How quickly to make a diagnosis
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How quickly to make a diagnosis, and to expect response

Q: i was sent to charter after trying to take my life for the second time im almost 18 they diagonosed me after a week i believe i am bipolar from all the reading ive done but is it safe for them to diagonose me after only a week im on some medicine but i still cycle at least five times a week is any of this normal ?

Dear Kristina --
I don't think how much time one takes to make a diagnosis really matters too much: what matters is did the right details get examined, was there something in those details that is really conclusive no matter who is interpreting them (e.g. an obvious manic cycle at some point in the past), and was there a proper check for "organic" factors -- physical illness like strep throat or hypothyroidism -- that if left alone will mess up any treatment no matter how accurate the mental health diagnosis.  That kind of thing, that's what good diagnosis takes.  When there's no clear diagnosis, then we have to pull out the "fine tooth comb", meaning we have to look for subtle details in your history.  And finally, sometimes when we're not sure, taking more time to see what happens over weeks and months helps -- or even over a few days on an inpatient unit, where we can see how a person acts, not just what they report as they problems. 

Not sure if they diagnosed you as "bipolar" based on your letter.  Let's say they did. Yes, I'd say that's "safe" -- especially if there's something in your story that's really clear, as I noted above.

After a week on med's, still cycling almost every day?  Question #1: on an antidepressant?  (said he, thinking the answer would be yes...).  However, even if you're not, a week is too short a time for mood stabilizers to do a complete job; and about half of people at your stage will end up needing more than one mood stabilizer, so it may be that until you clear out the antidepressants (that has to be done slowly) and add another mood stabilizer (this one can be low-dose, often) that you'll still be seeing cycling.  No drugs or alcohol, mind you, meaning literally none until you're clearly stable and can judge for yourself how destabilizing even a drink or two can be (some people can get away with one or two, others not; few can handle more than 2 a week without seeing some instability result). 

Keep learning and keep hoping.

Dr. Phelps

Published December, 2000

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