Tuesday, April 6, 2010

Comments to The People's DSM Articles

My Alternative Depression Diagnosis, My Alternative Bipolar Diagnosis


  1. Hello,

    This is very interesting way of differentiating the types of depression. There is a distinction (just like there is a distinction in types of cancer), and this distinction does require different treatment protocols.

    I have a long cycling, severe vegetative type depression. I have designed my own treatment protocol as I do not fit neatly into the DSM-IV classification model.

    It seems to me that if you want good treatment, you have to do your own homework, and arrive at the psychiatrists office prepared to defend the type of treatment you need.

  2. Please go on with your observations. I came back to your website as I am fighting my way through a rage state. It helps to read your thoughts about how people live with this.
    When asked "What's wrong?" my response is "I'm lost and I want to go home."
    In the past treatment for depression had wonderful results, but at 61, in different set and setting, the drugs no longer work and side effects damaged my kidneys and liver.
    I got married 8 years ago in 6 month long euphoric state to someone I now sometimes do not recognize. He moved into my home and overwhelmed the space with stuff. I can deal with it for periods of time, but something will trigger me and the messy cramped house begins to look like one on the HOARDERS programs. I get agitated, hopeless, and that slips into insane rage. That is what is now called by psychiatrist my "manic phase" - destructive and dangerous. I self-managed my thinking and avoided these extremes for the past year without drugs, examining my beginning thoughts and extreme emotions.
    At first I thought this current rage was the power I needed to stand up to husband's inaction but it took over by surprise, an ambush. I threw boxes of his books and trash onto front yard and shoved piles of his clothing into a hallway while he was away. I was able to do Kundalini yoga, drank water and ate rice, called my cousin who talks with me gently, the husband has no idea what I am doing. It got worse, I was terrified I'd burn the house down so I called social worker. They gave me Seroquel to take for 4 days of self-induced sleep. I slept 4 hours, woke up angry and went to your page, found this section.
    In younger days I would write for days streaming creativity, now "mania" is a period of rage, followed by shame and remorse. Is it the same thing?
    I consider my brain to be extremely sensitive to non-natural sounds and perceptions.
    I am taking another Seroquel in an hour and hoping to awaken feeling softer.
    I have felt great love for my husband at times and wonder if this is just a euphoric state! I also have PTSD. Insomnia is chronic.
    There are the basics peculiar to each person, what is needed to feel "at home".
    Living alone with a dog is probably better for me but because of diagnosis I am never sure if any change I make is rational or just mood based.
    Every month in my isolated small town there is another obituary with a "thank you" to the mental health team for "their concern as the person struggled valiantly" etc...
    Knowing the mood swings are endless, is a heavy burden. How do shamans treat this? I think they treat the family. I often wish I would be given pain medication for the rages, an opium den where I would be watched over and enjoy peaceful dreams, complete rest.
    Back to sleep on a dangerous drug where there is not a dream or hope upon awakening.

  3. I hope the people coming up with the "new" DSM realize all they have done is provide insurance companies with continued reasons to deny coverage.

    Insurance companies would not like your DSM either (but I do). It would actually require doctors to spend real time with patients. My first pdoc did that anyway, I was devastated when she moved. I wonder if its a coincidence that she was from Canada?

  4. Hmmm. This definitely makes more sense to me than any of the DSM mood disorders I've been told that I have.

    Two things leap out at me:

    1) You mention that under your current scheme, "cycling depression" and "bipolar III" may overlap too much. If you're conceiving of bipolar in general as cycling illness, why is "cycling depression" not in this category? Is there any reason to keep it separate?

    2) You haven't mentioned ADHD at all. Under the current DSM rules, its symptoms overlap significantly with bipolar illness, and many people seem to be misdiagnosed as one or the other (or the fact that they may have both is ignored). How do you see it fitting into the People's DSM?

    Finally, a question: do your diagnostic categories reflect your personal experience? An aggregate experience of patients you've talked to? What you've learned from healthcare providers? All of the above?

    Thanks for all your work on this. People have a right to know that the labels they're receiving have little basis in reality, and are more about accommodating their insurance providers than ensuring decent care.

  5. Hey, Addy. Thanks for noticing. There is overlap and I made no attempt to reconcile it. Bipolar III and cycling depression are virtually the same. You can make a good case that I eliminate one or the other completely, and maybe you can help by stating your preference. Here's the deal:

    Should the "up" threshold be set at hypomania, and everything else be regarded as depression, including cycling depression?

    Or should everything that cycles be regarded as bipolar?

    The old version of manic-depression basically included everything that cycles. I'm leaning in this direction.

    Re ADHD, this will be the next thing I research. There is a lot of overlap re bipolar and ADHD, and I need to be writing on this. Thanks for bringing it up.

    Finally, all of the above. Being someone with bipolar who was misdiagnosed with unipolar and sent manic on an antidepressant motivated me to find out what was going on and educate others. My research has brought me into contact with the world's leading authorities and with those with the illness. I attend psychiatric conference, I'm involved as a mental health advocate, I've run support groups.

    And here I am reading your comments. :)

  6. Thanks for answering my questions :)

    Now that I've thought more about this, there might be justification for keeping "cycling depression" and "bipolar III". Even if there's near-complete overlap of symptoms, at least it might get providers thinking about the fact that something that presents as depression *can* cycle.

    My own experience with all of this is still unfolding. My official dx is "major depressive disorder with psychotic features". When I'm not on AD's my mood can crash dramatically, usually in the late afternoon/early evening, and usually only in the winter. It's resulted in at least one psychotic episode.

    In my case, anti-depressants are sedating. If I put it in terms of the People's DSM, they improve my agitated symptoms at the cost of worsening my vegetative symptoms. My pdoc now has me titrating up on lamotrigine, and so far I'm having very good results. Here's hoping that continues.

    If I were diagnosing myself using the People's DSM, I would have cycling depression/bipolar III. I plan on discussing my dx with my pdoc next time I see him, but in one sense, the dx doesn't matter as long as I'm getting effective treatment. On the other hand, some damned answers would be nice.

    I look forward to seeing what you do with ADHD and all of this. It can be seen as overlapping with bipolar disorder as well as depression (both agitated and vegetative, I would say). I spend a fair bit of time on ADDForums, and I would say the majority of people there have a mood disorder dx as well as ADHD.