Should I switch from a psychiatrist to a therapist?

Background:
Rapid moodswings
Lots of anger
Diagnosed with Bipolar II
Bulimia
Anxiety
Paranoia

After many counseling sessions, my counselor and I came to the conclusion that I needed more help. I told her that I was suicidal because of my depression and we discussed my options. I settled for a psychiatrist who she said was good.

He is a bit expensive! The first session was $200 and the following sessions are around $100, not including my medication costs. He's so convinced that I'm bipolar and prescribed to me an anti psychotic drug even though I keep telling him that I don't think I'm bipolar.

My lows are extremely low, but my 'hypomania' are more like my normal stages. I have some paranoia that went away with the anti psychotic drug, but I still don't think I'm bipolar. I have anger issues, anxiety and nightmarish bulimia. There are moodswings, but it swings from normal to sad to anger. Rarely am I genuinely happy or ecstatic, except when I'm exercising. I think I might have borderline personality disorder, but definitely not bipolar. I think the way I behave is not because of some illnesses, but because of learned behavior.

Should I switch from my psychiatrist to a therapist to work on my anger issues and eating disorder? My psychiatrist seems to just want to focus on medicating me.

Hi there,

I know the time around getting a bipolar diagnosis can be extremely confusing and difficult, and I’m sure many people do question it and doubt how valid it is. It’s certainly something I’ve done myself at certain points, especially when some of my family members can be sceptical about the diagnosis.

The fact that, even when not on medication, people can have substantial periods of stability, or show only subtle symptoms can sometimes mask the underlying issue, I think.

For me, my symptoms can be so severe (psychotic mania and suicidal depression) that I’ve now had to accept my diagnosis. Plus, I’ve been having treatment for about 12 years, so it’s had time to sink in.

Did your psychiatrist explain to you why they’re so convinced you have bipolar? Sometimes hypomania can seem like a ‘normal’ phase until you learn to recognise the signs in hindsight. For example, irritability and anger are classic symptoms, and I get those with hypomania (which turns more to rage/violence with mania). When someone has been living with hypomania for their whole lives, I think it may also come to seem ‘normal’ (as it is in their experience). I’m not saying this is necessarily true for you- just that it’s a possibility.

By the way, I also have a chronic anxiety problem, and developed a mild eating disorder (restricted my eating and exercised quite obsessively) from the ages of about 10-15 when not receiving treatment, and I only have a bipolar diagnosis. These two issues have calmed down a lot since finding effective medication. Again, this is just my experience.

I think if you’re unsure about your diagnosis, perhaps the best thing would be to read around about Bipolar II and seek a second opinion, if possible. Certainly, therapy can be very useful but if you have bipolar disorder, I believe that a psychiatrist’s input is essential to manage it. Ideally, both medication and therapy would be used together.

There are lots of medications out there, including antipsychotics, mood stabilisers and antidepressants, which help with bipolar so don’t feel you’d be obliged to stick with your current antipsychotic if you chose to take meds.

I hope this helps a bit and you resolve this issue soon. Take care x

Hi

I think if it is possible you should probably have both - I think it is important to have the view of a psychiatrist in terms of meds and diagnoses etc but a therapist also can help a lot. I have a background of issues where therapy was needed such as self harm exacerbated by low mood but I also need a Dr to manage the complexities of my medication. Having the 2 together has really helped me. I recently finished with my therapist but she helped me a lot including in how to manage the BP as well as working on past trauma etc. It was really helpful to have both. now I think i am ready to just have my psych but I would highly recommend having both when you still have issues to deal with in therapy as well as diagnosis and med queries.

Cracked

I have an awesome psychologist who I love and trust. She has been great at getting to the bottom of my condition and giving me tools to cope. She can't prescribe medication, but she can recommend it.

She has saved my life more than once, and she got me through the worst times I've ever had. I'm also not afraid of being forced into treatment, because she doesn't have that power. She has helped me far more than any psychiatrist could.

My insurance pays for up to $2000 worth of treatment per year, and I spend it on her.

CrackedGirl wrote:Hi

I think if it is possible you should probably have both - I think it is important to have the view of a psychiatrist in terms of meds and diagnoses etc but a therapist also can help a lot. I have a background of issues where therapy was needed such as self harm exacerbated by low mood but I also need a Dr to manage the complexities of my medication. Having the 2 together has really helped me. I recently finished with my therapist but she helped me a lot including in how to manage the BP as well as working on past trauma etc. It was really helpful to have both. now I think i am ready to just have my psych but I would highly recommend having both when you still have issues to deal with in therapy as well as diagnosis and med queries.

Cracked

Hi, thank you (and everyone else) for responding. I have a counselor right now who is contracted by my university. She has helped me a lot and she seems to know what she is doing. She has many years of experience already and my tuition pays for her services...

Do you suggest that I go ahead and try to get in contact with a psychologist as well? I'm on a tight budget and am paying for everything out of pocket including my current medicine.

I was thinking that if I was misdiagnosed and just have clinical depression or maybe even borderline that maybe I should just stop going to my psychiatrist and opt for a psychologist for psychotherapy.

Hi

Ideally I think that the combination of a counsellor/psychologist/psychotherapist or similar plus a medical dr psychiatrist is the best. And I also think it would be good for the two of them to communicate with each other esp if you are questioning diagnosis. So if you currently have a counsellor and a psychiatrist then I think this is a good set up but that you need to tell them you are questioning diagnosis and this needs to be discussed with you and between the two of them - ideally the three of you meeting together to talk about this. Here as service users we have a meeting called a CPA every now and again where all those involved in our care meet with us at one time and the care plan is discussed. I think that something like this would be great for you if possible.

Cracked

I went to psychiatrist for diagnosis for while , then went to therapists. I used to go to a nurse practioneer who was great, I could do meds changes and therapy all in one.