Misdiagnosed as Bipolar Years Ago?
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Q:  Misdiagnosed as Bipolar Years Ago?

Dear Dr. Phelps,

I was diagnosed with bipolar II disorder approximately 8 years ago.  I originally sought help for depression, had some major life changes and stress going on which caused a big "shutdown". 

I was on disability for 5 years. When Social Security reevaluated by status, I did not fight their contention that I was able to work.  I felt I was.  This was in December of 1999.  I quit all meds at this time (didn't like the way they made me feel). I started working in June of 2000 and have been promoted twice since that time, doubling my income, and recently obtaining officer status within the company.  I have enrolled in night school to finish my BBA once and for all.  I work between 45-50 hours a week and take 3 upper level business classes 4 nights a week.  I am enrolled at Junior status and have an overall GPA of 4.0.  My days are extremely busy and I am tired at night.  As such, my sleep patterns are normal.

My question - is it possible that I was misdiagnosed years ago?  Is it common to go so long unmedicated without incident and be bipolar?  I am starting to feel the stress of my schedule and I am terrified of going to that place again.  Did my hypomania just transfer from unfinished household projects to work and school?  If so, how bad is that?  I'm very productive.  I have been noticing an increase in sick time this last year.  However, I complete and accomplish so many projects, nobody would question me on it.  What are the warning signs?  When does the overachieving hypomania become a problem?  Please answer.


Dear Ms. C' -- 
Several possibilities come to mind:  1) right, misdiagnosis, due to the stresses at that time; 2) bipolar all right but mild and not currently a problem; 3) bipolar all right but enjoying a sustained hypomania, which could imply but does not guarantee that a depressive phase will follow -- granted, this sounds like a very long time for this level of activity going on to be "hypomania"; or 4) there was some other factor, possibly a reproductive hormone issue if you're now in your late 40's or even maybe in your late 20's -- though we know very little about that speculation on my part -- which might have been setting you up to have symptoms back then but not now. 

Is it possible to go unmedicated without incident and "be" bipolar?  Definitely yes; several studies have shown that as many as 10% of people with a full manic episode, hospitalization and everything, won't have another one, even without medications (I find that hard to believe, but I heard Mauricio Tohen say it several times, and he's the (Harvard) expert on this topic, or was then for sure).  I'm pretty certain I didn't hear him wrong and that I've seen it again in print since...

What are the warning signs?  Further deterioration in sleep is one I always listen for; yet further increase in activity with a deterioration in performance -- too many ideas at once, can't concentrate, that kind of thing; and having somebody remark upon your behavior, that it strikes them as "abnormal" (presuming that hasn't happened yet, if it did, that's a good warning).  Good luck, and I hope you just stay the way you are now!  Congratulations on what you've achieved so far.

Dr. Phelps

Published February, 2003


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