Incorrect diagnosis? Bipolar vs. Severe Atypical Depression…
So, I’m really concerned about someone that is very close to me… She’s been diagnosed as having Severe Atypical Depression and I hate to second guess her shrink, but I think he’s wrong.
A little note:
I won’t mention her name or even an initial. Although I do keep this journal a pretty good secret from most people, I’d hate for someone who knows the two of us to eventually put 2 and 2 together. Not that talking about this sort of thing is bad, but so many people are quick to judge and label this type of thing … I’m just going to keep it as anonymous as possible.
I’m going to describe her from my point of view and share a few insights that she’s given me. I’m going to try and do this in a way that’s very neutral — Not holding back, but not judging her behavior either. It’s going to be a bit difficult as, I’ll admit, I’m very biased.
Since I don’t outline anything I write, and I try not to revise too much, this may come out as a bunch of randomness or a cohesive group of statements. Neither you or I will know ’til I’m done writing it and you’re done reading.
Ok, so I think the Dx is wrong. Since the Dx is wrong, the Rx is (probably) wrong. In the end a bad Dx + a bad Rx probably = a pointless spinning of wheels and a liver thats getting pounded for no reason.
Sometimes she really does fit the Dx of someone that’s severely and chronically depressed. Lets run down her behavior and make sure we agree. She:
- Feels helpless and empty.
- Hypersomnia (Sleeps forever sometimes, Insomnia others).
- Endless self-loathing.
- Unable to feel pleasure — of any kind.
- No energy.
- Suicidal thoughts … and unfortunately intentions.
All those typical indicators … All the obvious things you’d tell your PDoc about, right. Now here’s where the problem starts… Despite having all those indicators she also:
- Becomes extremely irritable.
- Talks on ten levels of tangents.
- Makes lists and gets ultra organized (We’re not talkin’ about your average make a shopping list behavior).
- Doesn’t “Give a shit” — not in the depressed, just don’t care way, but in the aggressive intentional distancing way.
- Things are very black and white — there is no gray area.
While I can see these things as indicators of a manic state, from our conversations I don’t think she’s aware of these things a lot of the time. In not being aware of them (to the extent that a 3rd party like myself or others around her are) I don’t know that she expresses them to her PDoc — which I think may be a common reason for mis-diagnosis of a bipolar patient.
Now, lets add some alcohol. Yeah, she likes to party a bit — as do I. So when we add a few drinks we get all the above behavior — both the depressive and the manic. Usually the cycle goes from a daily/weekly rotation to a washer on the spin cycle. Sometimes she’ll go the whole night in a good place, sometimes it’ll be a bad place — but both sides are elevated 100%.
To make things worse — she gets pretty neurotic … Now, most of us are neurotic to some extent, and for many of us this behavior is magnified when we’re intoxicated so maybe this isn’t an indicator of anything at all, but sometimes I wonder.
“He is incapable of holding an external dialog. Even when he seems to be interacting with someone else – the narcissist is actually engaged in a self-referential discourse. To the narcissist, all other people are cardboard cut-outs, two dimensional animated cartoon characters, or symbols. They exist only in his mind. He is startled when they deviate from the script and prove to be complex and autonomous.”
– Sam Vaknin
Although that quote only describes her when she’s really has too much, it does (from an outside and much more sober point of view) seem like the places she’s coming from. In her defense, I have seen the world from that place once or twice (or 10 times) after having a few too many as well, so again — maybe nothing.
Ok, so … Thats where I’m gonna stop. I’m distracted and having a real hard time writing much more about it — I’m even pondering deleting the last few paragraphs, but since I don’t really want to censor myself I guess it’s gotta stay.
What it all boils down to is that I’m worried about her.
Her current Rx (Effexor, Lamictal and one other med I can’t remember) isn’t working so she’s weening off the Effexor and on to Cymbalta (Quickly moving up to 30mg BID instead of trying 20mg BID to start).
Her suicidal confessions to me the other night.
I just can stand to see my best friend in this state. And I surely can’t stand by just watching and waiting if I think she’s been mis-diagnosed.
I’m guessing if anyone reads this they’ll have an opinion one way or the other — Tell me what you think.
Don’t try and make light of it please — Feel free to be negative about any other post on the site, but not here. If you can’t be constructive, I’ll kindly ask you to shut the fuck up.
Tags:Bipolar, Bipolar indicators, Depression, Mental Health, Wrong DiagnosisPowered by Gregarious (36)
-- Don't just Digg it, REDDIT!
March 26th, 2007 14:12
Hey, it sounds like you know your friend pretty well. It’s good to have friends like that. It seems to me that once she gets up to a therapeutic dose of the Lamictal, it should help the bipolar to start leveling off. If it doesn’t, it might be time to sit down with your friend and express your concerns about the manic side. It sounds like she’s cycling pretty rapidly, and I know from experience that that is very hard. Good luck.
March 26th, 2007 14:40
You are quite right to be concerned–if she IS bi-polar, then the meds (at least the effexor)she is being prescribed are adding to her mood instability, and possibly contributing to worse.(Known side effects for bipolar people with that drug are psychotic episodes, as well as increased mood instability.) If she finally gets desperate to have something succeed, she might try looking into a couple things that are currently considered “fringey”, if not alternative–EFT, or emotional freedom technique, is a therapeutic technique based on the chinese acupuncture system, and has great effect on bipolarity and depression in general. Also, there are a range of different supplements that are more effective than any traditional western meds that I ever tried–Evince vitamins, which are specially formulated for bipolarity and schizophrenia in particular. The theory behind this is that depression and other mental illnesses are symptomatic of systemic vitamin and mineral deficiencies.
Also helpful is the Pain and Stress Center, which sells basic amino acids and the stuff that her body isn’t producing enough of. All of these things should be done under the supervision of her therapist and/or doctor, of course.
Also, she will probably have to make a few lifestyle changes, if she truly wants to be happy, or even pain-free.
I myself was diagnosed as bipolar after twenty years of symptoms when I was 24; spent the next ten years trying everything; this route of both the energy therapy and the vitamin, mineral and amino acid supplements have made a huge difference: I went from episodes as rapid as every twenty minutes, to complete health and stability.
Sorry that I don’t have any websites for you; but you should get the info that you need if you type those resources into google. Good luck.
March 26th, 2007 15:04
The Medication in psychiatry is not that clearly related to the diagnosis at all.You´ll find a lot of different typical or atypical types of whatever diagnosis tryin to be cured with the same type of drugs. These medics are helpful on one hand and harmfull on the other, there you´re right.If you are into the shrinkers business you know that you don´t give a shit on the Diagnosis the other Dx made before… From the things you tell i just get different statements for you: You are very near to your Friend. That´s fine, all the best for her to happen in such a case to have at least one Friend.- that´s your role. you´re not distant enough to help her in a professional way/ Support her to share a normal life and to look for Therapists and Meds she will be compliant with (normal in your personal, social communities way of beeing normal, not in a jane doe way, but with resting times, movement, nutrition) / read about Borderline-Disease for information but don´t tell her in the first place / Visit a Trialogue-Group for Psychosis relatives…
Thank you for helping your Friend, it´s a hard work to do and it´s very good to do it
(even if it shows you´re more powered by mashed potatoes than hate…)
May the road rise to meet you
March 27th, 2007 04:03
What wonderful people to share your positive thoughts. As the afore-mentioned “Capital C”, may I just say the self-monikered “asshole” is my best friend, and I love him deeply, for a reason. I’m doing well on my new meds; so far, so good. It will be a life-long struggle, but I’ll fight the good fight.
Best of karma to you all.
~C
April 5th, 2007 15:01
I appreciate your concern about your friend and I congratulate you for reaching out for help. I have some thoughts for you to consider. First, no matter what Rx’s she’s taking, drinking will nullify their positive effects and maximize the mood swings/depression. You already see this when she drinks, not only while she is buzzed, but in between. Her Doc might not know about her “other symptoms” and her drinking. If she wants the proper help, she needs to be honest with those trying to help her. The Dx may be right given the information that the Doc has. And, not all Docs are sensitive to the drinking issue which may be a bigger issue than you think here.
There’s a strong link between substance abuse and mood disorders. 2/3 of adults who have been in residential treatment centers have what we call a co-occuring mental condition, of which the most frequent is bi-polar followed by depression, anxiety, ADD and others. Your friend’s other emotional symptons - narcissism, black & whote thinking, and ‘doesn’t give a shit” attitude are all classic for alcoholics and addicts. Your friend may be suing alcoho as medication to get relief from the mood swings. To some extent, alcohol works to fix moods and bad days, but not for those who suffer from clinical depression or bi-polar.
To get better, your friend may need to consider how her drinking may totally negate any Rx or other therapy. She needs to be willing to be completely honest with those who help her. If she is clinically depressed or biploar, her drinking may eventually kill her or land her in a mental institution. 2/3 of all successful suicides happen when the individual is drunk or high. The odds of acting upon suicidal thoughts are significantly less with a sober mind. Alcohol is a major depressant. Most people do not know that.
I apprecciate you listening as I have shared some sobering facts with you. I come from a place of caring having been there myself. I too, suffer from atypical depression with bipolar features, ADD and alcoholism. I had to learn to live without alcohol and drugs, to see docs and therapists, be impeccably honest with them and to take meds with significant side effects–all intense challenges by themselves. Now I live a happier life and am even in the business as a Psychotherapist specializing in substance abuse and mood disorders. I have the training and the experience. More importantly however, I’ve been there.
I am very open to discussing your friend’s situation further with you if you would like. I can be reached at kpadach@yahoo.com or phone
720-935-9763. Your friend is very lucky to have you in her life. I know that she can recover from these challenges and live a happy, more normal life. And, she will have to make some significant changes in her life to accomplish that. From my own perspective and those of my clients, the benefits far outway losses. I look forward to hearing from you.
Kevin Padach, MA
Help Along The Way
April 6th, 2007 09:48
Tell your friend and maybe yourself could try some solid exercise–I don’t mean an aerobics class, I mean the type of physical training where you run, do push-ups & sit-ups until you’re about to vommit. I would also recommend joining an underground boxing club that she can take her aggressions out and exhaust every last ounce of energy she may have that day so she is not a threat to you or herself anymore. Do that for 5 days a week for six months and then she will have a much better outlook on life.
May 15th, 2007 11:10
Good for you the loving, learning and caring for your friend. After 10 years depression my diagnosis is bipolar also and it is a mean sob. I’ve been trying to find any and all excuses to make it not so. How much good will that do? It’s fear; fight the good fight when she is too weary……but take care of yourself also.
May 25th, 2007 16:17
Have you brought up the fact that you think she may be bipolar? I would, in a diplomatic way of course. The thing is, the Dx will try several different combonations of drugs until something works, and no one person can say, “no, she needs to be on this”, everyone’s chemical make-up is different and we will all react differently to the drugs. I would try not to worry too much, I’m sure they screened her to rule out bipolar before perscribing her meds. Just being there for her is the best thing that you can do. If you have concerns, bring them to her, discuss them with her, I’m sure she wants to get to the bottom of her problems just as much as you want her to, if not more.
I do have to agree with Kevin though, drinking is probably the worst thing she could be doing to herself right now, and enabling that behavior is the worst thing you could be doing for her. I would suggest helping her to change that routine and start suggesting more nights in for pizza and a movie, etc.
Good luck, but remember, in the end, this is her problem, not yours, support her, be there for her, but don’t let her sickness ruin your life or cause you sleepless nights, if you’re not healthy you can’t be there for her.
June 12th, 2007 09:11
It’s only after you’ve lost everything that you are free to do anything.