Friday, September 21, 2012

You Don't Seem Bipolar To Me

For years I had been under the assumption that I was suffering from serious depression.

When I was discharged from hospital, I was placed under the care of an elderly psychiatrist who was very old fashioned. I later learned that the drugs he prescribed for me were also old – medications that had been used in the 70s and 80s, which had horrible side effects. When he began to spend our appointments talking about his failing marriage, I bailed.

I’ve now learned that, unlike cardiac surgeons or neurologists who are all top flight, psychiatrists can differ radically in their competency.

I used light therapy, exercise, meditation, whatever I could to fight my depression, which seemed to cycle seasonally.

Finally, it got so bad that I went to the drop-in clinic. I didn’t have a family doctor (there is a shortage here), so had been seeing one of the doctors at the clinic for a few years. He was a nice guy, but would breeze into the examination room, do a quick check, then give me a prescription and leave.

This time, he took a bit more care. He listened to my concerns, then rather than try to prescribe an antidepressant gave me a referral to the rapid access psychiatric clinic in our town. I appreciated that.

“These people are excellent, and will give you a good evaluation.”

Bipolar disorder tends to get worse the longer it goes untreated. I didn’t know this at the time, and was very worried that my depressive cycles were getting longer and deeper.

When my assessment came back and diagnosed me as bipolar, I was shocked. My wife wasn’t.

“I knew it. I kept telling you that you were.”

She had. Several of my friends had assumed I was, too…and were surprised when I told them that I was just depressed. I should have listened to them earlier.

The assessment included instructions for the clinic doctor, including starting me on Lamotragine, and then adding Lithium.

I went back to see the doctor, who has known me for maybe a total of half an hour over the last five years.

He looked at the report and clucked.

“I think this is wrong. You don’t seem bipolar to me.”

I looked at him, sort of amazed at his logic and apparent ability to diagnose based on five years of brief interactions.

“My wife thinks I am.”

“Really…well, that’s interesting, but doesn’t change my opinion.”

I was really starting to wonder about him, so I asked “…then why did you send me for an assessment, if you were going to ignore it if it didn’t fit your expectations?”

He went a little red.

“Look,” I said, “a specialist has assessed me. My wife and friends think the assessment makes sense. You don’t know me, and haven’t assessed me. I am desperate. Can we please just follow the instructions?”

He frowned. “I will prescribe the Lamotragine, but not the Lithium. It’s far too dangerous.”

I started on the Lamotragine. I went back to the psychiatric group clinic. The doctors there prescribed the Lithium for me, and were puzzled why a General Practitioner would adhere to the myth of the dangers of Lithium.

Soon after, a new family doctor moved into my neighbourhood. She is fantastic – the best doctor I’ve ever known. I feel incredibly lucky. She isn’t scared of Lithium. She will contact a psychiatrist when she needs to. She sends me for regular tests to monitor my Lithium levels and heart and kidney function. I feel like I am in very good hands.

As I’ve said before, if you can help it, never let a GP prescribe a psychotropic medication before first consulting with a psychiatrist. Get a regular family doctor if you can. Finally, if you and your psychiatrist are not a good fit, do what you can to get a different one. Getting access to a psychiatric clinic is a good start – even if you don’t like the doctor that assesses you, you will be able to see multiple psychiatrists.

In my case, a good family doctor and access to good psychiatrists saved my life. (see my post on PRNs).

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