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How long to get the right DX?


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They say it takes this or that amount of time in the system for us to get the right DX.

How long did it take you?

I"m looking for an estimate so when I go looking in the "literature" on the subject I know more or less which of those authors is full of BS and which one to look at closer.

----loon--------

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I'm hoping my story is atypical.

1) Was 1st dx'd as depressed when I was 14. Had been depressed as far back as I could remember; in fact my pediatrician wanted to refer me to a pdoc when I was about 6, but my parents refused. Got the dx when I insisted on seeing a pdoc when I was 14.

2) By the time I was in my early 20s, I was dx'd with refractory depression.

3) The first time BPII was mentioned was around 1991. But then I got into an open drug study of Effexor, I responded well to Effexor for a few years, so the BPII theory was never pursued.

4) My current doc feels that I am somewhere in the BP spectrum, most likely BPII. This makes more sense to me than anything else thus far. I think I am finally on the road to getting the correct dx. At age 51.

Looking back, I can see there were definite signs of BP from an early age. So, from the time my pediatrician first sensed I was depressed at age 6 till now = 45 years?

I very much hope this is the exception!

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I've been told it takes BPs, on average, seven years from the time of their first contact with the mental health system to obtain the correct diagnosis.

For me, I'm not sure of the precise number. I was diagnosed with depression by a GP at a walk-in clinic at some point in my early teens, likely heavily influenced by my strong family history of depression. I also had a therapist -- not a pdoc or GP -- when I was suicidal at the end of elementary school who was convinced my depression resulted from repressed memories of sexual abuse, even working with my parents to come up with a complete theory of who and when. I know my parents meant well, but fuck them and the hack they hired. I see nothing to support the theory.

In adulthood, I first sought treatment for not sleeping and feeling like my brain was about to spin out of my head last spring. I was then tentatively diagnosed as bipolar, then misdiagnosed as only having a labile temperament with a dab of dysthymia, then strongly suspected of bipolar by a string of medical and therapeutic professionals without the qualifications to diagnose, then finally diagnosed with bipolar affective disorder in March of 2005.

I'm now collecting diagnoses. ADD, Asperger's.... I don't know what will stick and what will fall away, but the BP part seems certain.

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This may seem like a silly question, but how does anyone know when they've been correctly diagnosed? If you've been given "wrong diagnoses" for years and get diagnosed as BP, how many more years on medications does it take to determine that this is your real diagnosis? How does anyone ever know?

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I'm far more stable on lithium than I've ever been before.  I consider bipolar to be the appropriate diagnosis.  I'm not overly concerned with the arbitrarily-assigned degree.  The assorted difficulties presently defined as "bipolar disorder" are under control.  This is good.

I still have a crapload of other problems besides bipolar, some of which may merit their own discrete diagnoses, but I'm not sure of that yet.  I'm just trying to fix things before they derail my life (which, at present, is crudely defined as wrecking my academic career -- for the first time in my life, I'm truly glad to be studying what I'm studying).  If I need more meds, then I'll take more meds, but I'd like to get a handle on things with as few drugs as possible.  Step A:  get a decently paying job which doesn't drive me crazy.  I'm still working on that.

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At the age of 25 I entered an outpatient hospital program because of extreme anxiety, sadness and dysfunctional behaviour. My first diagnosis was "situational deppression", with a recommendation that I get out of the situation and then I'd presumably be okay. No one thought to ask how I consistently landed in such a mess. Some Paxil was prescribed to help things along. About four months later, people tell me that my happiness seems out of range and I also recognize that I am making some stupid non-sensical decisions. I stopped Paxil cold turkey (without, I migth say, any discernable ill effects, being high on life and widly out of touch with anything but my maniacal hopes and dreams). No pdocs or tdocs in that town ever heard from me again.

Since my mom had Bipolar, by the time the next depression hit (by this time I had moved accross the country) I kind of could recognize some similarities between us, as could my husband.  I take books out of the library to learn more about it; it soon becomes obvious that I am BP. Nevertheless I promply start deniyng it. And feeling better.

So, another move accross the country. Another depression. A family doctor who prescribed ADs, seeral different ones, none of which I could tolerate for more than a few days...they somehow felt dangerous. I developped panic disorder (and PSTD); got benzos, plumeted into mother of all depressions. Was commited for suicidality; self-consciously filled in all questionaries to deny and hide any signs of mania (how stupid, I know. I remembered my mom, didn't want to ne like her, didn't want those awful meds). Get out, get a pdoc.

Now this is the best, most kind and respectful doc I have ever seen. I trust him. I am finally honest. He says BP is a strong possibility. I insist I have depression and ask for ADs. He says they may cause mania; we agree to watch for it. He gives me the famous "Zoloft BP Test". Five days later I am manic as hell, not to mention in the emergency room with Serotonin Syndrome.

So, he and three more consulting doctors agree that I have clear-cut BP, hereditary (both my son and mother have it). This time I accept it, but I knew it all along... I am 29. It took four years from first contact with mental health professionals.

Yeah I know, long story. But the point I am trying to make is that there's more to it than pdoc's ability or inability to diagnose. I read and hear everywhere that BP seldom seek help when not depressed, therefore no one sees those manias unless theyre psychotic rather than delusional and the person is somehow caugth. That they tend to be non-compliant, resist treatment, doubt diagnoses. That may be why it takes such a long time in most cases.

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Heya,

11 yo things went wacky.

12yo sent to counseling, no results.

17yo sent to counseling, no results.

20yo self-referred for counseling, CBT tried, no results.

25yo started med school self-dx'd MDD, tried SSRis, no help.

Finally, 32yo, dx'd BP NOS, lamictal started, doing so much better.

Hope this helps.

--ncc--

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I'm hoping the situation is improving, for example that more docs are becoming aware of the entire spectrum of BP disorder and more of the subtleties involved. I believe in my case, so many years went by because at that time it was black or white. If you didn't show blatant signs of full-blown mania, well then you were unipolar. That was it, nothing more to say.

At least I'm hoping things have improved. I may be wrong, but I'd hate to think that it's still taking say, 45 years (as in my case) or 20+ years (as in ncc1701's case) to get a correct dx. (And in both these cases it sure seems we were really trying, both self-referring to docs, neither one in denial or non-compliant.)

PS - Just a thought, but perhaps the difference in the length of time to get the correct dx for ncc1701 and me reflects the changes occurring in the med profession. I believe we probably each found the correct dx around the same time. So the fact that it took longer for me reflects that I am about 20 years older. (I hope this makes sense.) Again, hoping this indicates a real shift in how docs are thinking nowadays.

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Heya,

You know, revlow has a point.

I know that *now,* if I see a kid with anxiety, poor sleep, behaviour changes, and they have a family history of depression, bipolar, etc, I refer them for assessment.

Do not pass GO, etc.

One kid I suspected of BP turned out (by child psych) dx'd with BP, treated, and is doing well.

Few years back, even 9-10 years back when my FP was in training, we had no bloody clue.

20 years, or 45 years ago, there was *no* education or recognition of mood disorders in kids.

And, my aunt, who is roughly 60ish, was dx'd with schizophrenia in her 20s which was more likely BP.

So yeah, I think *when* you showed up with symptoms affects when you get dx'd.

Hmm.

--ncc--

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One kid I suspected of BP turned out (by child psych) dx'd with BP, treated, and is doing well.

<{POST_SNAPBACK}>

God, that is so wonderful! I truly hope this is getting to be more and more the case, that docs are becoming better educated and better able to recognize the symptoms.
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Heya,

Yah I hope so.

This kid, and another one I saw whose older sister (12yo) had been dx'd BP and treated, both are doing well.

(threadjack)

I think a big part of it is raising what us docs call our "index of suspicion," i.e., how hard we're *looking* for mood disorders.

You and I, revlow, would have immeasureably benefited from this.

A pediatrician that taught us called depression "the great imitator" in kids.  It can look like anything, and it's of paramount importance to rule it out.

Some kids who have supposed ADD actually have mood disorders.

And vice versa.

Anyways.

(end threadjack)

Easier now to get a dx.  But not perfect.  And be wary of the "disorder du jour," the thing everyone is supposed to have, when you actually may have something else.

--ncc--

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I first began having depressive symptoms at age 11 or 12.  Instead of being treated for them, I began to self-medicate with alcohol.  I continued to do that into my early 20s.  Finally, I had a depressive episode so severe, I couldn't work, eat, or sleep.  My husband made me go to a pdoc, and they prescribed the newly on the market Prozac.  My go round with meds had just begun.

From then, until I turned 37, I was on a constant go round of different SSRIs, and continued to drink to manage the horrible anxiety and mixed state feelings I had when I wasn't feeling depressed (of course I didn't TELL them that). I was a mess.

It all ground to a screeching halt when I got sober at the age of 37.  I was hospitalized mutiple times after that, with suicidal ideations, and someone put me on Lexapro.  I had a full blown manic episode, and someone finally suggested that I had bipolar II.

What a relief.

I was put on seroquel and topamax and I felt normal for the first time in my life.  It was like a revelation.

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Though we think I've had symptoms since I was 11, I was hesitantly diagnosed by a GP and officially diagnosed a few days after seeing my first pdoc.

Is it the correct diagnosis?  It makes sense to me, so as long as the treatment works, I don't even care.

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