Misdiagnosing Bipolar Disorder Happens More Than You'd Think

It's no secret that bipolar disorder is often misdiagnosed as unipolar depression. That puts patients in the bind of being half-treated and, as we well know, the consequences can be disastrous. Here's an article on the phenomenon alleging that 35 percent of bipolars are misdiagnosed for a decade and that 60 percent of bipolars are initially misdiagnosed as being depressed. That's a hell of a lot more than I thought, and if the numbers are true, then this is a big problem. It also argues for the American Psychiatric Association to alter some of the treatment guidelines for depression to include advice to docs to pay strict attention to depressed patients for signs of bipolar disorder.

It's of course a weakness of how psychiatry is done and how mental illnesses are diagnosed that's at the root of this. Diagnoses are made by patients self-reporting mood and behavioral symptoms. Quite often, patients will show at a doc's complaining of depression--it is very easy for even the biggest lout to recognize they are depressed--and not say a word about manicky symptoms. Why? Because they don't know any better, because there is far more stigma attached to bipolar disorder than to depression and because the heightened moods that come with the manic side feel damn good, desirable even, to patients with depression. What's more, I bet much of this misdiagnosing results from patients being treated by GPs and internists who just don't have the expertise to tease out bipolar symptoms.

It's true, too, that bipolar is sometimes misdiagnosed as ADD and vice-versa. On the manic side of bipolar disorder, symptomology often mimics ADD.

Here's a real world example. A friend of mine was diagnosed in 2001 as having anxiety. She took the standard meds for that. Nothing worked and she was especially beset by constant insomnia. In 2003, she was re-diagnosed as being bipolar. She took the standard meds for the disorder along with large doses of Seroquel, largely to address her inability to sleep. Treatment for bipolar didn't work very well either, although her doc at the time kept loading her with so much Seroquel (and later Geodon and Abilify) that she could barely function. When she made public that she was bipolar, she lost her job, despite doing everything that the medical system and American society demanded of her. Last fall, she began seeing another psychiatrist, who soon re-diagnosed her as being ADD. That treatment is working for her, which is nice and surely indicative of the diagnosis dilemma. But she lost many thousands of dollars in the process and was entirely chased out of her profession to which she can never return. Lovely.