this post was submitted on 10 Apr 2024
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The nurse practitioner I'm seeing about my ADHD diagnosed me with bipolar disorder

She literally could not have surprised me more if she tried

This makes no sense to me but it's scaring me a lot :(

I don't really remember having manic episodes? Depressive maybe but it's usually after something bad happens to me and not really consistently....

I told her I put off making this appointment cuz I've been feeling really bad recently, then she just asked me a few questions like if people say I talk too much sometimes or if I do things impulsively and prescribed me an antipsychotic (aripiprazole) wtf

I asked some family and they haven't noticed anything like this... idk :(. Has this happened to anyone else? Am I just in denial? I'm afraid to take this drug she gave cuz I really don't need to be even more tired all the time... or tardive dyskinesia or something (unlikely, worst case)

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[–] RobotToaster@mander.xyz 12 points 8 months ago (2 children)

That seems a little odd, although bipolar doesn't require a manic episode, only hypo-manic.

[–] Frank@hexbear.net 7 points 8 months ago

Hypomanic is Bipolar II, which presents differently from Bipolar I.

[–] PaX@hexbear.net 3 points 8 months ago (1 children)

I see :(

Maybe I have had hypomanic episodes? I'm not sure... some of this seems familiar but I'm not sure how I would tell it apart from ADHD. And I've never experienced anything like grandiosity or risky behavior or psychosis or anything...

This really sucks

[–] Frank@hexbear.net 15 points 8 months ago (2 children)

Get a second opinion. They shouldn't be giving you a Bipolar I diagnosis without evidence of at least one full-bore manic episode. Bipolar II is harder to diagnose and certainly shouldn't be diagnosed casually.

For me, hypomania has the following symptoms

  • i have too much energy. I need to be in motion, walking around, pacing, playing with things. This goes beyond adhd distraction or stimming. There's a strong nervous energy and a compulsion to stay on the move.

  • pressured speech. I want to talk, constantly, about whatever is on my mind. It's more than just interest in a topic or excitement. I feel a strong pressure to just keep talking and talking and get agitated if i try to hold it back. Holding back speech requires conscious effort. My excitement and constant flow of speech is usually noticeable to friends and family.

  • hypersexuality - i'm thinking about sex constantly in a way that isn't normal. I have to consciously remind myself not to txt all my friends and invite them in to bed. I think i'm the sexiest person alive. I'm aware that this is abnormal and it requires continual awareness and effort to keep under control. When i'm experiencing hypersexuality i'll go to bed with almost anyone who asks nicely.

  • related to that, but not directly connected, i'll flirt with everyone. I really enjoy wordplay and clever innuendo and the increased confidence and perceived competence, combined with the broad increased interest in sex and need to speak, brings this out strongly. I use a lot of overwrought speach in general during hypomanic periods.

  • lack of perceived need for sleep. I sleep less and perceive myself to be more awake and alert than I am. This often gives way to anxiety as the effects of sleep deprivation catch up. I'm often up all night and well in to the morning

  • i feel like the coolest, smartest person in the room. It's never gone as far as grandiosity or delusion, but i feel very cool, smart, handsome, and capable in a way that is not normal confidence in my abilities or appearance.

  • lack of patience and low frustration tolerance. I have adhd so this is a thing normally. Hypomania takes it up several notches. People speak too slowly, loading screens in games are too slow, people move too slowly on the sidewalks. Anything that's not moving at my too-fast pace feels frustrating.

  • impulsive spending. I buy stuff i don't need, often just things I think are cool or that strike my interest in passing. I buy restaurant food more often. I buy large amounts of groceries thinking i'll make new dishes, or because I misjudged how much I needed or was appropriate.

  • emotional volatility - i'm prone to getting very upset and either crying or writing angry diatribes. I do not become violent, to myself or others, i just feel negative emotions very strongly. It can go the other way, too. Movies and books become totally overwhelming because any emotional response i feel to them is so strong. I write sappy love poetry to my partners.

  • an awareness that this is all wrong. It took years to figure out what was happening, but once I understood what a hypomanic episode was I was able to identify episodes that I'd had going back to childhood, and to identify them when they happened. I can tell when my mood is elevated, when the world has too many colors and i'm talking too fast, and i can mostly tell when that trips over to proper hypomania.

My friends can also tell, and will let me know if they think something is off or my mood is too elevated.

Bipolar is different for everyone, and Bipolar I is very different from Bipolar II. But there are a lot of common and typical symptoms most people share.

aripiprazole can be diagnosed to help with bipolar I depression, but the first-line treatment remains lithium. I'm not a medical professional, just a guy with Bipolar II, but immediately giving you abilify without trying you on lithium first does not sound like the usual course of treatment.

Bipolar, adhd, and autism have a huge amount of overlap in the symptoms they present. But a Bipolar I diagnosis, as far as I know, requires at least one confirmed manic episode, while Bipolar II requires pretty solid evidence of hypomania.

A lot of people diagnosed with bipolar struggle with accepting the diagnosis, that's a real thing. But the diagnosis is weighed heavily on having had identifiable manic or hypomanic episodes. If you can't define specific episodes of mania or hypomania i'd suggest getting a second opinion. Mania is almost always very obvious, it's a very extreme state. Hypomania is less drastic, as people usually aren't delusional or psychotic and have more awareness and control, but it's still quite different from normal behavior.

[–] PaX@hexbear.net 7 points 8 months ago* (last edited 8 months ago) (1 children)

Thank you so much for sharing your experience. I don't understand why she jumped to this diagnosis after maybe a combined total of spending 30 mins talking with me (This was our 2nd appointment and I saw her for the first time in person today).

Your experience of hypomania doesn't really sound like me at any time... I think. Occasionally I will get very invested in topics or projects which brings me a lot of satisfaction and I might sleep a bit less than usual and use a lot of caffeine to stay focused but I don't really feel more confident or any kind of all-encompassing euphoria or any desire to engage in any risky or impulsive behavior out of the ordinary. Idk :( I guess sleeping less is the most concerning... last time this happened I just felt "okay" as opposed to my usual "things are hopeless and I'm barely hanging on". I have a lot of anxiety about my health normally so it's hard to tell what's a real symptom or what I have convinced myself I have. It's hard to remember my behavior exactly too... I'm not sure if I was sleeping less or not last time.

Do you have depressive episodes? What are they like for you? I have been feeling pretty bad in the last month or so (although I usually always feel bad these days, depression, anxiety, etc). That same NP gave me some medication for my ADHD that didn't really help and made me feel a lot more anxious and maybe depressed around the same time. Then some other condition I have was getting worse. It's just so confusing :( I guess I have good reasons to feel worse than usual?

I'll ask my therapist about it tomorrow. It could get weird though because they both work in the same small clinic and my therapist referred me to her. Maybe I could ask my primary doctor about it too.

[–] Frank@hexbear.net 5 points 8 months ago

Do you have depressive episodes? What are they like for you?

Yeah. I have Bipolar II. Depression is much more prominent than in BPI. I have extremely long periods of severe depression - Weeks, but more often months and sometimes years. Sometimes I can mostly function, other times it's completely debilitating to the point where I'm just shuffling from bed to the bathroom to the kitchen and back to bed for weeks or months at a time. This is, afaik, typical of Bipolar II - Extended periods of depression that can last weeks, months, or longer. Then periods of euthymia, normalcy. And then there are also hypomanic periods that can last weeks or rarely months.

Bipolar also tends to cause some serious cognitive problems with things like executive function, decision making, focusing on tasks. Part of the reason it's hard to diagnose is that many of the day to day symptoms overlap with ADHD and Autism. You can have a lot of symptoms that most bipolar people have, but you have ADHD or Autism (or a combination) because they have many similar symptoms. Like ADHD and Bipolar both cause problems with sleep, so lack of sleep and poor sleep isn't enough to diagnose one or the other.

[–] ReadFanon@hexbear.net 6 points 8 months ago

aripiprazole can be diagnosed to help with bipolar I depression, but the first-line treatment remains lithium. I'm not a medical professional, just a guy with Bipolar II, but immediately giving you abilify without trying you on lithium first does not sound like the usual course of treatment.

Agreed.

I could absolutely see someone prescribing valproate instead of lithium because it's a bit easier to manage the dosing of it. Same for lamotrigine but I would be questioning why a prescriber would reach for that first if they did.

The only way that I can square aripiprazole-first treatment for bipolar is if it was a BD-NOS diagnosis, and even then...