thinking back to that initial diagnosis

I responded to something over in Clinical Depression about how I first went in because of what others thought/said despite me being worried about the stigma of depression. It was 20 years ago and my wife and I were a lot closer in many ways; so the story about legitimate concern is true and something I felt might be helpful. I did not want to suggest that the "rest of the story" (with apologies to Paul Harvey) would be likely to apply. "Depression" had/has a stigma I was not very comfortable with. Little did I know I was about to hear another word that had a stigma so far removed from my comfort zone there are no direct flights (with apologies to Rod Serling)...

So I go in and see the doctor and it really was the stereotypical psychiatrist office.
"Couch or chair?"
"I'll take the chair." the one near the door, because I am not going to be here long.
He scribbles on his pad. It matters where I sit? I hope he didn't see me roll my eyes. He saw. He scribbles some more. "So tell me why you are here."
Mind games; he knows why and isn't asking a question. He wants to hear me say it to find out if I am on board with this crap or not. "My wife thinks that because I get a little down sometimes, I am depressed." I am not on board; scribble that, mf'er.
"And what do you think?" Wow - I can't believe he threw that fat pitch. Too easy.
"I don't think it is that bad. Sure, I let stuff get me down more than I should some times but I am new to being a family man and I worry about getting everything perfect for them. Besides, I pull myself back out of it pretty quickly every time." Nothing to see here, just a guy trying a little too hard to be the perfect father and husband. Pat him on the back, tell him it will get easier and send him on his way.
He switches to another pencil with harder lead so he can scribble faster - "You get better? This is so much worse than I thought."

OK, I am paraphrasing and embellishing (but not lying - oh no, I never do that). He didn't jump to that too quickly; he was much sneakier about getting me to describe what it felt like to be better first. I stepped right into the trap; when I bounced back I was so on top of my game that the wind quieted so the sun could hear me. Scribble, scribble, scribble. Open bomb bay doors...

"Bipolar"

NO. NOT POSSIBLE. This is something they say about crazy people. He just knows I won't come back if he doesn't pull out the big gun. It wasn't going to work on me though. I was faux polite about needing to get another opinion (I already had one formed). I took the prescription he wrote only because it was easier than arguing and left. I'm not coming back.

Glad that's over!

I totally forgot about the release I signed when I was filling out paperwork. Of course it was okay for them to share information with my wife; she does the family books and keeps the records. He called her, asked her perspective on my ups and downs and shared his diagnosis. So she tells me this as soon as I get home right? Ha! She hands me a shovel - "So, how did it go with the doctor?"...

This just seems so quick in diagnosing you. It took me about 7 years since I first began seeing the pdoc to getting him to diagnose me as bipolar. I actually wanted to be diagnosed because my depression wasn't letting up and no antidepressant worked. Ever! For me, after learning my diagnosis and reading everyone's day to day experiences, I connected so much with that. I studied and read and I looked to my past and I've been bipolar since my teens. My first manic episode was when I was 18 years old. But yet, it took so long for me to have an actual manic episode and then a mixed episode. That was confirmation of Bipolar I. Then my meds were changed and then, I am stable. But to just easily diagnose like that just sounds so sudden. Don't get me wrong, he's the doctor, the expert, it's just me thinking out loud, sort of. I would have definitely have considered a second opinion at that point.

When I do share to a few people that I have bipolar and that I've been hospitalized they get real quiet. I have not shared that I've been psychotic too, I can't trust them and it's not fair for me to get judged by ignorant people who do not know what bipolar entails.

Yes, it was quick and that is one of the reasons I treated it with suspicion. I did summarize, paraphrase and embellish some and left out a very important detail - the prescription. I don't recall exactly what he prescribed (I remember being disappointed it didn't have any euphoric effect) but he said I needed to give it several weeks to see if it helped and that how I reacted to the medicine would determine if he was on the right track. I thought that sounded sketchy - "I think you might have typhoid fever but I'm not sure, so I am going to give you penicillin and if you die, well then it must be something else."

I am not sure how long he talked to my wife, but she knew a fair amount about it when I got home and the internet was not yet the treasure trove of (good and bad) information it is now. She also is adamant about her opinion that I become substantially more high strung, condescending and leave lots of sentences unfinished for long stretches of time (across several days). She said she was worried I was doing drugs and was relieved. I was not relieved.

I agree that your initial diagnosis did seem kind of rushed, UpDownAround, but I suppose sometimes, from the information given, people present quite a clear cut case of whatever illness they most likely have. As for me, I was diagnosed in the midst of a major manic episode/psychosis around 15 years ago, and was on the verge of hospitalisation, so in that scenario I left the pdoc who started treating me in very little doubt as to my diagnosis.

I tend to only share my diagnosis with those who are extremely close to me, as the stigma and misunderstanding out there is real and I feel it's a gamble to share it with just anyone, so I'm quite selective. My last boss knew, as well, but before that I'd tended to hide my diagnosis at work. Hope this helps. Hugs, if wanted.

Stigmas suck. I have that other diagnosis from a pdoc I saw maybe 8 or 10 years ago that said depression and ADHD that has far less stigma yet the treatment would be roughly the same. That pdoc did not talk to my wife or anyone besides me. I think the hardest part for the pdocs is figuring out how to use our input. I am pretty self aware, but I do have internal bias and sometimes I lie, especially about risky behavior impulses.

I mentioned this in another thread, but for completeness - I got dragged into one of my kids' pdoc visit because my wife told that pdoc about my old BP diagnosis in family history. My son filled out a screener that indicated a possibility of BP. She (pdoc) showed it to me, watched me read it and asked about risky behavior. No way was I going to talk about my impulses in that setting, but it caught me off guard and I stammered and dodged. She didn't press but I don't think she discounted the diagnosis.

There is a lot of overlap between the common ADHD assessment and the manic part of the BP assessment. The depression part is nearly identical to the standalone depression assessment. So a lot of it comes down to the medicine you respond to, but what the pdoc thinks determines what medicine(s) are tried.

It will be interesting to hear what the new pdoc I see next week has to say. I am not feeling quite as bold as I was when I provided all the info to her.

I know I am prone to being really up or down for what seems like no reason, that my head just doesn't seem to clear, that I like to use drugs/alcohol to escape, that I get impulses to strip naked and sneak around or damage property and that resisting those impulses is only mostly successful. I really don't care what that is called if someone can help me get it under control.

I had depression in high school and mania/psychosis freshman year. They thought I had seasonal affective disorder in high school or possibly clinical depression. Anti-depressants would have made me manic but I just used a mood light in the winter. Typical partying and all nighters led to an ER trip for feeling paranoid and hyper religious, hyper sexual etc. They told me to quit taking drugs and sent me home with some valium. I was back the next day via ambulance very psychotic. Eventually was diagnosed Bipolar 1. Psychiatry is a guessing game and if you don't describe your symptoms well or accurately it is harder for them to help you.

One more piece of the puzzle...

I get accused of not having a very good memory, but I take it with a grain of salt because in most cases it is my wife that says this when we don't agree about something in the past. I just got hit with that this morning when I asked if she remembered more specifics (name, date). It came to light that I really did not remember the details of how I ended up seeing that psychiatrist.

Her version (so I don't have to keep saying "she said"):
I was not just a little down and a little up. I would be weepy and dejected for a while and then I would come home in a good mood, drink until I was babbling and then ask for sex. She suspected drugs at first because of my past (she doesn't know details but she knows it wasn't just light recreational). We both had the same primary doc back then and we were on an insurance plan where he was the gatekeeper for specialists. We went to him first. He talked to both of us and prescribed something. After a couple of months with no change, he referred me to a psychiatrist he knew well and talked to him before I saw him. Bipolar was mentioned as a possibility by the primary.

I do suspect some bias on her part; there was a little knife twisting about making sex feel like less than love making. But I do remember seeing the primary about it after she reminded me.

z7z wrote:They told me to quit taking drugs and sent me home with some valium.

Interesting; my first experience with psychiatric "care" 40+ years ago was similar. I was there because I got vandalizing equipment. My parents paid damages and agreed to have me evaluated by a psychiatrist. He said it was anxiety, have some valium; they gave it out like candy back then.

I got a bipolar diagnosis very quickly. I was inpatient for 4 days and they said I have bipolar ii. My counselor didn't believe it, as at the time I was seeing her, I was depressed, so she assumed I just had depression. After finally seeing me manic, and having a rather "dangerous" manic episode that landed me in the hospital, I got a bipolar i diagnosis. After about a year, I began to deny this, and asked my NP what I "have" and she said w/o a doubt, bipolar i. Hell, I still don't believe it.

I don't really know what this has to do with your OP, but I thought I'd just share my hasty diagnosis.

I think it is pretty difficult for them to gauge hypomania versus ADHD when the manic behavior doesn't seem to place anyone in danger or they don't know about all of it. If mania crosses the line to the point of needing in patient care, I think it is pretty clear it isn't just ADHD.

When I talked to my wife the other day I really was just trying to get a more definite date and maybe the pdoc's name. She seems to think I pretend to not remember that diagnosis because I did not react well at the time. I mentioned earlier that we had the same primary at the time. I left that practice because I had complained about the head fog for some time and he did not seem to be on the right track. He was treating me with ADs and I did not seem to be getting better. This I remember. My wife says that I did not take the meds regularly enough or long enough to know whether or not they worked and then bailed on the primary and pdoc. This is kind of a sore subject and I am not going to dig that hole any deeper (I get why she is bitter; she thinks I could have been a lot easier to live with the last 20 years). I see the new pdoc on Thursday.