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Garbage In, Garbage Out – The Failure of Depression and Bipolar Treatment Starts With Assessments

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The Experts Are Asking The Wrong Questions About Depression And Bipolar Disorder.

Over the last ten years I have spoken with thousands of people diagnosed with bipolar disorder. When I ask them to relate their story of how they were diagnosed, a troubling pattern is pretty evident; the diagnosis was very brief and largely irrelevant in regards to bringing any hope to the situation.

Most people I have talked with see the assessment as a life sentence with no path for making life work the way they had hoped for. I wonder where they got that idea?

For the last five years I have been speaking to groups of therapists and doctors. When I tell them assessments are not thorough enough they are often in agreement about others, but believe their own assessments are very thorough and use the best evidence-based tools available.

What tools? The Beck Depression Inventory (BDI) takes about 10 to 15 minutes to complete the 21 questions in a self-report format including the items intended to measure symptoms of severe depression that would require hospitalization. The BDI has been used for 35 years and is reported as being highly reliable regardless of the population. The Hamilton Depression Scale asks only 17 questions. There are others, of course, but none provide the insight needed to achieve Depression IN Order or Bipolar IN Order.

Poor assessments are why they have such poor outcomes. In their conclusion of the largest study of bipolar disorder, the National Institute of Mental Health said, “According to the researchers, these results indicate that in spite of modern, evidence-based treatment, bipolar disorder remains a highly recurrent, predominantly depressive illness.” With such little data from the assessments to work with, it is hard to determine the right course of action to produce better results.

But have no fear; the University of Michigan has created such a thorough assessment for results in depression that they call it “Toward a more comprehensive assessment of depression remission: the Remission Evaluation and Mood Inventory Tool (REMIT).” It only has 5 lame questions: Did you feel happy? Did you feel content? Did you feel in control of your emotions? Did you bounce back when things went wrong? Did the future seem dark to you? I have one question for them: Do you really know that little about depression?

From the perspective of someone with Bipolar IN Order, the common assessments show that the authors of them have very little idea of what they are talking about. They seem to think that we are so unaware that we can only handle a few superficial questions before being prescribed powerful drugs that will make us unable to be clear about anything. When confronted with my point of view the “experts” tell me there is a whole battery of such tests, but I have seen most of them and they are pretty much the same simplistic questions with overblown “studies” claiming how profound their insights are.

What is worse is that too many of us are not even being asked such simple questions. My experience, unfortunately, is all too common. The first time I was diagnosed with depression I went to an MD in general practice complaining of backaches. Without asking any questions, she took less than five minutes looking at me and sent me on my way with a Prozac prescription and a declaration that my backaches were a sign of depression. When I refused to pay for the visit I was called by her collection agency. I told them I would sue for malpractice and never heard from them again.

My second diagnosis, again for depression, was only slightly more thorough. It was several years after the first one and I had been going to a clinic several times for various aches and pains. After about five visits they told me I needed to see a regular doctor instead of just dropping in. The new MD, also not a specialist in depression or bipolar, asked a few details of my current situation and said the reason I had been in so often was because I was depressed.

I told him that I was going through a rough time and he said my depression was an adverse reaction to the difficulties I was facing. He suggested Lexapro and told me I would only need to take it for a short time until I got through it. He was convincing, so I took it, but it had no clear effect.

Like so many affected by our “Best Health System In The World™” I had to switch providers when I changed insurance companies, so I lost the relationship with the doctor that at least knew something about me.

When I told my new doctor (this time a Psychiatrist) about the Lexapro not working, he switched me to Effexor. It had a huge affect on me; within a few weeks I became psychotic and started rapid cycling every five minutes from extreme depression to extreme manic rage.

The next day I went to see him again and he declared, “You must be bipolar. Reactions such as yours are a sign of it.” At that point I was beginning to think MD stands for Mis-Diagnosis.

He switched me to Lithium and at least this time I was given a short questionnaire to base the diagnosis on instead of just my adverse reaction, but there never were any formal tests. I proceeded to see him for fifteen minutes every month or so and he changed his diagnosis a couple of times based on how I had been since our last meeting.

One memorable encounter was when I told him that in the last month I had been both deeply depressed and extremely manic. He said, “Are you aware that you just said the opposite things?” as if I had no idea what had happened to me over the course of the last month. I am not surprised he would think that, though. He had me so over-medicated that I spent much of the time laying next to the toilet because it was more convenient during the frequent times I needed to throw up.

Other than my own extensive research, I never was given a “proper” assessment if that is what you want to call the simplistic sets of questions I mentioned above. Even if they had, it is hardly enough to be used as the basis for handing out powerful agents that change our brain chemistry. Although I am still in support of some of what Psychiatry is trying to do, it is no surprise that others are not as forgiving and are pretty hostile. Too many of them have experienced far worse.

The therapists I relate my story to are usually not surprised, but too many act as if my story is the exception to the rule. My hope is that you will share your story so they will see the error in their thinking. Please do so in the comments.
Creative Commons License photo credit: vintspiration

Garbage In, Garbage Out – The Failure of Depression and Bipolar Treatment Starts With Assessments

Tom Wootton

Tom Wootton - see on YouTube, follow on Twitter, or Facebook - is CEO of Bipolar Advantage. Along with experts in complementary fields, including doctors teaching the next generation of therapists, their mission is to help people with mental conditions shift their thinking and behavior so that they can lead extraordinary lives. Tom is the author of three books: The Bipolar Advantage, The Depression Advantage, and Bipolar In Order: Looking At Depression, Mania, Hallucination, And Delusion From The Other Side.

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APA Reference
Wootton, T. (2012). Garbage In, Garbage Out – The Failure of Depression and Bipolar Treatment Starts With Assessments. Psych Central. Retrieved on August 15, 2020, from


Last updated: 27 Aug 2012
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