic" does not mean that you are bipolar.

    My pdoc is on the board of one of the top 10 Medical Schools in the US and he was completely unphased by the fact that I've been forced manic by so many different anti-depressants. He says this proves nothing. He is completely unconvinced that I am bipolar. Without drugs, I haven't been manic. His diagnosis is PTSD and PTSD alone.

    I mean think about it...you're fine until a MEDICATION forces you manic, thereby giving you an uncurable disorder. Then when I go off the medication, no more mania. EVER. It makes no sense to say that you are bipolar if the only time you go manic is on antidepressants.

    The other thing is that so many symptoms overlap between BP and PTSD. You can't say that moodiness is attributed to BP when many PTSDers have problems with mood regulation.
  15. Keenbean

    Keenbean New Member

    From a mental health professional point of view, I think it is probably not wise to assume that it is 'better' to have one illness over the other. Certainly, psychiatric illnesses are not ranked in order of severity, and whilst it is tempting to think that the diagnosis one has must surely be worse than any other diagnosis one could imagine, this isn't necessarily the best way to look at things.

    If a diagnosis is changed, it is therefore not a case of 'upgrading' or 'downgrading' to bipolar or PTSD, and it is impossible to say that one illness is more severe or worse than another. Of course, some people with PTSD will find their symptoms more debilitating than some people with bipolar, but the opposite is also true. If one looks at the stats, it is clear that PTSD is far more common than bipolar (at least 8 times more common), the hospitalisation rates are much higher for bipolar, as are the suicide rates. I am absolutely not saying that bipolar is 'worse' than PTSD in any way, but I am saying that we really can't rank-order illnesses in this fashion.

    Obviously, these are just general trends and only present the overall picture, but I feel uneasy about people 'rating' one illness over the other, as it really is not possible to do this. The most important thing is to try to get an accurate diagnosis, and deal with what you have in the best way possible. All mental illnesses are absolutely horrific to experience, I think that's all we need to remember, it isn't for us to argue over which is the worst.

    For the record, I have both bipolar and PTSD, with the bipolar being diagnosed long before the PTSD, so I don't really have any issues with the dual diagnosis. Apart from I would really rather not have either!

    Best wishes to everyone with PTSD/Bipolar/Any other mental illness!
    KB
    reallydown and supergirl like this.
  16. linasmom

    linasmom New Member

    For the record, I did want to mention that I have had manic episodes when not on antidepressants. I also experience severe racing thoughts - very different from intrusive thoughts, which I have rarely. My diagnosis is Bipolar 1 with mixed episodes - meaning I am depressed and manic at the same time, except my mania consists of racing thoughts, extreme irritability, and rage.

    I am now on Lithium and it has helped a great deal in a short amount of time.

    Also - my C-ptsd diagnosis has not been taken away, I simply have been diagnosed with both. (the bipolar diagnosis came at the hands of three separate psychiatrists).
  17. anthony

    anthony MyPTSD Admin Staff Member Premium Member

    Ursa, you are exactly correct. Physicians should do more detailed examinations when PTSD is involved, however; due to costs, they don't. Instead they take a guess and go with it, typically prescribing more medication which the medication is often providing the symptoms to begin with. It is very popular with PTSD to be misdiagnosed with bi-polar. Saying that, some actually do have it, though from the physicians I have discussed this with, they simply responded that they do not diagnose Bi-Polar with PTSD if the Bi-Polar was not present before medication, before trauma. It is rarely done because when reviewed honestly, they could not ascertain whether it was more a symptom of PTSD treatments / trauma that entailed a PTSD result.
  18. freya

    freya New Member

    I'm truly very thankful for Keenbean's post and I totally agree with her.

    I have been diagnosed with Bipolar disorder almost twenty years ago, a diagnosis of second-generation PTSD was made about two years ago.

    I think one can absolutely not state that PTSD should be 'worse' than Bipolar disorder.
    Like Keenbean said it's not possible to say one illness is worse than another.

    My personal experience is that there is defintely a difference between mania and symptoms of PTSD. One of the differences is that mania lasts longer (in my case) and can get far out of hand, ending in psychosis. The 'character' of the symptoms is different, as well.

    I do realize now that I have the diagnosis of PTSD, how it has often been symptoms of the PTSD (getting triggered in relationships, for example), that triggered bipolar episodes.

    A difference with regard to treatment is that while someone with PTSD may have hope that symptoms can be treated and cured, with Bipolar disorder there is no such hope.

    Linasmom, I often hear that psychiatrists assume that if lithium works (helps the person to feel better and be more stable) that in itself is a confirmation of a diagnosis of bipolar. If a person is not bipolar, lithium will not make a lot of difference - it is said; I'm no expert but it makes some sense to me.
    If you do have Bipolar disorder I think it's good that you got a diagnosis; it may help you find the best medications and treatment so that your quality of life will be optimal.

    I wish you all the best of luck in finding the best treatment.

    Freya
    reallydown likes this.
  19. freya

    freya New Member

    Adding: With regard to treatment there's a another big difference, and that is that while it's often advised for people with PTSD to talk about their trauma and re-live it, talk therapy is often discouraged for those with Bipolar disorder.

    It's considered to be 'dangerous' - a trigger for mania or depression - to get very emotional and for that reason I have often been refused therapy, while I felt I really needed it and that it helped me to deal with my problems in life.

    I can also say that I've read outcomes of research that said that about 80 per cent of people diagnosed with Bipolar disorder and Schizophrenia, have been through some form of traumatic experience as a child. The research stated that often, psychiatrists do not sufficiently ask new patients if they've experienced trauma during intakes.
    I've also read information that says that illnesses such as Bipolar disorder, but also other (Immune system) illnesses, and diabetes too, are the result of having been through traumatic experiences when young.

    Too bad that science cannot provide more clarity...

    Freya
    reallydown likes this.
  20. Keenbean

    Keenbean New Member

    Hey Freya,

    It's always good to hear someone agree!

    As you said, I feel as though I have more hope of overcoming my PTSD symptoms than of ever beating my bipolar, which I will have forever to a greater or a lesser extent. And like you, I have had symptoms of PTSD triggering bipolar episodes. Very recently I went on a 'Mindfulness' course- a fairly new therapy based on meditation but with a CBT component, which aims to help people with all sorts of physical and mental health problems. During one of the meditations I experienced a horrific sequence of flashbacks which left me dissociated for days (my flashbacks had been gone for 2 years prior to this), and was followed by a severe depressive episode which I am finally recovering from thanks to an increase in my bipolar medication and therapy. So I can see from my own experiences that the two disorders do interact if you have both.

    Wow, I am really surpised to hear you have been refused therapy because of your bipolar...I've not heard of that happening before, at least not in the UK. Along with my medication, it really helps me keep going, I couldn't imagine where I'd be without it...that's really harsh.

    Anyway, best wishes to everyone.
    KB

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