talking about bipolar disorder

Your Life Misdiagnosed with Unipolar Depression - The Bipolar Question of the Week

John McManamy Health Guide January 14, 2013
  • Yesterday, in a post, The DSM-5 and Bipolar, I observed that the DSM-5 - due out in May this year - does not address a very critical issue in our lives, namely doctors misdiagnosing those in the bipolar spectrum with unipolar depression. Most of you know from first-hand experience what I am talking a...

18 Comments
  • peachy
    Feb. 06, 2013

    To tell you the whole story might indeed take a book.

     

    I was mis-diagnosed so many times by psychiatrists, therapists, GPs (OMG who let them have a rx pad for psych meds???) and, frankly, myself that I don't even know how many times or how many doctors.

     

    I think I first started having symptoms when I was around 14 but for sure by age 19 I was having...

    RHMLucky777

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    To tell you the whole story might indeed take a book.

     

    I was mis-diagnosed so many times by psychiatrists, therapists, GPs (OMG who let them have a rx pad for psych meds???) and, frankly, myself that I don't even know how many times or how many doctors.

     

    I think I first started having symptoms when I was around 14 but for sure by age 19 I was having hypomania and depressions. Had a failed suicide attempt w/PTC meds at 19 that my friend covered up by simply taking me home and putting me to bed on her couch. I woke up about 28 hours later and neither of us said a word about it. I just got up and went home, end of story.

     

    When I was diagnosed with breast cancer at 32 the anxiety was horrible while I went through chemo. Saw a psychologist who had me draw nice pictures but never suggested or considered a "serious" diagnosis and never did a full history either. Oncologist gave me ativan to get me through.

     

    about a year later serious depression hit and I finally saw a psychiatrist for the first time. Spent 10  minutes with me and I left with Zoloft rx. The therapist I was seeing never did tell me a diagnosis and I was too ignorant to ask. Didn't ask the pdoc either but all he had time to do was write me a rx. A month on zoloft had me feeling worse but I just thought it was because the medicine wasn't working. Wrong answer. 

     

    When the prescription ran out I went back and said I was worse so he gave me a bigger dose. 

     

    About 2 weeks at the higher dose drove me to hell. I was in what I now know to be a full blown Mixed episode and should have been in the hospital. Instead I gave my therapist all my meds as she told me to do (never once suggesting hospitalization despite my obviously severe agitated depression, stated suicidal ideation and plan). Then I holed up in my house screaming, crying, beating on things and myself and drawing pictures anyone would recognize as nightmarish. I'm not sure how I survived that and I'm not sure how long it lasted. Less than 2 weeks but that's all I can say.

     

    I'm too tired to finish my story tonight. And the story is difficult to tell in spots. I'll post more again soon.

     

    What I can say is that my bipolar disorder that almost certainly started as BP II is now clearly BP I ultra rapid cycling, highly treatment-resistant.

     

    We are nearly at the end of the list of medications (alone and in combo) to try and have branched out to trying things like scopolamine patches, dextramathorphan and Deplin. I hold out some hope for the Deplin but haven't been on it very long to see if it is going to make a difference for me.

     

    I am still recovering from a hospitalization last Sept that includled psychotic symptoms for the first time. I am functional as long as you don't ask me to really do anything and the music isn't too loud or the room has no windows and lots of doors or there are snowman globes on the tree watching me. Well you get the picture.

     

    Thanks for asking the questions. I don't always agree with your ideas and answers but it's good that someone's asking the questions.

  • cathryne
    Jan. 17, 2013

    When I was dx'd with uni-polar I was just that.  Uni-polar.  That was amost 30 years ago.  No SSRI's then.  Just tricyclic anti-depressants.  I don't remember what it was, just that it worked.  I had just given birth to my first child and I chocked it up to post-partum depression.  It probably was.  I went off the meds...

    RHMLucky777

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    When I was dx'd with uni-polar I was just that.  Uni-polar.  That was amost 30 years ago.  No SSRI's then.  Just tricyclic anti-depressants.  I don't remember what it was, just that it worked.  I had just given birth to my first child and I chocked it up to post-partum depression.  It probably was.  I went off the meds about 6 months later and I was fine.  

     

    Ten years later I had an episode of violence involving my ex- husband and I was put on Prozac which worked quite well considering my PTSD was pretty acute.  I was taken off it 5 years later.  

     

    About 4 years later, maybe a bit longer, I started developing symptoms of mania that I figured was just stress induced.  My practice was going strong but I was becoming burned out.  My partner in the practice was going on vacation.  That's what I was told. I took on her client load for 2 weeks.  Sne never returned.  I now had a client load of 35 clients a week.  I had to refer 10 out, the other 5 stayed.  I was never sued, thank god.  They symptoms of light mania persisted.  

    I was on the phone with my bookeeper when I suddenly sat bolt upright and said to her "I'm bipolar, or at least cyclothymic"  I took myself to a psychiatris and he agreed and I was put on the med's I am currently on. 

     

    So, of course, I had to diagnose myself.  Hardly anyone presents to their therapist or psychiatrist as manic because if you're feeling on top of the world why on earth would you go to a psychiatrist.  

     

    I probably had symptoms for a year before I diagnosed myself.  So that would make the onset age 51.  That's why I have my suspicions that bi-polar does not just have biology as it's source.  I believe the trauma of my ex-husband, the burned out state of my practice and taking on a heavier load at work than I could then handle led to the symptoms of bi-polar II.   Plus that I was a newly single mom trying not to be scared all the time for my kids.  

     

    Years before I had cancer at age 26.  I never had to be put on anti-depressants (a log of people are when they have cancer) because I frankly handled the stress of cancer  and the chemo therapy while  beginning a new practice quite well.  I'm still in remission.  (you're never cured, not really) I'm adding this on because one would think that if my ability to process the event of cancer went so well then, I would lean towards the belief that I did not have bi-polar disorder then.  I believe still that the later traumas coming rather close together caused the bi-polar disorder.  Didn't hasten it along, but actually caused it.  

     

    So that's my weird little story.  Sort of meandered there.  But unipolar and bi-polar for me were very distinct episodes in my life.  There was no hemming and hawing over what was going on with me.  I take well to medication.  Side-effects are few.  (Klonopin doesn't even make me drowsy) If I'd had bi-polar when I had taken that tricyclic you'd would have-to-have  scraped me off the ceiling.  

     

    Sorry about the length, I'm a bit manic today.  I have a cold and cold medicine can bring on light mania symptoms.  

    • John McManamy
      Health Guide
      Jan. 17, 2013

      Hey, Cathryne. I love it when you write a book. I'm on cold meds, too. Ah, life. :)

    • Crystal
      Jan. 18, 2013
      Cathryne, Your story got me thinking. If we were dx later in life, I at age 43, does that mean we were always Bipolar from the start and just managed life, up to years later? I suffered with depression for as long as I can remember and have been a hyper person my whole life until I was medicated with BP meds. It wasn't until 40 that my life startied with what...
      RHMLucky777
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      Cathryne, Your story got me thinking. If we were dx later in life, I at age 43, does that mean we were always Bipolar from the start and just managed life, up to years later? I suffered with depression for as long as I can remember and have been a hyper person my whole life until I was medicated with BP meds. It wasn't until 40 that my life startied with what I call BP behavior. So I really don't know, have I always been BP and did not know it and managed or did it just show it's ugly head after years of stress and emotional upheaval along with a crappy childhood. Some people like kids get dx early. It's interesting to me when each of us actually gets dx. Why it's so noticeable at a young age and in others later in life. I know everyone is different, I'm unfortunately a black and white person, can't see gray. I like to have answers about the functioning of the human brain to answer all the whys and how comes. I'm rambling about this. I want to add that when I was 40 I knew something was not right with me, that it wasn't just depression. I loved to hang out at the bookstore in the self help section. One day I came across a book called Soft Bipolar. I flipped thru it, said to my self, this sounds like me. I bought the book that day, took it home and read it. I worked in a dr office with 14 dr. My favorite dr was also my personal dr. He prescribed antidepressants (just diff ones than my previous dr did ) to me and I new he had patients with mental illnesses. I made an appt with him and brought my new book. I showed him the book, told him that it sounded like me and said "do you think I have Bipolar?" Remember, I trusted him completely. His answer was, "no, you don't have Bipolar. I felt relieved but at the same time puzzled. I continued on my antidepressants and struggled thru the next three years until I attempted suicide. The mental hospital dx me. My life since then has been a true roller coaster.
    • cathryne
      Jan. 18, 2013

      Crystal:  I do believe we as bipolar affected individuals have a variety of onset dates, (Cathrine Zetta Jones, actor Michael Douglas' wife was late onset).  I also believe that for a period of time prior to dx we can be very functional and relatively a-symptomatic but still "have" bi-polar sprectrum disorder.  The affectation is so low that...

      RHMLucky777

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      Crystal:  I do believe we as bipolar affected individuals have a variety of onset dates, (Cathrine Zetta Jones, actor Michael Douglas' wife was late onset).  I also believe that for a period of time prior to dx we can be very functional and relatively a-symptomatic but still "have" bi-polar sprectrum disorder.  The affectation is so low that it can go undiagnosed until, not being medicated and here I choose the term "kindling effect" has challanged our ability to cope, we become symptomatic enough to be dx'd.  That's why I mentioned that I believe I had the disorder one year prior (and perhaps longer before that) to diagnosing myself.  I was not having noticiable symtoms,  I just seemed stressed. But I do believe some of us are indeed late onset and others have an onset date more cleraly  described in the DSM.  That is one but  obviously not the only reason why it is now termed a sprectrum disorder.  

       

      Everyone is different.  My mania is not your mania.  Mine looks like I'm in a bad mood.  Other people spend tons of money, I want to kill my boss.  I talk too much and stick my foot in my mouth when I am manic. I'm on cold medication but I have the flu so I'm fairly manic right now. 

       

      Because that is my style of mania I, though still licensed, no longer practice as a MFT.  I was not willing to  put my clients or myself through my form of mania. I went back to grad school (horrible idea looking back) and got my MBA and am now an auditor for an accounting firm specializing in the hospitality indursty. Actually, I hate to admit it but this job is more stressful than being a therapist.  Probably because I am not a natural accountant.  And I miss being a therapist- really really miss it.  

    • Tabby
      Jan. 18, 2013

      my manias... naturally... are giddy, lots of energy, think I can do and accomplish everything and the world is just awesome... God talks to me and I commune with the universe and notice it's working... have often been asked if I've "done drugs or on drugs?"

       

      but I do not have multiple sex partners... do not spend $1000s or $millions or start businesses...

      RHMLucky777

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      my manias... naturally... are giddy, lots of energy, think I can do and accomplish everything and the world is just awesome... God talks to me and I commune with the universe and notice it's working... have often been asked if I've "done drugs or on drugs?"

       

      but I do not have multiple sex partners... do not spend $1000s or $millions or start businesses to abandon them 2 weeks later, etc... do not beat people, threaten people, etc...

       

      my manias... when stressed due to external issues... are highly agitative, can't sleep, thoughts searing and soaring - bouncing and ramming... pacing a circle in the middle of the floor... brain won't shut off... everything "scratches" me... noise and stimulation agitates and feels like a roaring within my head, etc... I see and hear things, dance naked around bird feeders, etc..  I do not beat people, do not threaten people, etc...

       

      hypomanias... are just increased energy, lack of focus, attention deficits but feeling good about things in general... can multi-task but not accomplish anything well (though I think I am)... feel I'm smarter than all and if you just did what I told you, your life or work would be better, etc..

       

      then I have the horriable mixers... the agitative high mania with the suicidal depressions... bad... really bad... really really really bad... can't stand my own skin... uggghhh

       

      then.. well... i have the soul dying, spirit killing, blackened and suffocating suicidal depressions where everything is white on white and no colors to be found... everything is laborious and heavy and my little child hurts horrendously

      I have 4 of these - sucidial depressions - a year.  Sometimes more but never less.  That, which fall in between... are either hypomania or mania.

       

      I can be a negative vicious bitch, or a drugged crazed appearing hyped up squirrel that talks 5mp minute and can't settle down physically or mentally, or someone who just barely smiles and can't seem to "get there to get it,  in order to get with it."

       

      yet.. the last few pdocs I've visited... wanted to know if I beleived that I had Bipolar?   then told me it was more important as to what I believed.... really... really? 

       

      Never mind the various and assorted diagnoses upon the spectrum I'd received over a few years prior to... now the more recent ones, within the last 3 years (2 pdocs) have asked that exact and/or similar set of questions?

       

      i know that I have it.. it made absolute sense to me when explained in detail to me in 2006 while IP... and why the pdoc, that time, felt I had it - (he did a thorough medical exam first, then got the results, then sat down and went over my entire psych history.. and asked many many many questions.. to then spend a hour explaining to me and answering questions)... the lightbulb switched on and something way down deep clicked

       

      regarding meds though... what is normal for many is too high for me... I cannot make the MDs, PAs, or NPs. "get this"... they just think I'm med non-compliant.  I'm not.  I just cannot take high dosages and dosages that may seem "mild or normal" to the average population, is too high for me.  so why bother anymore?

       

      I just suffer and struggle and try to make do each day with as little destruction as possible for me and all surrounding....

       

      Thank God for the years and years and years of therapy and the therapy tools I pull out every so often... not all work all the time, but at least it's something

       

       

  • Willa Goodfellow
    Jan. 15, 2013

    Yes, well I am writing the book.  Or rather, rewriting it.  I wrote most of Prozac Monologues in a week, when vacationing in Costa Rica.  I had been off Prozac a few weeks at the time, after some very bizarre thoughts.  When I described writing "maniacally," she decided to screen for bipolar, "Are you manic?"  I said I wasn't manic,...

    RHMLucky777

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    Yes, well I am writing the book.  Or rather, rewriting it.  I wrote most of Prozac Monologues in a week, when vacationing in Costa Rica.  I had been off Prozac a few weeks at the time, after some very bizarre thoughts.  When I described writing "maniacally," she decided to screen for bipolar, "Are you manic?"  I said I wasn't manic, I was excited!  So she moved on to the next antidepressant.  In retrospect, yes, I think she should not have asked me to diagnose myself.

     

    On the other hand, six antidepressants, three psychiatrists and two psychologists later, I was the one who had to convince my pdoc that I had BPII.

     

    So Prozac Monologues is being rewritten, the original preserved as evidence of the hypomania, but surrounded with later insight, Prozac Monologues and Heckler.  The good news is that cognitive function has returned to the point that I am working on it again.  Coming soon...

    • John McManamy
      Health Guide
      Jan. 17, 2013

      Hey, Willa. "I'm excited" should be the cue for a whole bunch of follow up questions. Imagine if we went to a doc and said, "Don't examine the lump on my throat. It's just a mole."

  • Tabby
    Jan. 14, 2013

    I've mentioned this before and well... here goes:

     

    I am 46 years of age.  I've had some form of fashion of mental illness since first diagnosed at age 8.  It's been primarily, Anxiety and Recurring Major Depression - otherwise known as Unipolar Clinical Depression.

     

    I've been on MAOIs, Tricyclics, SSRIs and the newer non-SSRIs... and I've...

    RHMLucky777

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    I've mentioned this before and well... here goes:

     

    I am 46 years of age.  I've had some form of fashion of mental illness since first diagnosed at age 8.  It's been primarily, Anxiety and Recurring Major Depression - otherwise known as Unipolar Clinical Depression.

     

    I've been on MAOIs, Tricyclics, SSRIs and the newer non-SSRIs... and I've had NOT A SINGLE one do anything to benefit.  I've had them to completely "POOP" out, run me manic, develop EPS symptoms, cause psychotic hallucinations, agitation and wild mood swings, and at the very worst - suicidal ideation and attempt. 

     

    Guess what?  I still get ADs when I see psychiatrists.  In fact, many with Bipolar are prescribed a AD or 2.  When I've explained that I do NOT DO ADs, they smile.. and write me a script anyway.  Then assure me that everything will be fine and if not, they'll try something else.

     

    I put the script in a drawer, here at home.  I have several anti-depressant scripts never filled.  I know what ADs do to me..

     

    I've also had 2 episodes of severe Post-Partum Depression.  Both PPDs resulted in inpatient hospitalization and both manifested in psychosis and high mania. 

     

    I've had 5 inpatient hospitalizations, 2 of which were due to "high mixed mania" as I was told by the inpatient psychiatrists.  ONLY 1 psychiatrist in all my years EVER asked me to tell him in detail; how my "good" periods feel and how I act and think... ONLY 1.

     

    Since 2005, I've been diagnosed primarily with Bipolar II Mixed.  I've had Bipolar I Mixed, Bipolar NOS a few times, Bipolar I with Psychosis, Bipolar II with Psychosis, Schizoaffective Disorder-Bipolar Type... and the good ole Recurring Major Depression Moderate to Severe with Psychotic Features.  The psychotherapists have diagnosed me with MDD, Generalized Anxiety or Dysthymia-Severe.

     

    Why all the different diagnoses?  Because I've gone to different psychiatrists and therapists since 2005.  I've gone due to loss of work, gain of work, loss of money, gain of money, loss of insurance, gain of insurance and agencies that have closed, merged, or newly opened.

     

    Each pdoc has asked the envitable question, when I've reported having been diagnosed with Bipolar... "Do you believe that you have Bipolar Disorder?" 

    I have turned to them and asked, in reply "Why, what do you believe I have?".. for them to look at me and ask, in their reply "It's not so important what we believe you have as it is to what YOU believe you have.  Do you believe you have Bipolar Disorder?"

     

    Wait till you have a psychotherapist argue with a psychiatrist's diagnosis and tell you that the pdocs are insane and by no means do you have Bipolar and how the docs ever came up with that, is ludicrious because she - in her time with me - NEVER saw Bipolar I...

     

    you know, the "fly off the building cause you think you are wonder woman" or " having multiple sex partners" or "running through $1000s of dollars in 2 days... or completely off one's rocker....

     

    so, unless you have clear Bipolar I - to her - you didn't have Bipolar... no such thing as Bipolar II or lower, she noted.  She has been a psychotherapist for over 25 years, she notes and now has a doctorate in clinical social work.

     

    I no longer go to psychiatrists; mainly because I have no insurance, no money, do not qualify for government health coverage at this time and work full time.  Oh, and well... they can't decide what's wrong with me but ALL want me jacked up on anywhere from 3-5 different meds... 1 always being a anti-depressant.

     

    ALL pdocs and therapists have assured me that I do not have Borderline Personality.  Anti-social?  Yes.  Borderline?  No.

     

    • John McManamy
      Health Guide
      Jan. 17, 2013

      Hey, Tabby. I am trying to imagine an oncologist asking, "Do you believe you have cancer?" On the other hand, that's what it comes down to - at a critical period in my life I knew in my bones I had bipolar. You have to have this kind of realization to do something about your condition, but this is hardly a ringing endorsement for diagnostic psychiatry. Oy!

    • Donna-1
      Jan. 17, 2013

      I understand why MDs who have a specialty in psychiatry try to make mental illness into a list of symptoms, diagnoses, treatments, and prognoses.  That's how they were taught.  What I don't understand is why the patitent's subjective experience is left out of the equation when they are sitting in the doctor's office.  My psychiatrist...

      RHMLucky777

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      I understand why MDs who have a specialty in psychiatry try to make mental illness into a list of symptoms, diagnoses, treatments, and prognoses.  That's how they were taught.  What I don't understand is why the patitent's subjective experience is left out of the equation when they are sitting in the doctor's office.  My psychiatrist says he is a med-manager, not a psychologist or therapist or counselor.  He doesn't want to hear whether mania influences my daily activities and decisions.  He doesn't want to know whether delusions make me view everyone as a possible arch enemy.  He prescribes more medication if my paranoia tells me my medication is poison.  Sometimes it seems they really don't get it.  There is a disconnect betseen me and my pdoc when it comes to what's going on and what I would like done about it.

  • Donna-1
    Jan. 14, 2013

    In 1995, my life was really spinning out of control.   I couldn't sleep, I was considering killing my husband, I was anxious, I was doing weird things.  Like sewing all night, night after night.  My mind was going in circles, faster and faster.  The first psychiatrist I saw was in a university setting and she was into getting grants...

    RHMLucky777

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    In 1995, my life was really spinning out of control.   I couldn't sleep, I was considering killing my husband, I was anxious, I was doing weird things.  Like sewing all night, night after night.  My mind was going in circles, faster and faster.  The first psychiatrist I saw was in a university setting and she was into getting grants and doing studies in a laboratory.  She was just the only psychiatrist I could get into that day...and it had to be that day.  I only had to give her a few details and she said, "You are bipolar and need medication."  I had never heard the term bipolar and had no idea what I was getting into with the medication.  It was Trilafon, which is actually an antipsychotic.  My face was paralyzed the next day. so she sent me to a psycholgist with a clinical practice.  He decided to give me one mood stabilizer after another (you name it, I took it) as well as be my therapist.  He hospitalized me several times because the meds did not help in any way.  I attempted suicide.  I filed for divorce.  My house went into foreclosure.  My job was hanging in the balance.  I had to drive about 30 miles each way to work and the medications made me so sleepy I was afraid of driving into a pylon or another car every time I got on the freeway.  I attempted suicide twice more.  He sent me to an inpatient ward for 19 ECT treatments, which also did absolutely no good, and I got a bill for over $30,000.

     

    I switched psychiatrists for more of the same.

     

    I switched psychiatrists again after I lost my job and moved in with my parents.  He in turn diagnosed me with unipolar depression and schizophrenia.  Then schizoaffective disorder.  Then back to schizophrenia.  None of the antidepressants or antipsychotics worked for a long time, and finally Zyprexa put me in la-la land so that I wasn't freaking out all the time.  Plus 3 antidepressants.  Plus a benzo.  I was heavily sedated.  To my doctor, this approximated "recovery."

     

    After gaining almost 100 lbs quickly on Zyprexa, I begged to try other antipsychotics.  Many.  A couple sent me into orbit.  It was mania all over again.  I told him, "I was manic after taking an antidepressant way back in 1975.  I became manic again 17 yrs later for unknown reasons.  Another 17 years and here I am manic again on these antipsychotics and antiddepressants."  His reply?  "You never told me you were manic."  I had told him multiple times.  I had written it out in a memo to him twice, detailing my care to date.  This had to be in my file.  It just wasn't in his brain, and he didn't have time to glance through my file I guess.  Now, I am manic about 2 days every other month.

     

    And what am I taking?  An antipsychotic (Zyprexa again), Wellbutrin, Trazodone, Zoloft, and Klonopin.  Am I stable?  I don't know how to express what is happening.  It's like I am 20 different moods every day, -- mainly depressed and irritable and anxious.  If I complain to this doctor, he merely increases the dose of Zyprexa.  The more it is increased (I used to take 40mg and am now taking 10, but am moving upwards) the more confused I am, the more out of touch with reality, the more dissociation I experience, and the more I sleep.

     

    All this to say -- SOMETHING IS NOT RIGHT.  It hasn't been right for a long time.  Yes, there are stable periods, as many who are bipolar experience.  But these are interspersed between mania and severe depression and the usual malaise and lack of motivation.

     

    I feel I need to have my brain sucked out and sanitized and somehow refurbished.  I'm not sure it is really my brain anymore.  I think it is a soup of misbegotten dopamine and serotonin and who knows what else all mixed up together.  Plus this daily dose of chemicals I swallow.  I have often wondered if I would have managed better if I had just lived with what was wrong instead of what the medications continue to do.  Or is it the medications?  Perhaps it is the illness and medications are not solving the problem.

    • John McManamy
      Health Guide
      Jan. 17, 2013

      Hey, Donna. "I feel I need to have my brain sucked out and sanitized and somehow refurbished." Wow! I hear you!

  • Anonymous
    Wabbits
    Jan. 14, 2013

    Why don't they just be simpler and have the drug companies admit that a great number of people are allergic to SSRI's.  That's really more or less what it is.  SOme individuals' neurotransmitter soup will reequilibrate with only intervention with the serotonin balance.  Other brains that exhibit outward symptoms of similar nature for whatever...

    RHMLucky777

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    Why don't they just be simpler and have the drug companies admit that a great number of people are allergic to SSRI's.  That's really more or less what it is.  SOme individuals' neurotransmitter soup will reequilibrate with only intervention with the serotonin balance.  Other brains that exhibit outward symptoms of similar nature for whatever reason need to have more than one neurotransmitter system assisted.  I really am not convinced that it's a separate diagnosis but that it's a question of tolerance to medication. . . . Just wondering what your viewpoint on that is.

     

    • John McManamy
      Health Guide
      Jan. 17, 2013

      Hey, Wabbit. Your observations are spot on. Until we learn more about the brain, we won't be able to explain why antidepressants work in some people some of the time and not work in a lot of people a lot of the time. A lot of what I write totally endorses where you come from. But for this piece, I am validating what a lot of others (myself included) have observed...

      RHMLucky777

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      Hey, Wabbit. Your observations are spot on. Until we learn more about the brain, we won't be able to explain why antidepressants work in some people some of the time and not work in a lot of people a lot of the time. A lot of what I write totally endorses where you come from. But for this piece, I am validating what a lot of others (myself included) have observed through personal experience - namely that if one reacts badly to an antidepressant we need to be considering bipolar as a diagnosis. Maybe bipolar isn't the diagnosis, but we need to at least consider it and rule it out. Way too many docs indiscriminantly prescribe antidepressants. We need to get a lot smarter about this. All ideas are on the table. Please keep posting.

    • Anonymous
      Wabbits
      Jan. 17, 2013

      Well, John, you are absolutely right -- to get any benefit from the system, we do have to make use of the current paradigm which works by looking at behaviors and experiences and trying to infer a "diagnosis" which then is supposedly indicative of which type of medication we are to be put on . . . and then the experiments, some more dastardly than anyone who...

      RHMLucky777

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      Well, John, you are absolutely right -- to get any benefit from the system, we do have to make use of the current paradigm which works by looking at behaviors and experiences and trying to infer a "diagnosis" which then is supposedly indicative of which type of medication we are to be put on . . . and then the experiments, some more dastardly than anyone who had never been in the system would imagine.  It is strikingly like the state of astronomy as long as they were working with a model that put the earth at the center of the solar system.  The excuse they give is  -- well, every individual handles the medications differently . . . Hmmmm, how about just accepting that the table of symptoms/experiences/behaviors that we have drawn up to correspond to a table of "diagnoses" that then determines a class of drug, supposedly having more or less identified the biochemical mechanism without doing any biochemical measurement or analysis, simply is not a very accurate paradigm for determining what is biochemically going on, certainly not enough that we should be prescribing medications that do in fact, act on that balance.  Folks, we do not need the culture, bound judgments on behavior that pdocs typically give . . . we need some real science, some empirical evidence of biochemical states before we start treating with mechanisms that we know alter those states.  In fact, we might start by admitting that this presupposes a biochemical "balance" or "equilibrium" that no one has het bothered to biochemically describe, at least as far as I know.  Folks, we are in desperate need of a paradigm shift.  The fact that psychiatry operates as it currently does is why a good proportion of the population continues to regard it as quackery. . . I prefer the more sophisticated view of greedy oligopolist collusion between drug companies and the AMA. . . Pardon my blatant political views. . .

    • Anonymous
      Wabbits
      Jan. 17, 2013

      Well, you are absolutely right -- to get any benefit from the system, we do have to make use of the current paradigm which works by looking at behaviors and experiences and trying to infer a "diagnosis" which then is supposedly indicative of which type of medication we are to be put on . . . and then the experiments, some more dastardly than anyone who had...

      RHMLucky777

      Read More

      Well, you are absolutely right -- to get any benefit from the system, we do have to make use of the current paradigm which works by looking at behaviors and experiences and trying to infer a "diagnosis" which then is supposedly indicative of which type of medication we are to be put on . . . and then the experiments, some more dastardly than anyone who had never been in the system would imagine.  It is strikingly like the state of astronomy as long as they were working with a model that put the earth at the center of the solar system.  The excuse they give is  -- well, every individual handles the medications differently . . . Hmmmm, how about just accepting that the table of symptoms/experiences/behaviors that we have drawn up to correspond to a table of "diagnoses" that then determines a class of drug, supposedly having more or less identified the biochemical mechanism without doing any biochemical measurement or analysis, simply is not a very accurate paradigm for determining what is biochemically going on, certainly not enough that we should be prescribing medications that do in fact, act on that balance.  Folks, we do not need the culture, bound judgments on behavior that pdocs typically give . . . we need some real science, some empirical evidence of biochemical states before we start treating with mechanisms that we know alter those states.  In fact, we might start by admitting that this presupposes a biochemical "balance" or "equilibrium" that no one has yet bothered to biochemically describe, at least as far as I know.  Folks, we are in desperate need of a paradigm shift.  The fact that psychiatry operates as it currently does is why a good proportion of the population continues to regard it as quackery. . . I prefer the more sophisticated view of greedy oligopolist collusion between drug companies and the AMA. . . Pardon my blatant political views. . .