Q:  How does one know Diagnosis is Correct?


How does one know for sure that he/she has been
diagnosed correctly with this disorder. At the age of 45, after
undergoing a serious stressful event, I sought the help of a physician. I
just wanted zanex. I was then referred to a psychologist who then
referred me to a psychiatrist who believes I am bipolar II. How can it
be. After all these years, I am suddenly bipolar. Maybe he's wrong.
Maybe I'm just on too much medication. I experience very depressive
moods. After a period of about 3 months it seems like the meds stop
working. I started with paxil, later went to zoloft, then maprotilene,
first lithium, then ritalin, then back to paxil and now some sort of
medication used to treat narclepsy. I just want to be normal. These
drugs are making me crazy. 

How can I be sure his diagnoses is correct. The thought of going to
another doctor and starting all over again makes me sick.

Is it possible that it's not the disorder making me crazy, but the meds.

Dear Joanne -- 

A lot of people feel just like you do, let me tell you.  After a so many medication tries, the diagnosis starts not to matter so much (after all, the point of a diagnosis is to lead to an effective treatment; but after you've tried most of the basics, you have to hunt more blindly anyway, so the diagnostic label doesn't make as much difference.  The other thing it's supposed to do is tell you about your prognosis, but by this point you wouldn't (or shouldn't) trust anybody who told you they could predict what was going to happen, so that purpose is pretty gone too). 

You have anxiety, and depressive episodes.  And some weird sleep thing, thus the med' for narcolepsy.  You've already tried 3 antidepressants and two stimulants.  You've tried one mood stabilizer (lithium), but unfortunately, any trial of a mood stabilizer that happens with an antidepressant on board at the same time needs to be redone later because than can make it "not work".  

Can you become more certain this "bipolar" idea has some merit?  Two ways: first, read my site about bipolar II -- you'll see that making the diagnosis is tricky but that there are some pretty good clues to go by.  On that site, you'll find the second way: a questionnaire prepared by a bunch of national mood experts, called the Mood Disorder Questionnaire.  

At some point, regardless of what diagnosis you are being offered, you should try a trial of lithium without an antidepressant, and Depakote or Trileptal without also (unless something else gets you better and keeps you better first!).  Because we can't be certain you don't have bipolar disorder, and if you did, that's what you should be getting.  Try whatever makes sense to you and your doc' first, but if it doesn't work well (and keep on doing so), remember there's another way to go that you can try later.  Good luck with all that. 

Dr. Phelps


Published March, 2001