thank you, really love this post! i see that some of your recommendations hinge on using the bipolar diagnostic questionnaire as a diagnostic tool. I think that the questionnaire is actually part of the problem. I suspect that many people with treatment-resistant depression don’t become obviously hypomanic or manic enough for the doctor to be able to diagnose bipolar type II even if they have it, and so they keep trying wrong meds for years.
I suspect that the solution to this is to update the diagnostic questionnaire to check for differences in how people react to low sleep. The author of Unquiet Mind also wrote a textbook about this, and bipolar is super related to sleep. Most people feel terrible on low sleep, but bipolar people tend to feel great, and can get hypomanic or manic from low sleep. For example, I bet that guy who wrote that debunked post on the LessWrong forum about how people need less sleep has bipolar (https://www.lesswrong.com/posts/HvcZmKS43SLCbJvRb/theses-on-sleep).
For those trying to hack treatment-resistant depression who suspect they have bipolar, the right thing to do might be to ask to try Lamotrigine, if you’ve already tried a few other drugs that didn’t work. I’m less sure about this, but if your physician isn’t willing to do that for you, you could ask for something like Effexor which can trigger a hypomanic episode, and then get your bipolar type II diagnosis so that you can get lamotrigine.
Thank you for your comment and sorry for the late response!
The questionnaire that I suggest does factor in sleep patterns; agreed that it is a very meaningful symptom that needs to be factored into the diagnosis.
I would strongly advise against your final suggestion though—triggering a hypomanic episode on purpose seems like a really dangerous idea! Even if you succeeded in triggering hypomania as opposed to mania, you’re unlikely to manage to get seen by a GP while in that state. If you’re that desperate, it’s probably safer to lie to your doctor and say you have had a hypomanic episode than actually trigger it on purpose in order to be truthful...
ah, i guess it depends on the reliability of your health care… when i was thinking the most about this i was not in the USA. thanks, this is a good and balanced point.
thank you, really love this post! i see that some of your recommendations hinge on using the bipolar diagnostic questionnaire as a diagnostic tool. I think that the questionnaire is actually part of the problem. I suspect that many people with treatment-resistant depression don’t become obviously hypomanic or manic enough for the doctor to be able to diagnose bipolar type II even if they have it, and so they keep trying wrong meds for years.
I suspect that the solution to this is to update the diagnostic questionnaire to check for differences in how people react to low sleep. The author of Unquiet Mind also wrote a textbook about this, and bipolar is super related to sleep. Most people feel terrible on low sleep, but bipolar people tend to feel great, and can get hypomanic or manic from low sleep. For example, I bet that guy who wrote that debunked post on the LessWrong forum about how people need less sleep has bipolar (https://www.lesswrong.com/posts/HvcZmKS43SLCbJvRb/theses-on-sleep).
For those trying to hack treatment-resistant depression who suspect they have bipolar, the right thing to do might be to ask to try Lamotrigine, if you’ve already tried a few other drugs that didn’t work. I’m less sure about this, but if your physician isn’t willing to do that for you, you could ask for something like Effexor which can trigger a hypomanic episode, and then get your bipolar type II diagnosis so that you can get lamotrigine.
Thank you for your comment and sorry for the late response!
The questionnaire that I suggest does factor in sleep patterns; agreed that it is a very meaningful symptom that needs to be factored into the diagnosis.
I would strongly advise against your final suggestion though—triggering a hypomanic episode on purpose seems like a really dangerous idea! Even if you succeeded in triggering hypomania as opposed to mania, you’re unlikely to manage to get seen by a GP while in that state. If you’re that desperate, it’s probably safer to lie to your doctor and say you have had a hypomanic episode than actually trigger it on purpose in order to be truthful...
ah, i guess it depends on the reliability of your health care… when i was thinking the most about this i was not in the USA. thanks, this is a good and balanced point.