Not to come off as dismissive of your concerns but it's basically a rite of passage for a late-diagnosed ADHDer or autistic person to collect at least one mood disorder before arriving at the correct diagnosis. If you're AFAB or PoC then you can pretty much expect to run a gauntlet of mood disorders before you reach the finish line.

Try not to invest too much in the label - it's just a descriptive term but the condition that you have, whatever it happens to be, and the symptoms you experience are the same today as they were yesterday. You could call yourself haunted, you could call yourself bipolar, you could call yourself mad; that doesn't have a determining effect on what you're dealing with.

Obviously I'm not saying that you should go collecting diagnoses or that there isn't a degree of impact that a prior diagnosis may have on the type of treatment you receive but try not to get too caught up in the whole thing.

As a personal example, my psychiatrist has broached the idea of a diagnosis of chronic fatigue with me on multiple occasions. Each time it has been mentioned I have expressed my reticence towards it - I am not in the business of collecting diagnoses, a chronic fatigue diagnosis doesn't open up opportunities for better management or treatment of what I'm dealing with than what I already have, and I don't really need clinical validation where it's basically saying that I'm tired all the time, except it's Medically-Approved™. For me it seems as though getting diagnosed with chronic fatigue would serve no purpose and so I see no use in it. Whatever it happens to be you can name it, you can choose not to name it, but ultimately if naming it doesn't create opportunities for you - whether that's a better way of understanding and managing the condition, more avenues for treatment, access to supports and accommodations, or that sort of thing - then a label is not a useful thing and in that situation I'd seriously consider whether I need to carry it with me at all.

They're both stigmatized but borderline is more for sure

actually got an ADHD diagnosis from a psychologist at this clinic. It's weird, this is my 2nd visit with her (nurse practitioner) about it and after the atomoxetine she gave me didn't help she wants to treat me for bipolar

Sorry I'm double replying to you, but it sounds like the nurse is abandoning your ADHD diagnosis and assuming bipolar because your current ADHD meds weren't working? If so, why not try a different medication for ADHD if that is what your psychologist (an actual mental health professional) diagnosed you with?

Most psych meds, including those for ADHD, are kind of random with how much they work for different people. I don't know the statistics for ADHD meds, but I know like 50% of people who try an antidepressant don't experience any favorable effects. Not responding well to a specific treatment doesn't mean you don't have the thing you're trying to treat. I have a few friends with ADHD who had to experiment with different dosages from different medications before finding what worked for them.

Sorry i get kinda frustrated hearing about shitty mental healthcare, it can be such a brutal process but it shouldn't be

Well if people around you haven't ever noticed any manic or hypomanic episodes in you and you didn't report having these to the nurse practitioner then I feel like the bipolar diagnosis probably isn't a good fit.

Atomoxetine

I really shouldn't gloat by saying that I called it. Suffice it to say that your post set my expectations for this clinic at that level and this tracks.

Sorry you're having a bad time with it. Go rest up and come back to this post/situation/both of them when you're feeling up to it - there's no time pressure.

+1 looking into treatment elsewhere, if they aren't starting with trialing stimulants for an ADHD diagnosis I don't trust them to 'get' it. To start with a non stim and then when it didn't work to diagnose you with something else is highly suspect. I wouldn't really put stock in their diagnosis.

If you're able to find a psychiatrist who specializes in adult ADHD, or even better HAS ADHD it's honestly so much easier.

Everything these other comments have said is pretty accurate. Diagnosing bipolar after 2 visits, no history of mania, and a single depressive episode is dumb. People have depressive episodes, does not mean you are bipolar.

TD normally takes years to present (not always) if it even does, so if you do decide to take it, I wouldn’t stress too much about it.

I’m guessing you’re already on an SSRI. I would look at a different provider and see if they want to alter depression therapy instead of adding an antipsychotic.

The gold standard for treating the "classic" bipolar symptoms is still lithium but valproate is also very effective. It depends on the prescribing doctor and other things like lifestyle factors and how that person is managing their symptoms; because lithium has a especially narrow therapeutic window, at least in the mainstream literature, this means that in order to get an effective dose you have to be skimming just below a dose that is toxic.

Obviously if it was incredibly risky they wouldn't prescribe it at all but if you have someone who is manic/hypomanic and you aren't able to supervise them closely, or if they are in the pits of crippling depression, then you can risk a person not eating and drinking enough (or getting blind drunk and dehydrating themselves, for example) or accidentally taking too much lithium because they're on a bit of a rampage or because they can't remember if they took their dose and suddenly you can have someone who is quite seriously sick from lithium. Of course as you're titrating up you need to carefully monitor the lithium levels of the patient and so for someone whose mood is way too high or way too low, that can be difficult to manage.

(Caveat to say that there's at least some indication that sub-"therapeutic" doses of lithium may be effective especially for depressive symptoms, but I wouldn't expect to take a low dose of lithium and have my depression cured or anything like that.)

So yeah, I wouldn't be surprised if a patient comes in with well managed bipolar, or what the practitioner presumes to be bipolar but they're in their 20s with no history of hospitalisations for manic episodes, and for them to prescribe valproate because it's easier to manage and if you're working with someone who isn't at imminent risk because they aren't on that really textbook Bipolar I rollercoaster ride then you probably don't have the urgent need for lithium to stabilise them and so valproate is likely a decent choice.

Lamotrigine is really useful but I still think that the best first line treatment is really lithium and then next is valproate.

Obviously it depends on the individual and their particular flavour of bipolar but the broad brushstrokes are that lithium is the first port of call for Bipolar I whereas for Bipolar II or BD-NOS etc. it seems as though valproate tends to be preferred and then lamotrigine is really good especially for treating bipolar depression, so if someone is probably bipolar but they are mostly experiencing depressive symptoms or if it's a person whose depression isn't responding to conventional treatments like antidepressants (where there's suspicion that it might be bipolar depression rather than the typical depression) then that's where lamotrigine can really be effective, as well as where there is insufficient response to lithium/valproate or the side effects are not tolerable.

But it really depends on different factors and how a person responds to the meds in question. (Obviously with lamotrigine there's a slim chance of causing SJS/TEN 😬 so if anyone's considering taking it make sure that you're aware of those symptoms and that you have made your prescribing doctor is aware of any allergies.)

I guess it's also a tricky thing because once you step outside the classic Bipolar I then it gets very murky with differentiating between the other bipolar diagnoses and MDD or schizoaffective disorder etc. and so the treatment is often a bit of guesswork and a lot of understanding that the map =/= the territory; just because a patient doesn't report symptoms that indicate something like psychotic depression or schizoaffective disorder doesn't mean that isn't what they're dealing with; my armchair expert opinion is that there's a significant amount of blurring and there's sub-clinical symptoms or symptoms that go unreported and so you might have a person whose diagnosis is bipolar but who doesn't respond to the typical mood stabilisers much/at all but who responds really well to an anti-psychotic. And then you're left to ask whether the diagnosis is accurate, whether there's something else like comorbidity that hasn't been identified, or whether there's something else that the antipsychotic is hitting that the lithium wasn't which would explain the response. (And I think a good psychiatrist is one who treats a patient not as a diagnostic label but who works to understand the symptoms that a person is dealing with and to determine their etiology, and who takes a very strategic and scientific approach to how a person responds to meds rather than having a very mechanistic "Bipolar In -> Lithium Out" sort of approach.)

But yeah, that's a long way of saying that lithium really is the closest we have to an ideal medication for textbook Bipolar I and that outside of Bipolar I it quickly gets very murky trying to know what will work/how well it will work/what's going on.

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.

Wow, thanks for that image! The symptom overlap is something i remember from the psych 201 course i did in college, forgot the name, but yeah you notice it pretty quick once you need to write it out on tests.

I was on antidepressants for a while too and I would say they helped since I was depressed, but only marginally, and it was so long ago I can't remember clearly how I felt. I dont want to come across as anti-doctor and anti-treatment of course, just think that our opinions matter too as we know ourselves.

I've had a couple people in my life accuse me of being borderline or bipolar or a psychopath or things like that as a way to hurt me, so I'm pretty sensitive about it.