Q: Diagnosis Keeps Changing: BP II, BPD, IED
My diagnosis with my Dr. keeps changing like I am a puzzle to her.
first BP2, then borderline, then IED.
Is it possible to have the mini psychotic episodes and still be BP2?
I have read up on all three and BP2 still describes me best but I have to admit
I can relate to both the borderline and IED in parts but not fully.
She has me on paxil 30mg lithum 300 twice a day and clonazapam when needed.
I believe I shouldn't be on the paxil but I am not the doctor.
I also read your book never has anything hit home like that was like you knew
me. my mother read it too and is very impressed.
thanks in advance for your time
Dear Ms. M' --
You may have read my little essay on Borderline "versus" Bipolar, the bottom
line of which is that the two conditions are so close in terms of symptoms (not
a perfect overlap, but almost); and the treatments one might consider are so
close; that spending a lot of energy trying to figure out which one you have (or
both) is not a productive use of time and energy, in my opinion. The
psychotherapies for Borderline PD are potentially quite useful for bipolar
disorder, and very unlikely to make bipolar disorder worse (perhaps the time and
money and energy could be spent working on some skills that would be more
bipolar-specific, that would be about the only downside). So even a wrong
emphasis is not likely to make things worse -- with one major exception.
We'll come to that in a minute.
Meanwhile, IED ("Intermittent Explosive Disorder") has
been shown to respond pretty well to one of the main treatments for bipolar
disorder, valproate (Depakote). And a cognitive-behavioral therapy would be
pretty helpful there too, most likely -- just like the CBT that's now regarded
as an important part of the
psychotherapy for bipolar disorder. So the same story applies here as well
as with Borderline: similar symptoms, so similar diagnosis (IED and bipolar);
and the treatment options are nearly identical, so again, why spend much energy
trying to figure out "which one? or both?" Just get on with treatment, which
means examining all the treatment options with their pro's and con's, and making
a plan for which you'll try first, then second, then third (hopefully finding
one before you get to "ninth" or so).
But, there's that one major exception:
antidepressants. You've heard me go on about my views regarding the role of
antidepressants in the treatment of bipolar depression (in my
book, and to a lesser extent on
website), where the
bottom line is to recognize that -- in the view of nearly all mood experts --
antidepressants can make bipolar disorder worse, in some people. So, you say "I
believe I shouldn't be on the Paxil". Well, there could be some very good
reasons to be on and stay on the Paxil, and I hope that by working at it, you'll
be able to help your doctor explain to your satisfaction what those reasons are;
or bring her around to considering a trial of tapering the Paxil to see where
that leaves you (in which case you'll remember my quoting the recommendation of
Gary Sachs, the Harvard bipolar specialist, about taking as much as 4 months to
taper). You have also read the chapter on talking with doctors; the website has
which summarizes that section. Good luck working that out --
Published October, 2006