What’s in a Diagnosis?

A doctor taking notes

It’s been pretty clear to me and my loved ones that I’ve had depression for a long time. My first really bad episode happened when I was 22 years old. I was living in Los Angeles, had almost no friends, and drove up and down Pacific Coast Highway because I knew if I stayed in my apartment I would try to commit suicide. Things got better after I moved back to the San Francisco Bay Area, got a good job, and started doing aikido.

I didn’t get treatment for my depression until I was pregnant with Kaylee. I had hit Zach on the butt really hard, and I felt like a horrible mother who deserved to have him taken away from me. I joined a postpartum therapy group and started taking Zoloft. One of the side effects of antidepressants is that sometimes they can make a person suicidal. Ironic, I know. I was hospitalized for eight days. Thankfully, I started taking Celexa instead, which had only the brief, mildest side effect of slightly loose stools.

There have been times when I wondered whether I was also bipolar. My therapist suspected it when I had a manic episode in her office right after Kaylee was born. I had another episode a few days ago and talked to my psychiatrist about it. He said that I appear to have a “subclinical case of hypomania.”

Basically, I have a rapid succession of thoughts, a huge surge of energy, less need or ability to sleep, and feelings of euphoria. I do NOT have any urge to have illicit affairs, to gamble compulsively, and I don’t have delusions of grandeur.

The National Institute of Mental Health lists four different diagnoses for bipolar disorder. I keep reading them over and over, and I can’t tell the difference between the bottom three. I’m just sure I don’t have Bipolar I Disorder, since I don’t have full-blown manic or mixed-state (concurrent mania and depression) episodes.

I guess in some ways, it doesn’t really matter what the specific diagnosis is. I definitely have depressive episodes where I get really irritable, lose interest in activities I usually enjoy, want to sleep excessively, and start to have suicidal thoughts. I infrequently have surges of energy and euphoria, but I’m aware of them, and consciously try to slow my breathing, my heart rate, and my thoughts. Writing seems to help for both of these states.

My psychiatrist said we should monitor my symptoms and avoid any possible triggers. I know that caffeine and sugar definitely cause me to have mood swings. I usually only drink decaf or caffeine-free drinks. Sugar is a hard one for me to cut out. I tried a few weeks ago, and I seriously only lasted three days.

There are many other possible triggers, such as changes in my hormone levels, inadequate sleep, and stress. I’m also starting to wonder whether the hypomania is an intermittent side effect of the Celexa.

A diagnosis can be helpful, but I think it’s worked for me to focus mostly on the symptoms, the causes, and effective treatments.

Whatever the medical condition (physical, mental, etc.), do you find it helpful to have a diagnosis? Are doctors ever reluctant to provide one?

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