Sunday, May 24, 2009 kt asks

Q: I'm wondering these days if I have been misdiagnosed all along.

I was originally diagnosed with depression over 15 yrs ago. Internist said I was suffering from depression because I did from time to time have issues with anger & irritability. Was put on Serzone but quit after 6mos due to no effect. 4 yrs later was again told I was depressed & put on Prozac. Over the yrs was moved to Effexor, then Lexapro then Cymbalta. The docs kept changing the meds because I consistently was very down with no happiness. The meds never made me feel anything except dull. The biggest thing I noticed with being on medication that it zapped all my motivation & joy. I was always an A type person. Always on top of things, an overachiever, always completing things and of course I expected perfection. Also enjoyed life, felt happiness & of course did over react to things with yelling at times but not on a consistent basis. (had been this way since a child) But since being on meds, that is no longer the case.

Then several yrs ago I was diagnosed as bipolar. I never really experienced excessive highs but definitely have major lows. Still have the anger & irrability that I have had all my life but this seems to be more pronounced since being put on 50mg seroquel @night and 100 of lamictal, also at night. I'm very concerned that all my joy seemed to disappear when AD's started over 15 yrs ago. I've basically been very flat most of the time with low episodes since being put on meds 15 yrs ago.

So, my question is, have I been misdiagnosed all together? Has the medications that I have been prescribed made the lows & lack of motivation occur?

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Answers (4)

John McManamy, Health Guide

5/29/09 12:45am

Hi, KT. You have some very good advice here. Here's my two cents:

You are the best judge of whether or not you have been misdiagnosed. Nobody knows you like you. But you do need to know what questions to ask, so let me propose a few to you:

1. You were angry and irritable, but did this seriously interfere with your life? Did it make you unemployable? Did your career or education get seriously sidetracked? Did you lose friends or find it impossible to make friends. Was it impossible for you enter into or maintain loving relationships?

2. In what circumstances did the anger and irritability occur? If you were in a toxic relationship or dealing with an abusive boss, your reactions may have been perfectly normal. Likewise, if you were under a lot of stress, such as meeting obligations or working your tail off or having to look after a sick family member or dealing with personal loss.

3. How old were you? If you were in your teens, your brain was not fully developed. You would not have had all the circuitry in place to manage your anger. Even if you were an adult - you're now 15 years older and you may have mellowed.

So, here's what I'm driving at: When considering the possibility of misdiagnosis, consider the possibility that you were okay to begin with all along. Certainly, if the anger and irritability weren't interfering with your life, by definition you do not have a mental illness. We tend to get stuck in looking at symptoms, but the key indicator is functionality.

Even if the anger and irritability were interfering with your ability to function - that was 15 years ago. What about now?

In the meantime, it doesn't sound as if the antidepressants are doing you any good.

There is the possibility of a bipolar II diagnosis as someone suggested. But even then, being medicated may not be the right response, especially if the treatment is worse than whatever the illness is doing to you.

These are tough questions, and tough decisions. But again - you know yourself better than anyone else in the world. Too often, we try to urge people to seek help. But this often blinds us to the fact that sometimes it may be best to urge people to stand on their own two feet. You may still need to consider yourself a patient in need of medical treatment, but don't be afraid to look at the other option, either.

LadyBehindTheMask

5/24/09 9:19pm

An internist probably doesn't have enough education to recognize Type II bipolar disorder, which is what I have and what it sounds like you're describing. It's also only been a diagnosis since 1994, which is when you first entered the system, so you were likely to be misdiagnosed at that time ... and most people with bipolar are misdiagnosed for more than 10 years anyway because we don't object to our "Type A" periods. (As one friend says, depression makes us miserable; mania/hypomania makes everyone around us miserable!)

I will say ... My own medical journey did not in involve a "quick fix" at all. If I'd started out with a very good doctor, I probably would have cut off the first three years. But all told it took seven years to get me to a mix that involves very small amounts of five different meds, because I am so sensitive to side effects.

So based on what you're saying: no, I don't think you've been misdiagnosed. I'm not a professional, but it sounds to me like you have Type II bipolar disorder and just don't have the right meds yet.

Make sure you have a really good doctor who works with you. You'll get there.

Virginia W.

5/25/09 9:54am

Hi Lady,

Good points, especially about the bipolar 2 diagnosis. But, an internist is not an intern; usually that refers to an internal medicine doctor. Confusing, huh? I only know this because my brother is an internist, a professor at a medical school with a ton of experience. Still, he is not an expert in psychiatry as he will admit though he deals with lots of the side effects.

LadyBehindTheMask

5/25/09 10:07am

Yeah, my concern really is the difference between an internist and a psychiatrist. I'm seeing way too much bad psychiatry done by GPs who have been convinced by pharma companies that it's just a matter of prescribing. The brain is far too complex and psychiatric medicine is -- at this point -- far too individualized to be handled by internists who lack specialty training.

crog

5/25/09 1:00am

If it helps you somewhat, I was and still am recovering from 'clinically diagnosed longterm agitated depression' due to my then wife, who was the catalyst/cause, the outward symptoms I displayed to mental health professionals were eg, fast speech (which I have always had pre meeting my wife)...this is ME !!! but many other symptoms according to 'them' assessing were a outcome from also 'spousal mental abuse', the domestic kinda violence which is sinister and 'invisible' from those assessing me for bipolar...therefore they didn't fully have all the patient presentation signs that a sufferer would have, I only had a few from stressors...

Only now, years later have I actually been able to obtain copies of my assessments from the treating professionals to read thru to clearly see in readable notes, (some sections were blanked out so I could'nt see other 3rd parties mentioned in the case file notes), but could still 'read between the lines' to understand, this exercise I fully recommend just for your own peace of mind, the terms that are medical you won't understand, suggest you get help from someone who knows the meanings of mental health professionals terms used thru out the case file....happy hunting...wish you luck !!!

Virginia W.

5/25/09 10:03am

Yes, I agree with Lady behind the Mask. There is a ton of evidence that SSRI's like prozac make bipolar disorder, especially the dysphoric mania, much worse. I had this monster licked through five hard, wonderful years of talk therapy until I took an SSRI for--hot flashes! It unhooked something that was holding me together and undid all my hard work. I lost my job, several friends, barely saved my marriage. No one even believed I was ill. They just thought I was the worst person on earth!

And who goes to the doctor to say, I feel way too good? The poet Theodore Roethke did, and the docotr told him, you're just not used to not being depressed. I hope he felt guilty when Roethke committed suicide.

Lamictal made me feel pretty good, but I got the dangerous rash, so had to quit. I recommend being evaluated at the nearest medical school by a psychiatrist.

Q: I'm wondering these days if I have been misdiagnosed all along.

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