Bipolar Diagnosis Gives Patients New Lease On Life

Being misdiagnosed with depression when you have bipolar disorder is not unusual. Read this man's story of bipolar misdiagnosis.

When Curt Bohn's latest antidepressant failed to end his 10-year battle with depression, he stole a bottle of cyanide from his office where he worked as a medical engineer. He then went into his garage and made a final videotape, bidding farewell to his wife of 24 years and their two children.

Just in time, Bohn's wife convinced him to see a local psychiatrist in Salt Lake City. The doctor immediately diagnosed a recently identified mood disorder. He yanked Bohn off the antidepressants and put him on mood stabilizers. Bohn responded right away and has been a happy, functioning man ever since.

"I got very lucky," Bohn said. "Life is so much better."

Bohn is one of a few happy stories in a sad history of misdiagnosis of the disorder, bipolar II. Only officially recognized by the psychiatric profession as an illness in 1995, few psychiatrists and even fewer family physicians know how to differentiate it from classic depression. A wrong diagnosis can be deadly, experts say. Prescribing antidepressants like Prozac instead of mood stabilizers like Lithium can actually intensify the depression, and can lead to suicide.

"We're trying to get doctors to ask more detailed questions before they prescribe drugs like Prozac," said Dr. James Phelps, an Oregon-based psychiatrist. Phelps treats patients whose antidepressants have seemingly worked for a short period of time, then abruptly stalled, and others whose antidepressants made them irritable, sleep deprived, or hyper. This adverse reaction is the very subtle second pole of bipolar II disorder, called hypomania.

For those who aren't experts like Phelps, bipolar II's symptoms can be hard to recognize. Unlike bipolar I, formerly known as manic depression, the hyper-energetic happy swings are not so pronounced. In fact, Phelps believes doctors are looking for the wrong symptoms because the word hypomania is a misnomer.

"Hypomania can consist entirely of very unpleasant agitation, irritability or anxiety." Phelps said. Without proper understanding of hypomania, doctors may mistakenly look for periods of excessive happiness in a patient's history, or episodes of "mini-mania." Bipolar II patients very often exhibit no actual mania and therefore go without adequate treatment, including the mood stabilizers that could save their lives.

In a recent study by Harvard Medical School, doctors found that 37 percent of bipolar disorder patients who previously experienced a manic or hypomanic episode had diagnoses of classic depression. The study further concluded that it may take an average of 12 years for bipolar II patients to get the proper diagnosis and treatment, if the patient survives the lag time. According to the DSM-IV, the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, as many as one in five people with bipolar II will commit suicide.

"Since the DSM-IV came out, more bipolar II cases have been recognized," said Dr. Michael First, a DSM expert for the American Psychiatric Association. First says so many bipolar II patients appeared in the '80s and '90s, the illness was formerly added the DSM in 1994. "Bipolar II now has a precise definition to be used uniformly by clinicians who are encouraged to recognize it," said First. But patients who go unrecognized struggle to stay alive.

"General practitioners are to blame for many wrong diagnoses," said Dr. Larry Seivers, a mood disorder expert at Mount Sinai Hospital in New York. Seivers says bipolar patients can even become psychotic while taking antidepressants. "It happens often, and it's really dangerous," said Seivers. "These people can really go off."

Educating doctors before they put antidepressants in the hands of bipolar II patients who might "go off" is what Phelps hopes to accomplish with his educational Web site and a project he's launched with several primary care doctors in Ohio.

The doctors participating in Phelps' study are learning fast. They give a mood disorder questionnaire to every patient before an antidepressant is prescribed. If a patient scores seven or higher on Phelps' test, the patient is suspected of having hypomania and is sent immediately to a psychiatrist for further evaluation. Phelps estimates he and his colleagues diagnose one bipolar II patient a week.

Other doctors are not convinced antidepressants pose any risk. "No antidepressant ever made anyone suicidal," (see editor's note at bottom) said Dr. Jack Hirshowitz, also a Mount Sinai Hospital psychiatrist. Hirshowitz attributes the occurrence of suicide in patients who recently started taking antidepressants to the efficacy of the drugs, and not their potentially negative side effects.

"People feel more energized when the antidepressant starts working, but they are still very depressed," Hirshowitz explains. "They commit suicide because they have the energy to do it."

Energy is something Bohn is on guard for. While taking various antidepressants in the past, Bohn had surges of agitation so invigorating that he impulsively purchased a piano, a special edition Chrysler sports car and he chartered a yacht for his family in the Caribbean.

Today, Bohn is on the mood stabilizer known as Depakote, which appears to be calming the emotional roller coaster. When his wife accidentally sideswiped his Chevy Tahoe into their garage, he didn't feel the uncontrollable fit that used to mark his episodic behavior. "I'm finally on the right meds and I feel normal," Bohn said. "My life is truly normal.

Source: Columbia News Service

Editor's Note: In 2004, the FDA required a "black box warning" on all antidepressants saying: Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in children, adolescents and adults with Major Depressive Disorder (MDD) and other psychiatric disorders.