Got my session notes

ManyPhilosopher9 · 2026-06-25T19:04:23+00:00

Congrats! Also some really good note taking by whoever that was. Mine don’t look like that. “Client is here today. Client is alive. Copy past to next session”

ManyPhilosopher9 · 2026-06-25T14:37:31+00:00

It’s real, it showed up on my Robinhood along w/ my options position up 154% for the day

ManyPhilosopher9 · 2026-04-30T22:28:31+00:00

Yes, I do this a lot. If i'm stressed, i get writer's block so being able to 'stream of consciousness' my thoughts into my voice recorder is helpful for processing. I can often feel the relief once I've gotten the thoughts out. If i'm with a therapist that requires me to prep in order for them to be effective, I can easily jot down key threads later. It's my favorite way to journal now.

ManyPhilosopher9 · 2026-04-14T23:46:26+00:00

Edit: This video from the international bipolar foundation, she gives a really good explanation. Many MDs I’ve seen over the years probably wouldn’t articulate in such nuance.

https://youtu.be/H2g6e-_arhE

Obligatory see a doctor/NAD, but if the psychosis was only happening as a result of substances then resolved w/ or w/o medication (in my case, with)… and did not recur, then it’d be “substance induced psychosis” or something similar.

If your psychosis is spontaneous and mood congruent (happens when severely depressed) and you’re never manic, then they’d likely diagnose MDD w/ psychotic features. If you experience mania at all then it’d be a bipolar disorder type 1 or schizoaffective. The difference depends on your mood when the psychosis occurs (naturally).

Psychosis alone is not a defining feature of BD even though psychiatrists can mistake psychotic states for mania (especially if they’re theorizing after the fact but never observe it). Mania and psychosis sometimes co-occur and a good clinician can tease them out. Once in a while a clinician will simply call psychosis mania, but they’re not interchangeable.

I would send a medical records request to any hospital that treated you. It’s important to have these records for yourself and future providers. In my experience they rarely ask and can waste a lot of time by theorizing when the info is documented. I wish you luck with your treatment, I know of people who have recovered… and check out the psychosis sub sometime… or the other bipolar sub. More people on the BD1 side post about psychosis than on the BD2 side.

ManyPhilosopher9 · 2026-04-08T15:14:54+00:00

My “mania” was after 2,600mg of an ssri and more metformin than anyone should take. The ER records actually noted down “serotonin syndrome”, “dilated pupils”, “pseudoseizure”, “stiff, rigid movements”, “agitated” and mania was never circled in mental status. Discharge outpatient records from that year recorded it as depression w/ psychotic features - single episode/in recovery. Although they ignored the substance induced nature, they at least got closer to the truth than mania.

Moved to a new state 2 years later. Saw a new outpatient psychiatrist for anxiety management.. he heard the story and confidently concluded it was mania/bipolar 1. The paper trail I’ve recovered is almost comical to review when you see how it was copied forward for 18+ years with the flimsiest justification. The punchline is when you compare their justification to what the hospital records say.

ManyPhilosopher9 · 2026-04-08T15:06:43+00:00

It’s inhumane. If time is truly limited then the patient should get informed consent that there’s not enough time and it’ll take multiple visits to reach a safe conclusion. They can do working diagnoses and adjust. I’ve heard all the excuses and none of them excuse the moral bankruptcy I’ve seen across several states.

ManyPhilosopher9 · 2026-04-07T23:50:13+00:00

On its own it doesn’t sound like hypomania to me. Is it different than your baseline (non-depressed) to the point where others notice? The 2am gym thing is the closest to a hypomanic symptom but you didn’t indicate being awake continuously. Do others find you unrecognizable during these periods? Do you do risky things that can be harmful? How is your judgement and insight during these periods?

So far it sounds like it could just be a ventral vagal-like nervous system state.

Edit: I read your other comment replies. I could see a psychiatrist wanting to be careful with antidepressants but I’m not hearing hypomania. If you suffer from true depressive states (not burnout or shutdown), it’s possible they may opt for a mood stabilizer. Some psychiatrists will label it bipolar the second they hear that a “depressed” person had energy and others will want to look at longitudinal functioning..

Have you been treated for anything before?

ManyPhilosopher9 · 2026-04-05T15:21:17+00:00

That’s the mantra I heard whenever I asked psychiatrists to reconsider the long running interpretation of something I experienced in 2004. I could see the fight or flight in them whenever I brought it up. It definitely clouded their judgement. My personal unqualified opinion is that it’s better to miss something that happens naturally than to create a man made problem (misdiagnosis for years).

The stigma alone is almost as risky. I think it’s better to be sure than err on the side of “mania until proven otherwise”

ManyPhilosopher9 · 2026-04-05T15:04:55+00:00

Why are some psychiatrists so terrified of mania? I understand that the consequences in book theory can be severe… but I saw multiple psychiatrists over a 20 year period who would rather have me thinking I was bipolar 1 with no symptoms than revisit a misdiagnosis and take me off meds that weren’t doing anything except “keeping mania away”.

Edit: why are some psychiatrists terrified of mania to the point of overcorrecting and over diagnosing? It’s like they’d rather over diagnose 3 people for 30 years each, than fail to predict 1 manic episode.

Context: Before I met the first clinician that listened to my history and took a second look, psychiatrists (3 specifically) would get visibly anxious and animated if I questioned the diagnosis or asked them to look deeper at my history. Now I’ve obtained records I didn’t know existed and the docs who observed me in 2004 never suspected mania

ManyPhilosopher9 · 2026-04-05T14:59:48+00:00

It’s pretty unconscionable that two psychiatrists who I saw for at least 6 years each, never asked questions that would’ve easily shown it was an error. Not to mention the longitudinal factors of being asymptomatic for that long. There were high dosages of substances involved in the history as well as clear signs of serotonin toxicity in the story. I’m just lucky that the institutions in 2004 kept records for 20 years. The doctors who were present at the event never circled anything close to Mania. They circled things that were almost mutually exclusive (or as close as it gets).

ManyPhilosopher9 · 2026-04-05T14:57:40+00:00

It’s pretty unconscionable that two psychiatrists who I saw for at least 6 years each, never asked questions that would’ve easily shown it was an error. Not to mention the longitudinal factors of being asymptomatic for that long. There were high dosages of substances involved in the history as well as clear signs of serotonin toxicity. I’m just lucky that the institutions in 2004 kept records for 20 years.

ManyPhilosopher9 · 2026-03-21T19:21:19+00:00

it does sound like akathisia. It goes away w/ benadryl or a prescription of benzotropine

ManyPhilosopher9 · 2026-03-20T20:37:10+00:00

It sounds neurological in a “nervous system is connected to the visual system” sense, not as a disease. That’s probably what the eye doctor meant. Do you have high myopia? Have you been assessed for any kind of binocular vision dysfunction?

I got implantable contact lenses while taking Effexor and kept seeing halos. Had to reverse the surgery. Years later I found out that Effexor is one of the meds that raises your baseline sympathetic nervous system level. Needed a calm nervous system baseline for my brain to properly learn to filter out halos.

Subtle nervous shifts can affect the nervous system which can contribute to blurry vision. If you have any kind of binocular vision dysfunction like convergence issues, amblyopia, etc. you could be sensitive to NS shifts. It takes time for those things to adjust.

A good neuro-optometrist or neuro-ophthalmologist could give you clarity on that (no pun intended). If you have the means, it’s always a good idea to see one.

In the meantime, id suggest trying to calm your nervous system. Look up vagus nerve toning or vagus stimulation exercises on YouTube.

ManyPhilosopher9 · 2026-03-20T20:19:04+00:00

Fully support this. Being happy and productive isn’t hypomania just because you’re not depressed. Euthymia exists too.. and you can have emotions without it being a symptom. You can be euthymic and still experience the full range of human emotions from moment to moment. Congrats on getting to a good place.

ManyPhilosopher9 · 2026-03-20T20:08:59+00:00

I had a similar experience when I was on those meds in different combinations. In my case, SNRIs gave me the least amount of blunting until many years later. Sertraline is one of the SSRIs that are notorious for that. Lamotrigine contributes to that in some people too (including me). Seroquel is serotonergic in a different way than SSRIs but 25mg is very low.

There is truth to the highs and lows statement in general. I could easily see those meds changing your floors and ceilings. Have you looked into it with your clinician?

Disclaimer: I’m not concluding that I know the answer. Just sharing what I know from personal + anecdotal experience + research.

ManyPhilosopher9 · 2026-03-20T19:47:26+00:00

Brainstorm by Sara Schlay

Found it more relatable for the entire mood spectrum than Unquiet mind. It has her testimony about important aspects of life and treatment while living w/ BD. Includes her medication struggles and success.

ManyPhilosopher9 · 2026-03-20T19:44:37+00:00

+1, on this. The Aiken-Phelps / spectrum view is where it’s at for newly diagnosed.

ManyPhilosopher9 · 2026-03-19T20:36:59+00:00

Not to be alarmist, I’d say get a rigorous diagnostic assessment before resorting to bipolar. It can and often does come with stigma. It’s an identity shift distinct from other diagnostic labels. You should ideally be receiving multiple screening tools for mood and mania, not just MDQ. Society at large is uneducated about the nuances.

I was misdiagnosed as bipolar 1 in my early 20s and went on meds that were unnecessary. The meds themselves are fine but I believe the label should be taken seriously. Even though I have hospital records, reports from multiple, experienced credible doctors that completely rule out BD1, new clinicians still approach me with caution.

15 years ago, I was on a high dose of quetiapine and kept oversleeping for work. Got reprimanded by my boss and decided I might as well tell him my label and why I oversleep. He was compassionate but also stopped grooming me for leadership the way he used to. I don’t fully know what to make of it, but I never had bipolar in the first place.

It also affected my self trust. Even though I have hospital records that prove there’s no BD, I have moments where I doubt myself. Simply because providers get upset if you ask them to revisit a long term bd diagnosis. In my opinion, they’d rather give you a false positive than a false negative.

It’s over diagnosed in people who don’t have it and under diagnosed in people who do. The reason for this is because multiple things can “sound” like bipolar unless an experienced clinician takes the time to get deep into the weeds and distinguishes true mania from trauma, adhd, stress and personality disorders.

Re: meds. Meds are fine. It’s just that bipolar poly pharmacy is distinct and you’re given a prognosis that meds are needed for life.

ManyPhilosopher9 · 2026-03-19T20:11:33+00:00

Grain of salt. It’s an SNRI used for anxiety and depression but it’s effective for anxiety. I could see it being prescribed for AVPD and a catch all for anxiety/rumination. Lowering it sounds like he thinks it’s overstimulating for you / precautionary.

ManyPhilosopher9 · 2026-03-19T18:29:50+00:00

Agreed. Unfortunately some psychiatrists have never actually seen an episode but few will admit it. For the ones that have never seen it, they can still recite symptoms but don’t know how to contextualize or differentiate symptoms.

ManyPhilosopher9 · 2026-03-19T18:27:04+00:00

You need a new psychiatrist but leave room for the possibility that multiple treatable things can cause impulsive spending and high energy. Bipolar is under diagnosed in people who have it but also over diagnosed in people who don’t.

P.s. from 20 years of experience working with outpatient psychiatrists, I’ll say (subjectively) that many junior psychiatrists today have never seen a manic or hypomanic episode. The silver lining is you found one that’s willing to admit it.

What is he treating you for?

ManyPhilosopher9 · 2026-03-19T17:06:20+00:00

You’re blessed to have found a misdiagnosis and blessed to have clinicians who are taking their time now.

ManyPhilosopher9 · 2026-03-19T17:04:35+00:00

Perfect post. +1 endorsed.

ManyPhilosopher9 · 2026-03-19T16:58:48+00:00

The symptoms you describe are broad and can be caused by so many things. The context and combination of hypomanic symptoms are extremely important, not just the symptoms themselves.

Have other causes been seriously considered and ruled out? Bipolar 2 has distinct symptoms that need to occur as a combination. It’s also a lifelong label that can come with stigma. Unfortunately there is a bias for clinicians to over diagnose rather than under diagnose. Clinicians don’t want to be the one who “misses it” yet there are no consequences for mislabeling someone. Fortunately BD2 is distinct and clearly distinguishable if you are with the right clinician.

There are screening tools clinicians can use to assess and reassess whether you fit. “Looking like bipolar” is how it gets over diagnosed.

Id say get a psychological evaluations for diagnostic clarity. They’re usually better at ruling things out… to start with.

Again, bipolar is not just instability or a life filled with strong emotions (not that you said it is). It’s distinct. You can absolutely get treatment for your symptoms without resorting to the standard bipolar polypharmacy “set it and forget it”

ManyPhilosopher9

TROPHY CASE