Diagnosing Bipolar Disorder: Frequently misdiagnosed
Diagnosing Bipolar Disorder has the dubious distinction requiring 10-15 years to make the right diagnosis after your first brush with depression. Initially, many see their clinician and are giving a diagnosis of simple depression or anxiety. These aren't the same... or even close and have very different responses to treatment. This mistake can be unfortunate at best, life changing and potentially lethal at worst.
Diagnosing Bipolar Disorder: Antidepressants
When a clinician misses the real diagnosis they will often prescribe an antidepressant. This may seem to 'work' for a time but there are a few initial clues to what is really going on in your body. One can be that you might feel, ‘too good, too soon’. This is usually followed by the antidepressant seeming to "stop working" and then a rapid cycling of moods that are difficult to live with. This progression may take months to on average 10-15 years to express. Usually the symptoms of Major Depressive respond to an antidepressant more slowly taking several days to two weeks for initial response. Then, in the followly 6-8 weeks, people begin to consistently feel better. It is thought that antidepressants induce the brain to increase the production of brain derived neurotrophic factor (BDNF) to repair and add resilience to specific nerve cells and neuronal circuits. This slow increase in BDNF is a part of the timing of the process of leading you back to a healthy sense of self and a positive view of your relationships and your life.
However, if you have Bipolar Disorder, and are treated inappropriately with unopposed antidepressant therapy, you may feel ‘magnificently well’ in 2-10 days to everyone’s relief. You (And frequently the prescriber) may feel like a king. Then, in a few days to a few years later, for no external reason the bottom drops out. There are often no new stressors apart from those caused by feeling bad and blood work is frequently unchanged. Often a clinician will increase in the dose of medication and you may or may not feel better…and just as quickly the bottom drops out again. If you have Bipolar Disorder, and experience temporary relief using antidepressant, you may slip into insisting on yet another antidepressant to get back that feeling of wellness. No antidepressant alone is likely to provide sustained relief no matter what additional psychotherapies, diet changes, vitamins or other strategies are added. If this is you, you must talk with your clinician and seriously consider a second opinion from an expert in mood disorders. There are national guidelines for the treatment of Bipolar Disorder and familiarizing yourself with one of them can be very helpful when exploring your options. Be sure to include someone in your life you can trust to help you assess how you are doing day to day and to communicate these observations with your team.
Another possibility would be to ‘kind of respond’ to an antidepressant and then ‘kind of not respond’ over time. This leads to years of searching for the right psychotherapy, diet, over the counter remedies or antidepressant. Meanwhile, you will likely suffer an insidious down hill path both neurologically and in the relationships of your life. Often this leads to a secondary misdiagnosis of Borderline Personality Disorder. The traits of this personality disorder including feelings of emptiness and chaotic relationships are due to the Bipolar illness over time.
Surprisingly, there is one advantage to the more severe, Bipolar 1 diagnosis. Often, a manic or mixed episode is easier to recognize than a Hypomanic or Bipolar Depressive episode. Therefore, someone with Bipolar 1 disorder is likely to receive the right diagnosis and better treatments much more quickly. Bipolar 2 illness is much more common and just a devastating to your life when unrecognized.
Diagnosing Bipolar Disorder: Our responsibility
Many of my efforts in the past 25 years have been dedicated to helping people recognize the complexity of our Conscious and Subconscious connections. Having a thoughtful Wholistic evaluation is your best way to discover your potential and the answers to the questions you and your family has. This had led me to join in the effort to spread awareness the importance of a careful evaluation by an experienced clinician who will take the time with you and your family. Medications will likly be a part of the answer but only a part. Specific dietary recommendations, exercise, prayerful meditation and personal and family education are all a part of a Wholistic sustained effort. This is a journey and one that can be exciting to share. We are more than any illness we carry. Sharing and caring at this level is one of the best ways to achieve optimal results.
We are all waiting for the ‘brain scan’ or genetic test that will help us. Thus far diagnosing Bipolar Disorder requires a good relationship with your clinician, family participation and a careful history. This includes a comprehensive family history, extensive personal history, medical history and multiple points of view. Please see Bipolar Disorder and Drug/Alcohol Addition and Bipolar Disorder and Co-ocurring Disorders for further discussion and insights.