Posted by: Rob | 2010-05-30

Possible misdiagnosis

Dear Prof,

I realise what I''m about to get into will sound like a text book scenario - but please see it from my perspective..

I attended a workshop that Sadag had on Saturday, and a few patients shared their stories. Frankly, I don''t fit into the mould. I also studied psychopathology and I don''t fit into the DSM criteria either.

I do however understand that they have to write some sort of ICD 10 code on their accounts for the medical aid to pay. But I am concerned about the implications that this will have for me.

That aside, it got me thinking. In all the time that i was undiagnosed, I felt better compared to how I feel now (on meds). My doc thinks I''m being manic when I suggest new, innovative ways of going about my life - but - that''s who I am - if I may say so I am a creative type, and my work is high quality... the people that spoke on Saturday also suggest wacky ways of doing things, but then don''t do them. So they seem to be busy, but are unproductive. I however, am productive. Yes, the subjective experience of something like thoughts racing does come - but only lasts for as long as I am busy with a project. And yes, i might sleep less for a few days, but again, it gets the job done. Depression also comes and goes, but again, unlike those people on Saturday - I can still get out of bed and function, and it rarely lasts for more than a few days. I get very absorbed with what I''m doing.

I''ve been hospatilised, yes, but that was because my life had collapsed around me, (and this has not improved) - but I noticed that there existed, for me, a thought loop that kept me in depression. I reasoned that if I can break this loop, then it wont happen anymore. So now, with my " new"  thought patterns, I am not depressed, not suicidal, and perfectly capable of carrying on with my life.

I''m just wondering, is it possible for these meds to precipitate psychiatric symptoms? Sort of like a magnifying glass does.. alternatively, is it possible that I am a borderline case? subclinical most of the time, until I am actively engaged in something.

Just a note: I''m not suggesting that people should just abandon their meds, some people clearly need them. I''m just concerned that my quality of life is being adversely affected - and surely that isn''t the idea?

I am also not going to seek a second opinion. I believe that my doctor is brilliant, and I''m not in the habit of doctor-hopping. I would rather go to her and discuss things..

Thank you prof


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Our expert says:
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As long as you maintain a healthy scepticism about labelling, etc., the use of a required code on billing shouldn't affect you, should it ?
The trouble with manic episodes is that, at least in the early stages, it can be rather enjoyable, and the person may be understandably reluctant to seek or take treatment.
But though, again, in the early stages, it might enhance at least one's energy if not necessarily creativity as such, this soon passes to a stage where you may be entranced by the brilliance of your ideas, which appear silly or incoherent to others - we lose our quality of judgement and self-criticism. One may be more productive, but not necessarily in a way that anyone else values.
I have known some brilliant bipolar folks, like the late superb comedian Spike Milligan. In his normal state, and mildly high, he was one of the funniest people alive. As he got higher, his humour became more twisted and less funny, and eventually nobody enjoyed it at all, finally including even him. And of course his depressions were awful for him.
Its a matter of proportion. Sleep a bit less for a few days - fine. Sleep very little for several days, and the impact on your ability to think and function fruitfully can be major, and again, not necessarily noticed by you.
Sometimes, antidepressants can over-shoot in treating depression, and precipitate a manic episode ; the reverse doesn't seem to occur.
And you may well be fortunate enough, as your description suggests, to have milder mood swings, perhaps sub-clinical and not enough to be the major handicaps they can be for others.
And I'm pleased you have found a doc who feels brilliant and who is someone you can talk things over with - that's worth a lot !

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Our users say:
Posted by: Been there | 2010-05-30

Curious - what have you been diagnosed with...manic depression? Racing thoughts, productivity, creativity, salad words - the meds slightly below midline for now...Been there, done that - I loved being manic and I always thought I was on top of things. But then you sound ok....

Listen to your doc and CS.

Reply to Been there

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