Read Part 1
A very successful friend of mine recently said – "I need to come see you. I’m depressed half the time, and I’m having panic attacks." Other than the pressure of a successful business, he has no reason to be depressed. He’s tried a variety of treatments before and still occasionally takes medication.
In all likelihood, he has a form of mood disorder called bipolar. In practical terms it means common treatments like antidepressants or stimulants for ADHD given without first being on a "mood stabilizer" would cause more problems than they would solve.
According to Dr. Fred Goodwin (arguably the leading authority on bipolar disorder in the world), Dr. Emil Kraeplin more than a hundred years ago had a better understanding of bipolar disorder than the criteria in DSM IV. Dr. Goodwin believes that highly recurrent episodes of depression – especially disproportionate to life stressors – is closer genetically to bipolar disorder and responds better to mood stabilizers than to antidepressants.
Mood stabilizers are medications that help both depression and symptoms of mania (euphoric grandiosity or agitation/irritability), or at least mood stabilizers help depression or mania without making the other worse. The name bipolar refers to the two extremes, up and down; but the cyclicity component is equally or more important. Hence, Goodwin believes the old term manic depression illness is more accurate and useful.
What does this mean for my friend? His life would probably be a lot better on a mood stabilizer, but given his history, he’s unlikely to take action any time soon. When he’s feeling good – he’s hopeful that down days are over, so he doesn’t really need help. On the other hand, when he’s down, he barely has the drive and capacity to get through the essentials of the day – he doesn’t have the energy to call and make an appointment and then to go in for an evaluation. It’s "Catch 22" all over again.
Some sad facts about bipolar disorder:
National Depressive and Manic Depressive Association (500 & 600 people) in 1990 and again in 2000 show that the medical establishment is making very, very slow progress.
Bipolar patients misdiagnosed as unipolar depression:
1990 – 73%
2000 – 69%
Bipolar patients whose diagnosis was delayed by 10 years or more:
1990 – 41%
2000 – 39%
Why are we doing such a poor job? The system is broken. We need a complete shift in paradigm. Patients and doctors need to take the controls back from insurance companies.
