Disagreeing doctors and diagnosis..
 

Ok so now I'm a bit confused....

My previous doctor believed that I had Bi-Polar Disorder and put me on oxcarbazepine & clonazepam.. This combination worked ok at its dosage: 300mg twice per day (oxcarbazepine) and clonazepam.. as needed. Well, I began going to a new doctor closer to the house, after the first appointment they told me to just stop taking the previous medicine and start taking Lexapro. This made me a bit nervous because with any medication its probably not a good idea just to stop taking it. Also, they believe that I have an unspecific anxiety disorder and not bi-polar.

This is the confusing part. I exhibit most of the classic symptoms of mania not depression: Irritability, Talkativeness, Racing Thoughts, Distractibility and this is on a continuous basis and is not something that comes and goes which actually could be Adult ADHD. *I was diagnosed with add when I was kid*

Well I decided to wean myself off my previous meds which led to immediate increase in irritability. I began taking 10mg daily Lexapro. Within the first 4 days I had to stop taking it due to extreme agitation and uncomfortableness. I felt like I was off the wall, angery and non-stop... Needless to say I stopped taking the medication and after a few days felt a bit more stable. I discussed this with my doctor and he suggested I try Lexapro again in a smaller dose with the clonazepam to help with the adverse effects...

Now, I've read that giving someone that has hypomanic tendencies, Lexapro increases the chances of a manic episode and is counterproductive. I've discussed this with the doctor but he still thinks I should take the Lexapro..

I have no idea what I should do.. He's a doctor, but I think he is wrong on this one.. I know my body and I don’t think his diagnosis is right especially when my symptoms are almost textbook. I’m at a loss.. Could he be right? Anxiety disorder and not Bi-Polar Mania or even Adult ADD? There is also documentation that shows correlation between a vitamin B12 deficiency and mood disorders which is another possiblity I am exploring.

What should I do?

:confused:

Hi,
Are you seeing a psychiatrist?
M.

I hope that you're not making these med adjustments on your own... it can be dangerous and make your condition(s) worse. Also, as Mari hinted at, you should not be seeing your PCP for MH treatment.

If your diagnoses are in dispute, and you're not comfortable or disagree with the treatment you're receiving with your current docs....

My best advice is for you to seek another opinion. You can discuss differential diagnoses with your new practitioner, but please try to avoid self-diagnosis.

-Kay

Dear BAlive,
 

I can see why you are confused.

If this combo worked why did the new guy take you off?

Yes, the new doc should have helped you taper off the oxcarbazepine because stopping it suddenly can risk seizures.

ADD can coexist with bipolar.

This web site makes some sense to me in describing the differences between ADD and bipolar:
http://www.bipolar-lives.com/bipolar-vs-adhd.html
ADD is always present whereas bipolar can come and go (perhaps? I'm not an expert.)

=-=-=-
You describe well what can happen with Lexapro.
I had that same reaction to it as well. After three days I had to stop it and that was with a mood stabilizer on board.

Dr. Phelps' web site is one on the best of the web I think.
He explains anxiety and bipolar:

http://www.psycheducation.org/depression/Anxiety.htm



You are exactly right and I think that your doc should consider the downside to take Lexapro like that.

=-=-

Do you have any bipolar in your family?

You can get blood work for B12. While you are there, get blood work for Vit D. Some of us have benefited from Vit D3 supplements.

Mari

sorry i don't have much patience....get another doctor fast who knows something...doctors can be so dangerous. i have gad and am bipolar and have pernicious anemia...vitamin b12 deficiency....and i am bipolar II so don't have the grandiosity and the real highs or manias of bipolar I....
also be careful what they put you on..i gained 100 pounds....welbutrin doesn't cause you to gain weight...topamax a mood stabilizer doesn't cause weight cause and the two above might cause weight loss....i am on risperdal an antipsychotic for irritability..no i have never been psychotic but antipsychotics can really shovel on the weight like xyprexa...ask us a ton of questions...don't be shy
bobby

Dear BAlive,

if your prescribing doctor isn't a psychiatrist you do need one to help you here.

and if he is a psychiatrist, i strongly encourage you to get a second opinion, from another psychiatrist.

Trileptal should be weaned, yes, but 600mg a day as you were on, is not a high dose so there wasn't a huge risk there. i don't know if tapering from that dose was necessary or not. just saying your doctor may not be completely incompetent in that sense. and, he is at least consistent - Lexapro + Klonopin are adequate for treating anxiety. BUT...

in light of your history, your description of your experiences in general, and your reaction to lexapro, i am VERY concerned that he wants you to continue Lexapro! it is upsetting that he does not want to at least give you the screening questionnaire for ADHD. your assessment in that regard does make a lot of sense to me.

as Kay says though, it is difficult to self-diagnose. but yes, definitely another doctor - a psychiatrist - is in order here.

please keep checking in with us! (it doesn't matter if you're not bipolar... we aren't terribly nitpicky... some of our members aren't bipolar.)

~ waves ~

I've had bloodwork done and it shows that my levels are normal but folate is high. High follic acid levels can actually mask vitamin B deficiencies, something my general doctor is looking into...

And yes I'm seeing a psych.. I would never trust a gp to diagnose and prescribe meds of this nature. The new psych told me just to stop taking the oxcarbazepine. I questioned that and told him that I prefered to gradually take myself off, as I did. Then I began taking the Lexapro as instructed. Having adverse effects I attempted to contact this doctor three times and over a week later I was finally able to reach him and express my concerns about the negative effects this medication had on me. I had to stop taking it. I could not go another day feeling the way it made me feel and without the doctor calling me back what was i to do?


As far as self diagnosis, I am no doctor but I know what I feel inside and all to often doctors do not listen and are quick to prescribe that latest and greastest medication without further insight into the actual cause of the symptoms. Experimenting on a patient with various medications till "we get it right" can be quite dangerous especially when you can not identify the specific condition. A balance of therapy and medication, I feel, is far more benificial after determining what the actual condition is. Instantly medicating someone is not always the best answer.

Also, Thank you all that replied.. I'm glad to hear from other people. It gets frustrating to feel like your fighting the battle on your own. I normally post on "The Other Message Board" but rarely do I get a response and if I do it takes a long time.

It never hurts to do research. A good shrink should be open to discussing what you've found on your own.

I'd still look into another opinion, especially since you're not getting timely call-backs.

Sorry for making assumptions. It sounds like you are being proactive.

-Kay

thanks for checking back in BAlive.

yep. true, true, true, true....

Lexapro isn't exactly latest, though, and greatest and certainly Klonopin is not. they are consistent with this doctor's diagnosis. Your Trileptal (oxcarbazepine) is probably about as new as Lexapro, give or take a year.

what i find most disturbing about your doctor is:

- his readiness to rip you off medication that was helping. whatever happened to "if it ain't broke, don't fix it" :rolleyes:
- his insistence that you resume a medication which you suspended due to severe problems, and especially problems that suggest your original diagnosis might have been on or closer to the mark
- his unwillingness to listen to you
- his not calling you back or having another doctor call you back, for a WEEK, when you were on a new med and had problems

really, i think i'd want a new psychiatrist. at very least a second opinion from one. but i'd go to a new person, and if i liked them even a little bit better, i'd try switching. sometimes it takes switching people as well as switching meds.

you seem well informed - it's not as though you are grabbing at diagnoses out of the blue. self-assessment is important. professionals are needed to diagnose, but the way we feel, and our self-assessment count. it is important input.

keep posting. we'll stick with you.

~ waves ~

I take lamictal as a mood stabilizer, used to take trileptal which made me hyponatrimia( low sodium), the lamictal has been wonderful for many years now without any side effects. It also has some anti depressant like qualities. It does a great job for me.
bizi

dear Bizi,

i suspect your Geodon is doing much more for you as a mood stabilizer.

did you ever take the Lamictal as your ONLY mood stabilizer - as in, without your Geodon? and if so, did it "work" for any length of time, i.e did time between episodes increase significantly since you started on Lamictal?

it's just that i've read that Lamictal is not effective as an antimanic. it supposedly does help delay recurrence of episodes (mania and depression), and this is its official indication, but nowadays it seems more used as an antidepressant agent for those who have trouble taking antidepressants.

of course everyone responds differently.

~ waves ~

my guess is that it works best for folks who are bipolar 2 because of its antidepressant qualities.
I am bipolar 1...
I used to just take 40mg of geodon(an antipsychotic) at night with the 200mg of lamictal.
I now take 80mg of geodon at night and 40mg during the day. The dose increased 2 years ago when I took myself off my sleeping pill and did not sleep for 4 months....:eek:
any way. I still like lamictal and only take 1mg of klonipin to sleep at night.
I was taking my geodon incorrectly, it needs to be taken with a big meal in order for proper absorption. She said that we could think about decreasing the dose.
bizi

Well, because the doctors can't seem to agree on what me condition actually is; Bi-Polar, Anxiety, or ADD.... I have decided to take a different approach. I have decided against medication for the time being and go with therapy. I've made it 32 years being who I am, whats a little longer...

I'm tired of doctors throwing medication at me before really attempting to figure out the symptoms and the root of the problem and not listening to what i'm saying. I'm not a lab rat and do not want to be treated as such by pill pushers. I just want a better quality of life, as we all do. If I need medication to obtain this, then so be it. But, I don't want to be prescribed a new medication every week with tons of side effects "Till We Get It Right"...

As I was saying in a previous post, my new doctor tells me to abruptly stop taking one medication and start another. I had a reaction; anger, agitation, sinus problems, off the wall hyperactive etc, to the new medication (Lexapro). I had to stop taking it after attempting to contact this doctor for over a week to no avail. I finally get a hold of the guy the following week and he tells me to try the medication again but at a lower dosage. Give me a break...

Like I said, I'm a person, not a lab rat or a dollar sign and doctors need to remember this before just throwing scripts at people. Put the pad down and listen for once doc! Its becoming worse then these pain management clinics, I like to call this kinda thing "Brain Management" Believe me I almost lost my life once before because of a doctor that didnt take the time to listen to what I was saying, he just shot me up with a pain killer told me to make an appointment for 3 weeks later and sent me on my way. Next day in ER diagnosed with giant fusiform anuersym of the left carotid artery in my head ready to burst. Hmmmm how did we miss that after sitting in his office describing all of the symptoms to him as I was holding my eye in complete agony.

Sorry for the angry post, I just needed to let it off my chest.

It's ok, BAlive... you are welcome to come here and vent every day if you want.

I understand completely about not wanting to just have meds arbitrarily thrown at you. and this last guy with the Lexapro did sound like a bozo. but if the Trileptal had been helping... then... i think i'd consider seeing a different psychiatrist...

anyway, if you are getting along ok as you are without meds, certainly there is no urgency. you can see how it goes with therapy. it's never too late to try the med route.

i am a little burned on docs myself... my GP is complete bozo and i can't change right now... nobody else available, ahh the wonders of socialized medicine. btw, when i first came here, this guy - whom i'd *informed* i was taking psych meds - gave me erythromycin - if i'd taken it he would have put me in hospital. and patients here are supposed to stay in there place, i.e. remain ignorant. good thing i knew better... :rolleyes:

I am certain that there are alot of folks who are bipolar and not on meds!
Good luck and keep posting !!!!!:)
bizi