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.