General practitioners (GPs) should not be treating bipolar disorder. It’s as simple as that and I have no idea why GPs don’t get this. If it’s obvious to me, a little ol’ mental health writer then it should be more than obvious to a medical professional that GPs are simply not equipped to treat bipolar.
GPs Are Generalists
General practitioners are, by definition, generalists. This means they know a little bit about a lot of things. It’s a GPs job to rule things in or out and treat the most common illnesses. They generally do a pretty good job of this.
However, GPs, by definition, are not specialists and when something goes wrong that is out of the ordinary and not just something that requires antibiotics or a blood test, GPs tend to refer you to a specialist. This is critical because when something unusual or serious is wrong with you, you want someone who knows a lot about your particular condition and not a little about many conditions.
Brain Disorders Require a Specialist
And no one would argue that when something goes wrong with the brain, it is both serious and complex. If you had a seizure, for example, that problem with the brain would earn you a referral to your nearest neurologist – as it should. Brain disorders should be treated by specialists.
And lest we forget, mental illnesses are, indeed, disorders of the brain and thus they, too, deserve treatment by a specialist.
Mistakes GPs Make When Treating Bipolar Disorder
And it’s not that I have anything against GPs, I don’t, it’s that they do a strikingly bad job of treating bipolar disorder (and not a good job of diagnosing bipolar either). More often than not, they treat only the depressive part of the disorder and they do this with antidepressants alone and, as I’ve said, over and over, (as psychiatrists say, over and over) people with bipolar disorder should not be on antidepressant monotherapy.
Bipolar should not be treated with antidepressant monotherapy because it can make the bipolar disorder and the course of the illness worse. In other words, GPs do more harm than good to people with bipolar disorder.
Here’s an example. A person diagnosed with bipolar just contacted me. She said that she was being treated by her GP. The GP asked her if, during her elevated moods, she felt like god. She said no. So the doctor went on to treat her with antidepressants alone.
I can’t even start to tell you how plain stupid that is. Yes, some people with bipolar do have delusions of grandeur during mania/hypomania but that isn’t even required for the diagnosis let alone a universal experience. And I hear stories like that all the damn time. Why is it that I, a mental health writer, would do a better job treating bipolar disorder than an actual doctor?
Do Not Settle for a GP Treating Your Bipolar
If you’re stuck with a GP treating your bipolar, do not stand for it. Demand a referral to a specialist – a psychiatrist – that is what you need and that is what you deserve. Now it is true that the odd GP may do a decent job at treating the occasional, simple case of bipolar, and if that is you, and you are getting better, then don’t fix what isn’t broken, but if this isn’t you, then please, please see a psychiatrist. The same thing goes for unipolar depression. I get that they are harder to see and I get that there are waiting lists and I get that there are sometimes insurance complications. Nevertheless, psychiatrists are the specialists that should be treating bipolar. GPs should know better than to even to try. They just make matters worse.
On point about GPs being inadequate and actually sometimes harmful when it comes to bipolar. Recognizing that is very important. My mother’s GP suggested REDUCING an antipsychotic during a hypomanic episode!! I had to intervene and say that was not a good idea. As a GP, if you don’t have the training and understanding to treat mental health conditions like this, then leave them to the specialists or it is professional negligence.
Alongside that, in the UK we need for GPs to have more training in mental health (enough to recognise the signs and understand when referral is needed and the urgency required) as well as menopause training (to recognise when similar symptoms are actually caused by hormones during perimenopause). It’s 2022, let’s get moving!!!!!
General Practice is a specialty in itself. To claim that GPs are not specialists only demonstrates your ignorance of the specialised training, experience and skills they have (and your political attitude towards them).
Unfortunately you just undermine your credibility and undermine that of patients in general; I as a patient don’t want to be associated with your ignorance.
Because of a doctor who never asked me a single question about my mental health *before* I was pregnant, I was put on an ever-increasing dose of Zoloft that eventually caused the scariest manic episode I’ve ever had. At the same time, to see a psychiatrist this year, I had to wait SEVEN MONTHS. I was verging on an emergency, and if I had been thinking clearly, I would have called my new GP, the one who knew my diagnosis. The problem is the system
My daughter has been suffering with depression for 4 years. Our GP prescribed counselling sessions but we are still waiting. W have since changed GPs due to a house move. She moved away from home to University and tried to manage her health herself. I had no idea how bad she felt. 18 months ago she told me she didn’t want to live anymore and I immediately took her to my own GP and asked advice. My GP arranged a mental health assessment. The CPN who assessed her basically told her she was very luckt to have caring parents and a place in University and there were plenty worse off than her. To pull herself together, forget about her problems and concentrate on her University degree. My girl has taken 5 years to graduate from her 3 year course as her health would just not allow her to continue. The University (UWE) were fantastic throughout and the staff from student support were brilliant and helped us no end. Our family GP prescribed Fluoxetine, which, after a few months helped. Recently whilst waiting to start her first job she experienced severe anxiety, very low mood, then extremely excitable mood and started doing some really stupid and dangerous things. Her GP where she now lives suggested she have another mental health assessment. After the last assessment which put my daughter in bed day and night for 5 days, refusing to talk, eat or let us into her room, her father and I were on suicide watch, so we told her to ask for an assessment with a psychiatrist not a CPN. This was ignored and her assessment was done by a nurse who was not much better than the last one and ended by saying he didn’t know what to do. At the end of our tether and watching our girl go downhill I took her back to her Gp and asked for an assessment with a psychiatrist. I was told there was a waiting list so I asked if I could pay privately. The Gp recomkended a clinic so off we went. Psychiatrist diagnosed Bipolar type 2 and wrote to the gp suggesting my daughter be prescribed lithium. The Gp said that you can’t just take it, there have to be blood tests, ECGs etc. and these were arranged. After 5 weeks of all this toing and froing the GP has refused to prescribe lithium because it needs to be prescribed by a specialist. Daughter says “It has been prescribed by a specialist. A private psychiatrist in a private clinic, the details of which were given by my GP. Point bank, no reason. Telephoned the private clininc who said “They must prescribe it, we’ve never heard of anything like this before.” Back to the GP like a bouncing ball who decided to ask his colleagues in the practice and came back with an emphatic “No.” No offer of alternative treatment just no. What can we do?
Last week I started a new GP and she told me she wasn’t comfortable handling the bipolar and referred me to a psychiatrist. First time that has ever happened to me and I’ve been treated by three different GPs and one OB/GYN!! since my diagnosis.
Never been to a psychiatrist. Misdiagnosed for 22 years as having major depressive disorder.
I believe I am the rule, not the exception, although from the comments I may be mistaken.
This article is garbage. Once you are stabilized and are (very importantly) self aware, there is no reason you can’t see your GP and prescribed your standard dosage. Why should I pay $100 a visit to go “How are you doing today? Good, good. Okay here is your script. Have a good day, see you in 2 months.” if I can have the same conversation with my GP and only be charged $20.
Idiotic article.
I have a fantastic psychiatrist, but she is really expensive, 160$/ 30 mins or 130 for 15, also she is really booked and it might take couple of months to get an appointment. if i don’t need adjustment to my meds or i have a bigger need for a psychiatrist, my gp takes really good care of me. if i call to my gp , they immediately know that if i call, there is a need and not a little whinge out of nothing and usually i get an appointment in couple of hours. they know my moods and how they affect me and they renew my prescriptions even without a visit if i call ( they never change anything they leave it to my psychiatrist) they always remember to ask when do i have my next visit to my psychiatrist and generally they are fantastic. i never had a bad experience with them and its comforting to know that i have someone there if i need it. it is also nice that when i go there, i don’t have to start explaining my whole medical history etc, it makes things so much easier. i think i am really lucky to have that kind of support.
My experience was the exact opposite, and likely rare from what I gather.
My GP is the one who caught on to my Bipolar II. In my first appointment that I went to to address the depression, she noted little things like my inability to sleep, racing thoughts, getting all hyped up at times, etc. She thought I had a “milder bipolar disorder” (which I know doesn’t exist), but the point it, she did pick up on it. She referred me to a psychiatrist, the psychiatrist laughed off the possibility of a “milder Bipolar disorder,” talked to me for 15 minutes, prescribed me an antidepressant and sent me about my way.
Two years and three different antidepressants later, my GP notices that things are getting worse and again brings up the possibility of Bipolar 2, which she approaches carefully because she said she was “aware of the stigma” and didn’t want me to feel badly or anything. I mentioned how the psychiatrist reacted two year prior, so she referred me to a different psychiatrist. Lo and behold, the GP was spot on. Off the anti-depressants I went and on to a mood stabilizer.
Like I said, I know my experience was rare, but I am so thankful to have such a good GP who picked up on the smaller things and knew enough to get me a referral (even if it took a while to find a good psychiatrist).
I’m on the fence about this one.
My first of 3 hospitalizations was precipitated by a very stressful life event that caused intense anxiety followed by deep depression. I went to my GP complaining of depression and was prescribed anti depressants, effexor and paxil that caused me to cycle back into severel ‘anxiety’. I then went to the emergency department of my local hospital looking for relief of my ‘anxiety’ and was prescribed Ativan that didn’t even come close to relieving it. Looking back now, this ‘anxiety’ likely was the mania associated with undiagnosed biplar disorder. Ultimately it was my EAP (Employee Assistance Program) Advisor that was instrumental in getting me seriously looked at by a psychiatrist as a hospital in patient. In hospital I was severely overmedicated with haloperidol that resulted in a life threatening reaction, NMS (neuroleptic malignant syndrome) for which I was given an additional medication. When I got out of hospital a month later I promptly discontinued both medications
My 2nd hospitalization (10 years later) was again followed by another stressful life event. I took pills and self harmed. It was my dad that got me admitted. I was given risperidol but had no bad NMP reaction this time. I’d described most of my symptoms to the psychiatrist but conveniently left out the pychosis part because I was too afraid to admit it. I had even suggested that I might have bipolar disorder to the psychiatrist but he said he wasn’t certain. But when I left the hospital he gave me a prescription for only lamictal and told me to see my GP for further refills. My GP wasn’t comfortable refilling the prescription and told me that if I wanted it refilled she would send me to a psychiatrist which she did but I later stopped seeing now that I was ‘better’ again. Neither psychiatrist told me what my diagnosis was…
Before the 3rd in patient hospitalization (another 5 years later) which had followed yet another stressful life event I had initially gone to the emergency ward on my own looking for relief and was prescribed a small amount of lamictal and sleeping pills and told to see my GP who continued to prescribe the lamictal for over a year. The problem was that my original GP was on medical leave during this time and a number of locums (at my original GPs office where all my files were kept) who didn’t really know me were filling in for her. I asked one of them to refer me to a psychiatrist because I wanted him to confirm what I already thought, after much reading, that I had bipolar disorder. The psychiatrist confirmed I had bipolar ‘2’ and sent me back to my GP to continue prescribing the Lamictal. Eventually my original GP retired and gave her practice to another GP who realized after only 2 visits that I needed to be hospitalized and called the police to take me there from her office because she wrongly thought I wouldn’t go voluntarily on my own. While in hospital I was told I had bipolar 1 and given Lithium but I didn’t care for the side effects. When I got out instead of stopping the medication altogether I got a referral to a community mental health facility where I saw a different psychiatrist who I convinced to put me back on Lamical but only if I would agree to take Abilify in addition to it. I relented and so far no more manic episodes but now lethargy and lack of motivation have become a problem
In addition to Lamotrogine, I take Zopiclone. Without it I cannot sleep, this isn’t due to dependence it’s part of my condition (rapid cycling with rare periods of remission). I also take Diazepam both for pre-menstrual exacerbation and because my principal medication (I’ve tried everything) only improves rather than removes bipolar. However, my GP cuts diazepam and zopiclone without recourse to psychiatrists’ letters or recommendations. I have also been told that I must not take Lamotrogine if I wish to get pregnant. However a psychiatrist who is an expert in medications for pregnant bipolar patients has told me about the tiny risk/ammount of evidence that lamotrogine causes a cleft palate. I am not a candidate for not taking medication if pregnant and she has told me the benefits outweigh the risks. I have now asked for yet another medication review due to my GP’s continued reluctance to prescibe the medication I need to lead some semblance of a normal life.
Hi all, just to say I have written another reponse to this, but as its too long for a comment I have written it as an article here http://latestbipolarnews.info/how-to-get-the-best-bipolar-treatment/ for easier reading. Thank you.
My GP, who worked as a psychiatric registra, was the first to detect my bipolar.
She saved my life.
We have a shortage of Psychiatrists in our area and she plays an important role.
She gets the patients who can’t afford a private psychiatrist or cannot get an appointment.
It’s the system that sucks.
Perfectly said. WN
I have been saying this for years! A Generalist does not know enough about psych disorders to treat them. My GP gave me a mega dose of anti-depressants that almost killed me. No matter how ,any times I tell someone to visit a psychiatrist, they insist that their GP knows all. Thank you telling everyone about this. You are right. Anyone doubting you is vety, very wrong. If they doubt their psychiatrist then they need to do more research and/or find a new doctor. People are lazy though and want everything done for them.
I completely agree with you that in theory a GP shouldn’t be the one to diagnose or treat Bipolar Disorder. However, our medical care system isn’t in a place that makes this always possible. I have recently run into problems in my own life that reminds me of this. It takes 60 days to get into a Psychiatrist, I called at least 10 in my area, with my GP I can get in that week. Two months is a really LONG time to wait when you are suffering mentally and emotionally. I am without insurance currently, to see a Psychiatrist is $380 to $400 for an initial assessment and $180 there after, my GP is $100. In the past when I’ve had an HMO, they made me start with the GP and get a referral BEFORE allowing me to see a Psychiatrist anyway. I’m hoping one day our health care system will give those of us struggling with mental health issues an option for optimal treatment.
Hi Helen and Hi Natasha
Having re read my previous comment here to Natasha about her “sounding so angry”; I would like to apologise, because in hindsight I wrote bluntly and sounded even angrier myself!!
But (Helen) I am not sure we should simply say” like it or not someone is right” when we are talking about such a complicated illness and issue. Other people here have also expressed disagreement with this article, for other valid reasons… and maybe we should just respect everyones’ point of you as we all battle to survive!
Respect to you all…
Bottom line, there are more crappy (“unhelpful”) treatment providers, both GP’s and specialists, than otherwise. Training and aptitude matter, no doubt, but if someone won’t take the time or effort to ask the questions and actually listen, all the training in the world counts for nothing.
Yes. Also, people without training in clinical psychology and only personal research should not be counseling those who are seriously ill with brain chemical imbalances.
I generally agree with, and value, your views, Natasha–but not this time. In the two years I have lived in Maine, I have consulted four mental health professionals–your “specialists” in brain disorders–and not one has listened to a single word I’ve said. Prior to coming to Maine, I was on a medication regimen that worked perfectly and was affordable on my fixed income. As you know, psychiatric medications require monthly review. But not one single “specialist” here in Maine has agreed to continue prescribing the only medications that ever worked for me. Instead, each and every one has insisted that I “try out” one or another of the newest drugs on the market. When I explain that 1) I’d rather not change a regimen that works; and 2) that in any event, I cannot afford name-brand drugs for which no generic is available, they assured me that “All you have to do is fill out some paperwork for us and our facility will work with the drug company to get you the medication at reduced cost.” Clearly, they’re more interested in whatever kickback they get from the drug company than they are in treating a patient successfully and affordably. What does this have to do with your blog entry? Why, these individuals are all “specialists.” Whereas my previous doctor, in my home state of NJ–the very doctor who worked with me for months to help me find a regimen of meds that worked, and that I could afford–was (GASP) a general practitioner. Sorry, but far too many specialists these days are working with drug companies and are more concerned with lining their pockets and publishing papers on the newest drugs instead of actually helping the people they took an oath to help. I’m a little disappointed that you, of all people, should generalize in such a way. You do other people with bipolar no service by telling them to avoid the one doctor who might know them best–and thereby know best how to help them.
I also disagree that a GP absolutely can not safely and successfully treat bipolar disorder. I have no personal experience with this as I have only been treated by psychiatrists; however, I now know of a few personal acquaintances who are very happy that their GP is exclusively treating theirs. I’ve read that more than 1 in 100 people are now diagnosed with bipolar disorder, (and 1 in 5 are mentally ill.) At one time it was a rare and unknown disorder. Now it’s about as unusual as having a bad knee. There simply are not enough psychiatrists to treat everyone and there won’t be anytime soon, and yes, if you have an emergency or crisis it’s likely that your psychiatrist will leave you high and dry and your GP will not, (at least in my experience.)
I am posting under a new name here, against your posting rules. I am doing this because you wrote a comment here that you felt it wasn’t safe to use your real name, and I also don’t feel safe using a nickname associated with my real name.
Why do you think psych meds require monthly review? The psychiatry lecturer hear is happy to have six monthly reviews with his patients who are stable; some for years, there is absolutely no reason why someone who has been stable for years should require monthly reviews
OMG! You are so dead on with this. I could write a book about this, but I will keep it short. I have suffered from depression my whole life and at times would have periods of elevated mood. Unfortunately, I didn’t believe that I could possibly be bipolar, well….just because I couldn’t be. During one of my periods of depression my GP put me on Lexapro and, after a few weeks, I started feeling better.
As time when by I began acting in ways foreign to me and doing things I had never done. Delusions of grandeur. Check. Overspending. Check. Hypersexuality. Double check. I believed that nothing bad could happen to me and that no matter what I did it would all turn out fine. I mentioned this to my GP and his only question was, “Are you having a good time?”
By the time I eventually came down I had quit my six-figure job to drive big rigs, spent my entire 401k and was $100,000 in debt. The last few years trying to climb out of this pit has been pure hell. My feeling is that GENERAL PRACTITIONERS SHOULD NOT BE PRESCRIBING ANY PSYCHOTROPIC MEDICATION OR TREATING MENTAL ILLNESS!
The same thing happened to me when my psychiatrist prescribed me Zoloft. My life was completely ruined and I spent three months in a locked state ward because the same psychiatrist couldn’t medicate me out of my mania. Another psychiatrist eventually prescribed me lithium when my psychiatrist went on vacation, saying something along the lines of, “Why in the hell hasn’t he done this already?”
Sorry, Natasha. I must disagree. Since my last Psychiatrist retired two years ago I tried finding a new one. Minimum cost of $185.00 per visit. Non-negotiable. Cash at first visit needed along with a valid credit card, two forms of i.d. and bank account numbers. Only two psychiatrists in a fifty mile or so radius of me was taking new patients. Basically, care given for those least in need.
On the hand my PCP physician who is board certified in both Internal Medicine and Pediatrics has ten children with one having BP herself. He treats me with the kindness and respect as well as the knowledge I have never seen in any Psychiatrist (I’ve dealt with many and only my last one approached him). As well as spending any amount of time with me he charges be zero. He treats me at appts. I make for other reasons. There are more in this world then “official” credentials. Due to lack of funds, due to my illness, I also lack credentials in many things I believe I am very good, if not expert at. Suppose I don’t just think those who can work 9-5 or 7-3 etc. can be educated or proficient at something. I have learned to live outside the box, and also believe most Psychiatrists would be well served, to say the least of their patients if they would learn to do the same a little.
Sorry to say it but to say the shortage of Psychiatrists, Psychologists, Therapists of all kinds has brought out the greed in so many is a great understatement. Maybe the game should change in the direction the PCP, PAS, CNPS are playing in the US at least and stop asking for a brain surgeon for every headache and actually treating people. The credential wars have always gone on and will continue to in all aspects of medicine and elsewhere. Shall BP patients wait on the list 20-30 years for treatment? Reality as you know like MI itself is a big slap on the face.
The problems of course are always larger and more complicated, but I deserve help and medication same as you. Even though you may have more cash. If you don’t believe that (and I know you do), what are those of us who can’t seem to function in the cash grabbing dog eat dog, screw your neighbor capitalistic system of the US and other countries are loosing their souls to emulate. WN
No practitioner without specific mental health training, including physicians, should ever treat or prescribe meds for any mental health condition. I’ve seen too much of this in my career and the outcome is usually not positive.
Oh and my GP fully supports my psychiatrist. She regularly asks about my meds, but does not presume to make adjustments to them.
General practitioners are not the only one reaching into the psychiatrist’s pie and totally blowing it. Here in California we have nurse practitioners who can write scripts for medication. I know of a few people who have tried to use them instead of psychiatrists and found themselves in deep trouble because the NP paid less attention to the mental state of their patients than the psychiatrists are alleged to do.
Plus there is a problem with NPs writing scripts for things like Vicodin and medical marijuana where the drug has no proven value or is even — as in the case of MM — contraindicated for conditions such as bipolar disorder. This gap has fueled many a druggie’s habit.
Natasha,
I want to request a MRI of the brain for myself. Can they tell if I have a “bipolar” brain. I need proof. Please help.
Should have asked for “proof” you had cancer couple hundred years ago. Everyone knew you had it but there was now current science of dna, cell behavior, and on and on and on. Everyone knew you had the same thing everyone else had in recorded verbal memory.
Just like evolution can never, never say never be recreated in a lab doesn’t mean you aren’t a fool for not believing it.
If we all stopped dead trying to learn things there wouldn’t be MRI machines to begin with. Fools keep moving the line that science actually moves. Sit back and let the big boys with big minds figure things out. Keep rubbing sticks together and tell us all when the match comes out so you can enlighten us all. I’m guessing your in the show me state. I’ll meet you there and show you you are an idiot.
Grow up and learn just a little about science, just a little before you even attempt to comment on it. Your making a fool of yourself here. Better stick to the foolish comment section of your local newspaper where you have many fans.
Please, waiting for the one two all you have I refuse to read comment. Spend a little more time taking things in and less spewing worthless crap out. Your opinions have no value at all to anyone with any education at all. None. Sadly you think you actually think you have something to contribute. You don’t. WN
My GP of several years was the first to question, in 2005, as to whether I actually had Bipolar or just Major Depression? I had been diagnosed with fMDD for YEARS by both GPs and Psychs.
He knew that I had not done well with ANY anti-depressant over most of my lifetime and as such; he started briefly questioning me about “when you feel good…” In 2007, a year later; I entered a psych hospital with psychotic mixed mania and officially diagnosed with Bipolar.
Since then… he has often said “I’m a garden type doc and you need a psychiatrist. However, until you can get in to see one….”.
He also actually HEARS me… which so many psychiatrists simply refuse. I’ve had ADs prescribed to me from several psychiatrists who at the same time, agrees with the Bipolar diagnosis but keeps pushing the ADs along with the Mood Stabilizers. I mean seriously, Trazadone – commonly used for sleep – is an AD, folks.
In addition; I can get in to see my GP a lot easier and more frequent than I can with a Psychiatrist. He knows me and my medical history.. he doesn’t just “glimpse” through paperwork as many a Psych has done.
I do not always agree with you and this is one of those times that I do not. Psych docs, some – several, are no different than the random GPs.
Just cause you got a degree doesn’t mean you were at the top of your class. MDs with degrees.. get them whether they barely passed or far exceeded… it’s the same piece of paper displayed upon their walls.
Natasha, I totally understand where you’re coming from. I have been through a plethora
of GP’s, psychiatrists, and psychologists. It took 12 years before I was correctly diagnosed. I think it was harder for me because I was out of work at the time and had to use social services. So most of my medical group was under qualified, simply overworked and desensitized to mental illnesses. The good psychiatrists and psychologist didn’t stay because of the pay. I had a psychologist, who I felt, was sicker than me.
I was diagnosed with Major Depression and became the poster guinea pig for every antidepressant out there.I had become obese, because every med I tried caused weight gain. I became more depressed than ever. After I had began working again, through my insurance, after much searching, I was able to find a decent psychiatrist. We worked very close together to find medications and counseling that would work for me. I was in better shape than I had been in years. However, he retired and I lost any interest in trying to find another doctor. I also stopped the meds I was taking and also seeing the counselor. Needless to say I became a total mess.
After a third suicide attempt I was committed. There I was diagnosed as Manic Depressive. I tried everything short of shock treatment. I was put on Lithium and Paxil (which was changed to Effexor). I was taking 2 pills of each. I had great highs but the lows were debilitating. It would take at least a week to 2 weeks to get functioning again. I kept going off my meds each time I felt good. It was a vicious cycle.
It was just a year ago that I came across a psychiatrist, who actually listens to me and is not anxious to up my dosage or give me yet another pill to take. He diagnosed me as Bipolar 1-moderate mixed. I have been weaned off the Lithium and have started taking Lamotrigine. Now I am slowly being weaned off the Effexor (which is detrimental to the treatment of Bipolar Disorder). I am doing great!!!!
Didn’t mean to write a book. I said all that just to say this…I knew my problem wasn’t physical, sooo the thought of going to a GP never crossed my mind. Why would it?
Hi Jacqui,
My GP has also been fabulous and she leads my team. I don’t change anything unless she approves. She in her wisdom defers to my psychiatrist. However please do not be so hard on Natasha – read the blog on bipolar anger – she is bipolar. I would also venture to say that she is most definitely passionate about what she is writing about and like it or not she is correct.
Hi Mark,
My psychiatrist, therapist and GP all communicate about me and someone puts eyes on me every week right now. My psychiatrist was on maternity leave and I hadn’t seen her since Oct. In Sept I decided to go off all meds. My GP put me on a med for hot flashes and that contained an antidepressant. I started to rapid cycle and did some things that really scared me. I’m back on 10mg of Abilify for almost a week now but not really “better” yet.
You’re so right; general practitioners shouldn’t treat mental patients. Although I had and have whenever I need, a physiatrist free of charge I have to take care of my other health problems with my general practitioner and most of the times she doesn’t know how to talk to me. There’s nothing written in my forehead saying I have bipolar disorder type II unless I say I do, you can’t guess. And it’s not just about these professionals. Most doctors, no matter their specialties, they aren’t taught to address mental patients in sensitive matters of any kind in any situation. The stigma is always there either they are physiatrists or not. What makes me very angry is; just because you have bipolar is almost sure you won’t be taken seriously before you even open your mouth. How can we ever change these issues about mental patients?
Interestingly, I just stumbled across an article in the current issue of Doctor’s Review that talks about sharing care between psychiatrists and family physicians: http://www.doctorsreview.com/features/who-treats-depression/
Does it by chance mention True Death or suggest of have any links to it in any way? WN
“Why is it that I, a mental health writer, would do a better job treating bipolar disorder than an actual doctor?”
What a terrible generalisation! I don’t necessarily agree, nor disagree, with you… but you sound so angry and patronising! My GP is not a psychiatrist, nor a bi polar specialist ,nor does she pretend to be but my god she has been there for me over the years… including when I wanted to rant in a hypomanic state about how incompetent my (highly competent) psy is. She has always known what to do and has probably saved my life a few times and is the backbone of my bipolar care team.
And I am sorry to be blunt… but are you qualified as a “mental health writer”? Or are you someone with mental health issues who writes very well? There is a difference.
Peace. x
Thanks so much Natahsa, another excellent article! I agree, however…
even psychiatrists stuff up with diagnoses.
In my thirties my bipolar (further complicated by C-PTSD) was treated for years by a psychiatrist as depression, even though I was seeing him at least weekly and sometimes 3x a week when I was very unwell. He never seemed to pick up that when I thought I was well I was actually manic! So I was on (and off) anti-depressants for around a decade. I also saw a couple of psychologists in that time and no one picked it.
In my late forties with a new psychiatrist I self-diagnosed my bipolar as a result of an elderly family member’s comment comparing me to my mum “I can’t imagine you being that manic” and my catching a stray thought in response “oh but you haven’t seen me!”. Bingo! Back to my psych I told her what I now understood as my full history and she said yes you have bipolar type 1.
As far as meds go I don’t take them (I was severely ill at the time of the diagnosis as a result of taking an SSRI for my depression).
Once we realised that
a) I’d been managing the mania all these years on my own (usually by force crashing myself into depression without really understanding what it was I was avoiding by doing so)
b) medications generally haven’t worked well for me, it has often make me sicker, or at best done nothing
c) I’ve managed all these years to stay out of hospital, mainly because I’m so terrified of being hospitalised
d) I’ve learned to manage the depression much better, so I don’t experience suicidal ideation as I used to – the glimmers I get now are a signal for me to open the internal closet and embrace the skeletons which are in pain.
I know many people find medication helps them a lot – which is great. Unfortunately some of us are made worse by it. Correct diagnosis helps a lot either way, as it least gives some better self-understanding which makes room for self-compassion.
And hope always endures for finding our own path to wellness…
Kind regards, Kristin
I don’t think I would attach my computer to my car and go through a car wash to clean up the hard drive. The results might look bright on the outside, but the problem is with the inside. Ideally, I would hope that a GP would refer me to a specialist in depression or bipolar. Then, begins the challenge. BTW – I would expect that for any other physical ailment…We are blessed to be living in a very medically specialized period.
Many GP’s are capable of recognizing and handling (very well) many illnesses without a referral. Given the shortage of specialists on many occasions, that is a good thing! Knowing when to refer isn’t always easy though, and many GP’s aren’t good at that in one or more areas.
This article comes right smack bang at the time when I’m trying to get a referral. Some healthcare professionals cannot believe the way my care has been handled. Its in direct conflict with the NICE guidelines for handling bipolar.
I was first diagnosed with Bipolar two years ago by my GP. Six months after I was allocated a CPN and saw a registrar for ten minutes who diagnosed me as rapid cycling bipolar. I have not once seen a psychiatrist.
I now have three GP’s and one rather useless CPN trying playing around with my medications to find a cocktail that works!
I have contacted my local Advocacy service to deal with this on my behalf, which I would recommend anyone do if they are in the same situation. Although they are also inundated and can’t help immediately.
Natasha, I’m going to sort-of-agree, sort-of-disagree with you.
As you allude to in your last paragraph, there are exceptions and special cases. If you’re going to reduce your point to a one-liner, yes, I totally agree with you. If you want to share your frustration with incompetent GP’s who are way out of their scope and causing untold and incredibly needless damage to patients with a range of mental illnesses… well, please don’t get me started!
But, a few comments, mostly amplifying what you said.
1. There is no standard bipolar, and many (though not enough) remain stable for a very long period of time on the right meds. Even for those who have some fluctuations, a few have through experience discovered a med intervention that can quickly and reliably get things under control (usually coupled with a partner who is acutely sensitive to the signs of an episode). These select people can successfully be managed by the right GP.
2. GPs are generalists, but often have better knowledge and experience of some areas than others. While it’s way more likely you’ll find a GP whose knowledge (and tolerance for) mental health is lower than in other areas, there are some who are very on top of things.
3. While I’ve seen it work badly more often than work well, a collaborative care approach, where the GP has a psychiatrist available for advice and/or intervention when things go south, can be very effective. This is especially true in the cases where a GP can see the patient more regularly and/or for longer, which increasingly isn’t always the case.
4. There are some very shitty psychiatrists. Not just those who take forever to get into, but those who spend ten minutes and think they’ve decided they know everything. Or that will see people once every six months for five minutes without really listening. Again, don’t get me started.
So in general, I have to say I agree with you, but as usual, in the specific cases, “it depends”.
Mark
You say that many bipolar “patients” remain stable on meds for a very long time. What happened in the decades before medication to people? Did they spiral out of control like an amusement park ride and were quckly killed by the rather dispiriting notion that one’s own brain is non-functional, kind of like a dog that was trained and left out in the rain. Of course that dog is not “functional” as much as “wild” dogs, but I’ve seen time and again dogs let loose that turned wild.
Spot on!
Yes, and the other thing that needs to be made known is that if a GP is treating someone for “depression” and they have negative side effects or can not tolerate an anti-depressant or two at that point the red flags are up and someone who is truly a specialist in mental health needs to look at them, as they may be actually bipolar or have some form of treatment resistant depression. My personal opinion after my own experiences is a GP should only treat “depression” if certain testing like an eye focus test or even a personality test are give that indicate no possible presence of an underlying bipolar disorder. I think something like that needs to be the standard to most likely immediately catch people who need/potentially need more specialized care…
Oh MY How True!! I have the best GP, and she has been on my side for a couple years. For some reason I kept falling through the cracks for the psychologist and after last fall’s big crash she started pushing on the Psych, and I finally got to see her.
The difference in my life is profound! After following my Psych’s recommendations I am finally feeling human. Yes it meant new meds, and that was terrifying, but Oh! I am feeling so much better!
Push for that recommendation folks, it may take months like it took for me but it’s SO worth it!!