The pdoc that first diagnosed me, in 2006, did not necessarily ask me about my bouts of depression.  He asked me primarily, about the periods of time when I did not feel depressed.

He asked me to describe those periods, and I did.  He noted my different jobs and asked if depression affected them and then again, did the "other" periods affect them?  He then asked, how?

He asked how many times in the previous 10 years had I thought I had severe depressions?  Were they perhaps 5?  Were they perhaps more than 10?  Then he asked if the periods in between... how many would I say I had them, and how long?

He asked me to describe times when I felt mad for no reason or agitated.  He asked how I felt about my assorted co-workers over the years and how I compared to them in doing the same work?  He asked a lot of very very very strange questions.. questions no other pdoc had ever taken the time to actually ask me.

He asked about post partum depression, he asked about all the anti-depressants I'd ever tried and what happened, he asked if I had any direct family members that suffered with a form of depression or other mental illness?  So many strange questions and even more not listed here.

He then looked at me, put his pen down, and said "Bipolar with Schizoaffective traits." and I sat stunned.  See, I presented at that time - known later - as very very manic and because he had one other hospitalization in his facility's records years back of a similar stay... he stated I had 2 high mixed manic episodes within 10 years.

I asked why no one else, meaning docs and psychiatrists, had ever diagnosed me correctly with Bipolar?  He asked.. "Did you go to see any while you felt good and able to handle the world?" and I answered "of course not, I was fine and felt perfectly well.  Why would I go seem them.  I only ever went when suicidal except for this stay and the other one when something horribly has gone wrong."

He sat, leaned back in his chair, and nodded.

John McManamy, Health Guide

2/21/10 12:21am

Hey, Tabby. Spot on. What's amazing is all the other pdocs who never asked these questions.

John,

Thank you for keeping us updated on the goings on with the new DSM 5.

I have always been an advocate of my own health and wellbeing. It also was my own stubborness to avoid any meds to help my bipolar. It was too scary. But I broke through that stubborness with the help of God and family and now am getting relief.

I am able to be an advocate now for all differing modes and methods of treatment.

I just finished the book Voluntary Madness by Norah Vincent. I am appalled at the treatment of the mentally ill in some facilities after reading it. I'm sure the horror stories could go on and on.

It's us...those that suffer...those that want to get better...that need to speak out and tell our stories. We can't be silent. We must share. Get past the stigma. We have to be the voices for those that no longer have a voice. It's only then that the proper diagnoses and proper treatments can be brought forth. I certainly hope that the people that are in or going into the psychiatric, psychology, or counseling fields are open to what we have to say.

Thanks Tabby...

I have my first pdoc appt in April. I will be sure that we discuss the whole realm of my experience and behavior and coping skills.

God Bless you,

Shelly

I enjoyed reading your article and will look forward to the rest of your series on depression.  My friend was diagnosed with bipolar disorder so I've been trying to understand what she has been going through.  I picked up a book called <a href="http://www.bipolarbarebook.com/about-the-book">"bipolar bare"</a> which is a memoir about living with this disorder.  It really opened my eyes to the extreme high/lows and how they can effect a persons life.

I too went the route of antidepressants making my cycling worse until I got a good diagnosis -- this was in 1995-96. Part was due to my family doctor thinking she could do just as good a job as a psychiatrist and part was due to a psychiatrist who didn't know what he was doing. By then I had learned to my surprise that bipolar didn't mean spending your life savings on shoes or running around pulling off your clothes and screaming. The description of hypomanic was me, and so was the so-called "mixed state." I finally went to a university med school to get the deal figured out -- based on lifelong episodic depression, and family history. In fact, one of my clues earlier was my sister's psychiatrist coming to the conclusion that her problem was bipolar disorder, which horrified me at first until I learned more.

Considering all the moods and behaviors many of us experience, I'd also toss out the bipolar model. I'd draw a wheel with spokes for the more common states - agitation, anxiety, rage, as well as depression and hypomania. Then I'd put a mark on a 0-10 scale on each spoke, draw lines from those marks from one spoke to the next and get a changing shape that would show dimensions of my mood. Each of us would have a different shape representing our mood-states. I think that would show the complexity that the "bipolar" idea oversimplifies. We can't all get MRIs, but we could get pictures. I predict that research will start to tease out subtypes of bipolar that will let our treatments be more easily fitted to what we actually suffer from.

After 15 years since treatment started and I finally found a psychiatrist I feel good about, I'm still looking for the right combination. But I feel worlds better than I did before I got the mood stabilizers.

Thanks for keeping the conversation going.

Interesting that you mention pictures to describe the symptoms.

This article is so timely for me.  Recently I've been talking to my husband, therapist and psychiatrist about this, as I have been struggling with my Bipolar dx for yrs.  I found that I can relate to the term "manic-depression" because it feels to me like my "high" state is just sort of sitting on top of the depressive stuff- like oil on water was the image that came to mind.

The depression, anxiety issues prevail, then this agitated, weirdly excited, irritated, sometimes unreasonably good mood comes along and takes over, but the stuff I'm depressed and worried about is still there, and visible through the layers of the other feelings.

Other times it's all mixed together.  I really can't stand myself and wish to be unconcious- not dead, but amnesiac perhaps.

But it's not a "poles" thing at all for me.  It's complex and involves and overlaps other issues, like repeated childhood trauma and phobias.

When I think of Manic Depression I can relate, I can accept the dx.  For me it is Depression that is complicated by intense agitation or irritability, unexpected lashing out or inappropriate social behaviour (followed by self-loathing) overly sensitive to stresses, and so on.  The term has imagery for me, whereas Bipolar Disorder has none.

I've been reading the DSM V first draft and posting comments.  I'm glad that's available to us morons.

hmmm, I think I posted twice.  oops

Hi John, I like your take on the interrelationship of mania and depression. 48% of us have mixed episodes and on this I think DSM 5 has got its info off a Weeties packet. My favourite take on the interrelationship follows Kraepelin's (1921) classication of bipolar into Mood, Activity and Thinking. For every state in bipolar there is a corresponding alteration in one or more of these factors. If all three are high, we have pure mania; if all are low we have pure depression. These may be the only instances where Sach's star analogy may not work. But for mixed states such as agitated depression Mood will be down, Thinking will be down, and Activity will be up. The thing differentiating agitated depression from pure depression is just the nature of the Activity factor.

With Mood, Activity and Thinking describing every bipolar state, I think DSM should consider using Kraepelin's model for diagnostic purposes. It would put back some professional rigour if doctors had to analyse M, A, and T before coming up with a diagnosis, and your instance is a case in point.