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In Reply to: Peter's state of mind posted by Peanut Gallery on May 24, 2004 at 22:02:40:
Thanks for the details, now here are some immediate thoughts:
Severe depression characterized by real black, down moods can occur with bipolar as well as unipolar disease (Major Depressive Disorder). The thing with bipolar manic depression, is that every so often the individual will go into a "manic" state. However, it doesn't exactly look like mania, because it can take the individual in the direction of a deeper, blacker hole rather into an expansive mood.
So how does a clinician tell the difference between unipolar depressed and bipolar manically depressed? "Here, try this medicine, and let's see what it does to your mood." Accurate diagnosis of mood disoders really is something of a chemical crap shoot, although a prescribing clinician would call it "heuristic process."
If the medicine is one known to control expansive mania and it lifts the profoundly depressed mood--voila, you've got a differential diagnosis! However, good practice requires the clinican first prescribe a medication known to lift a unipolar depression if the client presents with depression and reports no episodes of expansive mania. In which case, the anti-depressant medication *may* trigger an expansive manic episode in a person with a biploar disease that originally appeared to be "simple" unipolar depression.
This is why it often takes time and patience to find the correct medication to stabilize the symptoms of a brain disease, particularly mood disorders. This is also why social support is so critical. Individuals with brain diseases need family and friends who can stay on top of what the psychiatrists and other clinicians are saying and doing in the treatment plan.
I don't care how talented the prescribing psychiatrist is or how compassionate the social worker, no one looks out for the interests of a loved one the way a family member or friend will once they've gotten enough psycho-education about the disease and understand how it is properly stabilized and managed. To get the necessary education, family members and friends should go to the NAMI website.
