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Re: Is It Depression or Bipolar?

Posted by violette on August 24, 2010, at 10:17:17

In reply to Re: Is It Depression or Bipolar?, posted by linkadge on August 24, 2010, at 9:08:04

Good points Linkadge. This is a huge study-look at the sample size and labor involved in the door-to-door methodology...How much taxpayer money did it waste? How does this help mental health patients? And who are the people who answered the door-the fearful/anxious types who have social phobia, PTSD, agoraphobia or other avoidant traits? lol

If anything, it shows people are not being diagnosed with personality disorders or attachment issues, imo, as MDD or Bipolar I are pretty much the 'default' diagnoses here in the US regardless of what you may really have.

"People can be at risk for future suicide attempts, trouble with the law, substance abuse, all are well established with mania rather than with depression.."

Those traits are also associated with impulse control and personality disorders as well.

"...so the key here is, we want people to be aware that there is a potential for risk that these people might have bipolar disorder and you might want to treat that differently than for major depression alone," said Dr. Merikangas."

So the problem is with the 'treatment approach' - not the design of the diagnostic manual and the politics of money?

"Another key to identifying major depression with subthreshold hypomania is the presence of a family history. The study showed that a family history of mania was as common among those with subthreshold hypomania as those with mania/hypomania."

Studies also show people with attachment issues, personality disorders, are more likely to come from abusive families.

"According to investigators, the expansion of the bipolar concept to include subthreshold hypomania would probably lead to important changes in the treatment of patients who are not diagnosed or who are misdiagnosed as having MDD alone."

Bipolar II is already a catch-all diagnosis-let's expand it, so more people can get more agumentive medications such as anti-psychotics (and get fat and diabetes and increase the country's obesity rates) instead of being informed about psychological treatments that may benefit them or finding other ways to prevent/address the psychological problems for those who don't want or can't afford therapy.

"If people have these episodes of increased energy that happen without provocation, even if they last only a short time, we recommend that you track that and take a careful family history because patients with major depression who have a parent with a history of mood swings and alcohol dependents, for example, may be at risk of developing bipolar disorder themselves," Dr. Merikangas said."

That's also known as mood dysregulation, and people don't need conscious provocation to have the mood swings. (Another form of mood dysregulation is PMS, a result of hormones).

"Jan Fawcett, MD, University of New Mexico, Albuquerque, told Medscape Medical News that there are a few factors that make the study clinically relevant, including the finding that confirms a conversion rate from MDD to bipolar disorder of 15% to 30% over time. "We know there is a certain proportion of patients with major depression who end up being bipolar," said Dr. Fawcett."

This was already known anyway. Let's do more research for the unknown, please. Quit wasting money.

"There is additional evidence from clinical trials where antidepressants have been shown not to work as well in bipolar depression as they do in major depression."

Duh.

"People are also starting to notice a proportion of patients who are not responsive to [antidepressant] treatment and some people feel a large proportion of these nonresponders have bipolar disorder," Dr. Fawcett added."

And some people feel a large proportion of medication nonresponders have long-standing emotional issues that need addressed. How about funding research for emotional issues-and how people who don't want to undergo psychotherapy can overcome them, or how to prevent them, instead of research that leads to more pill prescribing? Don't we have enough of that already.

Anyway, it was a good way for me to discharge some pent up anger so thanks Phillipa for the article.

 

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poster:violette thread:959557
URL: http://www.dr-bob.org/babble/20100821/msgs/959627.html