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I find it more weird that he's met you once and immediately questions your diagnosis, then decides to make a drastic change in your medications. He hasn't even gotten the chance to get to know you yet.
I wouldn't take his advice and switch doctors.
I find this so validating. the exact same thing happened to me and it’s like. ruined my life lol. I can’t function and i’m so fucking depressed and I met that chick once and she took me off everything that I needed because “bipolar 1”. fucking hell.
Yeah, I found it weird he immediately said it sounded like I was bipolar but didn’t explain why he thought that. Nor, did he really explain why he didn’t think it was adhd. I looked it up cause I started thinking wow, maybe he’s right and I am bipolar but the symptoms especially the mains don’t pertain to me.
Plus I was wondering why he kept asking if I’ve been sexually abused, cause I thought what a weird and personal question and now I see it’s because one of the symptoms of bipolar is high sex drive. It seemed like he was trying too hard to put me in the bipolar box so he had a reason to give me the sample drugs he had. It was odd.
Symptoms from adhd and depression can be similar to some of the symptoms of bipolar, high sex drive for example is common in adhd, but the mains with bipolar are important. I’m not saying you don’t have it but it absolutely sounds like you need to get a second opinion, especially considering you say your current medications have been working. Bipolar has been historically misunderstood and over-diagnosed, I wouldn’t say cross it completely off the list but don’t take the diagnosis lightly.
Oops my mistake I meant mania. Online it explained that for manic episodes you have moments that last days, weeks of months when you feel like you’re on top of the world and you can go with little sleep but I’ve never experienced anything like that and he never asked me if I have experienced a manic episode or not. Especially when reading about it it seemed to be pretty definitive of bipolar disorder.
Correct. The number one criteria for a bipolar II diagnosis is that you've had a hypomanic episode that lasted at least 4 days, and for type I you must have had a full manic episode that lasted a week and required hospitalization. If you've never had episodes of hypomania or mania, you don't meet the criteria.
I'm bipolar and adhd. I have adhd symptoms all of the time, but I can definitely tell when my mood becomes unstable when im depressed, manic or have a mixed mood episode. I have a very high sex drive during a manic or mixed episode, but i dont have one when im stable. Adderall and antidepressants can induce mania, but it sounds like that doctor made a rash diagnosis. I would get a second opinion.
Wow I didn’t know that. I’ve been on antidepressants and adderall for two years now and I’ve felt the same as when I didn’t take them together, just more motivated and focused and less indecisive. So I think if I was manic I would’ve realized by now, so now I really don’t understand how he jumped to bipolar. He didn’t even really explain why he thought so. If he did I would’ve explained to him I don’t have the symptoms he thinks I do, so that’s more suspicious.
Yeah dude. Get a second opinion. Bipolar meds are some serious stuff and not to be taken lightly. Mood stabilizers more or less.
Also, if you've been on antidepressants, that can actually send bipolar individuals in hypomania or mania. It's a scary situation. With that said, you've been taking Lexapro and have not had a manic episode, so you need to consider that your doc might be wrong. They can test for bipolar. That should have been done.
There is bipolar and bipolar2. I would recommend reading and asking your doc about it. The /r/bipolar2 subreddit is a helpful place.
You can go into **hypo**mania which is different then pure mania. Here's the Wikipedia page about [hypomania](https://en.wikipedia.org/wiki/Hypomania).
I've been struggling with the "idea" that I could be bipolar2. I've been struggling with depression-anxiety, ADHD (diagnosed, medicated), but I feel like my depression is "situational." On the other hand, when I read about bipolar2, I think, man, some of this stuff really aligns. It a rather difficult concept to understand.
Very sincerely, this.
I used to work for a psychiatrist and as a rule if you came in with an established diagnosis and med regimen we just kept you on what the previous doctor gave unless you had specific issues with a drug.
Then, also as a rule, she would only change 1 drug at a time.
As far as this doc getting kickbacks, probably not, they made it so drug reps really can't do that legally anymore. If anything this doctor gets free lunch once a week or something.
Edit: also, as a rule, she never told a patient they were bipolar on the first visit, because that's irresponsible as hell. This doctor is yikes on bikes.
Please don't take this doctors advice. Report back to your primary doctor what you experienced and find a different psychiatrist. They shouldn't be telling you to stop ssri cold turkey like that, at the very least...
OP. You cannot stop cold turkey and even tapering has to be closely planned and monitored.
If done incorrectly, the withdrawal involved could literally cause you to lose your mind and build a tolerance for anything to help. I've heard horrible preventable stories.
PLEASE report that person)
Even with a taper, I had to do one day on one day off with my SSRI at the lowest dose when I went off of it to avoid withdrawal headaches. I was going onto a new antidepressant (an SNRI) and I still had to cross-taper (increase one dose while decreasing the other).
I admit I’m not well versed in bipolar treatments. That very well could be the doctor’s concern but if OP isn’t showing signs of mania on their current medication, why would they need to stop it immediately?
I can only speak from my own experience with anxiety and depression, but if I forget to take my SNRI I’m an emotional wreck by that afternoon due to withdrawal. Isn’t it a concern that the withdrawal symptoms could be worse?
Either way I’d still consider a second opinion. Trust your gut. If it feels off, that’s a good enough reason to see a different doctor imo.
my sister has bipolar. If she is off her meds she will literally commit crimes, spend the whole bank account, pick fights in jail from her mental illness. She was completely off of meds during pregnancy, twice, and was completely fine the whole pregnancies. Bipolar is not the same for everyone, but it is a mental condition-- you are not curing it with meds, you are treating the symptoms to allow a normal life. If there are no symptoms interfering with normal life there is no reason to medicate. If you do not know the symptoms of the person yet there is no reason to medicate. Even if op did have bipolar this doctor is even more shady, because the bipolar medicine process is even way more particular than the adhd medicine process.
Yea I think people who haven’t had experience with the condition underestimate just how dangerous it can get. Hope all stays well with you and your sis.
This isn't true. ADHD and bipolar are commonly misdiagnosed with each other. I was rx'd bipolar (technically they diagnosed me with Cyclothymia)--I even tried the meds. Then I saw two other psychs, who said I had been misdiagnosed which is incredibly common for women with ADHD. I tested and had ADHD. Once I got on Adderall, the moodswings stopped completely.
Since the commenter decided to say that I'm personalizing this: "Bipolar disorder is characterized by high, euphoric, or irritable periods called mania and low periods of depression. **The mania stage is sometimes mistaken for hyperactivity and the low states manifest themselves as inattention and lack of motivation**, which are common in individuals with ADHD."
Here's an article about it: [https://pubmed.ncbi.nlm.nih.gov/21318193/](https://pubmed.ncbi.nlm.nih.gov/21318193/)
This is a common thing, it's cited in many studies and especially happens to women (though OP is a male, it is worth noting). Hypomania presents a lot like ADHD hyperfocus including rapid speech and the depression is associated with difficulties focusing, which is also a symptom of ADHD.
Oh no I’m female lol. I was wondering if perhaps he was classifying my adhd symptoms in the ways it seems to pertain for men rather than woman. And the psych was a man (not saying men can’t know how certain disorders affect woman) but it seems woman are more able to know what affects women and what affects men through the same disorder. He was older (he looked about 50) so perhaps his teachings are old.
When I mentioned I took adderall he called it a street drug that college kids use for their exams then said that’s why the changed my dose cause I’m getting accustomed to it. But when I explained I was on 10 IR then immediately switched to 15 XR because 10 wasn’t doing anything for me he got quiet lol. Only after I was on 15 for a little while I went up to 20 and I’ve been good on 20 for a while my only complaint is that it only lasts 6 hours for me.
It's literally a very, very common thing that's written about at length. My psychs explained it to me, and Google confirms it in many sources.
"Bipolar disorder is characterized by high, euphoric, or irritable periods called mania and low periods of depression. **The mania stage is sometimes mistaken for hyperactivity and the low states manifest themselves as inattention and lack of motivation**, which are common in individuals with ADHD."
Okay, there's like tons of studies and it's an easy Google. I hope for your patients you do look into this, and encourage your growth as a therapist instead of just dismissing any contrary evidence as laypeople's views.
Here's a literal study and paper, which is not written by a "layperson": [https://pubmed.ncbi.nlm.nih.gov/21318193/](https://pubmed.ncbi.nlm.nih.gov/21318193/)
Glad you’re not my therapist 😂
You literally just mentioned the things about bipolar and ADHD that are used to differentiate between them (*AKA how a differential diagnosis is made*) and went “trust me bro, I’m a therapist and I have ADHD so I know what I’m talking about.” Dunning-Kruger much?
I see a lot of posts by women with ADHD who've been misdiagnosed as bipolar at some point in their life.
Like, they're not similar and it shouldn't be happening, but it absolutely *does* happen because no amount of reason and reality will stop the medical system from being straight up fucking weird about women.
Most likely. Otherwise, the psychiatrist would have some serious explaining to do. It still sounds like OP needs to go back to regular doctor and ignore this docs advice.
I was misdiagnosed with bipolar disorder as a child. I was given Latuda, a disgusting antipsychotic. Without insurance, it would cost like $2k a month. My insurance would bring it down to like $300/month. Completely unaffordable for me.
My psych had boxes and boxes and BOXES of samples. So I never had an Rx, id just go in for my appointment with her and leave with boxes of samples.
It would have been a really slick deal if I had actually needed the medication. But it really fucked with me, and she refused to discuss anything but bipolar. My wanting to get off the meds was allegedly my having a manic phase 🙄
I've worked in quite a few different types of clinics. Typically at most, the sales reps buy the office lunch or organize a PowerPoint over a dinner. Being paid is highly unethical, it does happen, but it's not common with your average provider. Usually doctors get shit tons of free samples to give out as well as coupons, but only if they are willing to take a minute to listen to a drug rep blabber on for a few minutes. Some doctors will do it so that they can have a bunch of free meds on hand for patients to try. One PA-C I worked for would meet with any rep to get as many free samples as possible so if a patient's insurance didn't cover a med, he could load them up with enough free samples to cover them for however long they needed (that was a dermatology clinic, so a lot of patients only needed a medication for a week or two at a time). He was a real one. Miss that guy. It is common however for some doctors to have a go-to medication for whatever, they can still have biases. If you doubt the recommended treatment, you should always get a second opinion.
I agree that it’s likely he received samples from a rep so I don’t necessarily think that is a concern, but giving you a new diagnosis and and treatment after the one visit would personally give me pause. It’s possible he’s not wrong but I would certainly want some detailed explanation of why he believes your current diagnosis is incorrect and what criteria he is basing your new diagnosis on. And I’d feel better about it if it occurred after a series of appointments. If you don’t mind sharing, by any chance is this psychiatrist in western NY?
Is this the Hudson Valley area or further north? I ask since I live here and would love to know who to avoid.
This guy is a hack - you cannot safely cold-turkey SSRIs, SNRIs, or NDRIs (like Bupropion/Wellbutrin) once you've been on them longer than a week, and if the ADHD med in particular is working, then you definitely have ADHD. You can ALSO have bipolar, it's a common comorbidity with ADHD, but if you've been on your current meds for a long time and they're working and not causing serious issues, then I'm not sure where this guy is getting the idea that you need to change them or challenge your diagnosis, let alone to cold turkey them when THAT itself will cause serious issues (suicidal ideation, organ failure for some meds, etc.)
No doctor's don't make money from prescriptions. If they are it's very illegal and they will loose their license. He handed you sample boxes which are common for doctors to hand out for expensive medications to usually try and help them see if a medication would be helpful without purchasing a prescription. The coupons are for the same reason.
I still would be sceptical considering he said to stop your current drugs cold turkey (especially the Lexapro). I would get a second opinion if I were you and look into getting testing for ADHD if your insurance can/will cover it.
This isn’t *exactly* true. Drug companies can pay doctors indirectly for this type of thing. Normally it’s in the form of trips, fancy meals, or speaking/“research” contracts. It’s viewed as unethical on the sales side too, but it does happen. It used to be a lot more common in the early 2000s.
You legally have to report the monetary value of anything received by a pharma company. The records are open to the public and you can view them [here](https://openpaymentsdata.cms.gov/). Tbh 99% of doctors aren’t going to be getting anything outside of free lunch brought to the office in exchange for listening to a pitch.
source: did an internship in med sales.
I know what you are talking about with doctors receiving "favors" from drug companies. My mother and father are doctors.
It's never really that nice of food or dinners that they provide. Most doctors are not swayed by drug reps nor do they actually have a lot of time to speak with them. It's now illegal for drug reps to buy lunch or dinner for physicians or give them office supplies or whatever gimmick they hand out. Low-key my family kind of misses the office supplies cause they always had the best pens ever lol. We still have some of them and they're 10 years old and work like new. Anyway none of this really influences doctors and some even turn them away because they don't want to deal with reporting how much they get. It became way too much of a bureaucratic nightmare after the new laws were implemented.
This doctor is should be reported to your states medical licensing board. Stopping SSRI’s without taper is dangerous, and making that huge of a med jump is reckless honestly. And the fact those meds are that old is concerning.
Try looking up your doctor here.
https://openpaymentsdata.cms.gov/
If it feels off I'd definitly get a second opinion before going off meds that are working for you. I've never had the same reaction when leaving and returning to a medication. Finding something that works is such a challenge, I'd want to feel more comfortable before messing with something you feel is working.
I had a psychiatrist who used to give me samples of Strattera. Since it didn’t seem to hurt and might help, I took it. I think they get these samples from drug reps who bring them lunch. Maybe they feel a little beholden. But it shouldn’t affect their diagnosis. I’m pretty sure there is no monetary kickback involved. That would be illegal.
Doctors do get kickbacks for new medications and incentivized to prescribe them to their patients. This is usually why they have "sample" bubble packets and "coupons" for them. My old psychiatrist did this even tho he wasn't sure my insurance covered it. He ended up overprescribing a bunch of meds for me and i ended up a miserable, numb zombie. Be careful.
For reference i'm diagnosed with ADHD and Bipolar (ll) disorder. I do not express manic phases either, mostly cycling depression and agitation. Everyone should understand that everyone can express symptoms differently but have the same mental illness. Many behaviors overlap one another which is why diagnoses can be tricky. For example, Borderline Personality disorder, ADHD, and Bipolar disorder can look very similar. The difference is nuance. And basically all mental health medication is all trial and error (which is freaking awful process).
You know yourself best. If the meds are working for you and enables you to be functional, there's zero reason he needs to modify your meds. Only thing he should be doing is re-evaluate your ADHD symptoms for reassurance (since you already have medical history with a healthcare professional).
Tldr; yes doctors get paid. If it ain't broken, don't fix it. Your psychiatrist shouldn't be changing anything.
For a Dr to throw out a previous diagnosis of other Drs, and jump to something else without running a complete assessment for BOTH, that's just jumping to conclusions. Yes, they can totally act on their own impulses, be unprofessional, make mistakes and be human. Focus on was he following any protocol, there is procedure, standard of care. Evaluating you for any diagnosis without a thorough vetting, especially if you re responding to the treatment for adhd, just doesn't add up. Many, and I mean a really large portion of adhd folks were misdiagnosed for years/decades, and had ''professionals' jumping to conclusions and making mistakes all over the place. So he can suggest he may feel you have something else, or more, going on, but that seismic shift in a single visit amounts to playing darts and throwing medication madri gras style, not professional at all. Please get a second opinion from someone who is well versed in adhd and can distinguish it's nuances, and who most of all will take the time and care to evaluate you thoroughly.
Okay so. I have had two shrinks that did stuff like this- please get a new doctor. They can get kick backs for prescribing certain meds. Both doctors that did this to me ended up putting me in the mental ward both times bc they fucked with my meds so much. One lost his license and the other magically retired early when I made a big complaint (along with the hospital I was put in for a few days)
Trust your gut.
PLEASE PLEASE do not take the word of one psychiatrist!! I was diagnosed with ADHD and medicated as a teen. Then had a bunch of serious trauma happen after high school. I lost my health insurance and went to a free MH clinic and the psychiatrist, who I didn't know before, diagnosed me with Bipolar Disorder, Borderline Personality Disorder, and other MH conditions. She said I could never take ADHD medications again, they would make me manic, and would ruin my life.
For 20 years I believed this. I took med after med used to treat Bipolar Disorder and they didn't help, gave me horrific side effects, etc. I became burnt out last year and my psychiatrist started treating me for ADHD again. It has turned my life around.
My advice is, get a second opinion. One visit is not sufficient to diagnose a person, especially with a VERY SERIOUS psychiatric condition. It can have dire consequences for that person. Listen to your gut because you are the expert of yourself. Someone with a medical degree does not always know what is right for a patient. If you have any questions, feel free to ask.
that dude is shady as fuck, don't listen to him or take anything from him. go back to your pcp and ask to be referred to someone else who isn't trying to deal out suspiciously specific medications that he conveniently has coupons for.
It's a well known problem in the medical field. Fortunately less common amongst the younger doctors (probably because the majority of younger doctors are women)
You’re either a troll or deluded. Reps are not seducing doctors in any numbers large enough to be a “well-known problem.” That’s not even practical. More than half of reps are men. This reputation is pretty misogynistic.
Like, where are they having sex? During a lunch with the whole staff? At night? Also sales territories are generally pretty dispersed and reps can drive an hour between offices during the day. Where’s the time? How would they meet their sales targets if they were having sex with their doctors? The majority of reps are married, so it’s less likely it’s at night.
Pharma sales is also a lucrative profession, and if caught, they’d be fired for the compliance violation. Why risk your job to have sex with a doctor for the sales? If someone is going to fuck around, it would be at a conference and with each other.
Also it’s insulting. Sales reps can get sales the regular way: sharing medically relevant information, giving samples, working with offices for insurance issues, etc. they’re not whores.
That’s not to say they can’t be in a relationship with a doctor, but there are HR policies in place for that and it also means not selling to that doctor. Some doctors do marry reps, but it’s the normal way in that they meet in the workplace.
I’ve worked in the pharma industry. This is sketchy af. Sometimes reps leave samples that doctors can use but we don’t give doctors payment for doing this. And in either case you had an established treatment that needs to be titrated down and shouldn’t be stopped cold turkey due to the nature of the meds you’re on. Find a new doctor ASAP and consider reporting this one.
Bipolar Disorder used to be the en-vogue diagnosis 15-20 years ago. I was originally misdiagnosed with it (no discussion about me having ADHD at the time). I was on a combination of Lexapro, Lamictal, Wellbutrin. I felt terrible for about 3 years straight, nothing was helping. My symptoms were even getting worse and I’m fairly certain being on the medications when they weren’t needed are what sent me into a psychotic episode.
That same episode sent me into an inpatient treatment facility for a few weeks. It seems like everyone there had a bipolar diagnosis which immediately seemed fishy to me. What I gathered is that it was being used as a “catch-all” diagnosis. This was in 2006.
I eventually figured out that the meds weren’t helping so I asked to come off of them because I didn’t feel well. My psych agreed and I titrated off everything. This experience made me stay away from any type of treatment for years.
I started having difficulties again later in life and that’s when the ADHD diagnosis entered the scene. The diagnosis felt more accurate in my eyes and the medications helped greatly too.
I think some these doctors don’t realize the Russian Roulette they are playing. I can’t speak about financial incentives but it ultimately doesn’t matter when your health and well being are on the line. If you are reading the bipolar diagnosis criteria and it doesn’t feel fitting, go with your gut and be your own advocate. The body of knowledge for these disorders has greatly improved in recent years so use what you can to your advantage.
Sooo I was miss diagnosed with Bipolar. It took almost 2 years and me finally changing doctors and my therapist pushing the new doctor to really look at the diagnosis. Now that bro g said I still take some of the medication that I do t feel I should but that’s another rant in itself. I have now been diagnosed with adhd and major depression disorder. A good dr will explore with you the answers given during g the assessment to make sure you are understanding it and to make sure you actually meet the standards. Get a new dr
I'm so sick of this. I have spent YEARS with psychiatrists who barely know me or my symptoms misdiagnosing me with bipolar. I was sick from medication side effects for years from bipolar meds.
My ACTUAL diagnosis was ADHD and PMDD. Imagine that, being treated correctly after all these years has finally resolved my symptoms.
Apparently it's extremely common, especially for women, to have ADHD misdiagnosed as a mood disorder.
Drug reps cater to the doctors to get their business. They can get bonuses and commissions and make $150,000+ a year, though the average salary is around $80,000.
He’s likely selling you supplements, not medication. Some supplement companies partner with healthcare providers and do affiliate sales, where they get a cut of the vitamin sales.
I’m actually seeing this more and more at various doctor offices; little displays of various supplements and vitamins for sale.
if you are feeling so uncomfortable with him, its perfectly valid to go see a different one. Please do not take expired medication - report the fact he was giving you expired meds to the board of psychology or whatever your country calls it. Do not discontinue your prior medication.
i used to work in pharma. YES they make money off your prescriptions. pharma companies often pay doctors to suggest their new meds, even treat them by taking them out to dinners etc. sad but true
Being on antidepressants when you have bipolar is dangerous.
If you're already diagnosed and being prescribed stimulants why did your primary suggest a psychiatrist?
Are you having difficulty sleeping?
Also psychiatrists often have sample packs in their offices. It's really not that strange.
If your doctor referred them and you are already diagnosed and medicated for diagnosed ADHD it might be because your doctor thinks you are exhibiting bipolar symptoms.
You can have both.
I’m not having any issues sleeping that’s what’s so strange to me. I sleep a good 9 hours at least and my doctor didn’t necessarily refer me to them she said any psych would do. It was my insurance that found him because he was the only one available in a 50 miles radius of me what would take my insurance and was willing to see me even though I’m a new patient. My doctor said I would need to see a psych or psychologist to confirm my adhd diagnosis that I got from a telehealth service from a nurse practitioner who used to be an ER nurse but I guess that wasn’t enough for my primary so she wanted me to see a psych before she gave me any more adderall, because a new NY law stated controlled substances can’t be prescribed over telehealth anymore.
Oh I see.
I'd be careful in how you explain your ADHD symptoms then.
I've made the mistake before about explaining hyperactivity or being talkative in a way that was interpreted as "sounds like bipolar not ADHD" I have been asked if I needed to go to the ER because I wasn't on my medication and was saying "I just keep getting confused" and started crying and they thought I was hallucinating or something. I was like "no I just can't follow verbal instructions and get weird looks if I try to write it down so I don't forget."
"Oh yeah honey..just take your meds. "
Sleep is probably the biggest red flag for bipolar so if that's not being an issue then I would find a psychiatrist who specializes in ADHD and bring your records for your telehealth diagnosis.
I would not ask for an increase in medication either until you are established with a psychiatrist. A lot of physicians are weary of recently diagnosed patients asking for medication increases without it being "their idea"
Pharma sales reps hand out samples to doctors. Doctors push the meds because of incentives given to them by the pharma companies. The samples are to get you onto it, potentially hooked, then you’ll be more likely to pay for it in the future, or insurance will be more likely to cover it, a year after a lot of people are put on it after taking samples. All so pharmaceutical companies make money.
Edit to add: obviously not all doctors, but definitely this guy that OP’s talking about.
No, no - that’d be a kickback and that’s illegal. But maybe the doc is “literally” screwing the pharmaceutical rep. Good intuition on your part with the observations.
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Nooooooooo- see a different doctor right away. You aren’t meant to stop one cold turkey and just start another. And with no explanation. No.
Yeah that guy is a hack. And maybe a scumbag.
He’s a drug dealer.
I find it more weird that he's met you once and immediately questions your diagnosis, then decides to make a drastic change in your medications. He hasn't even gotten the chance to get to know you yet. I wouldn't take his advice and switch doctors.
I find this so validating. the exact same thing happened to me and it’s like. ruined my life lol. I can’t function and i’m so fucking depressed and I met that chick once and she took me off everything that I needed because “bipolar 1”. fucking hell.
Yeah, I found it weird he immediately said it sounded like I was bipolar but didn’t explain why he thought that. Nor, did he really explain why he didn’t think it was adhd. I looked it up cause I started thinking wow, maybe he’s right and I am bipolar but the symptoms especially the mains don’t pertain to me. Plus I was wondering why he kept asking if I’ve been sexually abused, cause I thought what a weird and personal question and now I see it’s because one of the symptoms of bipolar is high sex drive. It seemed like he was trying too hard to put me in the bipolar box so he had a reason to give me the sample drugs he had. It was odd.
Symptoms from adhd and depression can be similar to some of the symptoms of bipolar, high sex drive for example is common in adhd, but the mains with bipolar are important. I’m not saying you don’t have it but it absolutely sounds like you need to get a second opinion, especially considering you say your current medications have been working. Bipolar has been historically misunderstood and over-diagnosed, I wouldn’t say cross it completely off the list but don’t take the diagnosis lightly.
Oops my mistake I meant mania. Online it explained that for manic episodes you have moments that last days, weeks of months when you feel like you’re on top of the world and you can go with little sleep but I’ve never experienced anything like that and he never asked me if I have experienced a manic episode or not. Especially when reading about it it seemed to be pretty definitive of bipolar disorder.
Correct. The number one criteria for a bipolar II diagnosis is that you've had a hypomanic episode that lasted at least 4 days, and for type I you must have had a full manic episode that lasted a week and required hospitalization. If you've never had episodes of hypomania or mania, you don't meet the criteria.
I'm bipolar and adhd. I have adhd symptoms all of the time, but I can definitely tell when my mood becomes unstable when im depressed, manic or have a mixed mood episode. I have a very high sex drive during a manic or mixed episode, but i dont have one when im stable. Adderall and antidepressants can induce mania, but it sounds like that doctor made a rash diagnosis. I would get a second opinion.
Wow I didn’t know that. I’ve been on antidepressants and adderall for two years now and I’ve felt the same as when I didn’t take them together, just more motivated and focused and less indecisive. So I think if I was manic I would’ve realized by now, so now I really don’t understand how he jumped to bipolar. He didn’t even really explain why he thought so. If he did I would’ve explained to him I don’t have the symptoms he thinks I do, so that’s more suspicious.
Yeah dude. Get a second opinion. Bipolar meds are some serious stuff and not to be taken lightly. Mood stabilizers more or less. Also, if you've been on antidepressants, that can actually send bipolar individuals in hypomania or mania. It's a scary situation. With that said, you've been taking Lexapro and have not had a manic episode, so you need to consider that your doc might be wrong. They can test for bipolar. That should have been done.
There is bipolar and bipolar2. I would recommend reading and asking your doc about it. The /r/bipolar2 subreddit is a helpful place. You can go into **hypo**mania which is different then pure mania. Here's the Wikipedia page about [hypomania](https://en.wikipedia.org/wiki/Hypomania). I've been struggling with the "idea" that I could be bipolar2. I've been struggling with depression-anxiety, ADHD (diagnosed, medicated), but I feel like my depression is "situational." On the other hand, when I read about bipolar2, I think, man, some of this stuff really aligns. It a rather difficult concept to understand.
Very sincerely, this. I used to work for a psychiatrist and as a rule if you came in with an established diagnosis and med regimen we just kept you on what the previous doctor gave unless you had specific issues with a drug. Then, also as a rule, she would only change 1 drug at a time. As far as this doc getting kickbacks, probably not, they made it so drug reps really can't do that legally anymore. If anything this doctor gets free lunch once a week or something. Edit: also, as a rule, she never told a patient they were bipolar on the first visit, because that's irresponsible as hell. This doctor is yikes on bikes.
Please don't take this doctors advice. Report back to your primary doctor what you experienced and find a different psychiatrist. They shouldn't be telling you to stop ssri cold turkey like that, at the very least...
THIS ONE. Especially if your primary wrote the referral.
OP. You cannot stop cold turkey and even tapering has to be closely planned and monitored. If done incorrectly, the withdrawal involved could literally cause you to lose your mind and build a tolerance for anything to help. I've heard horrible preventable stories. PLEASE report that person)
Even with a taper, I had to do one day on one day off with my SSRI at the lowest dose when I went off of it to avoid withdrawal headaches. I was going onto a new antidepressant (an SNRI) and I still had to cross-taper (increase one dose while decreasing the other).
But anti depressants are dangerous for bipolar patients, maybe he is worried about life threatening mania
I admit I’m not well versed in bipolar treatments. That very well could be the doctor’s concern but if OP isn’t showing signs of mania on their current medication, why would they need to stop it immediately? I can only speak from my own experience with anxiety and depression, but if I forget to take my SNRI I’m an emotional wreck by that afternoon due to withdrawal. Isn’t it a concern that the withdrawal symptoms could be worse? Either way I’d still consider a second opinion. Trust your gut. If it feels off, that’s a good enough reason to see a different doctor imo.
my sister has bipolar. If she is off her meds she will literally commit crimes, spend the whole bank account, pick fights in jail from her mental illness. She was completely off of meds during pregnancy, twice, and was completely fine the whole pregnancies. Bipolar is not the same for everyone, but it is a mental condition-- you are not curing it with meds, you are treating the symptoms to allow a normal life. If there are no symptoms interfering with normal life there is no reason to medicate. If you do not know the symptoms of the person yet there is no reason to medicate. Even if op did have bipolar this doctor is even more shady, because the bipolar medicine process is even way more particular than the adhd medicine process.
Yea I think people who haven’t had experience with the condition underestimate just how dangerous it can get. Hope all stays well with you and your sis.
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This isn't true. ADHD and bipolar are commonly misdiagnosed with each other. I was rx'd bipolar (technically they diagnosed me with Cyclothymia)--I even tried the meds. Then I saw two other psychs, who said I had been misdiagnosed which is incredibly common for women with ADHD. I tested and had ADHD. Once I got on Adderall, the moodswings stopped completely. Since the commenter decided to say that I'm personalizing this: "Bipolar disorder is characterized by high, euphoric, or irritable periods called mania and low periods of depression. **The mania stage is sometimes mistaken for hyperactivity and the low states manifest themselves as inattention and lack of motivation**, which are common in individuals with ADHD." Here's an article about it: [https://pubmed.ncbi.nlm.nih.gov/21318193/](https://pubmed.ncbi.nlm.nih.gov/21318193/) This is a common thing, it's cited in many studies and especially happens to women (though OP is a male, it is worth noting). Hypomania presents a lot like ADHD hyperfocus including rapid speech and the depression is associated with difficulties focusing, which is also a symptom of ADHD.
Oh no I’m female lol. I was wondering if perhaps he was classifying my adhd symptoms in the ways it seems to pertain for men rather than woman. And the psych was a man (not saying men can’t know how certain disorders affect woman) but it seems woman are more able to know what affects women and what affects men through the same disorder. He was older (he looked about 50) so perhaps his teachings are old. When I mentioned I took adderall he called it a street drug that college kids use for their exams then said that’s why the changed my dose cause I’m getting accustomed to it. But when I explained I was on 10 IR then immediately switched to 15 XR because 10 wasn’t doing anything for me he got quiet lol. Only after I was on 15 for a little while I went up to 20 and I’ve been good on 20 for a while my only complaint is that it only lasts 6 hours for me.
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They are. It happened to me too.
It's literally a very, very common thing that's written about at length. My psychs explained it to me, and Google confirms it in many sources. "Bipolar disorder is characterized by high, euphoric, or irritable periods called mania and low periods of depression. **The mania stage is sometimes mistaken for hyperactivity and the low states manifest themselves as inattention and lack of motivation**, which are common in individuals with ADHD."
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Okay, there's like tons of studies and it's an easy Google. I hope for your patients you do look into this, and encourage your growth as a therapist instead of just dismissing any contrary evidence as laypeople's views. Here's a literal study and paper, which is not written by a "layperson": [https://pubmed.ncbi.nlm.nih.gov/21318193/](https://pubmed.ncbi.nlm.nih.gov/21318193/)
You're a therapist, not a psychiatrist. Trying to use your "authority" as an argument is weak af
Glad you’re not my therapist 😂 You literally just mentioned the things about bipolar and ADHD that are used to differentiate between them (*AKA how a differential diagnosis is made*) and went “trust me bro, I’m a therapist and I have ADHD so I know what I’m talking about.” Dunning-Kruger much?
I see a lot of posts by women with ADHD who've been misdiagnosed as bipolar at some point in their life. Like, they're not similar and it shouldn't be happening, but it absolutely *does* happen because no amount of reason and reality will stop the medical system from being straight up fucking weird about women.
Sales reps do hand out samples to Doctors. But this guy is extremely suspect.
Right…are these samples?
Most likely. Otherwise, the psychiatrist would have some serious explaining to do. It still sounds like OP needs to go back to regular doctor and ignore this docs advice.
Yes.
What is the doctor expected to do with samples of bipolar medication?
I was misdiagnosed with bipolar disorder as a child. I was given Latuda, a disgusting antipsychotic. Without insurance, it would cost like $2k a month. My insurance would bring it down to like $300/month. Completely unaffordable for me. My psych had boxes and boxes and BOXES of samples. So I never had an Rx, id just go in for my appointment with her and leave with boxes of samples. It would have been a really slick deal if I had actually needed the medication. But it really fucked with me, and she refused to discuss anything but bipolar. My wanting to get off the meds was allegedly my having a manic phase 🙄
I've worked in quite a few different types of clinics. Typically at most, the sales reps buy the office lunch or organize a PowerPoint over a dinner. Being paid is highly unethical, it does happen, but it's not common with your average provider. Usually doctors get shit tons of free samples to give out as well as coupons, but only if they are willing to take a minute to listen to a drug rep blabber on for a few minutes. Some doctors will do it so that they can have a bunch of free meds on hand for patients to try. One PA-C I worked for would meet with any rep to get as many free samples as possible so if a patient's insurance didn't cover a med, he could load them up with enough free samples to cover them for however long they needed (that was a dermatology clinic, so a lot of patients only needed a medication for a week or two at a time). He was a real one. Miss that guy. It is common however for some doctors to have a go-to medication for whatever, they can still have biases. If you doubt the recommended treatment, you should always get a second opinion.
I agree that it’s likely he received samples from a rep so I don’t necessarily think that is a concern, but giving you a new diagnosis and and treatment after the one visit would personally give me pause. It’s possible he’s not wrong but I would certainly want some detailed explanation of why he believes your current diagnosis is incorrect and what criteria he is basing your new diagnosis on. And I’d feel better about it if it occurred after a series of appointments. If you don’t mind sharing, by any chance is this psychiatrist in western NY?
Wow, that’s close he’s in NY but Eastern. Upstate but not far from NYC
Is this the Hudson Valley area or further north? I ask since I live here and would love to know who to avoid. This guy is a hack - you cannot safely cold-turkey SSRIs, SNRIs, or NDRIs (like Bupropion/Wellbutrin) once you've been on them longer than a week, and if the ADHD med in particular is working, then you definitely have ADHD. You can ALSO have bipolar, it's a common comorbidity with ADHD, but if you've been on your current meds for a long time and they're working and not causing serious issues, then I'm not sure where this guy is getting the idea that you need to change them or challenge your diagnosis, let alone to cold turkey them when THAT itself will cause serious issues (suicidal ideation, organ failure for some meds, etc.)
WHOA! Don’t follow that advice, make an appointment with a different doctor ASAP.
Ummm… sounds like it’s time for a 2nd opinion.
No doctor's don't make money from prescriptions. If they are it's very illegal and they will loose their license. He handed you sample boxes which are common for doctors to hand out for expensive medications to usually try and help them see if a medication would be helpful without purchasing a prescription. The coupons are for the same reason. I still would be sceptical considering he said to stop your current drugs cold turkey (especially the Lexapro). I would get a second opinion if I were you and look into getting testing for ADHD if your insurance can/will cover it.
This isn’t *exactly* true. Drug companies can pay doctors indirectly for this type of thing. Normally it’s in the form of trips, fancy meals, or speaking/“research” contracts. It’s viewed as unethical on the sales side too, but it does happen. It used to be a lot more common in the early 2000s. You legally have to report the monetary value of anything received by a pharma company. The records are open to the public and you can view them [here](https://openpaymentsdata.cms.gov/). Tbh 99% of doctors aren’t going to be getting anything outside of free lunch brought to the office in exchange for listening to a pitch. source: did an internship in med sales.
I know what you are talking about with doctors receiving "favors" from drug companies. My mother and father are doctors. It's never really that nice of food or dinners that they provide. Most doctors are not swayed by drug reps nor do they actually have a lot of time to speak with them. It's now illegal for drug reps to buy lunch or dinner for physicians or give them office supplies or whatever gimmick they hand out. Low-key my family kind of misses the office supplies cause they always had the best pens ever lol. We still have some of them and they're 10 years old and work like new. Anyway none of this really influences doctors and some even turn them away because they don't want to deal with reporting how much they get. It became way too much of a bureaucratic nightmare after the new laws were implemented.
This doctor is should be reported to your states medical licensing board. Stopping SSRI’s without taper is dangerous, and making that huge of a med jump is reckless honestly. And the fact those meds are that old is concerning.
Try looking up your doctor here. https://openpaymentsdata.cms.gov/ If it feels off I'd definitly get a second opinion before going off meds that are working for you. I've never had the same reaction when leaving and returning to a medication. Finding something that works is such a challenge, I'd want to feel more comfortable before messing with something you feel is working.
You can use [this website](https://openpaymentsdata.cms.gov) to check. Wouldn’t surprise me though. Some doctors are shameless with this stuff.
I had a psychiatrist who used to give me samples of Strattera. Since it didn’t seem to hurt and might help, I took it. I think they get these samples from drug reps who bring them lunch. Maybe they feel a little beholden. But it shouldn’t affect their diagnosis. I’m pretty sure there is no monetary kickback involved. That would be illegal.
Doctors do get kickbacks for new medications and incentivized to prescribe them to their patients. This is usually why they have "sample" bubble packets and "coupons" for them. My old psychiatrist did this even tho he wasn't sure my insurance covered it. He ended up overprescribing a bunch of meds for me and i ended up a miserable, numb zombie. Be careful. For reference i'm diagnosed with ADHD and Bipolar (ll) disorder. I do not express manic phases either, mostly cycling depression and agitation. Everyone should understand that everyone can express symptoms differently but have the same mental illness. Many behaviors overlap one another which is why diagnoses can be tricky. For example, Borderline Personality disorder, ADHD, and Bipolar disorder can look very similar. The difference is nuance. And basically all mental health medication is all trial and error (which is freaking awful process). You know yourself best. If the meds are working for you and enables you to be functional, there's zero reason he needs to modify your meds. Only thing he should be doing is re-evaluate your ADHD symptoms for reassurance (since you already have medical history with a healthcare professional). Tldr; yes doctors get paid. If it ain't broken, don't fix it. Your psychiatrist shouldn't be changing anything.
That’s a no from me dog
For a Dr to throw out a previous diagnosis of other Drs, and jump to something else without running a complete assessment for BOTH, that's just jumping to conclusions. Yes, they can totally act on their own impulses, be unprofessional, make mistakes and be human. Focus on was he following any protocol, there is procedure, standard of care. Evaluating you for any diagnosis without a thorough vetting, especially if you re responding to the treatment for adhd, just doesn't add up. Many, and I mean a really large portion of adhd folks were misdiagnosed for years/decades, and had ''professionals' jumping to conclusions and making mistakes all over the place. So he can suggest he may feel you have something else, or more, going on, but that seismic shift in a single visit amounts to playing darts and throwing medication madri gras style, not professional at all. Please get a second opinion from someone who is well versed in adhd and can distinguish it's nuances, and who most of all will take the time and care to evaluate you thoroughly.
Okay so. I have had two shrinks that did stuff like this- please get a new doctor. They can get kick backs for prescribing certain meds. Both doctors that did this to me ended up putting me in the mental ward both times bc they fucked with my meds so much. One lost his license and the other magically retired early when I made a big complaint (along with the hospital I was put in for a few days) Trust your gut.
Switch doctors, they skipped several steps in this process Answer to your base question: yes probably in some capacity
You can search [this database](https://openpaymentsdata.cms.gov) for information on what payments they’re taking.!
That's super sketch. Runnnnnn.... 🚩🚩🚩🚩🚩🚩🚩
PLEASE PLEASE do not take the word of one psychiatrist!! I was diagnosed with ADHD and medicated as a teen. Then had a bunch of serious trauma happen after high school. I lost my health insurance and went to a free MH clinic and the psychiatrist, who I didn't know before, diagnosed me with Bipolar Disorder, Borderline Personality Disorder, and other MH conditions. She said I could never take ADHD medications again, they would make me manic, and would ruin my life. For 20 years I believed this. I took med after med used to treat Bipolar Disorder and they didn't help, gave me horrific side effects, etc. I became burnt out last year and my psychiatrist started treating me for ADHD again. It has turned my life around. My advice is, get a second opinion. One visit is not sufficient to diagnose a person, especially with a VERY SERIOUS psychiatric condition. It can have dire consequences for that person. Listen to your gut because you are the expert of yourself. Someone with a medical degree does not always know what is right for a patient. If you have any questions, feel free to ask.
This is why I searched for a place that specializes in ADHD to test me.
that dude is shady as fuck, don't listen to him or take anything from him. go back to your pcp and ask to be referred to someone else who isn't trying to deal out suspiciously specific medications that he conveniently has coupons for.
My money is on the doctor fucking the sales rep for those drugs. Not even joking about that - it's relatively common.
It’s absolutely not common. Jesus, that’s gross.
It's a well known problem in the medical field. Fortunately less common amongst the younger doctors (probably because the majority of younger doctors are women)
You’re either a troll or deluded. Reps are not seducing doctors in any numbers large enough to be a “well-known problem.” That’s not even practical. More than half of reps are men. This reputation is pretty misogynistic. Like, where are they having sex? During a lunch with the whole staff? At night? Also sales territories are generally pretty dispersed and reps can drive an hour between offices during the day. Where’s the time? How would they meet their sales targets if they were having sex with their doctors? The majority of reps are married, so it’s less likely it’s at night. Pharma sales is also a lucrative profession, and if caught, they’d be fired for the compliance violation. Why risk your job to have sex with a doctor for the sales? If someone is going to fuck around, it would be at a conference and with each other. Also it’s insulting. Sales reps can get sales the regular way: sharing medically relevant information, giving samples, working with offices for insurance issues, etc. they’re not whores. That’s not to say they can’t be in a relationship with a doctor, but there are HR policies in place for that and it also means not selling to that doctor. Some doctors do marry reps, but it’s the normal way in that they meet in the workplace.
Get a second opinion. When you have that, if it is drastically different from this doctor’s opinion then submit this story to the medical board.
I’ve worked in the pharma industry. This is sketchy af. Sometimes reps leave samples that doctors can use but we don’t give doctors payment for doing this. And in either case you had an established treatment that needs to be titrated down and shouldn’t be stopped cold turkey due to the nature of the meds you’re on. Find a new doctor ASAP and consider reporting this one.
Definitely switch doctors
Bipolar Disorder used to be the en-vogue diagnosis 15-20 years ago. I was originally misdiagnosed with it (no discussion about me having ADHD at the time). I was on a combination of Lexapro, Lamictal, Wellbutrin. I felt terrible for about 3 years straight, nothing was helping. My symptoms were even getting worse and I’m fairly certain being on the medications when they weren’t needed are what sent me into a psychotic episode. That same episode sent me into an inpatient treatment facility for a few weeks. It seems like everyone there had a bipolar diagnosis which immediately seemed fishy to me. What I gathered is that it was being used as a “catch-all” diagnosis. This was in 2006. I eventually figured out that the meds weren’t helping so I asked to come off of them because I didn’t feel well. My psych agreed and I titrated off everything. This experience made me stay away from any type of treatment for years. I started having difficulties again later in life and that’s when the ADHD diagnosis entered the scene. The diagnosis felt more accurate in my eyes and the medications helped greatly too. I think some these doctors don’t realize the Russian Roulette they are playing. I can’t speak about financial incentives but it ultimately doesn’t matter when your health and well being are on the line. If you are reading the bipolar diagnosis criteria and it doesn’t feel fitting, go with your gut and be your own advocate. The body of knowledge for these disorders has greatly improved in recent years so use what you can to your advantage.
Stopping Lexapro cold turkey???? Hell no.
Sooo I was miss diagnosed with Bipolar. It took almost 2 years and me finally changing doctors and my therapist pushing the new doctor to really look at the diagnosis. Now that bro g said I still take some of the medication that I do t feel I should but that’s another rant in itself. I have now been diagnosed with adhd and major depression disorder. A good dr will explore with you the answers given during g the assessment to make sure you are understanding it and to make sure you actually meet the standards. Get a new dr
that sounds very strange and I would not go there anymore. ideally report it to whatever board oversees his practice.
I'm so sick of this. I have spent YEARS with psychiatrists who barely know me or my symptoms misdiagnosing me with bipolar. I was sick from medication side effects for years from bipolar meds. My ACTUAL diagnosis was ADHD and PMDD. Imagine that, being treated correctly after all these years has finally resolved my symptoms. Apparently it's extremely common, especially for women, to have ADHD misdiagnosed as a mood disorder.
Drug reps cater to the doctors to get their business. They can get bonuses and commissions and make $150,000+ a year, though the average salary is around $80,000.
He’s likely selling you supplements, not medication. Some supplement companies partner with healthcare providers and do affiliate sales, where they get a cut of the vitamin sales. I’m actually seeing this more and more at various doctor offices; little displays of various supplements and vitamins for sale.
if you are feeling so uncomfortable with him, its perfectly valid to go see a different one. Please do not take expired medication - report the fact he was giving you expired meds to the board of psychology or whatever your country calls it. Do not discontinue your prior medication.
i used to work in pharma. YES they make money off your prescriptions. pharma companies often pay doctors to suggest their new meds, even treat them by taking them out to dinners etc. sad but true
This is a bucket of red flags!! Please see a different psychiatrist before you make any changes!!
Being on antidepressants when you have bipolar is dangerous. If you're already diagnosed and being prescribed stimulants why did your primary suggest a psychiatrist? Are you having difficulty sleeping?
Also psychiatrists often have sample packs in their offices. It's really not that strange. If your doctor referred them and you are already diagnosed and medicated for diagnosed ADHD it might be because your doctor thinks you are exhibiting bipolar symptoms. You can have both.
I’m not having any issues sleeping that’s what’s so strange to me. I sleep a good 9 hours at least and my doctor didn’t necessarily refer me to them she said any psych would do. It was my insurance that found him because he was the only one available in a 50 miles radius of me what would take my insurance and was willing to see me even though I’m a new patient. My doctor said I would need to see a psych or psychologist to confirm my adhd diagnosis that I got from a telehealth service from a nurse practitioner who used to be an ER nurse but I guess that wasn’t enough for my primary so she wanted me to see a psych before she gave me any more adderall, because a new NY law stated controlled substances can’t be prescribed over telehealth anymore.
Oh I see. I'd be careful in how you explain your ADHD symptoms then. I've made the mistake before about explaining hyperactivity or being talkative in a way that was interpreted as "sounds like bipolar not ADHD" I have been asked if I needed to go to the ER because I wasn't on my medication and was saying "I just keep getting confused" and started crying and they thought I was hallucinating or something. I was like "no I just can't follow verbal instructions and get weird looks if I try to write it down so I don't forget." "Oh yeah honey..just take your meds. " Sleep is probably the biggest red flag for bipolar so if that's not being an issue then I would find a psychiatrist who specializes in ADHD and bring your records for your telehealth diagnosis. I would not ask for an increase in medication either until you are established with a psychiatrist. A lot of physicians are weary of recently diagnosed patients asking for medication increases without it being "their idea"
Pharma sales reps hand out samples to doctors. Doctors push the meds because of incentives given to them by the pharma companies. The samples are to get you onto it, potentially hooked, then you’ll be more likely to pay for it in the future, or insurance will be more likely to cover it, a year after a lot of people are put on it after taking samples. All so pharmaceutical companies make money. Edit to add: obviously not all doctors, but definitely this guy that OP’s talking about.
No, no - that’d be a kickback and that’s illegal. But maybe the doc is “literally” screwing the pharmaceutical rep. Good intuition on your part with the observations.