tag:blogger.com,1999:blog-3125132926699584358.post4825299567051187122..comments2024-03-28T02:01:21.139-05:00Comments on Family Dysfunction and Mental Health Blog: Re-labeling Depressive Symptoms as Manic Symptoms by FiatDavid M. Allen M.D.http://www.blogger.com/profile/06280912088483192599noreply@blogger.comBlogger11125tag:blogger.com,1999:blog-3125132926699584358.post-8944191189450455922013-10-20T13:37:59.434-05:002013-10-20T13:37:59.434-05:00It's amazing they can pull stuff like that out...It's amazing they can pull stuff like that out of their you-know-whats without any real evidence and be taken seriously.David M. Allen M.D.https://www.blogger.com/profile/06280912088483192599noreply@blogger.comtag:blogger.com,1999:blog-3125132926699584358.post-77505188719726311742013-10-20T01:59:56.023-05:002013-10-20T01:59:56.023-05:00Here's a new article here:
http://www.news-me...Here's a new article here:<br /><br />http://www.news-medical.net/news/20131017/Mixed-state-impedes-remission-in-bipolar-depression.aspx<br /><br />They say psychomotor agitation in depression is now a sign of a "sub-threshold mixed state."<br />beneficiihttps://www.blogger.com/profile/08107436044843445219noreply@blogger.comtag:blogger.com,1999:blog-3125132926699584358.post-70819583237986902752012-05-11T19:57:06.467-05:002012-05-11T19:57:06.467-05:00Thank you so much for your response! I have found...Thank you so much for your response! I have found your blog very enlightening, and was hopeful that I'd hear back. Looks like it's time to run away from the psychiatrist. I should have been concerned when she labeled me as bipolar before the appointment, and based the diagnosis on secondhand information about my mother, deceased almost 20 years. Unfortunate. I really liked her. (The therapist. Well, and my mother.) Thanks again!Adriennehttps://www.blogger.com/profile/13364008950099588536noreply@blogger.comtag:blogger.com,1999:blog-3125132926699584358.post-52017150899559851492012-05-11T16:43:59.035-05:002012-05-11T16:43:59.035-05:00Thanks for writing.
Unfortunately, as you know, I...Thanks for writing.<br /><br />Unfortunately, as you know, I can't possibly say what your diagnosis might be without taking my own history. <br /><br />In general: If it takes very little to get you into a downer and/or into an angry outburst, unfortunately it won't matter to a bad psychiatrist what you call that; they'll just call it hypomania, which it is not.<br /><br />Depending on other factors, I would usually use the term "affective instability," which is usually due to chronic, ongoing relationship stress, not a brain disease.<br /><br />Some depressed patients do indeed get more agitated on an SSRI. That is just a side effect that has absolutely nothing to do with bipolar disorder, and is usually an easy side effect to treat. A true bipolar patient might become fully manic on an SSRI, not just agitated or irritable.<br /><br />A bipolar II diagnosis is warranted when the patient actually meets the criteria, including and especially the duration criteria and the not-typical-of-their-usual-functioning criteria. I've only seen two such patients in 38 years of practice, and I suspect they were just mild bipolar I's.<br /><br />If your doctor has never even asked you about your current relationships, your childhood experiences, and if you are now being or have ever been significantly abused - and just asks you about your symptoms without digging too deep - run as fast as you can and get a second or even a third opinion. <br /><br />You can find more info about this on my other blog at: http://www.psychologytoday.com/blog/matter-personality/201204/how-recognize-bad-psychiatristDavid M. Allen M.D.https://www.blogger.com/profile/06280912088483192599noreply@blogger.comtag:blogger.com,1999:blog-3125132926699584358.post-37440424256608186682012-05-11T16:07:27.067-05:002012-05-11T16:07:27.067-05:00I apologize for dragging up an old post, but may I...I apologize for dragging up an old post, but may I ask what your recommendation would be for a patient who wants to describe an emotional state that they only know how to define with the word "irritable?" Are there any circumstances under which a bipolar II diagnosis is warranted? Is there such a thing as "high-functioning bipolar II?" <br /><br />If I'm being honest, I am a patient, not a doctor, who has been diagnosed as bipolar II after seeking treatment for postpartum depression. I fear honest disclosure of past depressive episodes and difficulty with SSRIs has contributed to the diagnosis. I've found myself quite skeptical of the diagnosis and treatment I'm receiving.Adriennehttps://www.blogger.com/profile/13364008950099588536noreply@blogger.comtag:blogger.com,1999:blog-3125132926699584358.post-27877316040591292912012-03-13T15:32:33.633-05:002012-03-13T15:32:33.633-05:00Your reply is almost true. Sorry to be crude, but...Your reply is almost true. Sorry to be crude, but I put my money where my mouth is. Do not ever underestimate that we, as paitents, afflicted, are too stupid to figure out when you are being treated well or not. Of course, the internet is full of garbage and I will always defer to my MD's advice. However, I noticed a reference to "transparent doctors", I actually put the greatest trust in my doctors' benevolence and intelligence (and I am a piece of work) by first, an MD and then Pyschiatrist, in fact, any physical health issues, I include him in it, as he gets it. He has wotked in some of the most frightening aspects of mental illness, yet the three women in his life, look at him with total adoration (his family). "Transparent doctors", sure there is inadequacy existing, it exists in all fields, and one must be wise to discern the difference and know intriscally what is best for yourself. At least I still know what is a revolting estimation of doctors, and one should not be patroning in other's good work. And, again, do not understimate one's capaccity to deal with mental illness and sill be most productive. And as for me, yup! Yes, I am more fortunate than others, and have at least been so blessed, I have had the pleasure of being treated by very decent caring and educated doctors. Somehow my psych seems to put it all together, first, as an MD. then as Psych. I expect no less! How does one explain dropping almost 15 pounds due to a cycle of depression, (I am 5'6 and do not need to hover close to 100lbs). Most disgracefully, some think this is really good looking....again, go figure. Cadavers are not something I aspire to be or most disgutinglly do not wished to be complimented on. I am an intelligent and very giving person, and should never be thought of any less. Do I have mental issues...yup! But compared to the rest of my successful and very completely "nuts", giving famuiy, all of whom - we do the best we can - and take care of each other - and have great hopes for our next up-coming genration and hope they will not be terminally blonde and blue eyed!<br /><br />Dr. Allen, plese do not take this as a personal offense. I think the most of your opinions and am most happy that there is a forum to post them. Please do not dump all doctors into the same bin.... you guys need to pool together to get respect. I am an advocate for mental health and wish there were more, like yourself, to bring the best to the field.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3125132926699584358.post-30153754609759434762012-03-12T11:43:52.946-05:002012-03-12T11:43:52.946-05:00This post is about the doctors who buy into transp...This post is about the doctors who buy into transparent nonsense, not about their patients. <br /><br />Unfortunately, some psychiatrists these days are not worthy of the trust that patients like yourself put in them. <br /><br />It's very difficult for patients to know whether what they read on the internet is accurate or not. I try to include my reasoning for the opinions expressed in this blog.David M. Allen M.D.https://www.blogger.com/profile/06280912088483192599noreply@blogger.comtag:blogger.com,1999:blog-3125132926699584358.post-29871633899745998932012-03-12T01:14:54.927-05:002012-03-12T01:14:54.927-05:00I am quite sure that you fully vetted your post. ...I am quite sure that you fully vetted your post. I expect nothing less from professionals and actually do read as part of my expectations as someone (not MD or pharma) to do so. Where do we, those afflicted, get most of our info - on the internet, of course. So when I moved recently to the SW, I was given a license plate with the preface ADD -should I drive with my hazards on (maybe)! But please keep in mind, that if I had any other "medical disorder" (I condider the mind a part of the body), you better believe I would read about it anywhere I could to be my own advocate. I would do the same for my car! Do not blame your patients for trying to figure out what is wrong or why their car is leaking oil. It is what most folks would do. Most of us know and trust our MDs, which is more than you can say for your car mechanic, even though, they are reimbursed at at a higher rate...go figure! I have the utmost respect for most MDs, but we do what we can trying not to sound like complete losers...leaky something under the hood...dysphoric depression, mania. irritable, sleepless,"check engine light", "check fluids", etc. It is not to be ridiculed. We are trying to sound somewhat knowledgable and not be ripped off!<br /><br />One does not go to their MD for a fun and fantastic proceedure nor does one send their car in for that either. One would hope that those that take care of us hope we are in healing hands and that we will get more than a good 20 years (God forgbid not treatment), and 200,000 miles, as I have done with my car!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3125132926699584358.post-3096490725634117222012-03-09T07:21:39.824-06:002012-03-09T07:21:39.824-06:00Irritability is the least helpful "symptom&qu...Irritability is the least helpful "symptom" in psychiatry. It's nearly ubiquitous in both psychopathology AND normal everyday life, making it wholly unhelpful in distinguishing one disorder from the next, or between psychopathology and normal undulations of mood in response to normal stressors of life.<br /><br />Can we all agree to strike "irritability" from the DSM? Has the presence or absence of irritability ever shed light on a single diagnosis?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3125132926699584358.post-30184198991799378612012-03-06T15:36:04.092-06:002012-03-06T15:36:04.092-06:00Steve,
I have seen patients who say, "I was ...Steve,<br /><br />I have seen patients who say, "I was really MANIC this morning." No they weren't. I wonder where they learned to label their agitation with that word?David M. Allen M.D.https://www.blogger.com/profile/06280912088483192599noreply@blogger.comtag:blogger.com,1999:blog-3125132926699584358.post-66041264263494625622012-03-06T15:01:54.973-06:002012-03-06T15:01:54.973-06:00Ah, yes, "irritability" and "agitat...Ah, yes, "irritability" and "agitation," those old chestnuts.<br /><br />Herein lies one of the biggest problems in modern psychiatry: terminology. Let's assume that, in this study, "irritability" and "agitation" were well-defined and that there IS such a thing as an irritability that is unique to a "mixed depressive state." In other words, let's assume that these scientists were actually doing science.<br /><br />The take-home message, however, is none of that. It is, instead, that irritability and agitation are signs of bipolar illness. And you can bet that most psychiatrists won't read the paper or give it the scrutiny you did, and walk away with <i>precisely</i> that idea. Moreover, drug companies who market drugs for bipolar disorder will be more than happy to make that statement (of course, with a reference to Judd et al, 2012, but which no one will ever ask to read).<br /><br />Next thing you know, the patients who come in and say "I get so agitated all the time" or "I'm getting irritable again" (and I had three such patients this morning!)-- especially when appointment lengths are only 15 minutes-- are bipolar.<br /><br />[Of course, "agitation" and "irritability" aren't the only loaded words in psychiatry. Others that come to mind are "anxiety," "depression," "insomnia," "anger," "poor concentration," "distractibility," "manic," and heck, even "bipolar." I'm sure the list goes on and on. If we fail to ask what patients <i>mean</i> by these words, we're doing nothing more than knee-jerk prescribing, which is precisely what pharma, our employers, payers, PPACA, and, increasingly (and unfortunately), patients, want.]SteveBMDhttps://www.blogger.com/profile/11937264509253612864noreply@blogger.com