Photo credit: Bipolar II Disorder: Recognition, Understanding, and Treatment, by Ed. Swartz, Holly A.Paperback
The following is an excerpt from my upcoming memoir, BrainStorm: From Broken to Blessed on the Bipolar Spectrum.
We drive back to Massachusetts from Florida at the end of March. It’s still icy, raw and grey in March, but I find solace being back with my circle of friends. Lisa has told our friends and family that I’m in truly bad shape. She decides to create a triage team to pull me out of the pit I’m in. She emails my closest friends, saying that I need someone to find me a psychiatrist, a therapist, and a body worker, someone else to cook and put food in the freezer so that we can feed the kids, someone to give Joe a break and help with childcare, and lots of people to get me out of the house and walking.
It’s my sister, Martha, who finally finds a responsible, caring, skilled and dedicated psychiatrist, Dr. Michael Perlman. Given our mother’s history, Martha agrees with me in suspecting that I am bipolar, so she researches doctors with expertise in affective disorders. She gets the referral from a Pilates client in Boston who is a therapist. Joe makes the appointment for me on a Thursday afternoon. But the idea of driving thirty-five minutes, finding Dr. Perlman’s office, and getting there on time is too daunting for me. At our next gathering, I tell my women’s circle that I have this appointment, but I’m afraid to go alone.
“I’ll take you,” Annette says in her characteristic upbeat tone.
We arrive at Dr. Perlman’s office at 4:00 PM for a thirty-minute appointment. I’m immediately turned off by his office. Stacks of books and piles of papers litter the floor. There’s barely a place for Annette and me to sit. How can this guy think straight in a mess like this?
Dr. Perlman sits down opposite us with his computer screen and Blackberry lit up. He’s distracted, I think. He’s not going to be able to focus.
At six feet four inches, Dr. Perlman has silver hair, a trim beard, clear blue eyes and glasses. I like the silver hair. Maybe he has some experience.
My judgments about the disarray of his office melt away when he begins his intake with a series of pointed, clear questions that no one else has asked me.
“When you were on Lexapro,” Dr. Perlman asks, “did it make you speedy? In other words, did you feel like you had five thoughts at once and had to express them immediately?”
“Did people give you feedback that you were interrupting them or were more irritable than usual?”
“Yes. My closest friend, my brother, and my husband all said these things.”
“And you say your mother responded positively to lithium for three or more decades?”
“Yes, absolutely. When she came off it last year, she tanked. Then she had electric shock therapy. We all agree that ECT saved her life, but she’s adamant against me doing it; she says she lost way too much memory.”
“I’ll put money on it. You’re bipolar. No doubt.”
Thirty minutes into an interview, and he’s figured this out. How did the other four psychiatrists I’ve been to, including a published psycho-pharmacologist from Columbia University and the “best of the best” from Harvard, miss these simple clues?
Perlman is unequivocal in his diagnosis that I have bipolar II. This form of bipolar disease doesn’t manifest in mania; I’ve never had the characteristic wild highs of mania. But it does show up in dark, persistent, debilitating depression. And because it shares the symptoms of typical depression, low mood, weight change, loss of memory, no joy in life, it is most often diagnosed incorrectly as unipolar depression. The patient is then prescribed one of the SSRIs – Prozac, Lexapro, Paxil – and sent on her way. Now, I’ve learned about the disastrous consequences of this mistake. SSRIs are toxic to the bipolar II brain. Everything I’ve been prescribed, everything I’ve taken until now has made me much, much worse. Lexapro had nearly been a death sentence for me, inducing racing thoughts, sleepless nights, bloody fingers, and suicidal dreams.
I leave Dr. Perlman’s office with a prescription for Lamictal and paid him the $10 co-pay required by my insurance company. Ten dollars. That’s it.