Bipolar Disorder Often Missed

Diagnosis overlooking manic phase of illness can delay treatment, psychiatrists say

(February 5, 2006) -- Kent Mulkey got a divorce, moved to California and took antidepressants to deal with his depression. Still, he couldn't control his reckless behavior.

"When it all comes down to it, and the jig is up, I'll kill myself," is what he figured. "That was my default. I saw it as my way out."

Fortunately, a solution came 10 years into his mental illness, he said, when his doctor determined he wasn't suffering from depression alone but had a milder form of bipolar disorder, also known as manic-depressive illness.

Mulkey is among the 35 percent of people whose accurate mental health diagnosis is delayed for a decade, and among the 60 percent of adults with bipolar disorder who are misdiagnosed as just being depressed.

Teasing apart symptoms, finding the right medications and dosages to treat them, and getting the patient to comply with the regimen are the fundamental challenges of psychiatry, the medical specialty that focuses on mental illness.

No blood test or high-tech scanning device can prove the existence of a particular mental illness. Instead, doctors rely on a psychiatric diagnostic manual and their own expertise to assess a patient's symptoms, find a diagnosis and choose a treatment.

"That's the problem with psychiatry," said Dr. Charles Schaffer, a Sacramento psychiatrist specializing in bipolar disorder. "Our diagnoses are not as valid or reliable as in other specialties."

Mulkey, now 49, said he was diagnosed with depression in 1994 after deciding to leave a job as a mental health counselor at a psychiatric hospital to start a private practice. He was put on the antidepressant drug Paxil.

"What felt like a step off the curb to anyone else felt to me like stepping off the Grand Canyon," he said. "I was free-falling into severe depression."

Compounding the depression, he said, was restlessness and boredom. "I was acting out sexually and keeping it hidden. I was really spinning. The cycle for me was in order to combat depression, there was the thrill of acting out, which leads to more depression because of the guilt and shame."

Dr. Joseph Sison, a Sacramento psychiatrist who specializes in treatment of mentally ill children, said that in some patients antidepressants increase a patient's agitation, restlessness and explosiveness.

"If that's the case, you probably should relook at the diagnosis, because it may be bipolar disorder," he said.

Dr. Linda Schaffer, a psychiatrist who shares an office with her husband, Charles Schaffer, said she discovered that depressed patients who weren't getting better on antidepressants improved when the drug lithium -- for mood disorders -- was added to the mix.

Although the diagnosis of depression was accurate, she said, doctors were missing the other side of the illness -- the nervous energy, anxiety and irritability. "If you treat that side, they get better," she said.

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Patients, too, neglect to describe those other symptoms when they see their doctors, in part because the manic moods and behaviors can be a welcome respite from the depression.

The stigma of bipolar disease, often perceived as far more serious and chronic than depression, also prevents patients and their doctors from arriving at the appropriate diagnosis, Charles Schaffer said.

"You are more crazy (with bipolar)," he said. "It's more acceptable to be depressed."

Source: MIT Technology Review

Last updated: 2/06

Related Information:

• Just Diagnosed With Bipolar - A Guide
• Symptoms of Bipolar: Mania and Depression
• Early Warning Signs of a Relapse or Oncoming Episode
• Questions to Ask Your Doctor
• How to Manage a Manic Episode
• Bipolar Patients Show Differences in MRI
• Brain Damage From Bipolar Disorder
• Bipolar FAQs - Answers All Your Basic Questions
• What Causes Bipolar Disorder?
• How to Diagnose Bipolar and Similar Conditions
• Bipolar Disorder in Children: How Common Is it?
• Bipolar is a Serious Psychiatric Condition
• APA 2004 Mtg. Report: New Research on Biological Psychiatry and Psychopharmacology
• How To Survive Bipolar Disorder
• Family-Focused Therapy Helps Bipolar Patients Cope

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