Why can’t doctors get it right?
Data from as far back as 2002 tells us that one out of every three patients diagnosed with depression actually suffer from bipolar depression. The problem lies not so much in the misdiagnosis of these patients but in their mistreatment. When patients are treated with the wrong drug at the wrong time the consequences can be catastrophic. When patients who are bipolar are treated with drugs that are intended to be used in unipolar major depressive disorder because they are mistakenly diagnosed they are at significantly increased risk of suicide. Bipolar patients exposed to unipolar drugs often experience treatment emergent mania. This mania is characterized by symptoms which may include increased energy, increased anxiety, euphoria, poor judgment, insomnia, agitation, and thoughts of suicide. In the United States we have not significantly decreased the incidence of suicide in the past decade. There are approximately 60,000 suicides each year. The major risk factors for suicide include overwhelming hopelessness and the energy to commit the act. Therefore when we energize a hopeless patient by accelerating them into treatment emergent mania with the wrong drug at the wrong time it becomes very clear how we are putting our patients at risk.
A significant number of chronic substance abusers suffer form bipolar disorder. Unfortunately these patients largely go undiagnosed and mistreated. the average bipolar patient has symptoms for 10 years before an accurate diagnosis is made and along that journey they have seen on the average of 4 physicians before the proper diagnosis is made. Just today I such a patient. A young man who has suffered with drug addiction for 10 years. He has suffered the loss of his marriage, his job, and legal issues partly because he was mistreated for many of those years. If he had been properly diagnosed and treated for his bipolar disorder perhaps he would have gained control of his life years sooner.
We have an obligation as physicians to train ourselves to better recognize and treat bipolar patients. Given the information above our patients can’t survive if we don’t.