Getting diagnosed
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Getting diagnosed, or mis-diagnosed (Dee)

Q: i attempted suicide 3 months ago. after 1 week in hospital I was released. a psyc. dr. prescribed over the course of 3 months, one at a time,lithium 600mg, depacote 1500 mg and remeron 40mg. None of these made me feel better. Without even looking up at me, he diagnoses me as manic depressive, which is ridiculous to me and all who know me. I've never been "up", i'm not even an excitable person! If I dont fit the criteria for bipolar and the medications dont alleviate my "helpless feelings", isn't it logical to think I do not have this condition? Also, isn't it possible that I just had a momentary lapse of reason. I would never attempt suicide again. it was very selfish of me. Also, why do psych dr's have to "put" you in a category. Isn't it possible to just be sad? Please give me your professional opinion. My best, Dee

Dear Dee --
I'm sure your question speaks for many people.  You're right, it would be very hard to be certain at all about a diagnosis after one interview, or even a series of interviews in the hospital.  Why do doctors seem so determined to "make a diagnosis"?

Here's one way to think about that: we search for details in your story, and your family history, and your experience of symptoms over years, in order to see if you might be like somebody else we've seen.  You see, people are like one another enough, in some ways, to sort out into categories.  We think, ok, is this a mood problem?  If so, are there signs here that suggest whether this is primarily a problem of life circumstances? (as can definitely be the case).  Or are there signs that suggest instead that there is some sort of genetic, chemical disturbance?  That's harder to tell for sure, as you may be pointing out in your note.

However, the advantage of this sorting effort is that we know from previous experience that certain groups do best with certain treatments.  Most importantly, in mood disorders, we are beginning to very strongly suspect that someone with a "bipolar" process can get worse with antidepressants, in the short or long term.  So one of the very most important guesses, right off the bat, especially if medications are going to be used, is to make the call: bipolar, or not?

We can guess wrong, all right.  And that may well be the case for you.  You might want to shop around for another opinion, if your circumstances permit that; or maybe two more, if possible.  Many people in your circumstance could find themselves getting several different opinions, though.  Then what?

Well, some treatments are helpful for almost everybody, and not likely to do harm.  This includes some forms of psychotherapy (the mainstream ones), and exercise (probably the best antidepressants from a benefit/risk view).  So you can start there.  But if that's not enough, then what?  Then you really have to face this "bipolar, or not"?  question.  Because the next question is whether you should have an antidepressant at all.  Right now you're sort of in the middle.

So maybe it's the wrong diagnosis.  Or maybe it's correct and the antidepressant is messing up what mood stabilizers are supposed to do.  Usually in this circumstance the first and most important step is to answer just the question you asked -- does this woman really have bipolar disorder?  Because the next step really depends on that answer.  Try reading over my site about Bipolar II, if you haven't already.  If you still don't think you have that, and you could be right, and it would be nice to be right about that!, then you should share that opinion with your doctor.  Then it's her/his job to help you "get on board" with the diagnosis, or change it in accord with your input.  Good luck.

Dr. Phelps

Published November, 2000

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