With the development of society and the surge of information, “depression” has been frequently reported. The disease of depression has become the “brightest star” known to the public among the complicated mental disorders.
When a person is depressed, he will find that he is sad all day long, has no energy, and has no interest in anything. He knows to see a doctor, and he can also focus on these discomforts to the doctor when he sees a doctor. These discomforts are indeed common symptoms of depression, and it is easy for patients and doctors to think of depression.
But, you know what? Depression does not only exist in depression. There is a disease called “bipolar disorder” (hereinafter referred to as “bipolar”) that is often presented to everyone in the form of “depression”.
In our country, at least 6 people in every 1000 people suffer from bipolar disorder. The mood of bipolar patients is like a roller coaster, with ups and downs. It is difficult for patients to study and work normally, and they lose their pursuit of a better life and sense of happiness. However, bipolar is often misdiagnosed as depression, adolescent rebellion, and schizophrenia. According to a survey, the misdiagnosis rate of bipolar at the first visit to the doctor is 69%, and more than one-third of patients need to go through at least 10 years to be diagnosed. A large-scale clinical survey involving 1,000 people in Europe showed that it took an average of 5.7 years for bipolar patients from onset to diagnosis. Among the 191 bipolar patients included in a study in my country, the shortest time required for their diagnosis was 2 months, the longest was 22 years, and the average was 3.9 years.
Why is bipolar diagnosis so difficult? The patients were all angry: Are all psychiatrists “cooked rice”? As a psychiatrist who focuses on bipolar, I can only sigh: it’s not that we don’t work hard, it’s that the “enemy” is too cunning.
For example, in February 2021, I saw a 23-year-old patient. About two years before this, he had seen 5 doctors successively. The diagnosis was basically the same: anxiety and depression.
I inquired about the patient’s medical history and felt that the previous diagnosis was fine, so I prescribed a new treatment plan for him, which was also an antidepressant. In the follow-up visit in March of that year, he told me that his symptoms had alleviated, and I was relieved; in May of that year, he told me that he had basically recovered to the state before the illness; in September of that year, as soon as he entered the consultation room, I I felt that something was wrong – he didn’t treat himself as an outsider at all, and he had a passion for me that was more than a family member than a relative.
During our conversation, he said that he was full of energy this month, his learning efficiency was very high, his confidence was bursting, his thinking was quick, he talked eloquently, he went shopping a lot, he had a very good appetite, he wanted to eat all day long, and he gained ten catties in a month . After asking again, I found out that he had this kind of inexplicable “good state” that appeared intermittently a few years ago. It usually lasted for a week or two, 1 or 2 times a year, and this time it was a little longer. problem, and I have been looking forward to getting back to this “good state”. Although many doctors had repeatedly asked him “whether he was overly excited”, he never thought that his performance was “excited”, so he always said “absolutely not”. At this point, I revised his diagnosis: bipolar disorder.
It took this patient more than two years to be diagnosed with bipolar, so he was unlucky in that sense; but he was lucky, too, because he walked into a psychiatrist when he was in a hypomanic state In the consulting room, he was “caught upright”. How many other people are actually bipolar but are being treated for depression or something else? There are no concrete answers, but all people diagnosed with depression need to be vigilant.
The blind man feels the elephant, and sees the leopard through the tube. Science has not yet developed to allow us to have the ability to see the hole cards at any time. For bipolar, a “cunning” disease with many changes, both the patient and the psychiatrist need to understand its complexity and pay attention to the changes in the patient’s condition. Evaluate and adjust treatment plan.
