Bipolar Disorder: How to Get Correctly Diagnosed
The average of seven years to receive accurate diagnosis is unacceptably high.
Posted May 26, 2021 | Reviewed by Gary Drevitch
It often takes many years before a person with bipolar disorder receives the correct diagnosis. People with bipolar type II, in particular, are often misdiagnosed as having pure major depressive disorder. They spend those years taking antidepressants , which, in a person with bipolar disorder, can result in mixed episodes: symptoms of depression and mania combined. They can have an increased risk of suicide, as well as an increased frequency of episodes.
Willa Goodfellow is such a person. An ordained Episcopal priest, author, and lecturer, she suffered for many years from misdiagnosis and incorrect treatments. (Note: She is not my patient, but instead is a writing colleague sharing the same publisher of her non-fiction book Prozac Monologues and my psychological novel The End of Miracles. )
What follows is a conversation with her about why such misdiagnoses are too frequently the rule. We also consider strategies that can improve the speed of receiving the correct diagnosis. These strategies, in Willa’s words, "do not require patients to diagnose themselves." Instead, they empower the patient to be a partner with their doctor and help ensure that the correct diagnosis is made.
A story of misdiagnosis
"Home from a week’s vacation in Costa Rica, I was at the office of my general practitioner to get a prescription for a different medication for my depression. I told the doctor that I had spent my vacation entirely in my hotel room 'maniacally writing.' While my wife went to the beach, explored neighborhoods, and visited my family who lived there, I just wrote. And wrote. And wrote. I wrote so much that I came home with seven chapters of what would become my first book.
"I needed a new prescription because my first prescription for depression, Prozac, had made me irritable. I also could not concentrate, couldn't sleep, and my language was coarse. These symptoms had been taken by the doctor to indicate a deeper depression, and so she had originally increased the dosage. But a new problem, a side effect of diarrhea, pushed me to noncompliance. I quit taking the medication, and went to Costa Rica during the period needed to wash it out of my system before getting a different medication.
"But now, at this appointment, my use of the word 'maniacally' caused my doctor to pause. Antidepressants can cause people with bipolar disorder to 'flip' into mania or hypomania . So she screened me by asking just one question, 'Are you manic?'
"I answered, 'No. I'm not manic, I'm excited!' With that, she gave me the next antidepressant.
"This continued a sorry trail that included three psychiatrists and six failed antidepressants, each leaving me more agitated, more insomniac, and more suicidal than the last. It took five years for me to be correctly diagnosed with bipolar disorder. That, in fact, is actually less time than the average of seven-and-a-half years.“
Why the diagnosis is difficult
How to increase the chance of getting the correct diagnosis
In her book , Prozac Monologues , Willa Goodfellow tells her personal story and shares her road to recovery. She also lists books, articles, and organizations she found most helpful along the way. She is a wonderful example of how people can educate themselves and become full partners in their own treatment.
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Monica Starkman, MD is a professor of psychiatry emerita at the University of Michigan. Her novel The End of Miracles is a suspenseful story about a woman who unravels psychologically after harrowing infertility and a tragic miscarriage, the shocking choices she makes, and the psychiatrists and close ones who try to save her.
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This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.