Bipolar Could Be Misdiagnosed As Depression


She said she was depressed and anxious.  She was 38, large, and animated, with almost glazed over excited eyes, and talking a mile a minute.

Every person who tells me he or she is depressed gets asked the necessary questions to determine if he or she has manic-depressive illness, otherwise known as bipolar illness. The only way to determine this that I know about is by asking.  Nobody who is depressed and comes in for treatment of same is going to spontaneously volunteer the info I need to make the diagnosis.

So this is, verbatim, the way I ask.

“Have you ever felt the exact opposite of depressed — which I wish meant wildly happy. It does not. It can mean pretty angry and irritable. It means bursts of energy, starting things you can’t finish because you get distracted, doing things you later regret, like sexual indiscretions, or overspending money you don’t have….”

I pretty much go through all the list of DSM IV criteria for a manic episode, but in the most every day no-blame way that I can figure, in the same tone of voice and manner I would use for anybody.  Informal but knowing.

This 38 year old woman who had asked me for an antidepressant (and was not stupid) “forgot” to tell me that in an episode of mania, subsequent to the birth of her last child, she got so angry she not only pretty much stopped sleeping and had wild bursts of energy, but ran after her husband with a knife.

Of course she “forgot.”  Robert Burns, the poet, said something about not remembering the bad times during the good, and vice versa.

It seems that subsequent to a show on Oprah, her next door neighbor had (correctly ) diagnosed her as manic-depressive.Unfortunately, most of the patients who are already diagnosed as simply depressed and who turn out to be bipolar all ask me the same thing.

“Why didn’t my last doctor tell me that?”

My favorite question (NOT!)

SIGH — If only more doctors would just ask that extra question …

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