The nurse practitioner I’m seeing about my ADHD diagnosed me with bipolar disorder

She literally could not have surprised me more if she tried

This makes no sense to me but it’s scaring me a lot :(

I don’t really remember having manic episodes? Depressive maybe but it’s usually after something bad happens to me and not really consistently…

I told her I put off making this appointment cuz I’ve been feeling really bad recently, then she just asked me a few questions like if people say I talk too much sometimes or if I do things impulsively and prescribed me an antipsychotic (aripiprazole) wtf

I asked some family and they haven’t noticed anything like this… idk :(. Has this happened to anyone else? Am I just in denial? I’m afraid to take this drug she gave cuz I really don’t need to be even more tired all the time… or tardive dyskinesia or something (unlikely, worst case)

      • ReadFanon [any, any]@hexbear.net
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        7 months ago

        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.

        • PaX [comrade/them, they/them]@hexbear.netOP
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          7 months ago

          Yeah, you’re right. I guess I’m just harboring such a bad attitude toward this purely out of anxiety tbh. Like you said, the label itself doesn’t change anything about the experience.

          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.

          Oh yes, 100-com% lmao, it took me years going through the gauntlet of medical bureaucracy on and off to even get this far

    • PaX [comrade/them, they/them]@hexbear.netOP
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      7 months ago

      I see :(

      Maybe I have had hypomanic episodes? I’m not sure… some of this seems familiar but I’m not sure how I would tell it apart from ADHD. And I’ve never experienced anything like grandiosity or risky behavior or psychosis or anything…

      This really sucks

      • Frank [he/him, he/him]@hexbear.net
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        7 months ago

        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.

        • PaX [comrade/them, they/them]@hexbear.netOP
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          7 months ago

          Thank you so much for sharing your experience. I don’t understand why she jumped to this diagnosis after maybe a combined total of spending 30 mins talking with me (This was our 2nd appointment and I saw her for the first time in person today).

          Your experience of hypomania doesn’t really sound like me at any time… I think. Occasionally I will get very invested in topics or projects which brings me a lot of satisfaction and I might sleep a bit less than usual and use a lot of caffeine to stay focused but I don’t really feel more confident or any kind of all-encompassing euphoria or any desire to engage in any risky or impulsive behavior out of the ordinary. Idk :( I guess sleeping less is the most concerning… last time this happened I just felt “okay” as opposed to my usual “things are hopeless and I’m barely hanging on”. I have a lot of anxiety about my health normally so it’s hard to tell what’s a real symptom or what I have convinced myself I have. It’s hard to remember my behavior exactly too… I’m not sure if I was sleeping less or not last time.

          Do you have depressive episodes? What are they like for you? I have been feeling pretty bad in the last month or so (although I usually always feel bad these days, depression, anxiety, etc). That same NP gave me some medication for my ADHD that didn’t really help and made me feel a lot more anxious and maybe depressed around the same time. Then some other condition I have was getting worse. It’s just so confusing :( I guess I have good reasons to feel worse than usual?

          I’ll ask my therapist about it tomorrow. It could get weird though because they both work in the same small clinic and my therapist referred me to her. Maybe I could ask my primary doctor about it too.

        • ReadFanon [any, any]@hexbear.net
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          7 months ago

          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.

          Agreed.

          I could absolutely see someone prescribing valproate instead of lithium because it’s a bit easier to manage the dosing of it. Same for lamotrigine but I would be questioning why a prescriber would reach for that first if they did.

          The only way that I can square aripiprazole-first treatment for bipolar is if it was a BD-NOS diagnosis, and even then…

  • LeopardShepherd [none/use name]@hexbear.net
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    7 months ago

    Not a knock on nurse practitioners but I personally wouldn’t be getting a mental health diagnosis from anybody except a clinical psychologist or a psychiatrist. Preferably one that has a special interest in whatever you are seeking help for as well as age group. I know this can be prohibitive but diagnostic criteria for this stuff is so much more subjective than any other field in health I would want somebody at the highest level of expertise.

    I come from a healthcare background and while nurse practitioners are great I honestly feel their role is best suited to maintenence and tweaking of treatment with most of the diagnosis handled by a much more specialised practitioner.

    Also in terms of viewing a diagnosis as having been given “another chronic condition” : just remember that it’s something you have already been living with, it just now has a description and you can recieve targeted help.

    • ReadFanon [any, any]@hexbear.net
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      7 months ago

      Yeah, I definitely think there’s a role for nurse practitioners and I feel like some of the more commonplace psychiatric conditions like depression and anxiety is up their alley. Agreed on tweaking and maintenance work too.

      But if I had bipolar I’d be going to a psychiatrist, same for ADHD.

      The hasty bipolar diagnosis is iffy and then going to aripiprazole just doesn’t seem to have a good rationale behind it - we can presume that they didn’t give a Bipolar I diagnosis for obvious reasons. That leaves BD II and BD NOS, but if this is the first time seeing a patient then you can’t really eliminate schizoaffective disorder and messing with dopamine in this situation is simply ill-advised.

      Chances are if it was one of those 3 the aripiprazole would probably be fine but it’s just a bit of an unnecessary risk and tbh I’d expect a prescribing professional to want to stabilise the condition first before (potentially) introducing antipsychotics, all things being equal.

  • Red_Eclipse [she/her]@hexbear.net
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    7 months ago

    Before I self-realized my neurodivergence, I went through a period of considering if I maybe had Bipolar 2, and took some antipsychotics. They did nothing, it was like taking a sugar pill.

    I took ONE pill of aripiprazole and it gave me akathisia (like restless leg but for your whole body) within hours. Never took it again lol.

  • damnatum_seditiosus [any]@hexbear.net
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    7 months ago

    CW : Story of suicidal thoughts and kind of self harm too.

    spoiler

    I too got diagnosed in the last few years with Bipolar with hypomania after I also did a test for ADD which was positive. I’ve struggled with suicidal thoughts since my teenage years but I knew that if I just waited it out, it would pass and I’d gain that sweet new will to live and a boost to my self esteem with it.

    But yeah I had typical depressed stuff, isolating, dropping everything and projects I had started and missing while days too. I’ve started with Aripriprazole too but I was getting some morbid thoughts racing in my head too and that kind of stopped using antipsychotics.

    But as other have noted, get a second opinion if you can, you know yourself better than anyone after all.

  • ReadFanon [any, any]@hexbear.net
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    7 months ago

    Definitely echoing the need for a second opinion on this one.

    I’m afraid to take this drug she gave cuz I really don’t need to be even more tired all the time… or tardive dyskinesia or something

    Aripiprazole isn’t too bad. Obviously it’s a psychiatric med so there’s going to be some people who don’t vibe with it, naturally. It’s unlikely to knock you out like quetiapine - some people find it activating and some find it to be a bit sedating depending on how you happen to respond but it’s very unlikely that you’re going to be a zombie on it.

    There’s a chance that it might have an effect on your ADHD symptoms but evidence supporting this is pretty slim.

    Honestly I’d be looking for a different prescribing professional. A hasty bipolar diagnosis is sketchy, aripiprazole as the first treatment is very questionable… I think that’s a fair indication that you’re going to be pushing shit uphill trying to get an accurate diagnosis and a coherent approach to treating symptoms.

    Without knowing more, this is the kind of situation where I’d expect it to take at least 3 months, likely longer, to eliminate bipolar and to move onto a more accurate diagnosis. Then you have to cross your fingers and hope that they land on ADHD. Then I wouldn’t be surprised if they prescribed you something wack like guanfacine monotherapy or atomoxetine straight off the bat, which could easily blow out your timelines by another 6 months before you might be able to get around to the first-line treatments. Idk if I’d be willing to piss a year up the wall trying to chase down an accurate diagnosis unless it was my only option.

    Obviously this is just speculation but it’s what I’d expect from a nurse practitioner who is apparently so haphazard in their clinical practice.

    • PaX [comrade/them, they/them]@hexbear.netOP
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      7 months ago

      I 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 (she didn’t specify what type, idek if she actually diagnosed me cuz idk if she can even do that but she prescribed me the aripiprazole). I’m just really confused about this whole thing :(

      atomoxetine straight off the bat

      yea Yeah, that’s what she did during our last appointment and it didn’t help

      Idk if this keeps being weird I’ll have to see if I can extract my ADHD diagnosis docs from them and go somewhere else :(

      This bipolar thing is really scaring me though, “looking into it”, as they say. I asked some friends and family and they said they never noticed anything like manic or depressive episodes from me

      Thank you for your input, tbh I’ve just been stressing about this all day I’m gonna go try to relax

      • ReadFanon [any, any]@hexbear.net
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        7 months ago

        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.