Last week, the American Psychiatric Association’s DSM-5 Task Force released the draft to the new DSM, available for viewing and comment on the APA website. The new version of the DSM is scheduled for publication in 2013. Two days later, I presented my initial take in a sharepost here at BipolarConnect.
I am also doing a running series of blog posts in my daily blog, Knowledge is Necessity. More recently, I issued a three-part Report Card concerning the DSM’s take on major depression. This involved a detailed breakdown of nine critically important diagnostic issues that have a direct impact on our well-being.
Today, I issued Part One to my Bipolar Report Card, which covered six topics. I anticipate at least three more installments. (Links to specific pieces are posted at the end to this sharepost.)
What I would like to do here and in future shareposts is comment on some observations that jumped out and hit me in the face as I was “grading papers,” and in turn invite your feedback. So, let’s begin ...
What came through very loud and clear is how intimately depression is bound to mania/hypomania. We can’t just pretend that the two occupy poles at opposite extremes with a huge gap in the middle. If I had my way, I would scrap the term bipolar entirely and replace it with something like “cycling disease.”
Think of depression and mania as dancing to the same music, but maybe with no mania for a good many individuals, just a subtle invisible force tugging from the other end. Two years ago, at a psychiatric conference, I heard Gary Sachs MD refer to depression as the pointer stars in the Big Dipper that showed the way to the North Star of mania/hypomania.
Why would you use depression to draw a bead on mania? Simple. We don’t seek out psychiatrists when we are feeling good. Typically, we are depressed, and when we are depressed we totally lack the ability to recall when we felt good, never mind feeling entirely too good for our own good.
This happened to me. My psychiatrist carefully listened to my tale of woe, then misdiagnosed me with unipolar depression. The antidepressant he prescribed flipped me into orbit. Once I was on a mood stabilizer and was able to think straight I was able to determine that my psychiatrist wasn’t to blame for making the wrong call.
Trust me, there was no way in the shape I was in that he was about to mistake me for the type who danced on tables.
My position began to shift when I researched my illness and discovered a depression is not just a depression, that there are very clear as well as subtle differences in the way unipolar and bipolar depressions present.
I’m sure the doctor must have asked me if I had ever experienced depression before and that I would have responded yes. Way back in junior high school, I would have replied. In high school, college, throughout my adult life. I probably would have told him that these depressions didn’t last forever, that there must have been interludes where I felt I could face the world, even if I was unable to recall them.
