18 and
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18 and "can't get a bipolar diagnosis" despite trying

Q: I am 18 years old, and I have been in and out of therapists' offices since I was 11 being treated for depression and to be evaluated for Bipolar disorder. My half sister on my father's side has recently been diagnosed as being bipolar, and originally she was diagnosed as cyclothymic, which has once again, after talking to her about it, brought about suspicion that I too am Bipolar or cyclothymic. I have only been to see social workers/counselors, and all of them said that I was not bipolar in their opinion. At age 15 I was diagnosed with clinical depression, but was not put on any antidepressants. I had been having panic attacks and sleeping all the time, but was not suicidal. This was during the winter. The following year I was again diagnosed with clinical depression, had a few incidents of dissociation, and went through a period of about a month in which I was completely terrified of my father for no known reason. That was overcome after an intervention with him and my mother. This was also during the winter. I began to have periods of time in which i felt excited and powerful that would fit the criteria for a hypomanic episode, but these went unnoticed by my therapist, who was only seeing me once a week when the episodes would last about 4-5 days, sometimes less. The counselor at my school however noticed. I was put on Prozac for the depression, the dosage was up to 70mg a day at one point because it didn't seem to be working for the depression. At the time I felt it was odd because I would be really hyper and excited, more so than previously, but then I would crash the following day. The mood swings became so severe that I requested to be taken off of the meds. I stopped seeing my therapist one day because i felt everything was fine, that i was doing great and that I wasn't in need of any help. 4 months later I crashed again, and sought out a different therapist in order to be evaluated for Bipolar again. She saw me 2x, and then said she didn't feel I was Bipolar, so I stopped seeing her as! well. Since the middle of my senior year I began to have what would meet the criteria of mixed episodes. They didn't occur very often, but when they did they were severe. A few months ago they began to cycle rapidly. I would be in a mixed episode for about a week, with intense anger and irritability lasting for a day, then normal the next, then depressed, then normal, then happy and excited, then angry again. The following week I would be completely normal, and the week after i would be completely depressed. This three week cycle has been continuous since sometime in september. Basically what I am asking of you is for a professional opinion as to what is going on, and what I should do to seek treatment. On the Bipolar questionaire on this site I answered 12 yes' on section 1, yes on section 2, and "moderate" on section 3. But I have been told by 4 different social workers that they don't believe I am Bipolar. What else could this be? I need to find out what is wrong because my college career is suffering because of it. Also, I don't know how relevant this is, but my father was diagnosed about 20 years ago as being a Borderline personality. Please get back to me on this. Thank you for your time, I know this was a very long question.

Dear Ms. J' --
You're trying to learn enough to make the diagnosis yourself -- and I think that's smart, as long as you consider other possibilities as earnestly.  Otherwise you're rather at the mercies of the particular therapist/psychiatrist you see, and her/his bias (as you have experienced). 

So, make sure you do similar homework on Borderline Personality Disorder.  There is a recent report in the current American Journal of Psychiatry (Jan 2001) showing that an intensive treatment relieved many, many symptoms of that condition, without medications.  No longer is that diagnosis so much to be avoided, or at least somewhat less so.  See the comparison of bipolar and borderline on my site: www.psycheducation.org/depression/borderline.htm

If you decide that bipolar really fits better, and I wouldn't be surprised based on what you report, take the Mood Disorders Questionnaire results and a few pages from bipolar sites that really clinch the diagnosis in your opinion and go to a psychiatrist with those.  If you're still looking for one, try the Harvard list (if you're in or near a big city).  Otherwise, try the guidelines on my site.

Dr. Phelps

Published January, 2001


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