The San Jose Mercury News has a fantastic news feature out- “Misdiagnosed Bipolar: One girl’s struggle through psych wards before Stanford doctors make bold diagnosis and treatment.” It relays the experience of a middle-schooler (Tessa) who developed a series of violent and bizarre symptoms- not over a long period of time like many mental disorders, but within a couple of days. Several successive psychiatrists diagnosed Tessa as bipolar, although two Stanford doctors (Jennifer Frankovich and Kiki Chang) believed her symptoms matched a new and poorly-understood condition- Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). Her brain wasn’t out of balance- it was under attack from its own immune system.
Misdiagnosis is all too common. In juveniles there is an ongoing war between psych professionals as to what bipolar disorder even is in that context. For the DSM-V standards, a controversial new disorder, Disruptive Mood Dysregulation Disorder (PDF), has been added. It will help better explain the huge spike in children diagnosed as bipolar, but don’t meet all the criteria. Or maybe DMDD doesn’t exist. Depends on who you ask.
A fear I have had is that when I switch to a new psychiatrist, they won’t understand my unique case and diagnosis. My current psychiatrist has a decade of data on my mood, symptoms, and reaction to medication- but that doesn’t all carry over to another person. That’s why I went to the Stanford Bipolar Disorders Clinic some time ago, and got a full intake with one of their experts. In short, that person agreed completely- I fit the criteria for bipolar II disorder, my mood swings are seasonal and rarely linked to stress or other aggravating factors. Together, there is a solid dossier of important information of who I am, and what the last nine years have been like for me.
A major issue some with bipolar symptoms have when they walk into a clinic and meet a doctor they’ve never seen before. Unless they’re actively in a manic or hypomanic episode, they may be diagnosed with major depression, and be given anti-depressants. This is a numbers game- more people have depression than bipolar. Looking at official numbers, it’s about 3:1 if you include chronic minor depression. However, anti-depressants are the worst thing one could prescribe for a bipolar. I have personal experience on this issue.
In 2012 I had a long period of chronic fatigue and depression- it was decided that a jolt of antidepressants for a short period could help break that.
And it did! Oh boy it did.
The situation was more complicated, however. Part of the reason I was so tired was that I had some untreated infection that eventually cleared. My body was getting more active and energetic on its own. The medication just shot my mood into the stratosphere. It wasn’t a typical manic episode (as type II I shouldn’t get those), but it was more intense than any episode before. This was my last major crisis; chain of medication aggravating the situation.
It’s terrifying to develop strange symptoms suddenly. Anyone who has had it happen in their family or among their friends knows the sense of anxiety and fear. That’s the nature of mental illness; it can happen to anyone, and each case is unique. Medication that works well for most may be worthless. Rare side-effects can crop up, even for people who had never had adverse reactions to medication before.
As with PANS, there may be other considerations that we don’t even know at this point. It’s 2014, science has made gigantic steps in the past decade, let alone the past century. Yet many neurologists think PANS is bullshit, and research on it is in its infancy. If Jennifer Frankovich and Kiki Chang are correct, then many families may get their children, wives, husbands, siblings back from the darkness. Still others are waiting for a diagnosis and a treatment.