Last week, in a post highly critical of the DSM-5 (due out in May) I wrote:
Basically, bipolar as we are expected to know it in 2013 (and probably for the next ten years) will remain the bipolar we knew back in 1994. This translates to doctors continuing to misdiagnose bipolar patients with unipolar depression. You’ve been through it, I’ve been through it. We get put on destabilizing antidepressants and tend to get worse.
Trust me, nothing in the DSM-5 addresses this menace.
In a Question of the Week, I asked you to tell me about your experiences having been diagnosed with depression. Your responses should be required reading in every medical school. It’s going to take at least two posts to do justice to your comments. Let’s get started. Tabby sets the scene:
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 two. 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.
Perhaps you see why we need to bring clarity to the DSM. Then again, this is a classic case of psychiatrists not listening, which will make a good topic for another series of posts. Okay, brace yourself. Tabby goes on to report that when she tells psychiatrists about her bipolar, they reply with “Do you believe that you have bipolar disorder?”
I had to close my eyes and hit my head several times to see if I had read that right. To illustrate just how totally bizarre this situation is, just imagine an oncologist asking his or her patient, "Do you believe you have cancer?" Then imagine the patient saying, “No, I think this strange growth the size of an egg is a pimple.” Now imagine the doc sending the patient out the door with a prescription for pimple cream.
If I am reading Tabby correctly, her doctors kept trying to convince her she had depression. After all, according to Tabby, her doctors have never seen her "fly off the building because you think you are Wonder Woman."
This is one of the major myths about bipolar disorder, namely that you have to be floridly manic to qualify for the diagnosis. It’s one thing for the general public to believe this, but doctors or therapists have no excuse. In 1994, the DSM introduced “Bipolar II” with its threshold of “hypomania” (mania lite). Mania lite can be nothing more than an energized state, but doctors still mistakenly believe there has to be a Wonder Woman (or Superman) component to this, only perhaps we don’t fly off of buildings.