Major Depression and World Bipolar Day

Your diagnosis is major depression. So what does World Bipolar Day have to do with you?

I mean, what a relief to just have major depression, right? Isn't bipolar another level of crazy? Well. . .

First, a reality check. Whatever level of crazy you are now, you can call it whatever you want, your mental health struggles will not get worse if your diagnosis changes. Actually, you might get better. I'll get back to that.

Second--and why people who are diagnosed with major depression should be paying attention--half of those with severe MDD eventually are diagnosed with bipolar. So, your chances of having the wrong diagnosis right now are 50/50. A 50% chance that you are taking antidepressants that are not working, or will stop working, and meanwhile are making your prognosis worse.

What?!? I mean, WTF?!?

Doctors have all kinds of explanations for this diagnostic failure. But when I was in grade school, people who scored 50% got a grade of: F.

But they have their explanations. The list starts with: Bipolar is hard to diagnose. That's it. This test is just too hard!

They continue with reasons that basically make it the patients' fault. Not that they are blaming us. It's just that our behavior is responsible. Not theirs. We fail to make an appointment when we are exhibiting symptoms of mania/hypomania. We don't report our symptoms. We fail to give the right answers to their questions.

Now, all of that is true. When we feel good, it does not occur to us that we have symptoms of bipolar. We tend to think that the doctor's treatment is working. When we are in the doctor's office, we don't remember feeling good. We don't give the right answers to questions we don't understand. When my doc asked me, "Are you manic?" I said, "I'm not manic. I'm excited!"

Framed from this perspective, identifying the problem as the patients' responsibility, there is an answer. Patients just need to become doctors! We need to study up on bipolar and how it manifests before we ask doctors to diagnose us. If we would only diagnose ourselves, then we could answer the doctors' questions. And they could improve their grade.

I mean, WTF?!?

The thing is, the correction has been sitting in the literature for two decades. The research gives doctors plenty of tools to better their grade without having to find better patients. As I have been checking and rechecking the bibliography of my book, I tear my hair out at the dates of these articles, 2003, 2006. . . Today I will name three ways that doctors can fix their grade.

First, the Structured Clinical Interview for the DSM is structured wrong. The thing works like a tree. The doc asks a series of questions. If the answer is yes, the doc continues along that branch of the tree with more questions. If no, that branch is lopped off and the doc explores a different possibility.

The stem question for bipolar is about mood. Have you ever had an unusually elevated or irritated mood for an extended period of time? Or as my doc put it, Have you been manic? Almost inevitably, the patient answers no, and they move on to unipolar depression.

BUT, if the first question is about activity, Have you ever had a period when you got a whole lot more done than usual? people do remember and are able to acknowledge overactivity. The interview continues and indeed, lots more people who have bipolar are diagnosed with it in time to treat it and limit its damage.

The other two ways actually are how patients can protect themselves from misdiagnosis, self assessments: the Mood Disorder Questionnaire and the Bipolar Spectrum Diagnostic Scale. They get permanent place of honor at the top of my blog, under Screening Tools. In an ideal world, the docs would use these diagnostic tools before giving you an antidepressant with its 50/50 shot of making your condition worse.

You can't diagnose yourself. But these tools give you something to show your doc, a cheat sheet, if you will, to help the doc improve his/her grade.

That's how I got my diagnosis. After six failed antidepressant trials (and a psychiatrist eager to try a seventh), I had deteriorated to the point of disability. I found the MDQ, told my next psychiatrist about it, had my wife come to an appointment to confirm my extended period of overactivity, and we switched to mood stabilizers.

And I got better. Not right away. By that point my baseline was pretty low. But I got better.

That's why you don't want to cling to your socially acceptable diagnosis of major depression if you actually are on the bipolar spectrum. Because when you stop taking the wrong medication and start taking the right one, you have a shot at getting better.


That, my friends, is my mission: to help you find the information that helps you get better. That is why I wrote Prozac Monologues: A Voice from the Edge. It is why I write this blog. It is why I keep World Bipolar Day. I want you to get better.

photo of red shoes by author
clipart from Microsoft

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