Consider the following scenario:
A person visits their doctor or psychiatrist in a state of near-suicide. After probing for other possible causes of the patient’s condition, the psychiatrist diagnoses that their patient with clinical depression and prescribes a standard antidepressant.
The pill works uncommonly fast. Within two or three days the patient’s energy has returned, their dark mood lifts and for one brief moment they know what it’s like to feel normal.
However, their mind is racing. They start making grand plans. Meanwhile, their mind keeps racing. They think this is a side effect that will go away, so they take another pill. After all, the very last thing they want to happen is to crash back into that horrible depression, knowing full well that next time there may be no return.
But their racing mind refuses to stop. Instead, it cranks into an even higher gear. They can’t sleep, their heart is pounding, they’re talking a mile a minute and soon they’re vividly hallucinating. Riding a roller-coaster is inadequate to describe the experience. One is not driving the brain. Rather, the brain is driving the person.
The illness is bipolar disorder, also known as manic depression. Toss an antidepressant at a person with bipolar – with no mood stabilizing medication to hold the antidepressant action at bay – and watch them flip out – totally manic.
For the crisis intervention psychiatrist who saw a person in this condition, it was a no-brainer. “Bipolar mixed,” they wrote on the script with no comment. With those two words, a life is changed. After a lifetime of denial, the patient knew what they were up against. Having identified their adversary, they could begin to fight it, with an excellent chance of winning.
Why hadn’t their first psychiatrist picked it up? Most people with bipolar do not receive a correct diagnosis until their third or fourth try, usually years later. Unless they happen to land in the hospital in the midst of a wildly manic episode, there is not much on which the doctor to go.
The patient was depressed. At the time, they had no knowledge of bipolar in the family (since their diagnosis they’ve discovered it exists on both sides). All they talked about was their depression. All of them – their depression within a depression, their depression following a depression, their depression following the depression on top of the depression, and so on. Their “ups” were what they mistook for normal behavior, so they didn’t feel compelled to bring them to their psychiatrist’s attention.