Bipolar A dual diagnosis - bipolar with ptsd - seeking advice

[Ursa]

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?

 

[Deleted member 1860]

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.

 

[Keenbean]

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

 

[linasmom]

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).

 

[anthony]

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.

 

[freya]

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

 

[freya]

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

 

[Keenbean]

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