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Sunday, January 31, 2016

Could I Have Bipolar Disorder?

     If you think you have bipolar disorder, proceed with caution, because it is far too easy to be diagnosed with. There is a significant amount of disagreement between mental health providers over the symptoms of bipolar disorder, as well as when a person should be diagnosed.

     If you have been diagnosed with bipolar, consider a second or even third opinion. Bipolar disorder is one of the most commonly misdiagnosed mental illnesses after ADHD. The number of people diagnosed with bipolar has about doubled since about 1996 (prevalence); this is serious, since even common side effects of drugs used to treat bipolar can be detrimental. Long-term use of bipolar drugs is strongly associated with early death by an average of about 15 years. There is debate about how reliable this association is, however, because many people diagnosed with bipolar have substance and alcohol abuse problems or engage in risky behavior (even though most people who do these things don't have bipolar disorder).

    The trend in over-diagnosing bipolar seems to be continuing. This problem can be accredited to several factors, such as:
(1) the accessibility of poorly written information or misinformation about bipolar on the internet
(2) people engaging in self-diagnosis with no training or experience on how to diagnose mental illness/no point of reference of severity or normality
(3) pharmaceutical corporations promoting the disorder in advertisements ("talk to your doctor about drug X... you may have bipolar disorder")
(4) medical doctors who work with pharmaceutical corporations (called  Key Opinion Leaders,  or KOL's) who are hired to shape the opinions of other doctors in favor of one drug over another, as well as to promote the illness through books and studies that are paid for by the drug corporation
(5) poorly trained or inexperienced mental health providers who may have never worked with someone who has had a manic episode or depressive episode, and therefore are lacking a point of reference where they could understand the real difference between bipolar mania versus moodiness

Self-portrait drawn by a client during a manic episode.
True Bipolar disorder is a severe mental health problem.
It should be applied with caution.

     I still have clients who are told by their psychiatrist that if they have a certain type of reaction to their SSRI's (selective serotonin re-uptake inhibitors, like Zoloft and Sarafem)  medication, they probably have bipolar disorder. Some examples include children, teens or adults who became intensely irritable, moody, or euphoric while taking SSRI's and were told that this indicates bipolar disorder. This idea was promoted by a KOL in the mid 1990's and is not true. A manic reaction to SSRI drugs can happen to anyone.
     To be diagnosed with bipolar disorder, you have to have a manic episode or a hypo-manic episode (these have the same symptoms, but hypo-manic episodes tend to be less severe and disruptive). This episode must take place while you have been sober for a period of time, since intoxication could cause the episode rather than bipolar disorder. This includes psychotropic medications which alter your brain chemistry, like SSRI's (you must be off of these for at least 6 months prior to having your first manic episode). It is very possible that any psychoactive substance that you take on a regular basis can yield mania or manic-like symptoms.

     Questionnaires are often used by mental health practitioners to assist in diagnosis. However, these need to be taken with caution. There are no definitive written tests which you can use to determine if you have a mental illness - none! These are just screening forms and should be taken with a grain of salt. Don't engage in self-diagnosis. Drug companies often sponsor screenings, because the more people who are diagnosed with bipolar, the more drugs they sell. Drug companies love the "bipolar market," because the assumption that is made by nearly every mental health provider is that if you have bipolar then you need "medication." But, if you're misdiagnosed, you don't need meds, and if you have bipolar, you might not need as many drugs and as often as you might think.
     Screening forms use vague terms, like, "I have felt extremely irritable for long periods of time," or "I don't feel the need for much sleep." Terms like, "extremely," "irritable," "need," and "long periods," are defined differently from one person to the next, and usually these ideas do not coincide with clinical concepts of the disorder. That is why there is no substitute for a thorough clinical interview, using the screen as a guide. It doesn't stop there. You can have all sorts of symptoms, but if you are not distressed by these symptoms or if they do not directly cause real problems in your life, then you have no disorder.

     In short, if you think you have bipolar disorder, be cautious when seeking diagnosis and do not self-diagnose. Do not walk into the mental health provider's office and say, "I think I have Bipolar disorder," (and I want to prove that I'm right...and smart... and know best...) and steer the provider into that diagnosis because you have convinced yourself of it. Simply report your symptoms. Ask some friends what they really think of your symptoms, not of the label people throw out in an argument. Realize that your worst moodiness is probably nothing compared to someone with bipolar who is manic, and that your worst depressed mood is nothing compared to someone with bipolar who is depressed. When you can still go to work, watch your TV shows, and call your friends, you probably do not have severe bipolar. Many people have depressive episodes which end with renewed energy and confuse this with bipolar, so many people that really have uni-polar depression are misdiagnosed with bipolar II.

     You can shop around for therapists and ask them to describe their experience and how they proceed with diagnosis. Steer away from those where bipolar is not a primary specialty and who are quick to diagnose you. Again, proceed with caution.

Mental Health Disclaimer: The information included in this post and blog is for educational purposes only. It is not intended nor implied to be a substitute for professional mental health treatment or medical advice. The reader should always consult his or her mental health provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a mental health or medical condition or treatment plan. Reading the information on this website does not create a therapist-patient relationship.

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