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 2020, August 8 from https://www.healthyplace.com/blogs/breakingbipolar/2012/06/misdiagnosing-bipolar-disorder
Author: Natasha Tracy
Great article. I too, was misdiagnosed, but by several psychiatrists, over the course of 8 years. My psychiatrist kept blaming me for not taking my antidepressants and mood stabilizers, when I was taking them, as prescribed every day. I kept getting worse, having panic attacks daily and falling into a deeper depression. I kept overdosing on klonopin, finally ending up being involuntarily committed to a psych ward, where I was finally correctly diagnosed as being bipolar, type 2. Funny thing is, I had spoken to my psychiatrist several times that I thought I was bipolar, after reading articles on the internet about the different types of bipolar disorder. She kept telling me that I wasn't bipolar because I didn't have "manic" stages, which is true...I have periods of time where I am "normal."
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
Doctors don't have any special powers of diagnosng. They learn through books, videos, and on wards. The first two anybody can research as well and for some of us we have that experience as well. If you ask top psychiatrists they will grudgingly admit that psychiatry is the crudest specialty in terms of treatment and knowledge of disorder out of all medical specialties. The fact that some medications show a response doesn't mean they're effective for all people nor do they know the effect on the brain's integrity or long term effects unless it's similar to an older drug. There are conflicting stories and who knows who to believe concerning whether mental illness causes brain damage or drugs cause brain damage. Side effects from the drugs are certainly unwanted brain or body effects and in many older drugs brain damage is inevitable such as tardive dyskenesia. Some peple even psychotics are manageable without hurting others or themselves such as John Nash. Who should say what's in your bes interest when the doctors don't even know what drug A for mental illness will do to you other than knowledge that certain drugs respond at least temporarilly at disrupting the experience of the disorder. Notice I said disrupt. That doesn't imply there was true relief. Even the doctors will say they havent a clue of the mechanism of the drug and wll oftentimes make disease models that bizarelly are related to what a given drug does to the brain. The fact that aspirin ameliorates headaches doesn't doesn't imply that an absence of aspirin in the brain is the cause of headaches. Such twisted logic was used for years in several mental disorders before the doctors admited their mistake. I was involuntarilly evaluated and commited for my grief and sadness over a traumatic effect. I was taking care of myself but was looking for a job but for whatever reason they signed me over. I was not a model patient in the hospital but I did no violence and am not violent by nature. I will not describe in detail because I don't want to be identified but trust me when I say that the doctor took a verified accident at work that happened one year previous to the hospitalisation and said it was a delusion. He didn't tell me that in person but wrote it in my medial file as the primary symptom. To this day my dad and sister agree with me that such an injury occured because they saw the chemical burn to my hands something that healed in terms of cursory visual inspection at the hospital. I wonder if I should ask them to call the original doctor and tell him about his error or will he take revenge or just point to some other "observation" while I was at the hospital. I never had definite symptoms listed other than this delusion that was in error. I have only evr been on one medication which I have not taken for a year. Neither me nor my partner have noticed any symptoms. This makes sense because I've only ever experienced grief which I am over as it was a very traumatic event in life. I will not tell the doctor I am not taking the medication but should I have some probability at sucess if I point out a misunderstaning or mistake on the doctor's behalf?
I to, have traveled the path of misdiagnosis, almost three years in my case, by the time I was correctly diagnosed as bipolar as a sectioned psychiatric hospital patient I had experienced a full range of hypomania and depression symptoms. One psychiatrist wanted to triple the antidepressants I was on, thank God that my GP said no to that.
(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.
Thanks for yet another informative article my friends and family should see.
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.
Please excuse above typos and improper grammatical errors. I was unable to proof my copy prior to publishing it, and it just continuously 'jumped around' on my page as I typed, making editing an impossibility! Is there any way to adjust/fix this issue? I believe in editing/proofing prior to publishing, but I guess the points trying to be made were established in above post. Thanks for any assistance you may lend.
Another excellent article, Natasha. Chock-full of reliable, informative information. Love how you underscore that there is a RESPONSIBILITY placed upon the reporter i.e. client to provide reliable, accurate, timely information to the doctor. And please, folks~! STOP going to docs who are NOT psychiatrists when one HAS a psychiatric illness! One may as well be going to the dentist to fix a broken leg when one chooses to see an internist or general practitioner versus a psychiatrist~! As we know, the docs get 'repped' via the drug reps, who frequently merely hand the docs a bunch of samples to dispense, some literature re: the meds, a quick 'sell-in' of the new med (which is frequently newly with patent, thus a money-maker for the drug companies, drug reps, and many docs who have investments in the drug companies. Is this a viable, reasonable, trustworthy method upon which to then randomly write Rxs to clients, desperately dependent upon the docs to be 'doing the right thing'. This is why I REALLY like what Ms. Monica MacKeachen states: why aren't we utilizing brain scans/neuropsychatiric tools to explore and establish much more confidently psychiatric diagnoses? To not utilize thes tools is clearly remaining in the 'dark ages'. Diagnoses and medication dispensing is far too complex than to merely be reliant upon 'words' and hope that the clinician is asking the 'right questions, coupled with being highly familiar with the DSM-IVcriteria.
You missed the glaring fact that the United States do not have the correct technology to scan the brain. The way I view the disorders of the mind is no different than the disorders of the body in the sense that body illness have tangible TESTS, so why is it considered "normal" and okay to treat the brain with mere words as the only indicator ? Sorry for the run-on sentence. I am in a hurry this afternoon.
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.
I too was misdiagnosed as depression. It wasn't until a nurse practioner at my doctor's office suggested that I see a psychiatrist since I was on the highest dose possible of an antidepressant. She felt I had something else going on. She was right and I am eternally grateful for her observation and advice. I now am properly diagnosed and on a med regimen that is working.
I also was misdiagnosed with depression only. I was given antidepressant and went on to paint the entire inside of my house. It was wild. I actually would swing back and forth from depressed to manic. Because I was still showing signs of depression my GP kept upping my antidepressant. I was lucky because I was on a depression message board and someone suggested that I may be bipolar. I then went to a psychiatrist and was correctly diagnosed. It was like 4 months that I was only on antidepressants.
Wonderful article. Very informative & insightful. I too was misdiagnosed. I didn't know that I should go to a psychiatrist, so I only went to my GP who diagnosed me with depression. I took one anti-depressant and the next day I weeded my entire yard by hand in an hour-there were a lot of weeds. I would do a lot of traveling into third-world countries for 2-3 weeks at a time, and my GP told me to double up on my anti-depressants while traveling. I flipped in and out of hypo-manic episodes all the time. It was wild to say the least!! I'm surprised that I didn't end up in more dangerous situations.
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.
Great article, spot on for me. I did not get help at first. Then I was misdiagnosed with depression, and antidepressants flipped me into a manic psychosis, which was actually diagnosed as psychosis not otherwise specified, probably because I was moved between hospitals and doctors for beaurocratic reasons. I was only diagnosed with bipolar disorder two years later, when hospitalised again with mania.
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.