November 22, 2014

Medina
Cloudy
40°F

Dr. Rakesh Ranjan – Many Faces of Bipolar Disorder: Part 1B

Dr. Ranjan

Dr. Ranjan

Do I Have Bipolar Disorder?

David’s Good Fortune: Lessons to be Learned
After landing in jail for a car accident that killed two friends, David began experiencing an improvement in the symptoms of his Bipolar Disorder for the very first time. He desperately wanted to be released from jail on time, and that meant complying with the rules, which included taking his psychotropic medications. Fortunately, the judge in his case had mandated his psychiatric treatment while serving his sentence. I vividly recall the sight of David arriving at my office for his weekly appointments clad in an orange suit and handcuffs.

After a few weeks of working together, David, his mother, and I were able to find an effective regimen consisting of two mood stabilizers and one stimulant. He was also referred to a therapist so the family and addiction issues could be addressed. With each passing week David felt better and could clearly describe improvements in his symptoms. He slowly but surely began to accept the notion that he suffered from Bipolar Disorder. He complained that he wished he had been diagnosed ‘right’ the first time. He admitted that he was feeling the best he had ever felt, and he marveled that he could feel so calm. After denying that he had Bipolar disorder for solong, David surprised me when he proclaimed, ‘The proof is in the pudding, doc! I guess I do have Bipolar Disorder.’

David was released from jail within a year. He went back home to live with his parents and continued treatment. Both David and his mother would sometimes ask how long he had to keep taking medications. Each time, I explained to them that bipolar disorder was a chronic, recurring condition with no cure and therefore, David should take meds for the long haul. He no longer experienced strong urges to use street drugs and he began to get interested in academics.

One day, about a year and half later, David’s mother stopped by my office. Wearing a big grin and beaming with joy, she told my receptionist that David had just graduated on time from high school. The receptionist called me on the intercom and I came out of my office to talk to David’s mother. She was joyful, ‘Doctor, I never imagined that David, with all his troubles, would ever graduate!’

At his next visit David asked me if it would be a good idea for him to attend college. He was worried that under the stress of college his illness would flare up. I emphatically told David that as long as he remained compliant with his medications, accepting of his illness and cognizant of signs of relapse, he could live a ‘normal’ life and actually accomplish anything he wanted to. He said he always wanted to be a veterinarian as he grew up on a family farm with animals. He decided to shadow a local vet doctor for a year. Due to his hard, high quality work and eagerness to learn, David was recommended to the veterinarian college at Ohio State University in Columbus. His family was ecstatic, hardly believing that David had made something out of himself.

I was very gratified as a psychiatrist but I also knew David was very fortunate in many ways. I knew David’s story was filled with the lessons to be learned by patients, families, mental health professionals and the legal system.

So, what are the lessons?
From my perspective as a psychiatrist who treats a large number of children and adults with bipolar disorder and as a mental health activist who interacts with a large number of families and friends of those affected with bipolar disorder; as well as based on the latest clinical research in bipolar disorder, here are the lessons which would and could be learned:
• Lesson 1: It is not a label, it is an illness. The crippling stigma that neurobiological disorders are associated with is often perpetuated by, of all people, mental health professionals. This unfortunate tendency often makes professionals ‘drag their feet’ on making a decisive diagnosis.
• Lesson 2: The earlier the diagnosis made the better the long-term outcome. This is true not only for symptom control, but also for social, vocational and legal consequences. Just imagine what would have happened to David had he had his car accident when he was 18 or older. The deaths of his friends were tragic enough; but he would be in prison for many years perhaps.
• Lesson 3: Any child who is diagnosed with ADHD should be routinely evaluated for the possibility of bipolar disorder and vice-versa. This is because these two conditions co-exist and have some overlapping symptoms. It is especially crucial since most medications used to treat ADHD can make symptoms of bipolar disorder worse. Therefore if a child has both conditions, bipolar disorder should be treated first.
• Lesson 4: Bipolar disorder is not more severe, serious, or untreatable than major depression. This is a very common misconception among both lay people and mental health professionals; the popular media certainly has contributed to this. And all of this leads to negative reaction from patient and family when a diagnosis of bipolar disorder is made.
• Lesson 5: Bipolar disorder is often underdiagnosed and misdiagnosed. It is common for a patient to have been seen by 3-4 psychiatrists before he/she is correctly diagnosed. I suggest that you read up on bipolar disorder if you or your loved ones are having mood symptoms especially if you have a family history of bipolar disorder or moody behavior.
• Lesson 6: A misdiagnosed case of bipolar disorder can become much worse if he/she receives medications for major depression. This again underscores the importance of receiving the correct diagnosis, accepting the diagnosis of bipolar disorder if that is the case and seeking the correct treatment for your bipolar disorder.

Next Time – Many Faces of Bipolar Disorder: Part 2A: So, I do have bipolar disorder: Now what?