Here are my top 10 tips for getting the right diagnosis and accessing the support you need:
1. Try to see the same doctor every time and any time you feel your mood shift dramatically go and see them so they can get a sense of who you are and what you look like in different moods
2. Ask to be referred to your local mental health team for a psychiatric assessment. Unless you present to your GP in the middle of a crisis most Doctors tend to diagnose depression. This makes sense when you think about it, do you tend to go to the GP because you feel good? Not usually, but you will go when you start to feel low; without seeing your hypomania or mania it’s easy to see how a misdiagnosis can happen. GPs actually know very little about mental health compared to a specialist and are only allowed to prescribe certain medications. For example a GP couldn’t prescribe me lithium without it being approved by a psychiatrist so it really is helpful to get referred if you can.
3. Keep a moody diary, you can get templates online specifically for Bipolar and they’re a great way for you to see how your moods are fluctuating. If you’re already taking medications then ensure you make a note of this on your diary. A lot of GPs will initially prescribe anti-depressants which for someone with Bipolar are a no go as they can send you high; if this is reflected in your mood diary it will help a Psychiatrist to diagnose. Most Psychiatrists will initially ask you to keep a mood diary for a month to get a sense of how you’re feeling so you’ll cut time if you’re already on it.
4. If you’re comfortable doing so then speak to your friends and family and ask them to keep note of your moods too. To save arguments you might want to ask them to keep their notes private from you until you need them, I always argue I’m just happy when I’m starting to go high and then sheepishly apologise later when I realise they were right all along.
5. Discuss with your family about what you want to happen at different stages. For example if you can see that at points you can be so unwell that admission would be good for you then make that arrangement when you’re well. You will never want to be admitted so it makes it much easier for your family to make that decision if you’ve asked them to when you’re well. It sounds terrible but your chances of a diagnosis improve in a ward setting where they can see you in crisis and can monitor your moods more closely
6. Use community support that is offered to you, a CPN for example is really helpful in getting a diagnosis as they can see you more frequently and get a real sense of who you are and how your moods change. CPN’s will report back to your Psychiatrist and are particularly good for feeding back an elevated mood which you might otherwise not have picked up on yourself or raised with your Psychiatrist.
7. Engage with services, it sounds gross but the more willing you show the more support is offered to you. The NHS are very pro responsibility, this means you need to take ownership and help yourself, if you don’t and are deemed to have capacity then a lot of support is withdrawn. It sounds unfair and in some circumstances it is but if you show that you are willing to try then services are much more likely to be sympathetic. An example would be my constant changing of medication, I have been a royal pain the bum in my refusal to settle with a medication which doesn’t feel right but by making all of my appointments, taking mood diaries and following a WRAP plan I have proved that I am not being deliberately uncooperative and as a result they have pandered to my stubbornness surrounding medication.
8. Try different forms of support out and then dismiss the ones that weren’t useful to you but crucially don’t rule anything out initially. Medications will generally feature in a diagnosis of Bipolar but these can include a range of anti-depressants (rarely), anti-psychotics, mood stabilisers and anti-anxiety medications. At the beginning I was loathe to take anything extra on top of my mood stabiliser, these days I recognise that I can sometimes curb an episode by taking an anti-anxiety medication or sleeping tablet for a few weeks. I was also offered therapy but found that I was able to articulate my feelings to my CPN effectively without the need for a therapist but some people have found this outlet very productive; without experimenting I wouldn’t have found the right plan for me or felt satisfied that it was my best option.
9. Similar to point 9 give treatments time to settle in and take effect. You might find that something that makes you super drowsy at the beginning eases off after a week or two. When I first started taking Promethazine for anxiety I found it relaxed me a little too much and I had to take it at night, now it’s settled a little I can take it in the morning and my body is tolerant enough for it to just calm me if I’m feeling overly anxious.
10. Listen to your gut! My mum instilled this in me from a young age and it is exceptionally useful in this instance. If your gut tells you you don’t have the right diagnosis then listen to it and discuss this with your support team when you’re calm. If you’re being told to stick out another week on a medication that is making you feel terrible then explain this rationally to your team. My gut has come in handy (aside from the IBS) many a time, from when I knew something wasn’t right with the way I was feeling at the beginning to refusing to accept weight gaining medications. As long as you have capacity and explain your thought process calmly and logically it must be taken seriously. As with anything in life a carefully thought through and explained argument will go a lot further than an over emotional and chaotic one!