A new study published in the Canadian Journal of Psychiatry shows that most people with bipolar disorder suffer with the condition for six years before receiving a correct diagnosis, which can lead to damaging traumatic events that could have been avoided with proper treatment.1
The study reviewed 27 previous studies that collectively included more than 9,400 patients. People who have bipolar disorder and not being treated for it often try to medicate themselves in an effort to “find the middle” between manic highs and depressive lows. This usually leads to disaster.
Often, a person with an addiction and an undiagnosed mental illness such as bipolar disorder will enter a drug and alcohol treatment center where the only focus is detoxifying the patient and encouraging sobriety. Without a diagnosis of the underlying mental illness causing the chemical imbalance, and comprehensive treatment, the patient is destined to fail because symptoms will return regardless of drug and alcohol use.
People with bipolar disorder often feel compelled to medicate intense manic episodes with alcohol, marijuana (although modern strains also can be stimulating) or other depressants. Bouts of depression may lead to use of “uppers,” such as cocaine and methamphetamine.
When depression is an initial symptom, clinicians may believe the patient simply is going through a crisis, possibly exacerbated by a drinking problem.
“While some patients, particularly those who present with psychosis, probably do receive timely treatment, the diagnosis of the early phase of bipolar disorder can be difficult,” Professor Matthew Large, lead researcher and a clinical psychiatrist and professor at UNSW School of Psychiatry in Australia, stated in a news release.2 Often, a person with an addiction and an undiagnosed mental illness such as bipolar disorder will enter a drug and alcohol treatment center where the only focus is detoxifying the patient and encouraging sobriety. Without a diagnosis of the underlying mental illness causing the chemical imbalance, and comprehensive treatment, the patient is destined to fail because symptoms will return regardless of drug and alcohol use.
“This is because mental health clinicians are sometimes unable to distinguish the depressed phase of bipolar disorder from other types of depression,” Large continued. “The diagnosis of bipolar disorder can also be missed because it relies on a detailed life history and corroborative information from carers and family, information that times time and care to gather.”
Be Aware of These Symptoms and Cycles
The researchers found that among more recently published studies, the amount of time that passed between when symptoms first appeared and diagnosis was even longer than six years. Studies that used a systematic method to establish an illness timeline also resulted in longer diagnosis times as well as studies with a smaller number of patients with type I bipolar (patients who have had at least one manic episode). This is because many clinicians waited until a manic episode occurred before making a diagnosis.
Manic episodes can be especially troublesome for people with bipolar disorder. They may feel high and not want to seek treatment, when in fact their behavior can become very erratic. They may spend massive amounts of money on frivolous items or engage in risky or promiscuous activities, for example. They may be unable to sleep or eat, talk very quickly and have racing thoughts, and find that they can’t get to sleep at night without drinking.
“The onset of bipolar disorder is difficult to define prospectively because early symptoms can include both depression and attenuated mania, which can be difficult to distinguish from normal fluctuations in mood,” the authors wrote.
They argue that medical research needs to produce more widely accepted (consensus) definitions of bipolar disorders, reliable instruments for diagnosis, and a better understanding that early diagnosis may lead to a better prognosis, and even prevention of debilitating manic episodes.
“Early detection of bipolar disorder might allow interventions based on symptom profiles, patterns of cognitive function, or biomarkers,” they wrote.
Social Stigma Perpetuates Cycle of Suffering
The authors emphasized that their study also shines a light on barriers to care for people living with undiagnosed bipolar disorders. “From a patient perspective, there is often a lack of awareness of illness and a lack of willingness to commit to long-term prophylactic (preventative) treatment of what is often a stigmatizing condition.”
They stressed that waiting until life-threatening or debilitating episodes occur, particularly when patients previously have been referred to other services that may offer clues to a bipolar condition, results in a missed opportunity to prevent crisis.
“Clinicians should look more closely at a patient’s history of mood symptoms, looking for distinct changes in mood, and other risk factors, such as a family history and mood swings caused by external events such as treatment with antidepressants, overseas travel and taking drugs,” Large said in the news release.
Of course, nobody knows someone better than a individual’s own self. If you find that your moods shift from depression to elation rather frequently, or if you experience extreme highs and lows in your energy level for no obvious reason, it’s a good idea to talk with a mental health professional.
If you are abusing drugs and alcohol on top of the mood swings, ask yourself if you’re doing so to pull yourself out of depression or to calm yourself down. If so, you could benefit not only from drug and/or alcohol treatment but also a comprehensive plan for addressing a possible chemical imbalance. Modern treatment can allow people with bipolar disorder to live healthy lives in recovery.