Q: Differing Opinions on Dx & Which Treatment Course
I recently visited a family member's psychiatrist for a casual depression
screening- mood disorders are endemic in family history. Perhaps benefiting from her insider knowledge and experience with my family member's
treatment, she hypothesized Bipolar II (with recommended initiation of mood
Since I live away from my family, I sought local referrals from a college
health center, but am finding that they are not supporting a Bipolar spectrum
I do not want to put too much weight on any single diagnosis, but I am quite
torn as to what treatment course I should consider valid, especially knowing
that unipolar medications can be a risk course of action if bipolar is present
in hidden form.
Do you have any advice on how to best assess symptoms in the murky waters of the
extended bipolar spectrum? Are there any likely pitfalls which might be causing
this inconsistency in diagnoses?
(I am still pursuing referrals for a psychiatrist/therapist who can provide a
combined treatment, upon the first psychiatrist's recommendation, so I do not
have a medication crisis or any extreme urgency in my case at this point.)
Thank you for your expertise.
Dear Jed --
That was a very thoughtful and straightforward presentation of a diagnostic
dilemma that many people face, although for most of them, they haven't learned
enough about the dilemma to even know they're facing it! Nor have their
providers. So here you are, having learned enough to know you're at a very
tricky fork in the road, and there's not much guidance for you out there. Worse
yet, those whom you've already consulted disagree! And yet your circumstance is
really very common.
I'll try not to go on about that. It's precisely why I
wrote my website about Bipolar II, and then the book version, which spends even
more time trying to help straighten all this out, as much as is possible. But
you've already recognized that the issue here is not a yes-or-no, but rather
trying to place yourself on a spectrum where on one end, if you use a medication
approach, you'd be looking at antidepressants; and on the other end, you're
looking at mood stabilizers that have antidepressant clout.
However, in your circumstance, as your symptoms are not
driving you to consider a medication approach right away, you can try using all
the non-medication antidepressant approaches, or at least those that make sense
for you -- before having to really decide where on this spectrum you might be.
Because none of the non-medication approaches have been shown to carry the risk
that antidepressants do, namely making an underlying bipolar disorder worse
(either by causing a "switch" into mania or hypomania; or perhaps by actually
changing your physiology in some more lasting way, my big worry, as you may have
gathered). Sorry, I've overstated it just a bit: two of those options actually
do theoretically have some risk like the risk of antidepressants, namely light
therapy with a light box, and perhaps, even more remotely, omega-3 fatty acids
from fish oil, for which there is a single case report of hypomania
perhaps associated with these pills.
These approaches are outlined on my page about the
non-antidepressant antidepressants, as you may have seen. The non-pill
approaches -- psychotherapy, exercise, and light therapies, all might apply for
you. After that, except for fish oil, the rest of the 9 are trickier to use and
you'd need a health care professional on board whose opinion you trusted.
Note in particular that "light therapies" is plural.
There are two light treatments hardly anybody knows about: dawn simulators,
which are simple and appear to be completely harmless if they don't work; and
"dark therapy", which is another whole subject, but very interesting and the
bottom line is another treatment that is likely harmless if it doesn't work.
That whole story is laid out on my page about
Disorder: Light and Darkness.
At the risk of sounding mercenary, the first three
chapters of my book version of this whole story are really much better than the
web-pages on diagnosis. It takes three chapters to lay it all out, I discovered.
But it's an easier way to hand the whole story to someone else, like your new
doctor, in terms of an explanation of what you already know! Good luck with all
Published November, 2006