One Patient's Recovery from a Bipolar II Mood Disorder

By Robert Sealey, BSc, CA
author of Finding Care for Depression, Mental Episodes & Brain Disorders

Introduction
My name is Bob. I work as a self-employed professional in North York. Many years ago I studied biological and medical sciences and psychology for a BSc degree, then took night courses in commerce and finance, qualified for a CA designation and became an accountant and consultant. A third of my clients have episodes of depression, anxiety, bipolar disorder, epilepsy, migraines, schizophrenia, autism or dementia or care for family members. While working as an accountant for more than 30 years, I met many decent, honest people. During a year as a fraud investigator, I learned that unethical people cut corners or override controls when they exploit innocent victims.

Episodes with Black and Blue Moods Until, Finally, The Right Diagnosis
My symptoms recurred over 28 years, but I didn’t know they were symptoms. Variable, volatile, reactive, intense, hypersensitive, periodically creative, surgingly energized and hypergraphic, I was also vulnerable to episodes of depression and anxiety. Black and blue moods alternated with normal periods and high-energy outbursts. For more than 20 years, I consulted physicians, psychologists and psychiatrists. As a trusting and cooperative patient, I tried their pills and talk therapies but something always went wrong. At first I was undiagnosed and untreated, then misdiagnosed and mistreated, even lied to and laughed at, or so it seemed. Those health professionals did not identify any cause(s) of my symptoms or offer restorative care.

Without proper care, I got worse. Just like ending a nightmare, I needed to wake up! At age 45, I found the right diagnosis in medical books – a bipolar II mood disorder, a form of manic depression (prolonged episodes of depression alternating with normal periods and flare-ups of hypomania, a high-energy state of mind). Variable moods make a bipolar brain difficult to live with and hard to diagnose. Getting a diagnosis helped me understand and accept that my brain was not mad, sad or bad, just moody. I wondered how to restore it and maintain it feeling well.

WRAP Tool #1 - Bibliotherapy – The Depression Workbook 
Alone with symptoms, I needed to learn how people recover from mental episodes. Reading became my first wellness recovery tool. I read about psychiatry, psychology and medicine, hoping to find restorative care for bipolar disorder. I became a well-read patient. The Depression Workbook: A Guide for Living with Depression and Manic Depression introduced other people with mood disorders. Their stories renewed my hope. Author Mary Ellen Copeland, PhD, a Vermont psychologist, had a bipolar disorder herself. Several years later, her W.R.A.P. book explained how a patient can develop a Wellness Recovery Action Plan.

The Practice Guidelines of Psychiatry Recommend Standard of Care Procedures
Eventually I read the practice guidelines of psychiatry. Clear and helpful, they recommend standard of care procedures for diagnosing and treating depression and other mood disorders.
The standard procedures for diagnosing a mood disorder include: (1) mental status exams;
(2) patient and family medical and mental histories; and (3) medical and psychological tests.
After making a diagnosis, a competent doctor uses standard procedures when caring for a patient:
(4) plans, discusses and offers safe and effective treatments; (5) explains risks and benefits; gets the patient’s informed consent before prescribing medications; (6) monitors progress; watches for problems and (7) monitors blood levels (if patients take lithium) and tests kidney function.

Quick Labels and Easy Pills – a Shortcut Alternative to Guideline-Quality Care
Would any competent psychiatrist shortcut the guidelines, label a sick patient as depressed and prescribe pills without medical tests or diagnostic workups? I cannot explain the rush to pills other than the obvious. Thousands of people have episodes of depression, anxiety, schizophrenia and bipolar disorders, migraines, epilepsy, stroke and dementia. No wonder the healthcare system gets overloaded. Without enough psychiatrists to go around, apparently some doctors cut corners. Quick labels and easy-to-prescribe pills, without warning about side effects or risks. Lithium for bipolars, antidepressants for depressives, even antipsychotics and the ever-popular two and three drug combinations which many doctors prescribe and lecture about, year after year. Quick labels and easy pills sound efficient, but what if a misdiagnosis leads to a mistaken prescription?

Nobody likes it when a moody patient gets sicker, not the doctor, not the family and certainly not the sick person. The system has three labels for these patients: (1) refractory depression,
(2) treatment resistance or (3) borderline personality. Unfortunately, these labels do not diagnose any medical or psychological problems. These labels do not treat any illnesses.

My Psychiatrist Wrote About “Refractory Depression” – his Chief Edited a Book
In 1995, I consulted a psychiatrist who specialized in mood disorders. I was an outpatient of the mood disorder clinic at a large Toronto teaching hospital which had 10,000 health professionals on staff, including 30 psychiatrists. Four years before, my doctor wrote an article for a medical journal in which he defined “refractory depression” as meaning problems with diagnosisand / or problems with treatments. His article outlined 6 steps for doctors to diagnose and treat depression. Both the Canadian and the American practice guidelines refer to that article. Per his analysis, a depressed patient needs an accurate diagnosis; a differential diagnosis focuses attention on the underlying cause(s) of symptoms. A depressed patient cannot recover without effective treatment. According to his article, a patient with refractory depression needs help: diagnosis and treatment.

His chief psychiatrist trained at Harvard medical school and cooperated with 31 mental health professionals to write a book about diagnosing and treating mood disorders. When these doctors write, they recommend guideline-quality care, but how do they practice on sick people?

A Case of Willful Incompetence by Shortcutting, Misdiagnosing & Mistreating
My doctor did not six-step with me. He quickly noted “refractory depression” and wrote easy prescriptions. His shortcuts were not consistent with his own article or his boss’s book. Instead of following standard procedures, the expert psychiatrist cut the care short. After each hour-long appointment, he noted nine words in the medical file. His notes prove that: (1) he did not discuss medical or other causes or make a diagnosis; (2) he did not discuss, do or document any standard of care procedures or any other helpful treatments; (3) he did no mental status exams, took no histories, ordered no medical tests; (4) he did not discuss risks or get informed consent for pills; (5) he did not check lithium blood levels or kidney functions and (6) after every visit, he noted “refractory depression”. For 8 months, his notes prove that he relied on shortcuts. As I got sicker.

The Doctor Noted Problems with Diagnosis and Treatments in My Medical File
When he noted “refractory depression”, in my medical file, month after month, the expert knew there were problems with diagnosis and problems with treatments. Even so, his notes show that he kept increasing the doses. He prescribed one medication at more than twice the maximum recommended level. He did not note that he always smiled and said “you will get well” while ignoring the reality that his pills made me worse by causing side attacks and toxic effects. His notes did not mention the appointment when my wife, a registered nurse, observed “My husband is fading away.” As the months passed, I deteriorated. Suicidal thoughts came every day – I did not want to die or leave my family with that anguish; I just wanted the pain to end!

Why So Many Shortcuts?
Why would an expert psychiatrist practice that way? Was he too busy to diagnose accurately? Was he too tired to treat properly? Was the bad outcome my fault? I was polite and well-dressed, a self-employed professional, a trusting and a cooperative patient but, who would notice if a mental patient got worse? In hindsight I was wrong to trust that psychiatrist. His shortcuts nearly cost me my life. As a published expert who specialized in mood disorders, he knew how to diagnose accurately and he knew how to treat effectively. No patient can predict whether any doctor will take proper care, follow the practice guidelines and use standard of care procedures for diagnosis and treatment. A sick patient cannot control the quality of care.

Why did I get substandard care as an outpatient of one of the largest teaching hospitals in Canada? The life-shredding impact of those incompetent shortcuts still haunts me years later.
I would still like to know why the care was substandard. Why so many shortcuts when my psychiatrist was a published mood disorder expert? Where was his boss, the chief psychiatrist?

A Second Opinion – Medication Triggered Hypomania
One day, my expert was not available. His colleague did a mental status exam, listened carefully, spoke calmly and detailed his notes for my medical file (which I saw two years later). My antidepressant medication, an SSRI, was causing hypomania - an energy surge. Later that day, a neuro-psycho-pharmacologist at the drug company confirmed that the medication can trigger hypomania in some patients. Their 30-page product monograph listed hypomania and other problems which the company discovered when they researched that antidepressant.

Had the Expert Psychiatrist Misdiagnosed and Mistreated Before?
I wondered if anyone else had been misdiagnosed and mistreated. With patient records kept confidential, could one patient learn about other patients? It did not take long to google. Yes my expert had misdiagnosed and mistreated before. How do I know? The psychiatrist wrote about another bad outcome for a medical journal, apparently after learning that antidepressants are not the correct treatment for a brain tumor! Where is that patient today? Dead. He killed himself.

Reporting Incompetent Shortcuts and Two Hearings with the Medical File as Evidence
Note - My case is a matter of public record at the Health Professions Appeal & Review Board. With the case on the public record, I can write about it without getting sued. I do not name the psychiatrist or his boss or the hospital where they misdiagnosed and mistreated. They know who they are; they know how they practiced on sick patients. In 1997, two years after recovering, I complained to the College of Physicians and Surgeons of Ontario (CPSO). They asked to see my medical file. It had clear evidence of shortcuts and willful incompetence. The Health Board heard my story in 1999 and 2002 and documented two hearings for the public record. At first the CPSO dismissed the complaint, then they cautioned the psychiatrist about history-taking. Will anyone ever investigate the shortcuts and take action to protect sick patients? According to the Regulated Health Professions Act (the law in Ontario), the CPSO must investigate. Even so, the College of Physicians and Surgeons of Ontario dismisses 99% of complaints without investigating thoroughly and without taking action to protect sick and vulnerable patients from substandard shortcuts and willful incompetence. The registrar disclosed that 99% efficiency rate to The Medical Post. In 2001, my former psychiatrist was elected to the governing council of the CPSO and appointed to the Discipline Committee which hears allegations of medical incompetence. In that role, he processes reports of bad outcomes involving physicians.

WRAP Tool #2 - Networking with Patients, Families and Health Professionals
The stigma of a chronic mental illness distances depressives from healthy family and friends. Fault-finding and excluding do not help when sick people need competent medical care as well as encouragement and support. Eventually, I decided to look for other people with similar problems, hoping to learn how they got well. Networking became my second wellness recovery tool.

At meetings of the Mood Disorder Association of Ontario – Toronto chapter, I met people with depression, manic depression and dysthymia. We heard lectures by health professionals. Most patients were anxious and unsettled, wondering about their treatments and their prognosis. We compared symptoms, side effects, diagnoses, and treatments. Some people did well taking high doses of meds, but others could not tolerate even low doses. Some talk therapies helped us improve our patterns of thinking and feeling but it was hard to make progress when we were sick.

Independent Depression Project
For several years, I operated IDP (an independent depression project). I read hundreds of books and medical journal articles, studied the mental healthcare system, interviewed more than 150 people and wrote a series of articles and several books. One day, a depressed woman mentioned the Journal of Orthomolecular Medicine. By that time, the journal had been in Toronto for five years. Ortho-molecular, an unusual word, means “correct the biochemistry”. Imagine my surprise to find restorative care just two miles away.

WRAP Tool #3 - Restorative Orthomolecular Medicine
Editor Steven Carter listened to my concerns and kindly recommended several books about orthomolecular medicine. Those books saved my life! Even though I was cranky after years of bad moods and failed treatments, his pleasant invitation encouraged me to read about restorative care, the 50-year history of scientific and medical research, the success of orthomolecular medicine and the progress of recovered patients. Could ortho-care become WRAP tool #3?

Books – The Way Up from Down, Nutrition & Mental Illness, Adventures in Psychiatry
Curious but skeptical, disillusioned after years of failed doctor-patient relationships and determined to avoid shortcuts, I read how orthomolecular doctors applied the life science of biochemistry to the art of medicine. The Way Up From Down, by California psychiatrist Dr. Priscilla Slagle, (whose own depression resolved when she used orthomolecular medicine), taught me how to take vitamins and nutritional supplements. One at a time. Slowly adjust each dose. Continue taking what works. The year before, I responded to extracts of gingko biloba and valerian but I restored my mental health by adding vitamins, minerals and amino acids – precursors, energy and enzyme co-factors and antioxidants. Nutrition & Mental Illness, by Dr. Carl Pfeiffer, outlined three orthomolecular regimens. His book explains that the optimum treatment depends on each patient’s diagnosis and biochemical individuality. Dr. Pfeiffer’s histamine-lowering regimen, with therapeutic methyl sources, worked well for me.

Adventures in Psychiatry - The Scientific Memoirs of Dr. Abram Hoffer explains how biochemists and psychiatrists cooperated to research and develop orthomolecular medicine in Canada - 50 years ago! In the 1950s, Dr. Abram Hoffer, Dr. Humphrey Osmond and their team researched the adrenochrome hypothesis for schizophrenia and developed restorative regimens for psychotic patients. Many of their patients recovered. Later, they developed the concept of orthomolecular medicine as a restorative dimension of care. Their approach has helped thousands of patients to recover and live well. Dr. Hoffer wrote about orthomolecular medicine in 30 books, more than 500 medical journal articles and many editorials for the Journal of Orthomolecular Medicine.

Recovery – Customizing a Regimen of Brain Fuel Supplements
With Dr. Hoffer’s, Dr. Slagle’s and Dr. Pfeiffer’s books as medical guides, I tested several B vitamins and vitamins A, C, D and E. Guided by other books and doctor-authors, I added mitochondrial supplements and trace minerals including carnitine, ribose, co-enzyme Q-10, trimethylglycine, GABA, magnesium, zinc, manganese, chromium and selenium. Optimum doses act as “brain fuels”. Since 1996, my orthomolecular regimen includes vitamins, minerals, amino acids, energy and enzyme co-factors, essential fatty acids, hormones, antioxidants and probiotics. These brain fuels complement gingko biloba, my antidepressant-antianxiety medication.
Restorative orthomolecular medicine makes sense. A depressed brain needs to “refuel” its energy, stabilize its enzymes, balance its neurotransmitters and restore its capabilities. As a sick brain heals, symptoms resolve. The recovered brain no longer misfires; bad moods pass; life looks brighter. A bipolar brain also needs to control its tendency to get overexcited. Bipolars can supplement gamma-amino-butyric acid, GABA, the brain’s natural calming neurotransmitter.

Documentary Film – Masks of Madness: Science of Healing
After years of painful problems, restorative orthomolecular medicine helped me recover and live well. Ten years ago, I started writing and speaking about restorative care. I appeared in the 1998 documentary film Masks of Madness: Science of Healing featuring Margot Kidder and six health professionals. I spoke at five conferences, meetings and workshops in Toronto and Vancouver.

ISOM conference – Nutritional Medicine Today – presenting with Margot Kidder
On April 22, 2007 the International Society of Orthomolecular Medicine hosted a workshop at its 36th conference, Nutritional Medicine Today. At the Royal York Hotel in Toronto, actor Margot Kidder spoke about her recovery. After many years of problems with manic depression, she found orthomolecular medicine and recovered. Margot has been well for ten years. Now she can work again in films and TV and perform on stage. At that same meeting, I also spoke about finding orthomolecular medicine and how ortho-care helped me recover and keep well for ten years, with no episodes of depression or hypomania. A third recovered patient was well enough to sing his presentation. Three doctors explained how they use orthomolecular medicine to care for patients.

WRAP Tool #4 - Volunteering
Volunteering became my fourth wellness recovery tool. I write book reviews, speak and network with the International Society of Orthomolecular Medicine, the Mood Disorders Association of Ontario, the United Mitochondrial Diseases Foundation and the Canadian Celiac Association. Few people recognize the word ‘orthomolecular’. As a patient-turned-volunteer, I review and recommend books written by medical professionals and recovered patients which share the research, progress and success of orthomolecular medicine. I explain how to navigate the mental healthcare maze, monitor the quality of care and ask for restorative treatments.

Andropause – New Symptoms: Diagnosed and Treated, Restoratively
At age 50, new symptoms started – difficulty sleeping, problems with memory and focus, low energy and low libido. After reading a newspaper article, I found a family doctor who diagnosed a hormone deficiency and prescribed testosterone supplements. Hormone replacement therapy worked right away. After getting a second opinion from Dr. Jerald Bain, a Toronto endocrinologist and professor of medicine who edited Mechanisms in Andropause, I continued my bipolar regimen as he prescribed supplements of testosterone and monitored my condition.

Wellness Recovery Action Plan with Four W.R.A.P. Tools
After getting the right diagnosis, I worked hard to understand my bipolar brain and develop a wellness recovery action plan with four tools: (1) bibliotherapy (reading to heal), (2) networking, (3) a daily orthomolecular regimen and (4) volunteering. My brain is not perfect, but perfectly good enough to read, write, speak, work, get along with family and friends and consult with clients. When things get tough, WRAP tools help me find quality care, cooperate with treatments, avoid relapse, and live well with a bipolar mood disorder.

Anthology of Recovery Stories - Mental Health Regained
You can read other recovery stories in Dr. Abram Hoffer’s 2007 Mental Health Regained. In their own words, 18 patients or family members describe their symptoms and their struggles to cope, find restorative care, recover and live well. Their stories share antidotes to misdiagnosis and mistreatment. My story will appear in a WRAP anthology of recovery stories compiled by Mary Ellen Copeland, the Vermont psychologist whose book renewed my hope for recovery.

Substandard Care Increases the Risk of a Bad Outcome
To wrap up - I am not anti-psychiatry or anti-medications. I do not tell anyone to stop taking their pills. That could be dangerous without medical supervision and replacement treatments. I question substandard care, warn about shortcuts and suggest caution if doctors ignore the practice guidelines and rush to pills without medical testing, without making any diagnosis and without offering safe or effective treatments.

Can sick people consider all these things? Difficult, but, healthcare is just like any other human system. Problems can get worse when systems overload; overloads can lead to shortcuts. When the focus of a healthcare professional shifts away from providing quality care to cutting corners, too much ‘efficiency’ can intersect with the tradition of nihilism in psychiatry. Patients are vulnerable. If doctors do nothing but watch sick patients suffer, their medical nihilism can increase the risk that some of their patients will deteriorate or suffer bad outcomes.

Suggestions for Coping with Depression, Mental Episodes or a Brain Disorder
If you suffer with depression or episodes of bipolar disorder, anxiety, schizophrenia, psychosis, ADHD, autism or any other brain problem, please remember this story. Do not trust your life to substandard care. During your first few appointments with a new brain doctor, you will not know whether your psychiatrist offers guideline-quality care or relies on shortcuts. When you ask for medical care, remember the saying “caveat emptor - buyer beware!”

You can become an educated patient by reading books. You can scan the practice guidelines of psychiatry for the standard of care procedures that competent doctors use to diagnose and treat. You can learn which medical, biochemical, psychological or social problems can cause episodes of depression, anxiety or other mental health problems. You can consider restorative orthomolecular medicine. No matter how sick you get, you can still monitor the quality of your care. You can ask your doctor to use standard of care and other medical procedures which researchers have tested and found safe and effective for diagnosis and treatment.

You can outline your patient and family, medical and mental histories and provide written history notes to your doctor. If those get ignored, you can ask to see your medical file. If the file has no mental status exams or diagnostic tests, you will know that your doctor has not tested you or looked for the root cause(s) of your symptoms or made a differential diagnosis. Your health professional may be a shortcutter. Do not expect to recover if you get substandard care based on quick labels and easy pills. You may test your limits of tolerance and resilience. Somehow you have to persist until you get an accurate diagnosis and effective treatments.

If you get worse, you can seek second or third opinions. If you have concerns about shortcuts or substandard care, you can compare your medical file with the practice guidelines of psychiatry. You can look for missing steps, request medical tests and ask your doctor to consult colleagues or refer you to specialists. Submit your concerns in writing; keep copies. Maybe the doctors will redo your tests, fine-tune your diagnosis, adjust your meds or suggest complementary treatments.

You can become a proactive patient. You can develop a wellness recovery action plan. You can search for and consult with health professionals who offer guideline-quality care. You can ask them to consider and recommend restorative treatments which have proven safe and effective. After you find quality care, your beautiful mind can recover and live well.

 

Request for submissions

Author – researcher seeks recovery stories for a book about restoring mental health.
(Sorry but I cannot compensate you for your story or guarantee publication.)

If you recovered from mental health problems such as a:
- mood disorder - depression, dysthymia, bipolar disorder, manic-depression,
- thought disorder -  schizophrenia, psychosis,
- attention disorder – anxiety, ADHD, Aspergers-autism,
- other – chronic migraines, epilepsy, anorexia, bulimia, stroke, OCD
and, if you want to share your experiences, consider writing and submitting your story. You could help yourself and help other people.

I am looking for stories written by people who benefited from a range of treatments which may include medication(s), talk therapies, orthomolecular regimens, transcranial magnetic stimulation, vagal nerve stimulation, EEG neurofeedback, or who recovered after the diagnosis and treatment of a medical problem which affected brain function. e.g., a thyroid, blood sugar, pituitary, cancer or hormone condition or a traumatic accident, issues, setbacks, social problems or other incidents.

I am looking for 3-5 page stories, 1200 to 2000 words long which present your symptoms, outline how you were first diagnosed and treated, share the results of your first treatments, problems, side effects, side attacks, difficulties and tell how you finally got well. I prefer stories from patients who found quality care, recovered and want to encourage other patients.

Note - As you write, you will remember what happened and think about your story. You will recall painful experiences, perplexing difficulties and healing times. Ideally you came to terms with your experiences and moved on with your life. You may find it upsetting to write; likely you will also find it helpful. If you start to feel sad or angry, please keep calm - do not distress yourself. Set the writing aside and give yourself time to process your experiences; continue writing when convenient.

The best stories will come if you write your first draft without editing. Let the words flow,
then let the story ‘simmer’ for a few days before you read, review, revise, prune and polish.
Repeat the process 2 or 3 times (more if you wish). Then decide – either keep your story private and confidential or submit your story for the book project.

For guidance writing a daily personal journal, consider J. Cameron’s book The Artist’s Way.

I cannot respond to all authors or publish all submissions, but I will contact accepted authors prior to publication. I will edit for tone, spelling, length and consistency etc., and I will ask for proof of recovery (excerpts from your medical file or a letter from your doctor or a family member).

Thank you for considering this request.

Submit your 3-5 page story, 1200 to 2000 words, in confidence, to sealey@sympatico.ca

 

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