I went to the psychiatrist Wednesday and received the oddest diagnosis of my life: he told me that I’ve got bipolar disorder and that I’m on the wrong medication.
For most of my life, I’ve been convinced that I’ve had major depressive disorder and nothing else. When I was a teenager, I thought I might have been bipolar (age 15-19) but my manic side gradually faded with puberty and I became much more of a depressive.
This is the first doctor or psychiatrist in the history of my life to ever tell me that I’m bipolar. At first, I thought he got his diagnosis wrong. “I can’t be bipolar, I’m not really manic. I don’t spend a lot of cash – well, not recently anyway – I don’t experience euphoric states quite often and I don’t have feelings of grandiosity. And I don’t engage in risky behaviors, you know. I don’t drink or do drugs. I’m a good girl. I can’t be bipolar.”
So he gave me a test; I had to check Yes or No:
1. Has there been a time when you were not your usual self, and you
felt so good or so hyper that others thought you were not your normal
self? Or, you were so hyper that you got into trouble?
2. You were so easily angered that you shouted at people or started fights?
3. You felt much more sure of yourself than usual?
4. You got much less sleep than usual and didn’t miss it?
5. You talked much more or spoke much faster than usual?
6. Thoughts raced through your head or you couldn’t slow down your mind?
7. You were so easily distracted that you couldn’t focus?
8. You had much more energy than usual?
9. You were much more active or did many more things than usual?
10. You were much more social than usual? For example, you phoned friends in the middle of the night?
11. You were much more interested in sex than usual?
12. You did things that were unusual for you, or that other people thought were extreme, foolish, or risky?
13. You spend money that got you or your family into trouble?
14. If you checked YES to more than one of the questions above, have
several of these things happened during the same period of time?
15. How much of a problem did any of these things cause you (like not being
able to work, or having money or legal troubles)? Choose one of the
following: No problem, Moderate problem, Minor problem, Serious
I had most of the items checked off for Yes with the exception of maybe, two.
This diagnosis struck me and my husband with shock. We walked into a psychiatrist appointment to talk about my current medication, Effexor XR, and walked out to with me having received a bipolar diagnosis and the choice of one of three mood-stabilizing medications: Lamictal, Seroquel or lithium. Joy.
To be honest, I’d begun overlooking bipolar disorder after I “grew” out of it. All the doctors I’d seen classified me as clinically depressed, so I figured that’s all I was. When I got home, however, I begun looking for answers. What is bipolar disorder exactly?
“Bipolar disorder (previously known as manic depression) is a psychiatrist diagnostic category describing a class of mood disorder in which the person experiences clinical depression and/or mania, hypomania, and/or mixed states. … Bipolar can be a disabling condition, with a higher-than-average risk of death through suicide.” (wikipedia)
That last sentence certainly got my attention. The Wikipedia entry quotes the Mayo Clinic in a section titled “Bipolar depression“:
“According to the Mayo Clinic, in the depressive phase, signs and symptoms include: persistent feelings of sadness, anxiety, guilt, anger, isolation and/or hopelessness, disturbances in sleep and appetite,
fatigue and loss of interest in daily activities, problems concentrating, irritability, chronic pain without a known cause, recurring thoughts of suicide. A 2003 study by Robert Hirschfeld, M.D., of the University of Texas Medical Branch, Galveston found bipolar patients fared worse in their depressions than unipolar patients. In terms of disability, lost years of productivity, and potential for suicide, bipolar depression, which is different (in terms of treatment), from unipolar depression, is now recognized as the most insidious aspect of the illness.”
And at the end of that little section is a nice little note – a reminder, if you will:
“It is crucially important to understand that there is no blood test or brain scan that expresses distinctly that this disorder exists.”
How charming. Let’s leave psychiatry to become a guessing game of the brain. But let’s ignore my cynicism of psychiatry for a few minutes and explore bipolar disorder much further. There appear to be four main classes of bipolar disorder: severe mania, extreme mania, hypomania and mixed state.
Severe mania includes euphoria, grandiose feelings, high sexual drive, irritability, rage, psychosis, paranoia, hostility and aggression.
Extreme mania concentrates mainly on the negative aspects of severe mania, psychosis, paranoia, irritability, rage, aggression, etc.
Hypomania concentrates mainly on the positive aspects of severe mania sans psychosis, tons of energy, euphoric feelings, highly confident and charismatic and full of new ideas. Hypomaniacs can lead normal, everyday lives without significant interruption.
Mixed state (which is what I think I’ve got) is when mania and clinical depression occur simultaneously:
“In this mixed state, people experience combinations of agitation, disturbances in sleep and appetite, suicidal thoughts and psychosis.” (Mayo Clinic)
Another sad but interesting statistic regarding bipolar patients:
“People with bipolar disorder are about three times as likely to commit suicide as those suffering from major depression (12% to 30%). Although many people with bipolar disorder who attempt suicide never actually complete it, the annual average suicide rate in males and females with diagnosed bipolar disorder (0.4%) is 10 to more than 20 times that in the general population.” (wikipedia)
It’s been a long time since I experienced a “high.” I don’t think I get particularly euphoric at any time – my wedding day was sort of a haze – maybe I was manic that day?
Four kinds of bipolar illness are identified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR): Bipolar I, Bipolar II, Cyclothymia and Bipolar Disorder NOS (Not Otherwise Specified).
Bipolar I is defined as having “one or more manic or mixed episodes.”
Bipolar II is described by “one or more episodes of hypomania and one or more severe depressions. A diagnosis of bipolar II disorder requires only one hypomanic episode.” Bipolar II, it seems, can be confused with unipolar depression (mainly known as clinical or major depression).
Cyclothymic disorder is characterized by many hypomanic episodes mixed with depressive episodes “that do not meet the full criteria for major depressive episodes.” Cyclothymic disorder interferes with day-to-day functioning.
Bipolar NOS meets the criteria for bipolar disorder but not for the other three kinds outlined above.
The wikipedia entry (which I’m getting most of my information from – sorry if I’m unreliable today) also includes a section on “Misdiagnosis.” The entry cites a California doctor who believe that PCPs (primary care physicians) and psychologists to misdiagnose bipolar patients with clinical depression. Apparently, history is very important in making the correct diagnosis, which many doctors fail to take into account. A bipolar patient prescribed with an antidepressant can agitate the depressive side of the illness causing homicidal and suicidal feelings in some instances.
Now, while I think that psychiatry has, in some respects, become a guessing game, I think many of these diagnoses capitalize on similar symptoms that a variety of people suffer from. Unfortunately, however, I wish there were a “blood test” or a “brain scan” that could accurately or somewhat prove the existence of this disorder. I’m a firm
believer that a bipolar patient would have a different MRI result in a euphoric state vs. a depressive state. I’m sure a lot of research has gone into this but I’m more concerned that psychiatry is run by pharmaceutical companies than the other way around. Hence, my aversion to Seroquel.
But that’s another argument for another day.