In the 2007 volume of the Primary Care Companion to the Journal of Clinical Psychiatry there is a study titled “Quality of Life Among Bipolar Disorder Patients Misdiagnosed With Major Depressive Disorder”. A mouthful, I know.
The study hits on some home truths for me. After being diagnosed with depression by my family doctor, I spent two or three years trying different anti-depressants without success. It was an awful period of my life. My doctor labelled me “treatment resistant” and explained that the medicines were “pooping out”.
After persevering for far too long I decided to see a psychiatrist. Not more than a few minutes into my first appointment with him, he said that “poop-out” doesn’t really exist. What appears to be “poop-out”, he explained, is more likely the result of incorrect diagnosis and inappropriate treatment. He was on the mark. His diagnosis of my illness was bipolar disorder not depression, and I enjoyed a significant improvement in health following appropriate changes to my medications.
The conclusion of the study is that people with bipolar disorder that are misdiagnosed as having major depression have a poorer quality of life than those with correctly diagnosed major depression or bipolar disorder. This makes sense to me. If the diagnosis is wrong then the treatment can be ineffective, or even counterproductive. Over time a person’s frustration and sense of hopelessness will only increase as the prospects for getting better appear to be vanishing.
It’s an important fact that bipolar disorder is hard to diagnose. The average length of time from onset to correct diagnosis is over 10 years and perhaps as high as 15. It was more than 10 years for me, and it never occurred to me once that I had bipolar. That is, until after diagnosis when my wife and I scrutinised my past behavior. Hypomania, which is more common than mania, can be hard to detect, especially if you aren’t on the lookout for it.
What to look out for? The symptoms of hypomania are many and varied, but some of the common ones are racing thoughts, a reduced need for sleep, increased energy, inflated self esteem, lack of concentration, an excessive sense of well-being and reckless behaviour. I have experienced all of these. Often the person with hypomania will enjoy their symptoms, as will their partners when they renovate the house while everyone is asleep. Unfortunately what goes up tends to come back down, and in my experience hypomania can spiral out of control and end badly.
The conclusion to this? If you are suffering from severe depression, but you aren’t making progress with your treatment, then it may be worth your while to have a second opinion. You might also think about whether you’ve had exuberant periods in your life as well as depression.
tg 13 Jun 2008 @ 8:40 pm
I believe this is true. I was diagnosed about two years ago with Bipolar II (in addition to anxiety disorders). This information has explained much of my life and the symptoms I have struggled with since age 7. (I am over 30 now). Bipolar II is much more complicated to diagnose and treat than just a depressive episode. It has been wonderful to FINALLY find an effective medication combo and a good Christian psychologist who specializes in mood disorders who is helping me move beyond survival mode to actually enjoying life on a regular basis, which I had never expected. The good news is that Bipolar II is highly treatable, and the earlier it is diagnosed, the greater the potential for vastly improved quality of life.
Rick L 14 Jun 2008 @ 7:43 am
I just found this little bit of info, since I set google to find these things about BP II for me… I have struggled with bipolar II symptoms most of my life, and my sister, who is a Christian psych nurse practitioner, finally helped me diagnose correctly. No wonder the antidepressants actually made me WORSE and MORE discouraged… Over 50 years old, I’d like to be able to help many other people with this and similar conditions… God has been with me the whole time through the awful struggles in my life. So, let’s go forward from here.
Wellness Writer 8 Jul 2008 @ 1:24 am
I’m glad you finally got the right diagnosis. Actually, antidepressants do “poop out.” There’s a medical term for it; I just can’t remember it. But, after three years of working, Zoloft “pooped out” for me. And I was also labeled medication resistant because none of the standard bipolar medication worked. However, I believe that atypical bipolar II was not the right diagnosis for me; and my illness was actually clinical depression. Alas…
chato 12 Jul 2008 @ 2:17 am
lol, fire burner just sent me a message you left, I hope you will still come by the site.. well the good thing is I got to see your site… great work.
Chato
http://mentalhealthhumor.today.com
claudia 21 Jul 2008 @ 9:03 am
I don’t think I’m bipolar, it’s mostly anxiety that I suffer from.
I’m also to scared to get any more diagnoses, I know it sounds stupid, but I don’t like admitting I have problems… Does that make any sense?
Adam 1 Oct 2008 @ 6:09 pm
On the subject of meds pooping out. I’ve read somewhere about this and then experienced it myself.
First though: as soon as your family doctor or internist mentions depression, look for a good psychiatrist. Internists are not trained well enough in this area to prescribe you proper medications in proper doses and to properly identify your problem. Depression may be are result of something else that needs to be taken care of first. Meds have to be started slowly, in small doses and progress, side effects must be monitored. You need to see the doctor at minimum once a month and discuss it. Anyway, what I’m getting at is this: most internists, and some psychiatrists too, will start with some latest and greatest medications. As it turns out many people 30years or older do not have a very good reaction or non at all to the newest meds. For example, Lexapro did nothing for me for over a year. Yes, I made the mistake of not seeing a specialist and having my internist prescribe me drugs. I showed a great response though to good old Prozac! Within weeks I started feeling better. At first it was combined with small doses of Klonopin (“painkiller” for anxiety and tension) which immediately, overnight lowered the tension and anxiety so Prozac had easier time kicking in. Klonopin was slowly phased out over a period of months and I’m still making a progress.
Claudia, I lived in denial too: “oh. I’m just stressed or overworked”. Then I thought I was just depressed and everyone is depressed these days, but it turned out the underlying problem was severe, chronic anxiety related to some events in the past and certain fears, one of them being kind of perfectionist I was always worried about not doing things right. Admitting that you have a problem is the first step towards recovery. See a good specialist and start proper therapy.
Cheers!
Adam