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Coming as a surprise to more than a few mental health professionals, a new study out today suggests that bipolar disorder is often missed in patients who present only with major depression. The study examined 5,635 adults seen at community and hospital psychiatry departments in a number of different countries.

The discrepancy was reported because of the use of “bipolarity specifier criteria” that are broader than the DSM-IV criteria, the standard for diagnosis of mental disorders by mental health professionals.

Using the broader bipolar criteria developed by the researchers found an additional 31 percent of patients who could have been diagnosed with bipolar disorder.

So what’s really going on here? Are professionals really “missing” bipolar disorder? Or have the researchers stacked the deck in this study simply to suggest it is so?

Dear Mrs. ——–

You have asked me about the cause of your mood disorder, and whether it is due to a “chemical imbalance”. The only honest answer I can give you is, “I don’t know”—but I’ll try to explain what psychiatrists do and don’t know about the causes of so-called mental illness, and why the term “chemical imbalance” is simplistic and a bit misleading.

By the way, I don’t like the term “mental disorder”, because it makes it seem as if there’s a huge distinction between the mind and the body—and most psychiatrists don’t see it that way. I wrote about this recently, and used the term “brain-mind” to describe the unity of mind and body.1 So, for lack of a better term, I’ll just refer to “psychiatric illnesses.”

Now, this notion of the “chemical imbalance” has been much in the news lately, and a lot of misinformation has been written about it—including by some doctors who ought to know better 2. In the article I referenced, I argued that “…the “chemical imbalance” notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists.”1 Some readers felt I was trying to “re-write history”, and I can understand their reaction—but I stand by my statement.

Last month, Andrew Brown writing for the UK’s Guardian, noted when Professor David Nutt kept referring to depression as a “brain disease” on a popular UK television program.

We commend Andrew Brown for his calling out Professor Nutt in trying to dumb down the portrayal of mental disorders to simply “brain diseases.” Mental disorders remain complex disorders that involve all aspect of a person’s functioning and life — their brain and biology, their psychological makeup and personality, and their social interactions and relationships with others. The cause isn’t just one of these things in the vast majority of people who have a mental illness — the cause is all of these things, in differing proportions.

I’ve written about this in the past and in fact, I tag it as one of the top 10 myths of mental illness — because it still is. Even well-meaning family physicians and psychiatrists still refer to the false chemical imbalance theory as though it were fact. A theory, by the way, that has never enjoyed strong research support.

Take a minute and answer this question: Is anyone really normal today?

I mean, even those who claim they are normal may, in fact, be the most neurotic among us, swimming with a nice pair of scuba fins down the river of Denial. Having my psychiatric file published online and in print for public viewing, I get to hear my share of dirty secrets—weird obsessions, family dysfunction, or disguised addiction—that are kept concealed from everyone but a self-professed neurotic and maybe a shrink.

“Why are there so many disorders today?” Those seven words, or a variation of them, surface a few times a week. And my take on this query is so complex that, to avoid sounding like my grad school professors making an erudite case that fails to communicate anything to average folks like me, I often shrug my shoulders and move on to a conversation about dessert. Now that I can talk about all day.

Here’s the abridged edition of my guess as to why we mark up more pages of the DSM-IV today than, say, a century ago (even though the DSM-IV had yet to be born).

If there is no struggle, there is no progress.
~ Frederick Douglass

Let’s get this out in the open: I am bipolar II. That means the mania is really low-key and infrequent and the depression, at least in my case, for most of my life, has been pretty much nonstop.

There are degrees of depression, of course. Mine gets severe relatively quickly and stays that way a relatively long time. Yes, I have been an inpatient at psychiatric hospitals. Yes, I have self-harmed. Yes, I have been on every psychotropic medication known to man, and failed most of them. The two that I’m on right now combine for one really annoying side effect.

I have even, since about New Year’s, been undergoing a course of electroconvulsive therapy (ECT). My memory is shot, along with many other things, but the suggestion to do it came up in month 6 of an unrelenting depressive episode. Nothing else was working.

Despite all this, I’ve managed to push through as best I can. I’ve found work, and a work schedule, that works for me, as well as a compassionate employer.

For many mental illnesses relapse is part and parcel. Bipolar disorder is one of these. What’s especially unnerving for people is that relapse can seem random, as though you go to bed feeling one way and wake up another, feeling hints of mania or depression.

Why relapse occurs is largely unknown. But we do know certain facts based on research findings, according to Joseph R. Calabrese, M.D., director of the Mood Disorders Program at the Case Western Reserve University School of Medicine, in this excellent article in bp Magazine on relapse:

“Those who are diagnosed with bipolar II are more likely to relapse than those with bipolar I. Their episodes of depression, mania or hypomania are often shorter than the episodes experienced by those with bipolar I but tend to return more often, according to Calabrese. It’s also far more common to relapse into depression than into mania or hypomania. Calabrese estimates that in bipolar II, there is a 40-to-1 ratio of depression to mania; the ratio of depression to mania drops to 3-to-1 in bipolar I.”

Even though relapse may be the rule, you do have some control in shrinking its severity and impact.

The following post is by Hilary Smith, author of “Welcome to the Jungle: Everything You Ever Wanted to Know About Bipolar But Were Too Freaked Out to Ask” (Conari Press, 2010) as well as a cool blog to go with it, Welcome to the Jungle.

We’ve all heard about “mood foods” that can promote wellness for people with bipolar and depression–fish oil for brain health, oatmeal for stable blood sugar, chocolate for, well, chocolateness. But it’s also important to think about how we eat. How we eat can have just as big an impact on our mood as what we eat, yet it often gets neglected in conversations about bipolar and food. Here are some tips for maintaining a healthy mood through mindful eating practices.

Dear readers, I owe you all an apology. I was wrong in my post about Catherine Zeta Jones’s diagnosis of bipolar II to compare bipolar II to Diet Coke. It was flip, inappropriate, and a lame attempt at humor. I hereby admit that I was wrong. So there is no need to further bash me.

I was wrong because it suggests that bipolar II is not as serious, not as painful, not as debilitating as bipolar I. But, as a person diagnosed with bipolar II myself, I certainly know that isn’t the case. I realize that the depressive cycle for someone with bipolar II can actually be more severe than the depressive cycles of folks with bipolar I. And sometimes the depression can be psychotic.

I was there myself, although I’m not sure if it was the illness that made me psychotic or the drug cocktail of about 20 pills that my psychiatrist at the time, who was in bed with big Pharma, prescribed for me.

And I’m very aware that a person with bipolar II can cycle much more rapidly than someone with bipolar I, which makes bipolar II more dangerous in some regards, and definitely more difficult to diagnose.

Although I wouldn’t wish the pain of bipolar disorder on anyone, I am sort of glad to find out another accomplished, beautiful movie star has joined our manic-depressive group. After spending five days in a mental health facility, Catherine Zeta Jones has been diagnosed with bipolar II disorder. I like to call bipolar II the “Diet Coke” of bipolar, if you recall the scene from “Austin Powers” when Dr. Evil says to his son, Scott: “You’re quasi-evil. You’re semi-evil. You’re the margarine of evil. You’re the Diet Coke of evil. Just one calorie, not evil enough.”

That’s how I view bipolar II: one calorie short of bipolar I. Those with bipolar II experience the same symptoms as persons with Bipolar II, just not to the extreme. For example, when I get manic, I don’t hallucinate. I may not even seem manic to a person who doesn’t know me well. I might talk a little faster, have more energy, and, in general, feel much more confident than I would if I were not manic. In fact, my form of “grandiosity” is simply not needing to solicit so many affirmations to feel okay about myself.

The subtle symptoms can make it difficult to tease apart bipolar II from major depression.

“Were you bipolar growing up?” a magazine editor asked me the other day.

“I don’t know,” I said.

“Do you think you were misdiagnosed back then as depressed?”

“I don’t know,” I said.

I wasn’t annoyed. I wasn’t rushed. I just really don’t know.

I can clearly say that something was wrong with me, but I’m very careful to throw the “bipolar” word around when it pertains to kids given all the debate today on the topic.

Friends of mine rant on another friend for medicating their daughter for bipolar disorder, who, according to the friends’ eyes, is perfectly fine.

And then I hear the sadness and utter frustration of another friend whose bipolar daughter was just expelled from school.

I’m pleased to welcome you to Adventures of a Bipolar Mom. Beth is a 30-year-old wife and mother of 4 beautiful children. She was …