Ignorance Is Not Bliss: The Importance of Screening

Author: Willa Goodfellow

I didn’t want to find out I had bipolar disorder.

I was on a plane. The person in the seat next to me saw the Journal of American Psychiatry in my lap. He was curious, he said, because he was a doctor and worked on a psych ward. Why was I reading that journal, he asked.

So, I told him about the book I wrote in three weeks, most of it during my one-week vacation in Costa Rica. I described the blog that I started later, my research into what I thought was my depression. I acknowledged my treatment just wasn’t going well.

I don’t know if it was the story about the book, or the story about six failed antidepressant trials, or maybe it was the volume at which I related my whole psych history to a stranger on a plane. He said, “I am not diagnosing you. I can’t diagnose you while we’re talking on an airplane. But when you get home, why don’t you Google ‘MDQ,’ Mood Disorder Questionnaire. Just remember ‘MDQ.’”

So I did. The Mood Disorder Questionnaire is a brief screening tool. It doesn’t list the diagnostic criteria. It makes a series of plain language statements about a person’s life. You score one point for each statement that describes your life and add up the points. The tool recommends that a family member read it and score it for you, as well.

When I added up my points and consulted the scale, it said that chances are, I had bipolar disorder and should talk to my doctor about it.

Well, I didn’t want to have bipolar disorder. I did not ask my wife to fill out the questionnaire, and I did not talk to my doctor.

But what is worse than having bipolar disorder? – Having bipolar, but being treated for something else, that’s what.

A person with bipolar disorder is likely to go to the doctor complaining of depression, one of the two poles in bipolar. In the absence of adequate screening, that person is likely to be diagnosed with unipolar depression, as I was. People with bipolar are misdiagnosed for an average of seven and a half years from when symptoms first emerge; a third of us go misdiagnosed for ten years or more.

There are many reasons for this misdiagnosis. We don’t present with manic symptoms, so the doctor doesn’t know about them. We don’t remember or recognize the milder hypomanic symptoms as problematic, so we don’t report them. We don’t understand the screening questions that are asked, or we are uncomfortable answering them in the way that they are asked. Doctors don’t recognize the differences between how bipolar depression and unipolar depression present.

As a consequence, we are most likely treated with antidepressants. The results may be a “flip” into a manic episode or a mixed episode, a combination of depressive and manic symptoms with its high risk for suicidal ideation or attempts and subsequent rapid cycling, episodes that occur more frequently than they would have in the absence of antidepressants.

In other words, if you are treated for unipolar depression when you actually have bipolar disorder, you get sicker or even die. My foray into those six trials of antidepressants made me seriously suicidal and unstable for a long time even after I quit them. Ignorance can kill you.

There are ways to improve on doctors’ lousy performance of diagnosis.

  • Use plain language screening tools. The MDQ is one. The Bipolar Spectrum Disorder Scale, BSDS, is another. Patients can screen ourselves.
  • Talk with family members and have them fill out the screening tools, referring to the patient’s history. While people with undiagnosed bipolar are more likely to identify depressive moods, family and friends are more likely to recognize the manic symptoms that steer toward the bipolar diagnosis. Family members can do this before talking with the doctor.
  • Ask questions about elevated energy or activity (e.g., Was there ever a time when you had much more energy than usual or were able to accomplish many more things than usual?) before asking about elevated mood. This is a modification of the Structured Clinical Interview (SCID) that the doctor uses. Simply switching the order of the questions asked has been demonstrated to improve the accuracy of the diagnosis.
  • One more thing, for people who have recurrent depression. One screening for bipolar is not enough. Every episode of depression brings an additional new risk for switching to mania or hypomania. Screen for bipolar with every new episode and with every antidepressant failure.


Finding out I had bipolar was not good news. Except it was. With the right treatment, I finally could get better.



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