Misdiagnosing Bipolar Disorder
Earlier this week I wrote a piece about being scared of trying antidepressants and as one commenter pointed out, there are increased risks associated with treating a person with bipolar with antidepressants. In fact, some would say that treating a bipolar person with antidepressants can worsen the course of the illness (always contraindicated as monotherapy and possibly undesirable altogether). Now, when I wrote the article I was only thinking of unipolar depressives, but, as one commenter pointed out, being diagnosed, correctly, with bipolar disorder, in itself, can be a challenge.
And this is absolutely true. Studies have found that it takes 5-10 years (from the time of the first episode) for a person with bipolar disorder to get an accurate diagnosis. There are many reasons for this, predominantly that people don’t get help when they have their first episode, but a major contributing factor is also misdiagnosis. People with bipolar disorder are often diagnosed with depression or schizophrenia first and this can have devastating outcomes.
Misdiagnosis of Bipolar Disorder
According to the study Polarity of the First Episode and Time to Diagnosis of Bipolar I Disorder, many people with bipolar I disorder are mistakenly diagnosed initially, and this leads to between a 2.5 – 5.6 years delay in correct diagnosis. People who first present with mania are much more likely to have correctly been diagnosed but they also are sometimes given a diagnosis of schizophrenia. People presenting with depression first are often diagnosed with unipolar depression and it may take years before the correct bipolar diagnosis is made.
Misdiagnosis of Bipolar Disorder as Schizophrenia
The problem with misdiagnosis is that it affects the way the patient is treated. In the case of being diagnosed with schizophrenia, the first course of treatment would generally be antipsychotics to combat the psychosis. This, though, is not the frontline treatment for bipolar. The first treatment for bipolar disorder is often lithium or an anticonvulsant. (However, antipsychotics are often used in the treatment of bipolar as well.)
Misdiagnosis of Bipolar Disorder as Depression
Unipolar depression, on the other hand, is often a much more harmful misdiagnosis as unipolar (non-bipolar) depression is treated with antidepressants and using an antidepressant alone on a person with bipolar disorder is contraindicated. This is because people with bipolar disorder who are treated with antidepressants alone often are flipped into hypomania or even a life-threatening mania. Often, unfortunately, the biggest clue a doctor has to a patient’s bipolar status is because they react to antidepressants that way. However, at that point, it’s already a little late as medication-induced mania can be harder to treat than the average type of mania.
Why All the Bipolar Disorder Misdiagnoses?
Of course, I don’t have that answer for that but I think there are several reasons.
- Diagnosis done by GPs isn’t done thoroughly and doesn’t show enough regard to the “softer” signs of bipolar disorder
- Non-psychiatrists still fail to recognize the dangers of prescribing antidepressants alone to people with bipolar disorder
- Doctors fail to ask the questions that will trigger the answers that would give them the information necessary to make a correct diagnosis
- Patients fail to appreciate that something they have experienced is actually part of an episode and not “normal” (this is not their fault, just reality)
- Patients aren't honest with their doctors
(And by the way, I was first diagnosed with unipolar depression too. I knew I was bipolar but my doctor didn’t agree. He was wrong.)
My best advice in avoiding any type of medical misdiagnosis is:
- Be completely forthright and honest with your doctor about absolutely everything you are experiencing it. Let him decide if it’s diagnostically relevant; don’t try to do it yourself, that’s not your job.
- Take into account family history. (This is very indicative of current disorder.) This may mean querying family members as mental health history isn’t necessarily something we all share naturally.
- See a psychiatrist for a full diagnostic interview.
These steps can’t guarantee a correct diagnosis but I can tell you that we’re getting better at spotting the signs of bipolar disorder all the time. Unfortunately though, this current knowledge is often only known by specialists (like psychiatrists) so it’s important to have a person like that make a diagnosis whenever bipolar is suspected.
Tracy, N. (2012, June 14). Misdiagnosing Bipolar Disorder, HealthyPlace. Retrieved on 2019, September 16 from https://www.healthyplace.com/blogs/breakingbipolar/2012/06/misdiagnosing-bipolar-disorder
Author: Natasha Tracy
I was finally put on an anti- psychotic, 3 years ago, and now I can control my "cycles." I understand my triggers, mainly excess stress, and my new doctor gave me the tools to pull me out of a cycle, by upping my dosage for a few days and that seems to help. I now understand my "illness," understand that it is genetic and understand what happened to my father 20 years ago, when I was a teenager, and his father, 60 years ago. Unfortunately, both of them were misdiagnosed and since I no longer have contact with my father, and have no idea where he is, I can not help him.
Being misdiagnosed has taken so much of my life away from me. I lost several jobs because of it, the anti-depressants made me worse, to the point where I could not function as a "normal" person. And every time I feel like I have rebuilt my life, another cycle hits, and something else is taken away from me. I refuse to let this "illness" win and I keep starting over again and I will overcome it. Someday, I will "win" and get everything under control...I am too intelligent, creative, good at my job, to let my bipolar ii, win!!!!
I could say many things about your comment, but initially I'll just answer your question, as you asked one.
It's up to you whether you wish to tell your doctor that you're taking medication or not but certainly I wouldn't withhold that information as it could be relevant if you ever need medical attention (such as being in an accident). I can understand your concerns around that but as you haven't suffered any symptoms of a disorder in over a year, I would be honest about that and the fact that you're not taking medication.
As for what you feel is a mistake in your medical records I can tell you that medical records are a nightmare to correct - BUT patients do it. The first step is to obtain your full medical record from the hospital so you can review it. You have a right to your patient record and while it may take them some time to get it to you, I believe they have to by law provide it.
If you do find a mistake, then yes, I would talk to your doctor (or preferably the one you made the mistake, if you can) about correcting it. It is your right to have an accurate record. In this case it might be helpful if another person who can verify the inaccuracy write a statement to that effect.
Part of being an active patient can, for some, mean checking their medical records and correcting inaccuracies, if found, so yes, you can do it, but I can't promise it'll be easy.
- Natasha Tracy
(Not long after that I was hospitalized). In hospital the antidepressants were stopped cold turkey and I was started on antipsychotics, months later a small dose of antidepressants were added, I haven't been back to my private hell since then, yes I still cycle but the intensity of the episodes are manageable, (still a learning process for me). I have done a lot of reading about bipolar and I think there's a lot of bipolar symptoms being misdiagnosed as severe depression, and a some peoples lives put at risk because of it.
GP misdiagnosed me and gave me Effexor. 4 months later I hula-hoed about 3000 square feet of my backyard, even though for the last 20 sf or so, my arms and hands were so numb I finished it up using my armpit to hold the hoe. I gave myself a bad case of carpal tunnel that was finally treated almost 2 years later.
By the time I got a proper diagnosis all the damage was done: broke, divorced and even homeless for a time.
I'm finally on the right meds and therapy and it's made a world of difference. I can't fix everything I ruined, but at least I know the warning signs of hypomania, and I don't get so depressed I want to kill myself when I think about everything that one avoidable episode cost me.
I've heard good things about nurse practitioners and yours is another story where they have spotted things others have missed. Glad to hear you took her advice :)
Thanks. At least it was only four months, but that's another example of a GP doing more harm than good. I wish I could just shake all the GPs by the shoulders and tell them to stop doing this! However, that's more shaking than I can probably manage.
Yes, many people don't even know what a psychiatrist does let alone that they should see one. It is ignorance on that part of the patient - but that is understandable - it's not like you went to med school.
I'm glad you got the proper diagnosis although it's sad it took so long. Hopefully you're finding treatment that's working for you now.
You make a good point. My recommendations for avoiding misdiagnosis pale in comparison to the doctor's job in that situation.
The irony is that when skilled practitioners diagnose someone, their accuracy rate is very high (when compared to other skilled practitioners) which just goes to show you that it can be done, but one some can do it.
It was 2 years later while talking to a psychologist and explaining what was happening that she referred me to a great psychiatrist. What helped me when I finally did go to the psychiatrist was that my psychologist wrote a letter explaining what she was seeing. This helped my psychiatrist interview me. I didn't know what to do or say,or what information was important to give. I wasn't intentionally withholding information, but I was just ignorant. But with the input from my psychologist and my psychiatrist's own good assessment skills, I was finally given the correct diagnosis.
Your points on "why all the misdiagnosis?" and "avoiding misdiagnosis" are so true and very helpful. I wish I knew this information when I first started seeking help.
I don't think there's much as patients we can actively do to avoid misdiagnosis. We are too sick to think about what to say in the interview. It is up to the doctor to create rapport, and structure the interview in such a way as to get the information he or she needs from us.
Improving the doctor's art of the interview is just as important as developing new treatments. Assessment and diagnosis are the crucial first step in high quality treatment - better than prescribing a drug and seeing what happens.