Welcome to Bipolar in Focus, I'm Jane Pauley. Bipolar is a treatable disease but getting the right diagnosis can sometimes take years.
With us now is Dr. Neil Price from Silver Hill Hospital in Connecticut. Typically, how long does it take to get the correct diagnosis?
Well some people despite going for help will never get diagnosed. One out of three people will -- it will take at least 10 years for them to get the right diagnosis.
What's the problem? Why is it so hard?
Because by definition, all of our moods are fluctuating. There is no such thing as a straight line mood day after day. So, the question is how much mood fluctuation means impairment.
How much mood fluctuation requires treatment and for that you have to get enough information to make that diagnosis.
A doctor can only know what is available knowledge in family history and what a patient reports. How much of the diagnosis depends on what the patient tells the doctor?
A lot. A lot of the diagnosis depends on that. The doctor sees the signs.
The signs are what the patient shows during the interview. However, most of the information comes from a report of the symptoms
and that is a subjective report that the patient gives the doctor and that is the overwhelming majority of the data that the doctor is going to get during the interview.
I think remembering different times when they didn't feel like themselves and reporting that would help the physician to make the diagnosis of bipolar depression.
If the only doctor someone is seeing as a primary care physician, how likely is a diagnosis of bipolar?
Unlikely because, it's very time consuming to do a clinical interview that in which we will be able to distinguish between a bipolar depression and a unipolar depression.
And depression is the most common reason why someone would come to see a doctor in the first place.
Not because of mania or hypomania.
Why is bipolar depression so often misdiagnosed as the unipolar depression which is more common?
Well, I think because it's more common, because primary care physicians and psychiatrists are more familiar with unipolar depression.
It is necessary for the psychiatrist to question, any person who's depressed as to whether they have had hypomania in the past or whether they have had manic symptoms in the past.
Or for example whether there is a relative who has had bipolar symptoms in the past. That will give a lot of information.
How can drug use or alcohol use interfere with the diagnosis?
Well when people use certain drugs, those drugs will cause mood swings that may mimic bipolar disorder.
For example the use of cocaine, amphetamines, ecstasy can mimic manic episodes. When someone is using tranquilizers or alcohol,
they can get depressed and that can mimic the depressive component of bipolar disorder.
What is also confusing, even more confusing is that some people who have mood swings bipolar type mood swings will self-medicate those mood swings.
How often does bipolar disorder coexist with substance abuse?
Very often. 40% to 70% of the time, people who have bipolar disorder will be using drugs and/or alcohol.
Dr. Price, thank you and thank you for watching Bipolar in Focus.