Scared: "bipolar" after 2 visits? Lithium?

Q: My question is basically that I am concerned about my taking Lithium..I mean I am scared, how can a psychatrist after two visits tell someone they are bi-polar? Should I go to another doctor?

Dear Ms. J' --
Certainly an understandable concern, and nice of you to write and give voice to what so many people must have thought.  At your stage of this process, we would call almost any diagnosis "tentative", a "working diagnosis" -- meaning we'll start by looking at it this way and if things get better that would support but definitely not "prove" the diagnosis (things can get better for other reasons too!). 

The diagnosis of "bipolar disorder" is made by looking at a pattern over time.  You probably told your psychiatrist what things had been like for you in the past, but that is definitely not as good a source of information as watching things directly as time goes forward (you can forget important details, or she/he not ask about them; or you may remember particular details that get a lot of attention in the diagnostic process because they stick out, like a phase of difficulty sleeping.)

And as for lithium, well it is certainly understandable to be afraid.  Some of my patients at this stage are not only afraid, they're extremely hopeful as well, because they have had severe symptoms for a long time and many antidepressants, etc.  I hope there's some hopefulness there too for you; if not, ask your psychiatrist to address these very concerns and see if she/he can help you with them.  Then, as I tell my patients, we all wait to see what happens with a cautious trial of a medication, for "the proof is in the pudding"!

Dr. Phelps


Published February, 2001