Q:  Bipolar or Borderline Personality

I have a long story but I will try to keep it short - I was running around the mental health system for ten years not getting anywhere with a diagnosis of ptsd, borderline personality disorder and chronic depression.  I then left the area and for two and a half years I have not looked back - well - that's what I thought - Until now.  For the past two years my life has been a ball!  I have been full of life and energy and projects, projects, projects...I
am a web designer - then in October last year I started to feel depression coming back and I started drinking again...life then began swinging from depression to hyperactivity.  My mind has always never stopped for as long as I can remember, I am 32 now.  I remember throughout the course of the past two years that I would try to get a job and then when I didn't get it - I would phone the employer and demand to know why they didn't employ me - I have also felt that the whole world is just full of absolute complete MORONS.  When I was nineteen I was given anafranil and it made me high as a kite.  Just as if I had been on Dope!  By the way, I hate dope and never use it - just alcohol. Anyway, I saw a psychiatrist and he diagnosed me with Bipolar II Rapid Cycler but then he decided that that was not the case because I was showing manipulative behavior.  They now still think I am borderline.  Meanwhile I have been going to my GP as I was told to do my Mental Health and I stopped drinking and started Tegretol I am on 800mg per day and my level is up to 7 which is supposed to be in the therapuetic range.  Yet I am still swinging and getting depressed - the GP tried me on aropax and I went MAD - I was High as a Kite from day one!  When I get high now I notice I get like an electric sensation across the top of my head - they said it was a somatoform hallucination?  In other words not only is it in my head but I am putting it ON - this whole situation is annoying the heck out of me - I became very aggitated and restless until about the fifth day I tossed the aropax away and am now just swinging from hypo to slightly depressed - the tegretol doesn't even make me tired - infact I have to mark off when I have had it because I don't notice a difference accept that I now sleep like a baby - no more waking up every couple of hours - I sleep 7-8 hours straight and it is great!!!!!  Am I Bipolar or Borderline?????  I have never felt chronically empty or alone - ofcourse I felt hopeless and empty when I was depressed but when things are good they are absolutely fantastic for me and I feel my life is fullfilled.......Can I ask them to do an MMPI test to rule out borderline for sure!!!!  The Mental Health Hate me Yet my GP want me to deal with them - I am caught between a rock and a hard place because I had stopped all that horrible attention seeking behavior and had been doing really well until I lost the plot when I was on the aropax - hit the grog and slashed myself up again - I hate when I do these things and I hate being a burden on people and the whole system of things...Please help with your suggestions..I would appreciate it immensely...

Dear Ms. M' -- 
You would probably be surprised at the number of people I've treated with stories like yours.  It lead me to write an essay about bipolar or borderline that I hope might be helpful.  There's also an excellent site on self-harm if you haven't found that already.  

From there, as you can see, I'd just proceed on "both fronts" with medications for bipolar disorder and therapy for borderline, if you can get it, and especially if you can get something like the DBT described in the essay (which would be pretty good for just about anybody, and is almost certainly good for someone with mood instability from any cause).  

Then there's the alcohol, which might merit a separate targeted approach as well (some chemical dependency people would squawk at getting low billing on this list, and would probably put this first), like AA?  

In any case, I hope it helps to hear that I've seen many folks like you get a whole bunch better on medication alone (because they couldn't access or afford the therapy part, in many cases), so I would hold out some hope there following the routine treatment approach for rapid cycling bipolar disorder.  Believe it or not, I look forward to seeing folks like you because often they haven't been on mood stabilizers before and often can have huge improvements, which is always nice to be a part of.  Not always fun every step of the way, mind you; but not for you either, eh?

Dr. Phelps