![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Phillipa on August 23, 2010, at 21:34:30
Kind of based on the new DSM to come out in 2013 or there abouts Phillipa
Large Proportion of Individuals With Major Depression Also Experience Subclinical Bipolar Symptoms
Pam HarrisonAugust 23, 2010 Almost 40% of individuals with a history of major depressive disorder (MDD) also have a history of subthreshold hypomania, a condition that may ultimately increase the risk of developing full-blown bipolar disorder, according to findings from the National Comorbidity Survey Replication (NCS-R).
These findings indicate that mild but clinically significant symptoms of bipolar disorder are much more prevalent in major depression that previously appreciated and could affect treatment decisions accordingly.
Jules Angst, MD, Zurich University Psychiatric Hospital in Switzerland, and colleagues found that when considered together bipolar spectrum conditions were nearly as frequent as unipolar major depression without subthreshold hypomania among participants in the NCS-R, a nationally representative, face-to-face household survey of the US population conducted between February 2001 and April 2003.
The lifetime prevalence of major depression with subthreshold hypomania was 6.7%.
"We know what depression is like but people outside of the mental health field are not necessarily aware of all manifestations of bipolar disorder, and the public tends to have the view that somebody who is manic is just extremely happy and energetic," Kathleen Merikangas, PhD, told Medscape Medical News.
"But mania is much more than that, and we are interested in people who may have episodes of increased activity and decreased need for sleep and who may not be able to focus as this may indicate that that person is suffering from bipolar disorder rather than major depression," she added.
The study was published online August 16 in the American Journal of Psychiatry.
Higher Rates of Substance Use, Anxiety, Behavioral Problems
The NCS-R interview was performed in 2 parts. In the first part, an interview was administered to a nationally representative household sample of 9282 respondents in which core mental disorders were assessed along with a battery of sociodemographic variables.
In the second phase of the study, the interview was administered to 5692 of the part 1 respondents, including all part 1 respondents with a lifetime core disorder plus a probability subsample of other respondents.
Criteria for subthreshold hypomania included the presence of at least one of the screening questions for mania. In the survey, respondents were also asked whether or not they ever felt as if they met certain criteria for mania.
Investigators then characterized those with MDD according to the presence of mania spectrum as having MDD with mania (bipolar I disorder), MDD with hypomania (bipolar II disorder), MDD with subthreshold hypomania, or MDD alone.
"Particular focus was placed on comparisons between major depression with subthreshold hypomania, unrecognized by current nosology, and the 2 DSM-IV [Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition)] mood disorders for which clinical manifestations are most proximal: bipolar II disorder and unipolar major depressive disorder," the investigators write.
Findings revealed that compared with those with MDD alone, individuals with MDD and subthreshold hypomania had greater rates of comorbidity with anxiety, substance use disorders, and behavioral problems.
"In comparison to respondents with bipolar II disorder, those with major depression with subthreshold hypomania had lower comorbidity," the study authors write.
According to investigators, although "the proportion of respondents with major depression with subthreshold hypomania who had suicide attempts (41%) fell between that of the bipolar II subgroup (50%) and that of the major depression alone subgroup (31%), these differences were not statistically significant."
Those characterized as having MDD with subthreshold hypomania also had an earlier age at onset than those with major depression alone but a later age at onset than those with major depression with hypomania (bipolar II disorder).
Table. Prevalence Estimates of Bipolar Spectrum Groups in the National Comorbidity Survey Replication
Lifetime Prevalence, % 12-Month Prevalence, %
Major depressive disorder with mania 0.7 0.3
Major depressive disorder with hypomania 1.6 0.8
Major depressive disorder with subthreshold hypomania 6.7 2.2
Major depressive disorder only 10.2 5.4
Need for Increased Awareness
Converging evidence from clinical and epidemiologic studies suggests that current diagnostic criteria for bipolar II disorder fails to include milder but clinically significant bipolar syndromes; a significant percentage of these conditions are diagnosed by default as unipolar major depression.
"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 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.
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.
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.
"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.
Clinically Relevant, Implications for DSM-5
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.
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. "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.
As a consequence of this, experts who are currently involved in updating the DSM-IV are proposing a "mixed specifier" be considered in the new Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) manual in which physicians will be asked to look for symptoms of mania in depressed patients.
This qualifier would then be applicable across the spectrum of bipolar disorder and in major depression. "We are just partly through with this process, but we are looking at this in field trials so when patients are diagnosed with major depression, we are instructing physicians to look for manic symptomsthe same symptoms they used in the Angst studybecause we want to locate who is really bipolar and who is really unipolar and be more effective with our treatments," Dr. Fawcett said.
The NCS-R was supported by grants from the National Institutes for mental Health with supplemental support from the National Institute of Drug Abuse, the Substance Abuse and Mental Health Services Administration, and grants from the Robert Wood Johnson Foundation and the John W. Alden Trust. Dr. Angst has served in advisory or speaking capacities for AstraZeneca, Eli Lilly, Janssen Cilag, and Sanofi-Aventis. Dr. Merikangas and Dr. Fawcett have disclosed no relevant financial relationships.
Am J Psychiatry. Published online August 16, 2010.
Posted by violette on August 23, 2010, at 21:42:19
In reply to Is It Depression or Bipolar?, posted by Phillipa on August 23, 2010, at 21:34:30
The study may as well be worthless as many people (in the US) who do not have MDD get that diagnosis anyway.
Posted by Phillipa on August 23, 2010, at 22:11:08
In reply to Re: Is It Depression or Bipolar?, posted by violette on August 23, 2010, at 21:42:19
And more to come as how will the drug companies make money? Phillipa
Posted by violette on August 23, 2010, at 22:45:33
In reply to Re: Is It Depression or Bipolar? » violette, posted by Phillipa on August 23, 2010, at 22:11:08
I don't know, Phillipa...I'm just tired of all the b*llsh*t in the mental health system.
Posted by linkadge on August 24, 2010, at 9:03:21
In reply to Re: Is It Depression or Bipolar?, posted by violette on August 23, 2010, at 22:45:33
I agree with violette. What do these studies show? What about the possibility that the antidepressants are in fact making people a little more unstable? I.e. causing akathesia, difficulty concentrating, sleep disturbance etc.
So are you going to add a mood stabiliser or AP?
I think the problem is that researchers want a reason why antidepressant performance sucks so much. So, of course they try and rediagnose the patients as having a different illness.
As violette mentioned, everybodys bipolar these days anyway, so whats the difference
Linkadge
Posted by linkadge on August 24, 2010, at 9:08:04
In reply to Re: Is It Depression or Bipolar?, posted by violette on August 23, 2010, at 22:45:33
>Converging evidence from clinical and >epidemiologic studies suggests that current >diagnostic criteria for bipolar II >disorder >fails to include milder but clinically >significant bipolar syndromes;
I.e. what -- normal life highs and lows?
>"People can be at risk for future suicide >attempts, trouble with the law, substance abuse,
depressed people don't attempt suicide anymore? WTF? People with substance abuse issues can't just be depressed. Why is everything a hidden symptom of bipolar these days?
>all are well established with mania rather than >with depression so the key here is, we want >people to be aware that there is a potential for >risk that these people might have bipolar
What does that mean? All? I.e. suicide attempts are well established with mania rather than depression? This is nonsense.
Linkadge
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.
Posted by Phillipa on August 24, 2010, at 19:15:23
In reply to Re: Is It Depression or Bipolar?, posted by violette on August 24, 2010, at 10:17:17
I guarantee you will not like the new study I posted today from my newsletter. It in of itself is depressing. I'm also fed up. Phillipa
Posted by emmanuel98 on August 24, 2010, at 19:32:42
In reply to Re: Is It Depression or Bipolar?, posted by violette on August 24, 2010, at 10:17:17
One of the things driving this, besides the drug companies constantly trying to redefine mental health issues to broaden their markets, is that insurance oompanies in the US won't pay for therapeutic treatment of personality disorders, like simple mood and emotional dysregulation, fears of abandonment that lead to suicide attempts, etc. They only pay for AXIS I disorders -- major depression, bipolar, -- and psychotic disorders. So a dysregualted person with suicidal tendencies who attempts suicide but meets none of the criteria for MDD, will be classified as MDD nevertheless and put on drugs, when therapy might be more useful.
Posted by violette on August 25, 2010, at 7:34:20
In reply to Re: Is It Depression or Bipolar? » violette, posted by Phillipa on August 24, 2010, at 19:15:23
Yeah, well that's ok Phillipa I already have my conclusions about that stuff. :)
I was just pulling a 'Dr. Grohol" yesterday...Did you ever read the articles on Psych Central? I used to read them, but Grohol picks apart and criticizes research studies in such a way that is so annoying (to me) that i cannot even look at the site anymore!! I think he is unfairly devalues researchers some of the time...I've wondered if that's possibly his way of discharging anger so I thought I'd try it...as I don't think any researcher would be interested in what a 'kook' has to say about their studies anyway, so why not.
Posted by ed_uk2010 on August 26, 2010, at 15:32:06
In reply to Re: Is It Depression or Bipolar?, posted by linkadge on August 24, 2010, at 9:03:21
>I think the problem is that researchers want a reason why antidepressant performance sucks so much. So, of course they try and rediagnose the patients as having a different illness.
It's essentially a case of 'blame the patient'. Note that pdocs often say 'the patient failed to respond to fluoxetine', not 'fluoxetine was not effective'. Apparently, it is the patient who failed, not the drug.
>As violette mentioned, everybodys bipolar these days anyway, so whats the difference
The bipolar diagnosis is becoming increasingly all-inclusive. Soon, it may be the only diagnosis! Promotion of the bipolar diagnosis is certainly very good for selling expensive new medications, especially antipsychotics.
Posted by ed_uk2010 on August 26, 2010, at 15:37:00
In reply to Re: Is It Depression or Bipolar?, posted by violette on August 24, 2010, at 10:17:17
>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.
As well as the issues with insurance, there's also the tendency of some psychiatrists to only diagnose conditions which are treated with medication. Conditions which are not normally treated with medication are never the 'default' diagnosis.
Posted by simcha on August 26, 2010, at 16:07:43
In reply to Re: Is It Depression or Bipolar? » violette, posted by ed_uk2010 on August 26, 2010, at 15:37:00
As a psychotherapist (ok, so I came out again), I find this trend to include more and more people under the "Bipolar" label to be misguided. As others have said, many of the symptoms they are now describing as "mildly Bipolar" are also attributed to Personality Disorders, Chronic PTSD, Adjustment Disorders, and Attachment Disorders. I hope that Attachment and Chronic PTSD get more room in the DSM V. But it seems like they are widening the scope of the Bipolar diagnosis as a "catch all."
As a worker in the field working with Social Workers, Drug Counselors, Psychiatrists, Psychologists, and other Master's Level Psychotherapists I have noticed a trend to focus more on more on Bipolar Disorder. Sometimes I'm disturbed by this and sometimes I wonder if we are just becoming more accurate and attentive of symptomology in widening the definition of Bipolar. And there's a lot of politics and money that is involved here as we all know.
One of the frustrations I have with our mental health non-system in the USA is that psychotherapy isn't valued. Insurance (public and private) reimburses poorly if at all for psychotherapy. We Master's Level Psychotherapists are paid crap because of this. And some of our work is dismissed as "not evidence based" as if everything in the human psyche can be measured and quantified nicely in scientific terms.
I believe that our mental health non-system places way more weight on using drugs and psychiatrists due to the giant medical and pharmaceutical lobbies. We Master's Level Psychotherapists have been playing "catch-up" for decades in order to get properly reimbursed for our services and even to have our contributions to the field of mental health recognized.
Yes, psychotherapy can be expensive especially if it's indicated as a long-term therapy. CBT gets all the press and is one of the few treatments that gets reimbursed because it's allegedly "evidence based." There are issues with the "evidence" that many CBT practitioners use to claim that their treatments are "evidence based." And insurance companies prefer CBT because it's more quantifiable and it's a form of more brief psychotherapy. Therefore they don't have to pay for longer-term treatment that might actually get to the root issues causing the symptoms that CBT treats.
As a mental health client/participant/patient/consumer I have more and more practitioners really stretching and searching for any signs that I may be Bipolar even though I've never been manic, ever. They look at me sometimes like I'm lying when I tell them this. I even had a pdoc give me a book written by someone who suffered from Bipolar Disorder to see if I related to it. I related to the depression. I didn't relate to the mania detailed in the book.
Have I ever had "sub-threashold" symptoms that could be categorized as "sub-threashold" hypomania? I'm not sure. There are many people in my family who suffer from Bipolar Disorder. So I have a greater likelihood of developing Bipolar Disorder. However, is it useful to classify periods when I'm feeling well (and not "better than well") as "sub-threashold" "hypomania?" Does this change the direction of my treatment? Does this mean that other medications should be used with me?
I wish I could afford psychotherapy. I know that when I could see a psychotherapist weekly I did much better than with just medication alone. It's ironic that I provide psychotherapy and can't afford it for myself because my insurance doesn't cover long-term therapy and I don't make anywhere near enough to afford to pay full price for weekly sessions.
However, I do wonder sometimes if the mental health practitioners may be seeing something I haven't seen in myself. I do have a hard time focusing sometimes. I'm a starter and not necessarily a finisher when it comes to projects. I'm a major procrastinator. I have anxiety around procrastination. In my younger adulthood I had a very difficult time in choosing a career and I've been through 4 very divergent career changes in my life. So, I do wonder if I don't have some "sub-threashold" "hypomania" sometimes, or if I experience mixed states when I'm depressed.
There's a lot to consider here and I've wandered more than a bit in my ranting here. I hope this makes sense.
Posted by ed_uk2010 on August 26, 2010, at 16:41:57
In reply to Re: Is It Depression or Bipolar?, posted by simcha on August 26, 2010, at 16:07:43
>(ok, so I came out again)
Lol :) What type of psychotherapy do you provide? Do you find it problematic as a psychotherapist to receive psychotherapy?
>However, I do wonder sometimes if the mental health practitioners may be seeing something I haven't seen in myself.
I think they may be looking for something that isn't there.
Posted by simcha on August 26, 2010, at 18:00:39
In reply to Re: Is It Depression or Bipolar? » simcha, posted by ed_uk2010 on August 26, 2010, at 16:41:57
> >(ok, so I came out again)
>
> Lol :) What type of psychotherapy do you provide?
>Currently I work with 18-25 year old homeless youth. I see people suffering from Bipolar, Schizophrenia, Schizoaffective Disorder, Personality Disorders, Major Depressive Disorder, Generalized Anxiety Disorder, and lots of PTSD plus a host of a lot of other things.
I'm more of a relational psychotherapist. I use the psychotherapeutic relationship in order to help guide people in finding that which is within themselves that may help them to heal from whatever it is that is holding them back. Like most psychotherapists I use many different techniques. I am well-versed in mindfulness techniques, narrative therapy, sand tray, psychodynamic theory, CBT, and in varying techniques used to treat trauma. I believe in Carl Rogers's idea that I am to hold the people who work with me with "unconditional positive regard."
Also I have a specialty in transpersonal psychology. That means that I have a spiritual path (not religious) and I recognize the important role that spirituality (the inter-connected-ness of human beings and the possibility that there may be something greater than us to which we are connected also) plays. Also, I am trained in somatic techniques related to body tracking and breath work. I greatly revere Jung's work and I am well-trained in working with dreams, symbolism, and archetypes. I'm more of a holistic psychotherapist as you have probably guessed.
>Do you find it problematic as a psychotherapist to receive psychotherapy?
>Yes, sometimes. I have to get out of my own way when I'm receiving psychotherapy. I can over-analyze my own issues and try to "therapize" the psychotherapist who works with me. Also since I'm a provider, I have to get past the "I think I've seen it all and I know what you're doing" attitude and thoughts I can have while being a client. Also I can omit things that would be useful for the psychotherapist to know simply because I'm afraid of what the psychotherapist may do/think/say/diagnose, etc. So, I really have to humble (become teachable) myself when I'm a client.
> >However, I do wonder sometimes if the mental health practitioners may be seeing something I haven't seen in myself.
>
> I think they may be looking for something that isn't there.Perhaps. Or perhaps not. When I'm depressed I get agitated very easily. Often I have "angry depression" or "agitated depression." I do wonder sometimes if this is simply part of my own brand of depression or if it might be slight hypomania. Again, I try to get out of my own way when working with another mental health professional from whom I'm receiving services.
Posted by violette on August 26, 2010, at 19:25:49
In reply to Re: Is It Depression or Bipolar? » violette, posted by ed_uk2010 on August 26, 2010, at 15:37:00
"As well as the issues with insurance, there's also the tendency of some psychiatrists to only diagnose conditions which are treated with medication. Conditions which are not normally treated with medication are never the 'default' diagnosis."
I don't think it's about lack of diagnosing the problems, it's pretty much about ignoring emotional problems....Those same psychiatrists are not looking at emotional issues unless they are extreme manifestations. So mental illness does not just 'go away'. And if they do, they often come back or get worse over time.
And the trend to label more people with the catch all bipolar II diagnosis is another way to ignore emotional problems, while encouraging more drug usage.
Every patient in psychoanalytic therapy will have 'traits' of personality disorders discovered. It's not PD, it's about your defense mechanisms, object relations, inter states, all sorts of things that can form patterns-sometimes to a small degree, sometimes to a large degree. Sometimes those traits are actually adaptive and change from time to time, serving a useful purpose to avoid psychosis.
It would benefit patients to get over the term 'personality disorder' because people can really learn alot about themselves from reading about them. Glen Gabbard is an excellent source. It's just a very stigmitizing term that unfortunately is used when describing the concepts of how traits are formed, often describing more fully manifested personality patterns for the sake of attributing conceptual terms to a group of features.
But if you read case studies, they usually describe how someone's 'traits', as opposed to actual 'PDs' cause and interact with the axis I stuff. They are not 'seperate' concepts.
It might be more helpful to not seperate axis i and ii-because they are so intertwined. And some estimates are that 50% of the mental health population in treatment actually would qualify as having a 'personality disorder' at time of treatment. I recall the last psychodynamic study I read about suicide attempts-over 80% of those people met the criteria for PDs, but were diagnosed MDD. People are not tested or treated for emotional problems.
Every therapist in psychoanalytic training will identify their own 'PD' traits/tendencies whether they be avoidant, narcissistic, ocd, codependent or whatever. It's not about PDs as much as it is about recognizing and treating the psychological parts of illness or whatever obstructs you in daily life or prevents you from living the best you can. Traits of PDs or PDs themseles-which are basically larger defense patterns-actually cause certain symmptoms to emerge at certain times-the same symptoms people take drugs for. People with certain PDs are somewhat less likely to benefit from pharmacuetical treatments, but the Axis I problems are not seperate-they are dynamic with the Axis II.
A person with OCPD traits who loses their job will likely get MDD-because OCD is a defense mechanism to prevent painful emotions and your job success is intertwined with your 'self'. People with various PD traits will get MDD after losing a relationship...often the other half of the relationship serves a purpose in affirming a person's worth. Others can get MDD or other axis i when approaching 'success'-if you have a very low self worth-it can cause an inner conflict you are unaware of. Why do you think so many people get mental illness after losing jobs and relationships? It's really about object relations; your brain's neurotransmitters are triggered by emotions. If not, then more people would spontaneiously get MDD or anxiety. It can often be traced back to something that effected you emotionally, maybe not as noticable as a job loss.
The problem is, those traits can come and go, intensified with stress. Medications may treat you temporarily, but for those in the mental health system for extended periods, you will likely never be well without addressing those emotional issues-even if drugs will temporarily mask the pain. People can learn alot...
I feel like one of those confetti bombs used on new year's eve...where after the confetti might provoke some for but 1 second, it just floats aimlessly around people, landing on the ground with no purpose or effect. Maybe I should save my confetti for 'special occasions' only.
Posted by emmanuel98 on August 26, 2010, at 19:51:18
In reply to Re: Is It Depression or Bipolar? » ed_uk2010, posted by simcha on August 26, 2010, at 18:00:39
Fortunatly for me, I live in MA which has a mental health parity law. I suffer from MDD and PTSD and have various symptoms of personality disorder. My insurance pays for unlimited therapy visits, both with a p-doc and a social worker. I have been hospitalized so many times and for so long, that my p-soc says they'll pay for anything to avoid another hospitalization expense.
Posted by violette on August 26, 2010, at 20:26:27
In reply to Re: Is It Depression or Bipolar?, posted by simcha on August 26, 2010, at 16:07:43
Simcha,
I'd pay my therapist $10,000 a month for what he is doing for me if I could afford it.
Sorry to hear you are underpaid and undertreated for your health concerns. You have a really tough job and many of us do attribute high value to those in the profession.
ps you can usually get psychoanalytic therapy for free or sliding scale if you have a training institute near you.
Posted by Phillipa on August 26, 2010, at 21:15:01
In reply to Re: Is It Depression or Bipolar? » linkadge, posted by ed_uk2010 on August 26, 2010, at 15:32:06
Ed what a perfect response agree l00% Love PJXX
Posted by Phillipa on August 26, 2010, at 21:26:59
In reply to Re: Is It Depression or Bipolar?, posted by simcha on August 26, 2010, at 16:07:43
I'd welcome the opportunity to have you as a therapist we seem to think on the same lines. Phillipa ps don't question yourself. You know yourself better than anyone.
Posted by emmanuel98 on August 27, 2010, at 20:13:55
In reply to Re: Is It Depression or Bipolar? » ed_uk2010, posted by violette on August 26, 2010, at 19:25:49
I think good therapists see the DSM criteria for personality disorders as a heuristic -- useful for thinking about how certain traits cluster and emerge, but not very useful in describing actual people. Glen Gabbard, as you mention, is great this way. His textbook Psychodynamic Therapy in Clinical Practice, uses the DSM as an outline, but his case studies and dynamic explanations are much more nuanced.
Posted by violette on August 27, 2010, at 20:50:56
In reply to Re: Is It Depression or Bipolar? » violette, posted by emmanuel98 on August 27, 2010, at 20:13:55
Hey Emmanuel, I agree with you....but was speaking of general psychiatry-where emotional traits are basically ignored, then people go around searching for medications for years upon end. Maybe it's more where I live, as most psychiatrists here are not psychodynamic, and none ever suggested my emotional issues/childhood trauma should be addressed; instead, I was prescribed drugs for several years...but still had MI issues. Thankfully I did my own research. But pre-internet era? Who knows where I'd be now.
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