Friday, January 28, 2011

Over-diagnosis of Bipolar Disorder: Why is it a problem?

It has struck me over the past few years that more and more individuals were being diagnosed, mainly by psychiatrists, as suffering from Bipolar Disorder. I haven’t seen any published surveys to support this observation, but other psychologists have also reported seeing the rise in how frequently this diagnosis is made. I have had more than a few occasions where patients have been, in my professional opinion, diagnosed with Bipolar Disorder, whey I believed that they instead suffered from other disorders, such as Major Depression, Borderline Personality Disorder, Post-traumatic Stress Disorder, or Obsessive-Compulsive Disorder. So what’s all the fuss about—it’s just a label, right?

Labels have consequences. Let me point out a few that you might want to consider:

1. Bipolar Disorder is a Major Mental Illness and is seen as truly a physical disease process in the brain. There has been very strong evidence published for at least over the past 20 years that it is strongly influenced by genetics—that is to say that you likely inherit the disorder or at least a tendency to develop the disorder. Studies have shown that if one parent has Bipolar Disorder, children from this parent may have about a 20% chance of also having the disorder. If there is a strong family history of Bipolar Disorder, that is to say if several blood relatives also have Bipolar Disorder, the chance for a child to have the disorder skyrockets. If the parent and several blood relatives have the disorder, the chance for a child to have the disorder may be near 70%. This raises some concern for parents who are considering having children and whether parents want to risk creating a child that has a high risk of a serious mental illness that is not curable and may cause severe disability in life. Now, with increased frequency of this disorder being made, sometimes inappropriately in my opinion, parents who are faced with a possible dilemma that is not actually present.

2. Bipolar Disorder is treated with several different powerful classes of drugs, including anti-seizure medications and anti-psychotic medications. Many of these medications are relatively new to the market, and as such, they are extremely expensive. Also, it is not uncommon for psychiatrists to prescribe more than one of these medications to a “bipolar” patient at the same time. The prices were derived from the website on 01/28/2011. See the example below:

LAMICTAL XR (brand) 100 MG TER (30 tab) $309.99
Trileptal (brand) 300mg (60 tab) $235.99
Seroquel XR (brand) 600 MG (60 tab) $617.00
Risperidone (generic) 3 mg (60 tab) $299.99
Risperdal (brand) 3 mg (60 tab) $756.00 (estimated from price of 30)
Zyprexa Zydis (brand) 10 mg (30 tab) $529.99
Invega 6 mg (100 tab) $1,372.99
Geodon 60 mg (60 tab) $574.97

Cheaper medications such as Lithium (which is cheaper) are still sometimes used, but not as frequently now as these newer classes of drugs.
Now while some individuals without the diagnosis of Bipolar Disorder may be prescribed the anti-psychotic and anti-seizure medications, many more are treated effectively with simply an anti-depressant medication.

Now also consider the cost of prescription anti-depressants:
Sertraline (generic) 100 mg (30 tabs) $15.99
Zoloft (Brand) 100 mg (30 tabs) $131.99
Fluoxetine (Generic) 40 mg (30 tabs) $40.99
Prozac (Brand) 40 mg (30 tabs) $398.49
Lexapro (Brand) 20mg (30 tabs) $109.99
Celexa (Brand) 20 mg (30 tabs) $120.49
Citalopram (generic) 20 mg (30 tabs) $39.99
Pristiq (brand) 50mg (30 tabs) $141.99

Also remember that Bipolar Disorder is a life-long condition that necessitates medication (most of the time) for a life-time. Many other disorders may require long-term medication, but not necessarily for the rest of a patient’s lifetime.

3. Labels have consequences: while any psychiatric diagnosis carries a stigma, some of which may be more stigmatized than Bipolar Disorder, applying the incorrect diagnosis might mean that the person faces discrimination based on that diagnosis that they might not otherwise face.

4. Finally, when a misdiagnosis of Bipolar disorder is made, the accurate diagnosis may be missed and specific treatments, such as psychotherapy, may be not considered, when they are very effective. Treatment may be focused on simply maintaining the patient and controlling symptoms (that is to say with ongoing medication), rather the ameliorating the mental health problem (helping the person function more effectively with or without medication).