What should I tell the new doctor?

[Izera]

I'm looking for a new psychiatrist again.  It seems that whenever I find a good psychiatrist, they quit the practice or I move.  And not all are good.

I have always considered myself as having an easy to treat case, medication works wonders for me.  I actually have an entire personality switch and I like the person I am on medicine.  I am nothing like the typical person with bipolar disorder who either starts medicine and then can't handle the side effects and must quit, or just doesn't feel relief and quits.  I am one of the rare people who reacts well to medication.

But I need a *lot* of medicine for that effect.  I need an aggressive doctor who isn't afraid to push the boundaries.  A conservative provider is going to leave me unstable.  I have maxed out more medicines than I can count and my response to anti-psychotics and anti-seizures tends to make me need dosages higher than the FDA limit for mood stabilization, I tend to need dosages in the range for someone with psychosis or with seizures.

And that's the problem.  My last psychiatrist had a health issue and left the practice.  The only other provider in the area is a nurse-practitioner who told me last appointment that she will not push the envelope, she will dose me to typical mood stabilization needs, not to my symptoms.

And that scares me.  I'm already looking for a new doctor.  But what can I say or what can I do to make sure I've got a doctor that will treat to my symptoms, not the typical model?

[Bubulous]

I was also on a very high dose of Seroquel at the time I was maxed out on Lamictal which isn't typical but even with all that and being inpatient for a lot of it.... I was still manic.  I can tell you more if you tell me more about your cycles.

[Izera]

Oof, long history.

My first psychiatrist believes my bipolar disorder developed prior to age 10.  However it seemed that doctors in the 80s didn't want to take children seriously, so I didn't get a diagnosis until age 21.  It's type 2.  The first five years were a roller coaster, I was still bouncing between suicidal depressions and hypomania expressed as rage.  After about 5 years I was relatively stable but I didn't recognize medication failure until things got pretty bad.  About 10 years ago I got really good at watching my moods so just laughing too hard at a joke or crying too long after watching a sad movie had me calling my doctor.  My biggest problem in the last 5-10 years has been the paranoid delusions as when the medicine starts to fail and I slip it seems perfectly reasonable to me.  But there are people I trust absolutely and when they say I'm paranoid I call my doctor.  With the recurring delusions, no matter how reasonable it seems I tell myself to call my doctor because I know I have a history of altered perception of reality.

I lost my insurance at the end of May and there was a delay in getting me on my husband's insurance and I had to stop my medicines cold turkey first week of June.  (Because the good psychiatrist I had a relationship with left the practice in February and the one I saw one time in May was so bad I swore I was never going back, I had no psychiatrist to make payment arrangements with.)  It took a whopping two weeks before I was a monster.  Every emotion under the sun, so very extreme, very very extreme, severe paranoia that triggered the rage, no sleep, no sleep at all.

Got the insurance back in August.  Even with the slow start to Lamictal, the anti-psychotics were started full strength and in three weeks I actually felt better.  I'm still experiencing powerful emotions, more powerful than I should.  Just thinking strong thoughts can trigger outbursts of laughter or hard crying, things more appropriate to actual events not thoughts.  And I react to events so strongly that my husband will tell me at times that while my emotion is appropriate, my expression of it isn't fitting the circumstances.  But at least I'm rational and I have a good amount of control.

[Bubulous]

My ex would have out-bursts of emotion that seemed extreme to me at first.  She was a type 2 as well.  We would play monopoly and someone would crack a joke.  Everyone else would laugh but she would laugh so hard that she fell over and could not stop.  The first time it happened it was actually embarrassing to me.  She was just meeting some of my friends.
Eventually it stopped but she would have strong emotions from time to time and I started to understand a little bit more about her.
When she would laugh like that she was just happy and it was a perception change.  She found humor in the world that before was so dark to her and her reaction was like that of a child.  I have had reactions like that too but it was when my emotions had not matured yet.  That may not be the case with you but you have been medicating those emotions for so long that it could be part of it.  Intellectually she had matured normally.  Her cognitive ability was fine and she valued animals, people, and life.  But when that value was compromised she could not emotionally handle it.  So she would be angry.  When she made a mistake it made her feel worse than when emotionally mature people would.
There is no need to fear.  your emotionally maturity will come (if that is something that you relate to).  Eventually you will be able to react to things like an emotionally mature person would.  I saw it happen to her and although before we broke up there were still moments of over-reaction- they were connected to things that she felt strongly about where a lot of people would be slightly less caring or indifferent to it.

[Bubulous]

I also react well to medicine.  Sometimes I just stop it so I can stay awake.... but not anymore.  I have learned my lesson.  I am home before dark.
It seems that you have good insight into what you need.  You are only lacking the ability to appreciate what you have instead of seeking what you may never find.  I cannot tell you what to expect or whether that perfect dr is out there but it would be wise to take the dosage and then let the current one be able to observe how you react.  I know how you feel and I have been there.  I have been maxed out on Lamictal a few times according to the FDA and i was still manic but I realized that my normal (or as you say) typical state that I operate in best while medicated is still a little higher than a typical person.... with ot without bipolar.  I don't know if this helps or not but I am only giving my best to what little I know about you but again I will commend you on your insight because that helps a lot in dealing with this.