The Bipolar Trend




Psychiatry and Psychology CategoryIt’s a funny thing, being diagnosed with a mental disease. As I’ve mentioned in prior posts, instead of a scientific tests, most mental illness diagnoses are made after you’ve talked to someone, answered specific questions, even completed a questionnaire. I know that someday diagnosing conditions such as depression or bipolar disorder will be more exact, more like the process used to diagnose heart conditions. But for now, we make do with what we have.

The question that always comes to my mind is:

How certain is it that I have this or that?

Burn my ShadowLet me illustrate this with a pretty “funny” situation that happened a few years ago. I visited a mental health facility for the first time and was seen by someone we’ll call Wanda. She was not a doctor; she was working towards some certificate or degree and was being “mentored” by a psychiatrist at the facility. Well, after talking to me she gave me a brand new diagnosis, one that had never even been suggested to me before. It was a type of low-level bipolar disorder and she prescribed medicine to treat it. Turns out I didn’t feel comfortable with this diagnosis and didn’t continue with her suggested treatment plan.

I became friends with two people who worked at my company and had been seen by Wanda within the same time frame. (Since we all lived in the same part of town and had the same insurance company, this wasn’t too odd.) What was odd about it was that after talking we realized that all three of us had been given the exact same diagnosis. And, stranger yet, none of us believed in the diagnosis so we all three stayed away from the medication and promptly either found someone else to see or found other ways of coping with the anxiety/depression/mood swings.

So, when I encountered Michael Day’s BMJ article, Drug industry is partly to blame for over diagnosis of bipolar disorder, researchers claim, I had to read it. According to researchers from Brown University, many drug companies that make medications that treat bipolar disorder are heavily marketing to doctors. According to lead researcher, Mark Zimmerman:

You cannot go to a meeting on bipolar disorder that doesn’t have a big discussion right at the start about how under diagnosed this illness is and how doctors need to ensure that patients are treated.

Therefore, many people, especially young people, are being diagnosed as being bipolar when they are in fact, not. He notes that along with marketing to doctors, advertising directly to the patients (through TV commercials and such) is probably associated with this problem as well. Zimmerman is concerned because bipolar treatment side effects can be serious. On the other hand, Ken Johnson, from Pharmaceutical Research and Manufactures of America, is worried more about under diagnosing the disorder than over diagnosing it.

In the end I believe this raises the tired question of how interconnected drug companies and doctors should be. I don’t have the answer but from an outsider’s point of view it seems like a very convoluted conflict of interest. And at the end of the day, after all, the decision needs to be based on what’s good for the patient. Because it’s really not funny to get a wrong diagnosis.

Reference

Day, M. (2008). Drug industry is partly to blame for overdiagnosis of bipolar disorder, researchers claim. BMJ, 336(7653), 1092-1093. DOI: 10.1136/bmj.39577.442650.DB

  • Liz

    I’m noticing something that goes hand in hand with the subject of this article: bi polar disorder being blamed for a person’s lack of self control. “It’s not my fault, I’m bi-polar, I can’t help myself.” I struggled for years before accepting my chronic depression diagnosis and I try really hard not to let it interfere with work or family, but I’m seeing so many people just act out and misbehave and then claim “Oh, I’m bi-polar”. Drives me crazy.

  • Anonymous

    Liz,

    Because you are absolutely spot on! You are correct and they all are making excuses for their behavior or lack there of.

    I have to say, it’s good to see that we are not alone in this understanding.

    This is the world we are now living in…
    Where good is evil, and evil is being called good.

    Since the bonding of psychology and physical medicine, (prescribing and sucking up to each other) somewhere in the late 70’s, both started to support each other by increasing drugs to the mainstream public.

    Who of course trusted their doctors since they were ignorant, unfortunately believing in the lies, of the theory of psychology.

    • Psychology IS a theory, and not a fact.
    • One thing that is sure.
    • God’s word is true.
    • And if people would look to Him.
    • And crawl out of their self centered holes they have dug themselves into, they wouldn’t want to be medicated.

    PsychologyDebunked.com — This website is a great source for what is going on in that arena, and what God has to say about it.

    — Written by someone who was once in the profession.

  • Knows More Than Your Someone

    Dear Anonymous:

    People like you really piss me off.

    It is true that there are a few people out there that like to act out to get attention and it is true that bipolar disorder is over diagnosed. However, it is also true that conditions such as manic depression, major depression and schizophrenia are real medical conditions just like heart disease and cancer. Just because it attacks the brain does not mean that a person can “think their way out of it” or “crawl out of their self centered holes”.

    Being self centered does not cause audio or visual hallucinations. It does not cause blackouts, delusions of grandeur, pressured speech, altered states or any of the other super fun things that come with having a mental illness.

    People who willingly take psych meds without a serious mental disorder and without doing basic research are idiots. These drugs can permanently change the physical structure of your brain and can do serious damage to your body. Common side effects are physical addiction, obesity, diabetes, lethargy, depression, mania, hallucinations, decrease in libido, memory problems and intestinal issues. Does this sound like something self centered people would take? Do your research.

    Whether you believe in a god or not, we were not put on a perfect planet nor were we created stupid. We are here to help one another. Telling people with mental disorders to go off medication and put their faith in god is lunacy. That’s like playing Russian roulette and praying you won’t get shot. It is far better and more practical to ask your god to aid those that work to help others.

    So bite me.

  • Been There, Doing That

    So bite me.

    Hear, hear!

    Disorders such as Bipolar Disorder and Schizophrenia are now being termed as brain diseases. I’m bipolar, and I can tell you right now this is the last thing I want to be. I suffer from memory loss, confusion, I get my verbal sentences turned around. When I’m depressed I have bodily aches and pains, along with flu-like symptoms. When manic I experience pressured speech, take way too many chances, and have spent myself twice into bankruptcy. The fact that I went undiagnosed for almost forty years has not helped any of these conditions. I have what is termed as “childhood onset,” which presents itself differently than adult onset bipolar disorder in that we tend to be more difficult to treat with a tendency to rapid-cycle. In fact, I, along with my twenty-four year old son, experience what is known as ultradian rapid-cycling.

    Combine that with what researches term colloquially a “noisy brain,” with its never-ending soundtrack of music and thoughts intertwined at a wild pace, and you can see why this has nothing to do with anybody’s perception of God. We literally live in confusion, with a mind that won’t stop, and other physical symptoms. Without medication I’d be disabled, as would my son.

    I definitely did not ask nor want this. My son didn’t ask for nor want this. Neither of us use our illness as an excuse for wrong behavior. It may be a reason but it’s not an excuse. If I’ve done something wrong while off my rocker I own up to it.

    Oh, and the website with all of the “information” as suggested by Anonymous? It appears to be nothing more than a site designed to promote the sales of a book, by exaggeration and glorifying the pain of others. Shame on them.

    What’s more, Anonymous, Karma has a strange way of biting you in the ass when you least expect it. By passing on judgment to those with mental illness you have opened the door to be judged, and often the Divine has a way of slapping you in the face with it. It could be that not too far down the road a loved one of yours will be diagnosed with a severe mental illness. My advice to you is to pray to your God a lot, then back off out of a topic that you have very little knowledge of.

  • http://wellbeingandhealth.net/ Evan

    I think a well trained person is likely to give a better diagnosis than a quiz. For a philosophical defense of this position see Dreyfus and Dreyfus’s What Computers Can’t Do and What Computers Still Can’t Do.

    The influence of drug companies on diagnosis I regard as scandalous.

  • http://chaosmotor.com Chaos Motor

    See, here’s the thing, kind of a flip of what Liz said, I -do- have manic depression, but refuse treatment or medication (anything done for-profit is not for your benefit but the person who is profiting), and will not blame my behavior on my condition because that eschews essential responsibility. You can’t use your limitations as a crutch or an excuse.

  • enyatwo

    We all have some disease or disorder whether it be ADD, LD, Depression, etc. Medication is powerful and so are we. I could take pills to decrease depression and pain I feel from “life,” but life is not pain-free. I could also take a pill to help my attention/concentration but am first trying to create strategies to help me with such issues — just as I have strategies to ease some “bummed out” days I may have.

  • http://psychcentral.com/blog/ Sandra Kiume

    Hi – you asked me to comment on your post, so here goes:

    1. Don’t believe everything you read.

    2. The BMJ “article” was actually a news item based on a real article in Journal of Clinical Psychiatry. If you’re going to criticize a study, please go to the source rather than provide commentary about commentary. Have you heard of the telephone game?

    3. Scientologists love to tell people that every type of mental disorder is overdiagnosed and non-existent, just disease mongering by Big Pharma. It’s part of their disinformation strategy. See http://www.youtube.com/watch?v=I8sDa84AJ7c which refers to their “Antipsychiatry Media Index” and gloating over the number of newspapers they manipulated into reporting that antidepressants don’t work. Other, antipsychiatry groups and leftist media disseminate Scientology messages without realizing it.

    4. The BMJ news item did feature two quotes I think are very important; one from a mental health charity rep (not a drug company) who said, “…failing to identify the condition can have extremely damaging consequences.” That’s very true. There is a lot of literature about the under-diagnosis and under-treatment of bipolar disorder, that goes way back. Data based on people who are unquestionably bipolar tells us that on average it takes nearly a decade to be correctly diagnosed. Talk to nearly anyone who is bipolar and they’ll tell you (anecdotal) stories about the chaos in their lives before getting appropriate help.

    5. It’s a straw man argument. The problem is not really that something is under or over-diagnosed statistically, the issue is one of correct diagnosis (I refer you also to autism arguments), and it really is a big deal with bipolar disorder because the medications for unipolar depression are different and using the wrong drugs can make things far worse.

    6. This kind of thing makes me weary.

    I’m glad you shared your story because certainly there are people misdiagnosed as bipolar who aren’t, and it’s important to recognize that. But, the opposite tendency is and always has been worse, IMHO.

  • http://healthfitnessvitamin.com Scott Becker

    Almost every time that I visit my therapist there is some salesman from a drug company sitting in the waiting room with me also waiting to see the therapist. Many times instead of writing me a prescription the therapist gives me enough med samples to get me through to my next appointment – actually they seem to have drawers of them, not to mention stationary and pens with the drug companies name on them. Drugs are a really big business and unfortunately the most important thing to them is not people, but the almighty dollar – kind of like the oil companies. I’m sure that this leads to plenty of over diagnosis.

    So my question is how are we going to stop the process – I can’t boycott the drug company. I don’t have bipolar depression, I have unipolar depression, but I am doing very well on my meds.

  • Bottlerocket

    Will psychiatry ever learn? Psychiatry and psychology are very real disciplines—each with a large and detailed literature. When the APA published the DSM-III in 1980, the issue was one of diagnostic reliability. This was basically a measurement or diagnosis issue. Psychiatry has drifted away from the spirit of DSM-III. Go to any psychiatry conference, and you’ll be hard pressed to find much about diagnosis or diagnostic reliability. The bipolar diagnosis problem would be much easier if the diagnostic criteria and a measurement system–either diagnostic interview schedules or psychometric tests–were developed before we launched into treatment.

  • A Fighter

    Hey, I had discovered that I have bipolar disorder at the worse time ever. My final exams start after tomorrow and my family doesn’t know anything about it. I had depression episodes before, but I didn’t suspect it would be DEPRESSION (I refused to believe it was) so I ignored it back then, only weeks before now I started my own research to figure out what was wrong with me, and here I end up, sure that I have the bipolar disorder, now when I look back I see all of the symptoms of depression. I’m really in a bad condition now. I don’t know what to do. I can’t tell my parents, I don’t think they’ll understand. I have to get over this depression for at least now. I must pass this semester. I need help. An advice would be great.

  • http://psychcentral.com/blog/ Sandra Kiume

    Hi Fighter – I’ll offer a bit of advice since nobody else has replied. Your campus most likely has a mental health centre, you could get in touch and make an appointment with a counsellor. If you’re worried that depression will impact your grades you can speak to your profs and with documentation from the mental health centre or a doctor they will often give allowances on exams, or grant an extension on assignments.

    It’s really important to speak to a professional though. Those online quizzes and so on are good to give you an idea of what your illness may be but as you can tell from this post it’s not easy to diagnose bipolar disorder and it takes an experienced psychiatrist. Sometimes more than one; second opinions are good.

    As for your parents, it is often hard for people to understand mental illness but a counsellor can help you approach them, and also recommend some books and other info you could give your parents to educate them. There’s also something called family-focussed therapy that helps the whole family help you and each other cope.

    Best of luck, and try to keep in mind that many people do recover and manage their bipolar disorder, and you can too.

    P.S. Avoid drugs and alcohol, at least for now. It’ll make things worse.

  • Roja

    A Fighter, you may just have what my daughter has – cyberchondria. It’s like hypochondria but reinforced by self research on the internet. Anyone and everyone can publish on the internet whether it be true or not – no one to challenge all the misconceptions, etc. I would suggest seeking professional help, first from your campus mental health services – not the professors. They can refer you to real help. You may just be anxious over the exams, peer pressure, stress from grades, etc,

  • a fighter

    Thank you Sandra and Roja for the replays.
    I’m a school student at my senior year , I’m not sure if I should talk to my family about it yet because my condition is very confusing. Sometime I have suicidal thoughts then just hours after that I feel happy, as if I moved on from my depression forever. (BTW my suicidal thoughts are more tilted to bleeding to death than just killing).
    Right now I’m fine, but still scared of the next depression episode. I know that I don’t have control over my self during these episodes but I can’t find any one to trust not to mess it up. (I really don’t want to hurt my self or anyone else unconsciously).

  • http://www.youmeandapollo.com JD Stottlemire

    I saw a website in California the other day that said, “A Diagnosis is not a Destiny.” I really liked that.

    JD Stottlemire, author,
    “You Me and Apollo: Hope Beyond Bipolar Disorder”
    http://www.youmeandapollo.com

  • Clay Smith

    Since Mark Zimmerman was the physician who originally diagnosed me with Bipolar disorder, does that mean I honest-to-goodness have it?

  • megalomani

    The only two drugs that are mood stabilizers used to treat biopolar depression (lithium & valproic acid) are both generic so drug companies are not pushing these. The assertion that drug companies are convincing doctors to diagnose bipolar disorder so they can sell more drugs is simply false… for this disease. While there are some other drugs that are still protected by patents that may be used for bipolar disorder, they are all second line therapies and have other approved primary indications. Drug companies do cross ethical boundaries by marketing all sorts of drugs, but don’t target people with mental disorders as a way to criticize the money greedy Pharma dogs. Mental disorders have been stigmatized and misunderstood as long as time. Progress has been slow in having these disease recognized as legitimate medical problems. Taking that away is equivalent to trading evolution for creation.

  • PsychFugue

    There is certainly a trend in being diagnosed bi-polar. Hollywood underlies that trend as so many so-called “stars” are afflicted by it. Therefore it’s chique to have it.

    However, bi-polar illness can only be accurately diagnosed if historical evidence indicates mood shifts lasting periods of six months to two years reoccur with regularity. Even that, I question.

    Anything else is just plain moodiness and erratic behavior, which we all have. :-)

    But the again I question mental “disorders”… period. What has become labeled as “disorders” are simply temporary states of distressing symptoms caused by changes in the brain’s chemistry due to an individual’s inability to adequately cope with environmental stressors.

    It really isn’t “rocket science.” LOL

  • jerickloo

    I believe there are so many depressed people in our society because they aren’t happy with themselves. There are so many outside pressures — including the ones we let in through the media etc., that we are bombarded with how we should act, feel , work, play and so on. Come on people — forget the status quo!

  • Been There, done that again

    Psychfugue rambled:

    There is certainly a trend in being diagnosed bi-polar. Hollywood underlies that trend as so many so-called “stars” are afflicted by it. Therefore it’s chique to have it.

    So, my having bipolar disorder is fashionable? Imagine that! Wonder if it comes with a purse and shoes to match!

    However, bi-polar illness can only be accurately diagnosed if historical evidence indicates mood shifts lasting periods of six months to two years reoccur with regularity. Even that, I question.

    Facinating. Would you mind showing me solid research that indicates Bipolar Disorder doesn’t exist? Obviously, you’re well-informed and trained enough to draw such conclusions.

    Anything else is just plain moodiness and erratic behavior, which we all have.

    I’ll be sure and pass that on to the manic guy wearing a hospital gown and directing traffic at a busy intersection.

    But the again I question mental “disorders”… period. What has become labeled as “disorders” are simply temporary states of distressing symptoms caused by changes in the brain’s chemistry due to an individual’s inability to adequately cope with environmental stressors.

    Man, I wish I’d known that before I spent ten years going from doctor to doctor in search of why I was either spending money like it was going out of style or sitting in my recliner all day, staring at the ceiling because I was too depressed to move. Just think of all the money I could have saved!

    It really isn’t “rocket science.” LOL

    No, but apparently it’s your science – at least one you made up in your head. No, wait… that would be a mental disorder, and according to you there isn’t such a thing!

    Now, all sarcasm aside, here’s is what irritates me the most about posts such as this:

    People who have either never had a loved one or experienced themselves debilitating results of having a mental illness, along with the side affects of medication, just seriously need to back out of a subject that they have no clue about. Go away. Honestly, your so-called knowledge of mental illness is something we don’t need. It’s difficult enough to gain acceptance socially without nonsense such as this going around.

    Am I angry? You betcha I am. Unlike a lot of individuals with bipolar disorder, I’ve “come out of the closet” with it. I refuse to let society intimidate me any more than, say, someone with diabetes. Enough is enough. On the other hand my son (now 25) keeps his illness completely under wraps. My cousin won’t even carry pills in her purse for fear that they will rattle and people hearing it will think she’s “crazy.” My son’s best friend is afraid if his boss finds out he will lose his job. Given that I lost two jobs when my employers found out just reinforces that concept. Sure, it’s illegal to fire someone based on an illness, but believe me when I tell you that if an employer wants to get rid of you, they’ll find a legal way to do it.

    We get enough b.s. from society without having posts such as these contributing even more problems. I wouldn’t call this way of thinking rocket science. It’s more like Monopoly when you’ve rolled doubles one time too many: Please leave us alone. Do not pass Go or collect $200.

  • http://wylfwt.com RJ45

    Yeah, why should people who have went undiagnosed get diagnosed, treated, and feel better when you could just continue to feel miserable. After all, its all in our heads and bi-polar is the new normal according to these people.

    The reason why there is a rising trend is because medicine has advanced since the days of leeches and bleeding people, so we are catching it easier.

    Seriously, shut the fuck up. Anyone who says that bi-polar is all marketing, well… you’re either bi-polar and in denial or you’re just a hateful ignorant pudz.

  • http://physiology-physics.blogspot.com/2007/08/lithium-lightweight-champion.html Amiya Sarkar

    Its really sad that we need to resort to DSM criteria for psychiatric diagnoses; biochemical & other investigational ones which are devoid of subjective biases are not available. But Lithium is a rather safe drug, been there for decades; though it has a low therapeutic index. It is quite cheap too, thus I don’t see any reason for marketting malpraxis in this. I admit, my economic/marketing knowledge is rather poor.

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  • chris

    i think that medicating for a reason other than a real case of bipolar disorder is really bad. it just make sit so that doctors can get some change in there pocket

  • Anonymous

    People get depressed because life is depressing: your parents die, your friends die, you die, and your children die. Mania may be a protective homeostatic reaction against depression to return a person to a productive state. BP is probably underdiagnosed since it is likely a natural state for a human being living in a world that is complex in several distinct ways (family and local society, larger society, the non-human environment). It may only be worth treating to those that want an everyday routine until they die. However there are several types of bp, some include psychosis.
    Those diagnosed with bp that have psychotic episodes may have a stronger reason to use drug treatment. Because psychosis is much more disruptive than spending sprees and maxing out credit cards, taking risks such as multiple sexual partners, gambling on high risk ventures, losing social attachements through depression or radical change in behaviour not related to psychosis.

    To the Blog writer, salutations on questioning the veracity of the Wanda diagnosis; but how does a non-doctor perscribe medicine? This is problematic. My understanding is that pharma has a restrictive relationship with health providers in that only doctors are allowed to prescribe their products. ALso salutations on meeting and talking with other people who saw Wanda. A rule that is good to follow is if it isn’t broken don’t fix it. Mood swings, anxiety, and depression are normal. Maybe the best manner of dealing with these things is the realization that they occur and to stay focused on as stable a presentation of oneself as possible. When you get picked up by the police for acting crazy, find yourself unable to get out of bed for the third morning in a row, unable to hold a job for longer than a couple of weeks, or not able to sleep for a couple of nights, then and only then it may be time to reconsider drug therapy. ;)

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  • http://bipolar-plaza.blogspot.com Deepak

    Bipolar Disorder symptoms do not follow a set patten.Depression does not always follow mania.A person may be in the same mood state for a variable length of time-for weeks or even months or years before experiencing a mood change.The degree of severity of mood change many also differ from person to person.

  • PsychFugue

    Dear “Been there, done that again”

    Sorry to hear you have spent tons of money in the past ten years and seen many doctors in search of relief for your condition. If you haven’t found the help you needed or the cure, what does that say about the illness?

    1) symptoms of mental illness have existed since time began

    2) diagnoses of specific mental disorders have only existed since the advent of the DSM which is a manual that exists to insure 3rd party reimbursement ONLY

    3) I have 16 years of clinical experience in psychiatric care and fully understand how devasting the symptoms may be to individuals, as well as understand how few will ever experience any relief from the mental healthcare system

    4) regarding the question of nature vs nurture, there is no evidence of a biological genesis towards mental illness, therefore it is an illness derived from our environment and any cure will not likely come from medicinal treatment

    5) the likelihood of a positive outcome relies on one’s ability to change perceptions, those cognitive changes may then allow a disruption of the “thinking/feeling” cycle which is pervasive in underlying all symptoms of mental illness, which in turn may reduce the actual chemical and hormonal changes which result from disrupted brain chemistry

    6) I have experienced mental illness myself so I do know intimately how it is from both sides of the fence

    I understand your anger as I’m sure it comes from the frustration of finding no relief from the symptoms that have taken over your life. Your best hope of getting well lies within yourself and I hope you do find it soon.

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  • Personsofinterest

    The current state of pharmaceutical industry, and consequently the psychiatric industry, is crippled by profit.

    Brain Chemistry in relation to the various disorders that are deliniated by the psychiatric industry is in fact a theory. Its never been proven, and you can check this out for starters:
    http://www.ahrp.org/cms/index2.php?option=com_content&do_pdf=1&id=109

    I understand that the bipolar symptoms are very real. This does not mean the pharmaceutical drugs are necessarily the way to go. I believe many of these issues can have a lot to do with adaptive traits and coping, past emotional issues, etc. This needs to be dealt with in a more thoughtful in depth way, rather than just slapping a prescription on it and damaging/diminishing your mental apparatus.

    I understand that the rarer psychiatric cases involving serious episodes and hallucinations need to be treated with what means will prevent a person from harming themselves or others. But it’s a whole other thing to have even severe and crippling emotional problems, and not attempt extensive analysis and talk therapy first before going on a drug. Of course, there aren’t many affordable resources for this kind of thing. They want to sell you the drugs and corner you into feeling they’re the only solution.

    • Bill

      Very good comment. The symptoms are real but the term Bipolar Disorder was created to sell psychiatry drugs.
      No one can show any exam proving a physical problem in the brain.

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J. R. White

J. R. White is a graduate of the University of Texas at Austin. She has over five years of experience in education and pedagogy.
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