Which diagnosis should I choose?

[lindsay111]

I am wondering which psychiatric diagnosis I should choose. This is how I am trying to make a decision -

Depression diagnosis
- The most experienced and the most educated psychiatrist diagnosed me with depression
- There is 99.9 percent chance I am not psychotic or schizophrenic (factoring in age and gender)
- I don't think I am psychotic or schizophrenic
- 10 friends don't think I am psychotic or schizophrenic

Psychosis or Schizophrenia diagnosis (2,2)
-1 psychiatrist diagnosed me with Psychosis (though I didn't think she was a very good doctor)
-3 other psychiatrists had brief consultations and diagnosed me with Psychosis or Schizophrenia
-Some family members think I am psychotic or schizophrenic.

Which diagnosis do you think I should choose? I would choose the depression diagnosis, but I'm hoping for another opinion. Thank you SO much in advance.

[j17c27]

Maybe get a 3rd opinion...if 2 doctors diagnosed you with completely different things

[weaveme]

I like jcook144's idea to maybe get another opinion.  Also, do you know if the treatment is the same or much different depending on the diagnosis?  My reason for asking is if the treatment is similar, does it really matter what the diagnosis is as long as you are working hard to deal with it and keep it under control as much as possible?  Just a thought so you don't get so hung up on what "it" is.   I understand depression may sound like less of an issue than the other but maybe approach to staying healthy is the same so then who cares what you have.  

However, if treatment and approach to healing is different then you obviously would want to know.  

Just my thoughts!  Blessings and best wishes!!  

[lindsay111]

Thanks for your responses! Sorry, I was away, hence the late reply.

Getting a third opinion did cross my mind. I think that is what I will do, I just needed reassurances that I wasn't getting too many opinions.

Weaveme - the treatment is quite different. The depression diagnosis comes with the recommendation for depression medication. But the Psychosis/Schizophrenia diagnosis means I would need to go on an anti-psychotic medication, which is a very serious and strong medication.

Thanks again!!

[MMahon]

It's hard for us to tell without knowing more details of your condition.
A person suffering from depression can have symptoms of psychosis in severe cases.
http://en.wikipedia.org/wiki/Clinical_depression#Symptoms_and_signs
If you have these symptoms you may need antipsychotic medication regardless of the correct underlying diagnosis.  You may need antidepressants as well.
Find a good doctor that you trust and follow his/her guidance. We can't choose our own diagnosis.  Sometimes it's just trial and error until everyone gets it right.
Good luck.

[lindsay111]

MMahon - yes, I suppose it would be difficult to tell what's wrong without knowing details. I suppose I'm somewhat overloaded with opinions already, which is why I didn't include details.


And it does seem odd that I'm trying to "choose" my diagnosis, I agree. I'm just not sure how else to approach getting treatment with two different opinions. I definitely don't agree with the Psychosis/Schizophrenia diagnosis. And to be honest, I don't think I have the symptoms of depression. But I think I definitely have an Anxiety disorder. So I suppose a third opinion could be a great answer.

Anyways, thanks for the luck :)

[Jaquta]

You could always try looking up the dsm-iv diagnostic criteria for each diagnosis and seeing which fits best.

The info you have presented isn't all that specific.  I'm not sure that another psychiatrist would run a very different differential or come to a different conclusion.

Just stabbing in the dark and with minimal info to make a decent decision I would say depression with psychotic features.

Your presentation may differ between doctors based on timeline, life events, etc.

I think that you would probably know if you had schizophrenia.  Mental illness doesn't discriminate (that much) so I don't think age or gender are necessarily good indicators to either rule stuff in or out.

Personality disorders can also have depression, anxiety and psychotic symptoms as criteria.

You need a decent assessment.

[churnman]

The problem with getting a second opinion is getting one, then you become the doctor.

I was given medication more suitable to a patient in greater need than my condition. Not long into this course of meds I discovered that they actual made my condition worse.

Disclaimer, I'm not a doctor.

Subsequently I went with the depression medication. It didn't make me feel worse but it did seem to help somewhat. That little help provided the basis of me working on my problem myself. Then real therapy started.

[Mickey88]

Have you checked the symptoms of both to see which you identify with?  I do know schizophrenia doesn't show up beyond age 30 or so; I'm unfamiliar with psychosis.  

I would value the input of friends and family who see you on a regular basis ... they know you the best.  

[lindsay111]

Jaquta - Yes, I have read through the DSM-IV criteria. That's how I came up with an Anxiety disorder self diagnosis, and why I'm rejecting the Psychosis/Schizophrenia diagnosis, and rejecting the depression diagnosis.

Churnman - You're right, after getting a second (different) diagnosis there sure is a heavy decision to make. Good luck in getting healthy!

Mickey88 - Yes, I identify most with an Anxiety disorder. And I know I need help in managing it, so I suppose I'm going to keep trying until a psychiatrist is willing to help.

[Jaquta]

Maybe you should just start with psychotherapy.  It will help with any depression and give the therapist an opportunity to assess other symptoms.

It can be dangerous to self-diagnose and often we misinterpret criteria anyway.  There's all sorts of stuff that also needs to be taken into consideration.

Not sure how well a person can diagnosis psychotic events in themselves.  ??

[Jaquta]

My spelling is a bit off.  I meant diagnose.

[lindsay111]

Jaquta - I've tried a few psychotherapy sessions, and I wasn't too impressed. I think I'm just going to go for a consultation first, and decide from there.

And apparently in many cases it is difficult for someone who is psychotic to realize they are psychotic.

[Jaquta]

Another psych consult possibly isn't a bad idea (but what if you don't like what they have to say either?).

Some therapists aren't as good as others and some aren't always a good fit for us.  Perhaps you could ask if you could try another therapist.  Sometimes you need to give them a fair chance too though.

Have you looked up the dsm-iv for bpd?  Does that seem remotely relevant?

Psychosis seems to indicate an inability to reality test so if you were psychotic, how would you tell?  Surely if you were psychotic your family would take you to hospital during those times.  Have you considered the possibility of bipolar?

What are your symptoms?  I know that nobody can diagnose over the internet but a list of symptoms may help give others a picture of what may or may not be going on.

Regarding diagnosis, it may be that the first doctor wants to treat the depression before assessing other symptoms.

I went for a psych review recently and the doctor said that other diagnoses shouldn't be made until the depression is treated.  It makes sense.  It really depends on the primary diagnose though.  Diagnosing can be tough.

[lindsay111]

Jaquta - I'm not sure what I'll do if I don't like the results from the psych consult. I suppose I could just continue treatment with my primary physician, as I think he could manage my complaints.

I have looked up the dsm-iv for bipolar disorder, and it definitely doesn't match my complaints.

I know I don't have delusions or definitely don't have hallucinations or any other psychotic symptoms, so I don't think I'm psychotic but I suppose I have sought the agreement of friends. My friends don't think I am psychotic, though a couple family members do.

My symptoms are (from most troublesome to least troublesome)

- Restlessness
- Fatigue
- Nervousness
- I sleep alot
- Muscle tension
- Irritability

From my reading of the dsm-iv, I seem to have an anxiety disorder. My primary physician is treating me, but it would be nice to get an opinion from a psychiatrist.

[Jaquta]

A family doctor can manage a patient but I don't think they can effectively treat them.  For anxiety and depression psychotherapy is often recommended and family doctors often don't have the time or the skills.  I was seeing my GP weekly but instead of really helping it has kind of just dug me into an even deeper hole.  I respect my GP and he gives me more time than he should but it hasn't helped my underlying issues.

Family members can be biased so I'm not sure how much their input should be valued.

It sounds like stress, anxiety and depression.  The muscle tension is something that happens when you get stressed.  Fatigue can be present in both anxiety and depression.  Sleeping a lot sounds more like depression.  So maybe what is causing you stress and causing you to feel anxious is also causing you to become depressed.

Definitely have a consult with a psychiatrist.
I would strongly encourage you to continue with therapy though.
Not sure if that helps.  I hope you are able to get adequate and appropriate support and work through this.

[lindsay111]

Thanks so much for listening and for all the advice!

I would totally agree that a GP isn't sufficient in treating problems. I guess I am desperate at this point though... I started trying to get help for my mental health two years ago, and yet I have seen no improvement with any of my complaints. And I've had most of these complaints for well over 10 years. But anyways, I hope you start seeing some results from either your GP or a psychiatrist... sounds frustrating.

I really think your opinion is accurate. If I were to describe myself, the first thing I would say is stressed, I have a problem dealing with stress. If there were a stress disorder, I think that is what I would have. And I think there is some anxiety and depression mixed in there.

I'll definitely consider therapy, it just seems that it takes a long time to see results, and it's already taken me such a long time to see results with medication.

Thanks again, you did help. Take care and good luck with your journey!

[Jaquta]

It is frustrating not moving forward or making progress and equally frustrating not having a decent quality of life.  Mental illness can be extremely debilitating.

Are there things that you can do to better manage your stress?  Stress management, relaxation skills, time out, ...

Meds and therapy combined is said to be most effective.  Meds really only mask or help manage your symptoms.  Therapy is what makes the most difference.  It can take time but it is a good investment.

Have you tried making a list of your complaints or issues to take to your therapist?  Being up front about everything can be most effective and save truck loads of time.

Good luck for your journey too.  I hope you see results soon.

[lindsay111]

I take nutritional supplements for my stress, and they have really helped me over the years. Other than that, I find that music really helps me too.

I think that is what I will do, I will make a list of my complaints for when I see the psychiatrist.

Thanks again, and good luck to you too.