Friday, December 01, 2006

Is It REALLY Depression?


Over the past few months, I keep getting banner ads referring me to www.isitreallydepression.com, so eventually I gave in and gave the good folks at AstraZeneca a visit to this "patient education" site.

The questionnaire, as you can see above asks you if there has "ever been a period of time" when you were "not your usual self" and had the following symptoms. Nowhere is it stated how long the period of time is supposed to have lasted. So, if you've ever had racing thoughts, yelled at someone, had an unusually high energy level, etc. -- you just might have bipolar disorder. The lack of a time qualifier is ridiculous. Nearly everyone has had some, if not the majority of these so-called symptoms for a short time period (even a few minutes). Even extremely high functioning, successful individuals have yelled at others, been more active than usual, been more talkative than usual, and so forth.

The questionnaire moves on to ask if several of these have ever happened at the same time. My guess, again, is that for normal people, several of these "symptoms" have occurred simultaneously.

There is one attempt at a saving grace -- a question that asks "How much of a problem did any of these cause you — like being unable to work; having family, money or legal troubles; getting into arguments or fights?"

On the final screen, I noticed that I answered over 7 of the symptoms in the bipolar direction. Seven is the cutoff score indicating possible bipolar. I also answered yes to these "symptoms" occurring together, also something that gets scored toward bipolar. I was fortunately saved from a diagnosis of bipolar disorder by not having more than mild impairment (moderate or severe impairment due to the symptoms is the final straw -- yes to that and meeting the other two criteria just described and you're labeled with possibly having bipolar). Phew -- that was close!

But seriously, the closer on the last page, which appears regardless of how you responded to the questionnaire, states: "Regardless of your results, we recommend that you print and share this questionnaire with a qualified health care professional who can provide you with a full evaluation." No matter how you score, you should talk with your doctor about it. Why would I talk to my physician about an online screening that turned up negative?

Warning: I am about to speculate and I might be wrong. Could it be that if I demand a "full evaluation" for bipolar disorder, my doc (who is regularly receiving all sorts of promotional materials discussing how bipolar is surprisingly widespread and is frequently misdiagnosed as depression) will think, "Hey, this must be one of those bipolar people. Look at those symptoms -- talking fast, racing thoughts -- yeah, definitely bipolar. I read about it in that educational material I got in the mail. I'm sure glad he brought in that mood questionnaire."

There's nothing wrong with patient educational material that helps to increase disease awareness when there really is a disease present. If this gets people with serious bipolar disorder into treatment that helps, great. I have a feeling, however, that this is an attempt to crack into the lucrative but largely untapped "soft bipolar" market. There is very meager evidence on treating bipolar II/soft bipolar disorder, but that's beside the point. If AstraZeneca keeps cracking into the bipolar II market with Seroquel, then by the time the bipolar II awareness campaign is in full swing, they'll have a foothold on the market.


1 comment:

Marissa Miller said...

"Nowhere is it stated how long the period of time is supposed to have lasted. So, if you've ever had racing thoughts, yelled at someone, had an unusually high energy level, etc. -- you just might have bipolar disorder. The lack of a time qualifier is ridiculous."

I thought this was odd too. (I took the same questionnaire when I was diagnosed.) Basically, having all of these symptoms at least once in your life qualifies you for bipolar disorder.

"There is one attempt at a saving grace -- a question that asks "How much of a problem did any of these cause you — like being unable to work; having family, money or legal troubles; getting into arguments or fights?""

I wouldn't necessarily call that saving grace. I had a period of time that I got into financial trouble - when I was in college. I received my very first credit cards (Discovercard, Capital One, Victoria's Secret, you name it) without the ability to stop spending money I didn't have. This practice is not uncommon among college students. I haven't had these "manic" sprees since I've graduated and my financial situation is doing much better. (Hooray for 100 pts. on the credit score!)

"I was fortunately saved from a diagnosis of bipolar disorder by not having more than mild impairment (moderate or severe impairment due to the symptoms is the final straw -- yes to that and meeting the other two criteria just described and you're labeled with possibly having bipolar). Phew -- that was close!"

That's also weird. It's the depressive part of bp that has impaired me in the past. (Hence, my 10-year diagnosis of MDD.) Really, what's the difference? Perhaps I have ADHD with psychotic features? *shrugs* I feel like diagnoses put square pegs in round holes.

"Warning: I am about to speculate and I might be wrong. Could it be that if I demand a "full evaluation" for bipolar disorder, my doc (who is regularly receiving all sorts of promotional materials discussing how bipolar is surprisingly widespread and is frequently misdiagnosed as depression) will think, "Hey, this must be one of those bipolar people. Look at those symptoms -- talking fast, racing thoughts -- yeah, definitely bipolar. I read about it in that educational material I got in the mail. I'm sure glad he brought in that mood questionnaire.""

My guess is that it'd be a PCP who does this. Any psychiatric dr. who diagnoses someone based on an online questionnaire and fails to take a detailed history is an idiot. I'll go on record saying that.

"There is very meager evidence on treating bipolar II/soft bipolar disorder, but that's beside the point. If AstraZeneca keeps cracking into the bipolar II market with Seroquel, then by the time the bipolar II awareness campaign is in full swing, they'll have a foothold on the market."

Perhaps I don't understand bpII. I was under the impression that bpII has little negative effects and does not impair judgment or normal activities. BpIIers tend to function well, don't experience psychosis, don't suffer from depression so why do they need meds?

Unless there's something about bpII I've overlooked...