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Mental Disorders

Borderline or Bipolar?

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

Q. Could I be Borderline? I had an ‘episode’ about 2 years ago, a few weeks after I started on anti-depressants for the first time in my life. I was very impulsive, spending a lot of money, binging a lot on food, making risky decisions, and worst of all…sexual indiscretions. Since this all happened right after I started on anti-depressants, the first thought is that I am Bipolar. But I really don’t fit the bill for Bipolar. Even in that incident that was medication-induced…I was not moving any faster. I have never had racing thoughts, or inflated self-esteem (my self-esteem is constantly very low!). I have never had any issues with sleep — either too little or too much, not even during that episode 2 years ago. I have never been really “high” or agitated or anything like that. I have read the symptoms of Borderline Personality Disorder, and that seems to fit me a lot more than Bipolar. It also includes impulsivity…which explains the binging, sex, etc. I have had some periods of impulsivity that were not related to any medication — in fact, one was very recent, last month. I have not been in therapy or on medication for almost 2 years. However, since that one episode 2 years ago did occur right after I started the anti-depressants, does that automatically mean I’m Bipolar? I am somewhat confused.

“What is my diagnosis?” is one of the most frequently asked questions. Unfortunately, it is extremely difficult to know what a person’s diagnosis is without meeting with them in person or getting to know them. To identify your diagnosis over the Internet is almost impossible. You may meet some of the criteria for each diagnosis; bipolar and borderline personality disorder but to know for sure which one is correct, or if you suffer from both I cannot tell you.

Although many may disagree with my sentiment, I am not sure how much you would be helped by knowing your exact diagnosis. I am not even sure it’s possible to get a definitive diagnosis. Even though mental health professionals have a guidebook to assist in diagnosing (Diagnostic and Statistical Manual of Mental Disorders (DSM), often times, clinicians, when assessing the same client will come to very different conclusions about what he or she may be suffering from. Ten different diagnosticians may give you 10 dissimilar diagnoses; this is not all that uncommon.

What is most important is that you get help. If you are having psychological problems in which you cannot control your behavior, and you are being harmed by your inability to control yourself then it is imperative that you get help for these issues. It’s been almost two years since you engaged in treatment. What’s the delay? If you are able to find a competent therapist there may come a time when your “episodes” are a thing of the past. Your effort is better spent on trying to find good help rather than trying to pin down your specific diagnosis.

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What is My Diagnosis?

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

Q. What could I possibly be as far a diagnosis? I was just wondering if you could at least give me some direction in which diagnosis I probably have. Sexually abused 6 times by different men, unable to recall certain events in my early life and bad short term memory. When I trigger, I guess you could call it, I tend to rock back and forth, repeat things, (ex-im a bad girl, bad girl), tend to go into the fetal position, I get exteremly paranoid, I play with my hair, in really bad times I suck my thumb, I hear things out loud at times not alot though (ex. Theres a spider in there)…when I sort of trigger, I tend to repeat things in my head but thats it or rock standing up..its not that noticably though.My triggers happen everyday though I do not know why. I have nightmares ever ynight, and I have been an SI for over 6 years. I have never been diagnosed or have a therapist, Im currently trying to get one. I dont do those tests because I feel Id be biased and get test results maybe not so accurate. I have had sucidial attempts 6 times. but I have been trying to hurt myself since I was very young…dropping my moms weights on my feet trying to break them, sitting in the middle of the road playing cards waiting for cars to run me over, and trying to put my legs on the car exhaust pipe to burn them. I never thought those were SI attempts however I put two and two together later realizing they were performed intentionally for intentional harm plus this website helped me realize that. Do you have any outline on what I might have? What it possibly seems like, I know you cant diagnose me but any idea would help.I have asked others about this, however I am getting sick of being mentally unwell and not knowing what I possibly have.Thank you.

As you have alluded to in your question, it is difficult for me to give a diagnosis over the Internet. To be honest, I am unsure whether you have a psychiatric diagnosis per say. I am not saying that you are not suffering and I am not saying that you do not have any diagnostic symptoms. What I do mean is that your symptoms do not seem to match any one formal diagnosis, as measured in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Given the little information that I do have from your e-mail, your symptoms seem to be closest to matching the diagnosis of Major Depression. You must remember that I am basing this on very little information and I have no true way to know what diagnosis you may actually have. The truth of the matter is that having or getting a diagnosis, in many cases, has little utility. What matters most in your situation is that you are suffering and have suffered with depression and suicidal ideation since you were a young child, and you have yet to seek treatment. The goal for you now is not to find out if your symptoms match DSM-IV criteria. Rather, your time and energy should be geared towards finding a mental health professional who can help you relieve your mental anguish so that you can start living a happier, healthier life, free from depression and suicidal ideation. You have lived with mental anguish for far too long and for your own well being, it is time that you make your way to a professional. I am glad that you are getting sick of feeling mentally unwell. Perhaps now you will take the necessary actions needed to help yourself feel better.

Allow your therapist to thoroughly investigate your case and allow that person to find the source and solution to your problem. Many conditions have multiple components and as such fit no one diagnosis code well. Good luck on your journey into therapy. It could be the road to the contented, happy life that each person so richly deserves. Take care.

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How Does a Homebound Agoraphobic Get Help?

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

I’ve been a homebound agoraphobic for 3.5 years. I want to get help, but obviously can’t get to a therapist’s office, and I don’t work and my family has no money so I can’t afford to pay for therapy. My family also doesn’t want me in therapy, and since I live with them, my only option would be online treatment. I’ve tried to search the web for what I can do, but there doesn’t seem to be any help for someone in my situation except to just deal with it myself. If I could deal with it by myself, I would have in the last 3 years. What do I do?

Some quick background: The agoraphobia seems to be linked to when I was homeless. I lived in a car from age 16-17, and when I got out of that situation at 18, the agoraphobia began to set in. My main problem is with cars – for a while, once I was able to get to whatever the destination was, I was fine; it’s in the car that I freak out. I’ve had mental disorders (or whatever you’d like to call them) before: 2 bouts with depression, apparent kleptomania as a child, and dermatillomania as a teen. I don’t suffer from any of those anymore. Obviously my family was not great; my father was an alcoholic and drug addict, he was abusive to my mother and neglected me (both emotionally and in the criminal sense), and my mother, I suspect, suffers from undiagnosed mental illness (she seems to display a lot of manic behavior, has rage issues, and was and is emotionally, mentally, and verbally abusive).

So, clearly I need help, and I want it, but I have no idea where or how to get it.

Agoraphobia is an anxiety disorder. Anxiety disorders tend to become worse over time, partly because individuals with the disorder often have difficulty tolerating uncomfortable feelings. Therefore, when possible they avoid situations that produce uncomfortable feelings. The counterintuitive result of this avoidance generally leads to an increase in anxiety levels and subsequently a degradation of one’s quality of life.

An additional problem is that you have no health insurance. One possible option is seeking treatment at a community mental health center. They offer psychiatric services to individuals without health insurance. It may be helpful to call your local community mental health center and ask for their advice. There may be some help they can offer you over the phone. Other possible options include:

  • Joining an online support group for individuals with agoraphobia. You may learn important information and coping skills from other group members. Perhaps there are some strategies that other group members have used for getting help that you might try yourself.
  • Calling local therapists and asking for their advice. They may know of low-cost or free services that may help in your situation. You should also ask them whether they offer psychotherapy sessions over the phone. Maybe someone will offer their services to you at a reduced cost.
  • Contacting the Anxiety Disorders Association of America. Here’s a link to their website. Present your situation to them. They may have good advice for you.
  • Applying for two government social programs: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). These programs can help you access health insurance and a monthly income. Click this link to read more about these programs.
  • Contacting a therapist on Live Person. Live Person ostensibly provides psychotherapy over the Internet. It is a pay site so there will be a charge but you may be able to hire a therapist at a discounted price. Usually the first few minutes of interaction with the therapists are free and it is during this time that you may be able to negotiate a reduced rate. If you are interested, here is a link to their website.

The bottom line is you are faced with a challenging situation. Treatments exist that can actually cure agoraphobia. I understand that you are homebound. Obviously, if you could leave your house you would have but at some point the only way to cure this problem may be to force yourself into therapy. I wish you well. Thanks for writing.

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Should I See a Specialist?

by Dr. Marie Hartwell-Walker
written by Dr. Marie Hartwell-Walker

Okay, I’ve been pretty sure that I’ve had some kind of psychological disorder for almost three years now, since I was 16. I haven’t been to a specialist as such because mental disorders aren’t something I can explain to my parents. Although now, I am looking at visiting one just to be sure. I just want to know what you guys think.

I have frequent feelings of euphoria and depression. These have varied extremely over the years. When I was around 16, they were incredible and unbearable, almost always following each other. At that point in my life, I was also very depressed and felt caged, thought I was bipolar. As I grew, they became more tangible and I was able to deal with them better after I’d left home and gone to college at the age of 18. I still feel them, and I feel as though I have no control over them, even as I try to emotionally streamline myself now. I used to feel desperation but lately I’ve grown very numb and my states oscillate between being incredibly euphoric or into plain nothingness, or pointlessness. My drive for life constantly fluctuates.

I have self harmed in the past, and had suicidal tendencies, that are recurrent even now. These tendencies however are mostly passive and I wouldn’t act on them. The need to self harm varies on the level of depression I feel.

I’ve greatly numbed myself and do not feel pain as vividly as I used to. Nothingness defines my depression. I feel alone and helpless and sometimes wake up in panic in the middle of the night unable to control it.

I have varied states of over-eating/sleeping and lack of sleep/appetite which are recurrent throughout ever 2 months nearly also accompanied by complete normal states

My states of high and low can last anywhere from 10 minutes to a few weeks. I do feel normal for periods in between, which can last even up to a couple weeks. When I feel normal, I feel fine and wonderful (not euphoric)

I used to have very low self esteem and my views of myself changed rapidly according to how I felt. I could feel worthless and dejected and then bounce to feeling invincible and wonderful. These feelings of low self worth have changed over the last month after I confronted my father about some underlying issues, and discovered the meaninglessness of life. I don’t think they are gone but rather that they are deeply imbedded but I don’t care about them anymore

I have used to have severe abandonment issues, but they have also changed over the course of the last 2 months, but this may also be due to the numbness I feel towards these issues. I have recently gone through some relationship troubles. I have very evident trust issues and do not trust nearly anyone.

Despite all of this, most days I am able to function properly and I am actually quite happy. I tend to become socially reclusive at times and this leads to either peaceful solitude or depression. At college, I have a bit of a reputation to be crazy and insane.

I feel reckless and impulsive at times. It makes me feel alive. I crave this feeling.

I have a horrible attention span. I can’t watch television shows and until recently found it really hard to finish a book (I used to be an avid reader when I was younger). I feel as though my thoughts are racing at times.

The mood swings tend to leave me quite exhausted. I do not let myself get close to people often, I think it may be because of abandonment fears. My relationships are quite stable even if my feelings towards a person may change continuously.

I develop very strong emotional relationships with people as compared to the norm, people trust me easily. I have been told continuously that I have a talent for empathy and understanding. I am aware of my emotional power over people and know I can get what I want out of them, but sometimes it happens unconsciously. Regardless, I actually do care about these people and have very strong morals when it comes to keeping their secrets. I do not use them.

I do not feel needy and clingy most of the time, but there are moments in between. I used to feel empty a lot. Now, I feel nothing or empowered.

I have a family history of depression, my cousin is diagnosed with it, and my aunt was.

There are times when I am very irritable and other times when my love for people and the world in general is undoubtable.

I felt unloved and neglected by my parents for the longest time. I got over it almost completely during the last 2 months. I also think I am numb to feeling that way now, I can’t even imagine it.

I deal with being alone really well. Most of the time I enjoy being alone, I enjoy solitude. Now and then, usually after some kind of trigger, I feel dejected.

I do not crave love or worldly attachments as far as I can understand. I crave passion and my common state is being fine and in love with the world and all of its mysteries

I used to be very sure this was borderline PD, but after looking through cyclothymia, I feel like this could be more apt as I do not feel empty or unloved or needy anymore and have states of being normal in between. Your thoughts?

I think you should go see that specialist. From your letter, I can’t tell if you are just a very passionate, sensitive teen who has been learning to manage her own feelings over the last few years or if there is something amiss.

People normally have highs and lows. The greatest artists and thinkers tend to experience them more intensely. Good therapists tune in to others and are able to still keep themselves in balance. Is that you? Or are you out of control? A counselor will be able to help you decide.

I do worry about the tendency these days to pathologize almost any feelings that are above or below neutral. It’s as if we’re all expected to be driving a car at one moderate speed all the time, regardless of the circumstances — never fast, never slow. It would be boring and at times dangerous. It’s more sensible to learn to drive the car (or your feelings) according to the situation.

So I think you should get your question settled so you can relax about yourself. A mental health counselor will be able to hear your entire story and discuss your history thoroughly with you. A good place to start would be with your letter and this response.

I wish you well.
Dr. Marie

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Do I Have Mental Illness Too?

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

I have a few family members with mental illnesses such as narcissistic personality disorder, bipolar, alcoholism, and arrested development and siblings with autism. I am not sure if I have a mental illness since I am only a teen and life is just starting out for me but I do have a lot of anxiety and I have been very depressed lately. I also have noticed that when I stopped seeing my school counselor on a weekly basis I started isolating myself from social situations and that’s when my anxiety and depression came along. It’s been 3 years since I talked with a counselor or a teacher and now when I am in need of talking with someone about my problems I find it very hard to do so without reading into their facial expressions and getting really nervous about what they think of me. When I use to stay home alone after school I use to get really paranoid and scared about every thing even when I tried to talk to myself telling myself everything’s alright. I couldn’t calm myself down and I would hide up in my room the whole time. When my mom would come home after work she would ask me why I didn’t clean or do anything productive in the time I was home. I would just tell her I was tired and I took a nap or I would tell her that I did do a few things but it was obvious that I was lying. I grew up with my parents thinking I was lazy and had no motivation of doing anything but that wasn’t the case they just didn’t know that I was just hiding the way I was feeling from them because I knew they wouldn’t understand. I have lost almost all of my friends because of my low self esteem since I am a bit on the heavy side and the constant weirdness that I have like not being able to trust people, not sure of other peoples intentions, anti social, low self esteem, a bit on the compulsive side, some OCD problems and more. I really want to be a psychologist because I like working with people and I do a lot of research on mental disorders but since now that I think I might have a problem myself I am not sure if I get diagnosed with a mental disorder they will let me go into that field. I believe I could really help people but than again if I have a mental issue how could I be a help to others. I think that if I go see a psychologist and I talk to someone about my problems then I will slowly be able to be myself again because I really feel like I am not myself and that I am trapped by what ever is going on with me. I am afraid to tell my parents about this and I feel like I have to wait to move out of my parents house before I can go get some help so I don’t have to drag them along with this. I hope you can tell me what’s going on with me and if it’s a good idea to wait to go get some help or if I should get help now. I also hope you can tell me whether or not something is wrong with me or not. Thank you for taking the time to read this.

Thank you for writing to us with your thoughts and concerns. The best therapists tend to be those who have had therapy for themselves and know what it is like to be on the receiving end of a therapeutic relationship. In everything your have said the tipping point for me was that things got worse for you when you stopped talking to your counselor. Since you are still in high school, go to your counselor and begin talking again. This will help to sort though your current concerns and begin the process of planning for your future. Take care of yourself now and this will serve you well in the future.

Wishing you patience and peace,
Dr. Dan

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I can’t finish anything

by Dr. Marie Hartwell-Walker
written by Dr. Marie Hartwell-Walker

The inability to finish a task has got to be the one aspect of my personality I am simply failing to cope with. Through the years I have been able to learn and adapt myself so I can function in a small measure, but this bleeding away of my motivations has become unmanageable.

I have been stamped with many mental disorders such as, depression, generalized anxiety, primary insomnia, agoraphobia and others I care not to mention. However, I have been able to overcome many of those issues after my last break down during which I had a major life style change concerning my health.
I manage my depression very well and am in good control of dead spells. Anxiety is not a issue since I quit smoking, years back. If fact I believe most of my issues started with smoking but did not all end with it.

To get to the point, I am not responding to any type of positive nor negative motivation anymore. This is not the usual end of the world, depressive, can’t do anything emotion. There is no conflict what so ever. It is just “powered off”. I don’t feel depressed, not like I was years back.

At this moment I am trying to get through a bunch of red tape to get medical assistance for a heart condition I have developed but I just can’t seem to go out. It is a rather serious condition that I need to take care of but I can not motivate myself, even though I am in physical pain. This is not a uncommon pattern for me not to be motivated, not finish things, or do what I should. I don’t know why, tasks I do manage to take on are easy for me and don’t really cause me distress if I don’t have to do them even though many people find such tasks complex, impossible or mind numbing.

It is just now that I really really have to do something and now I have a brick for a lower brain that won’t move. I am sure it will be very good if I just get what I need done to take care of this problem. To put a scale on it I would say this is more demotivating then extreme shame but there is no emotion other then a slowly building frustration or the inability to do simple tasks.

Thanks for reading, hope it makes some sense. 😉

Yes, you make sense. Please stop berating yourself. There is a very high correlation between depression and heart disease. From what I’ve read, it’s unclear which causes which. It’s probably a recursive loop, with each contributing to the other.

Psychology Today’s website outlines a few actions to take to help ensure finishing what you start.

“1. Become aware of your pattern of starting and stopping. A way to recognize a possible pattern is to list every past project you can recall. Every class, resolution, language, book, or plan you have begun. (Maybe a close friend can help.) Write down why you started this activity, and when and why you stopped. Can you determine any commonalities?
2. Research more deeply into your next project before jumping in. Learn what others have experienced when aiming toward your same goal. Don’t think you’ll be the first one to learn Mandarin in a month, or the first to complete a novel that needs no revising, or the first to lose much weight and keep it off while never feeling the least bit hungry.
3. Know yourself and try be realistic. If you’re not particularly reality-based by nature, it may be a useful trait to work on. Setting goals that you can’t possibly achieve, while insisting you can and you will, merely sets you up for failure.
4. Make a time line or write out a set of steps toward your goal. Adding structure to your plans can really help. So many words a day, so much time per week promised to this activity, that sort of thing. It’s not “successes” you’re counting at this point, but rather specific efforts you can realistically make.
5. Ensure your main motivation is intrinsic. Do you really want to do this for personally meaningful reasons? Or do you think finishing your book will get you lots of money or girls (or the equivalent)? If you can find pleasure in the doing, in the learning, you won’t get as anxious when things take longer than expected.”

Somehow you found the motivation to write. Now please scrape together the motivation to find a friend or relative who can organize you until you can organize yourself. You have a serious condition. You need to get to your appointments. You need to inform your cardiologist about your moods and ask that there be collaboration with a psychiatrist. Your body is one organism with each part affecting the others. I therefore believe it’s wise to approach treatment in the same way — dealing with both issues at once. I hope this is helpful.

I wish you well.
Dr. Marie

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Wishing I Were Mentally Ill

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

I have this strange obsession with mental disorders. Everything I do I relate to myself having some sort of illness. I know that I must have depression, because no matter what I do those feelings of helplessness towards myself keep coming back. But I don’t know what I have, really. Most people are afraid of going insane, and they think “I’m not crazy!” when they’re in my place: lost, alone, depressed, suicidal, and self injuring. But with me, I WANT to go crazy, I WANT to see/hear things that aren’t there. The simple thought of being schizophrenic (which is my favorite mental disease) just makes me smile ear to ear. I love hospitals, and have this great desire to be in one. I want to be sick, and I know that’s horrible, but I can’t help it. I had a dream that I was in an ambulance, being raced to the hospital, and I woke up smiling. The thought of having problems is this huge thing for me. I get all sorts of books on mental illness and psychology. Just today I was thinking, “Am I obsessed with going insane? But then does that make me insane already? Can I just not deal with the fact that I’m sane? But then all these other symptoms I have, does that make me insane…?”

I just have no idea what’s wrong with me, if anything is wrong with me. But that’s just it, I can’t fathom that nothing’s wrong with me. Would you have any idea what I should do?
Oh, but you should also know, that I’ve been recommended for therapy by my school counselor for cutting myself, and to speak the truth I’d love to go to therapy, but I say I don’t want to. It’s like I want people to decide what to do with me. I don’t know what that is either.
Help, please?

There must be some part of you that is starved for attention. That’s the only logical rationale behind why you’d want to have a mental illness or to be hospitalized. Maybe you believe that if you were hospitalized you’d have many people concerned about you. There might be teams of doctors caring and looking after you. Your parents or family would likely be involved too. You may see hospitalization as a form of “guaranteed attention.” Perhaps that is your goal.

Your deep desire for attention has turned into an obsession. The desire to be sick may be related to a disorder called Munchausen syndrome. Individuals with this disorder not only desire to be ill but they actually pretend that they are. Many even undergo risky or painful tests and treatments for their fictitious disorders in order to receive sympathy and attention. This is not the type of behavior you’re currently engaged in. The concern is that in the future you may progress from wishing you were ill to actually pretending that you are or doing something to make yourself ill.

You wrote about schizophrenia being your “favorite” mental illness. You say that you “want” to experience delusions and hallucinations. No one who had schizophrenia or knew anyone with the disease would have this desire. You must be unaware of the fact that schizophrenia is one of the most debilitating mental illnesses that exists. It’s treatable and people can get better but there is no cure. Individuals who have the disorder say that it’s “hell on earth.” No one who was thinking clearly or knew anything about it would want this disease nor would they wish that they could experience any of its terrifying symptoms.

It’s normal to want attention. Children need attention and when it’s not given they might act out inappropriately to get it. Teenagers need attention too. If they do not get it they too may misbehave. Individuals who are physically or emotionally neglected may go to great lengths to get noticed. I suspect the cutting behavior you’ve engaged in and your desire to be ill are misguided attempts to gain attention and sympathy from your caregivers. It’s human nature to need and want attention but it shouldn’t come at the expense of harming yourself.

You want to attend therapy but when presented with the opportunity, you lie and say you don’t want to go. Why do you do this? If you have the chance to receive help then you should take it. You are engaging in self-harm and it needs to be treated. The desire to have a mental illness or to be hospitalized also is something that desperately needs to be addressed in counseling. A counselor can help you find more appropriate ways to ease your emotional pain. You are clearly suffering and your thinking is distorted but these things are correctable. The next time you are offered the chance for counseling make the very smart decision of saying yes.

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Can drug use cause bipolar disorder?

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

My husband has been on Depakote for 10 years for bipolar disorder. He was diagnosed at 30, after a manic episode he experienced for two weeks after taking the drug ecstacy. (He took the drug June 24, went into hospital july 4). My husband was not a drug user up to this point, nor did he ever experience bouts of depression or mania before this time. After having the same initial doctor for 10 years, my husband is looking for a new doctor to help him come off of the medicine, as he believes he was misdiagnosed. I am petrified that the drug could have been the catalyst, and maybe he will have another episode. What are your thoughts? Would a doctor agree to take someone off medicine for this condition?

The story you have told is very common. An individual experiments with drugs and subsequently develops or suffers from psychiatric (usually psychotic) illness related symptoms. To know whether or not ecstasy was the catalyst for your husband’s manic episode is very difficult to know but it is highly likely that it did contribute in some way. Science still does not have a definitive answer on what causes bipolar disorder, or any other disorder for that matter. The mechanism by which psychiatric diseases develop has yet to be elucidated. Some theorists currently believe that some individuals, those who use drugs and subsequently develop psychosis, may have a predisposition to developing psychiatric disorders. Under this theory, drug use has the potential to serve as a catalyst for psychiatric symptoms. This may mean that if the drugs were never used, psychiatric symptoms may not have developed. It is my educated opinion that the drug did contribute to your husband’s manic episode but I could never know this for sure.

According to Mind.org’s website: “Medication, drugs or alcohol can’t cause you to develop bipolar disorder, but they can cause you to experience some bipolar moods and symptoms. For example:”

“Some antidepressants can cause mania or hypomania as a side effect when you are taking them or as a withdrawal effect when you are coming off them. If you begin to experience mania after taking or after coming off antidepressants for depression, this might lead your doctor to give you an incorrect diagnosis of bipolar disorder, or prescribe you more medication. But in this case it’s usually worth waiting to see if your symptoms pass without treatment first.”

“Alcohol or street drugs can cause you to experience symptoms similar to both mania and depression. It can often be difficult to distinguish the effects of alcohol and drugs from your mental health symptoms.”

Additionally, it is difficult to know whether the doctor would agree to take someone off of their medication. That depends entirely on what the doctor believes to be the correct diagnosis and which treatments or medications the doctor prefers. As far as getting an accurate diagnosis, this can be a challenge. Even through guidelines exist, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM), there can be so much variability between diagnosticians. I have read studies where 10 different doctors gave 10 different diagnoses for the same patient relaying the same set of symptoms. The key for your husband may not be getting the “correct” diagnosis as much as it is finding a doctor that he likes and trusts. I would advise him to search for a doctor who is willing to take the time to work through different medication and treatment trials. The ultimate goal for your husband is to find a treatment that he can tolerate and gains him respite from his manic symptoms—and to find a doctor willing to take the lead in this process.

I hope this helps. Please write again if you have any more questions.

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