I Object

I read an article stating that 20% of teenagers hospitalized for psychiatric symptoms may have bipolar disorder. This was apparently such an exciting story that it was highlighted and featured on hotmail and was an MSN main story.

Early diagnosis of bipolar disorder is certainly important. I would give anything to have some of the time I lost due to improper treatment back. I have been diagnosed for nearly 4 years. In that time we have gone from having 3 medications approved to having something like 10. There are plenty of others known to help that are not yet approved specifically for bipolar disorder. I am grateful for this, as I need the field of available meds to be as large as possible since I am able to tolerate so few of them. However, it has made bipolar more and more "popular". Suddenly everyone knows someone who is bipolar.

Many of those diagnosed with bipolar disorder have what is called "bipolar spectrum disorder". This is not yet the formal DSM description of bipolar disorder, but it probably will be eventually. It allows for many degrees of bipolar disorder, from the moody person who has little impairment of functioning, to patients with repeated psychotic manias. During the year and half before I was diagnosed formally I was treated by a doctor who did not see that I was as sick as I was because I was able to work. I was not able to function at all besides working, but to her that meant I was not bipolar. In reality I am much more at the worse end of the bipolar scale, but I maintain an ability to work. The areas in which I can't function are more social and doing anything not working related.

A majority of those diagnosed with bipolar disorder in the last few years seem to have the softer forms of the illness. These people deserve treatment of course, and it is a great thing that medications are finally available which can treat bipolar symptoms without the horrible side effects of the heavy duty meds. However, having soooo many people diagnosed with this disorder is resulting in a mis-understood illness being even more mis-understood. I've been told things like I should refuse to take certain meds because of the side effects and opt for meds that are easier to handle. If only it worked that way for everyone. But telling me that in regards to things like an antipsychotic (which is the only choice at times) is much like telling me that Prozac alone can cure me.

The reality is that most teens have serious mood swings and many have behaviors consistent with bipolarity. Many teens are quite depressed. I remember it as being the norm. Certainly some teenagers need mood stabilizers. But if teenagers are assessed for signs of mania and depression using measures that don't factor out that teenagers are normally going to appear quite bipolar at times, many will falsely be diagnosed. There are repercussions to this diagnosis and I think a delay as long as possible is wise. The medications used to treat this are not pleasant and often have long term side effects. At 30 years old I have hypertension and have to be screened for diabetes annually. I've gained 50-60 lbs from the meds. At least one medication can impair fertility. Several are unsafe during pregnancy. Many require monitoring to be sure the liver and kidneys are not being harmed. And it's not easy to come off of the meds. It is very hard to convince a doctor that you are not bipolar after you've been diagnosed. We're notorious for being non-compliant with meds anyway, and then if you are doing well and taking meds it's hard to prove that you're not just doing well because of the meds. There is also vast prejudice against those with this illness. Even a trip to the emergency room can result in a fight to prove you are not there for psychiatric reasons, despite ample physical symptoms. Some doctors will not treat bipolar patients. Others treat us as if we are a guaranteed problem, unable to comprehend instructions, report symptoms accurately, or follow through with anything. Despite laws to the contrary it can affect employment; I have a resume to prove it.

When I was first diagnosed and first treated I was very angry that I hadn't been diagnosed earlier. Looking back through my life there were warning signs all along, and officially my first episode would be as a young teenager. However, I believe that not being diagnosed allowed me to achieve so much more. I could not take these medications and complete college or graduate school. I benefitted from being old enough to not buy the limitations that seemed so obvious when I knew what was wrong with me; I had been working for nearly 2 years while my moods and behaviors were uncontrolled, so I knew I could find a way to do it when I felt better. I was able to see that I was not destined to live like a stereotypical bipolar. Had I been told at the age of 14 that I had this illness, that it would affect my life in such and such a way, I would not have tried some things that I am so proud of. I know this for sure because now there are many things I "know" I can't do. Many are realistic, but I know that I choose to limit myself at times out of fear.

I would much rather have been identified as "at risk" (and to be fair I was at times by people who did not follow me long enough to be sure, and probably by those who were afraid I would harm them if they hinted at it because to say THAT WORD invoked great wrath for many years), than to have been diagnosed before there was any doubt.

I also would much rather this be kept a "rare" illness than the illness of the week. I know what it does to me. I know what it does to my patients. That is true bipolar. If everyone suddenly wants to be bipolar then it becomes casual, and that is like saying any potentially fatal, life-changing, non-curable, treatable only with things nobody wants to deal with, illness (say viral pneumonia) is as common as bronchitis. When "everyone" is bipolar in some way, then I have to deal with physicians who have just been through my medical history and medications in great detail with me asking "but WHY did your psychiatrist put you on an antipsychotic?". Answer: "Um, because I'm bipolar and was having symptoms best treated with an antipsychotic?" DUH. (That's a true story).

I want it both ways. I want acceptance, but I don't want commonality. My bipolar is not your depression. My depressions are more than likely nothing like your deepest depression, medicated though that may be. I want bipolar to be more than "moodiness", as it seems to be becoming known. It's so much more. Call it what it is. Diagnose it only when it's real. Treat it carefully. Respect it. Don't make it what every parent suspects.