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Comment by danieltillett | Hacker News Reader

I wonder how much of this correlation between disorders is just an artefact of inconsistent classification of patients by psychiatrists? What might be being measured here is not the likelihood of getting a second illness, but the probability that person with illness X get diagnosed with illness Y despite the underlying symptoms not changing.

I have always thought that mental disorders are no different to physical disorders. We all know some people who are robustly healthy while others seem to get a bewildering array of different diseases. Illness is not randomly distributed.

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That's been my experience. For decades, I was diagnosed with depression. Eventually, I was prescribed an SSRI. And that became a disaster, over the course of a few years.

But then I saw a psychiatrist who inquired about my use of psychoactive drugs. And based on my love of stimulants, he diagnosed me as having bipolar disorder, manifesting primarily as depression. And so he prescribed modafinil, with lamotrigine to reduce the risk of mania.

So I wonder if bipolar disorder is actually relatively common. I mean, I was self medicating primarily with caffeine, and for many years used nicotine to take the edge off. Maybe that's fundamentally why coffee, tea, etc are so popular.

Edit: typo

Lamotrigine has been a life saver for me! Way more effective than snri, ssri for me at least. I wish more people knew about it. Bonus it's like 5 cents a pill unlike so many patented depression meds

lamotrigine & modafinil (with a few other things) works well for me too

You probably know this, but for the benefit of other readers, bipolar disorder masquerading as major depression until flushed out into mania by SSRIs is a common (and dangerous) enough misdiagnosis that psychiatrists avoid prescribing SSRIs for depression until they're confident that enough time has passed that they're not dealing with bipolar disorder. It's basically the go to example of one disorder being mistaken for another.

There's a milder form of bipolar disorder called cyclothymia that is rarely diagnosed unless a patient seeks psychiatric care for a different reason. Estimates suggest it's fairly common, potentially up to 1% of the population.

Huh. I didn't know that. It wasn't well enough known in the mid 90s. But perhaps it was by the mid 00s, which is when I was properly diagnosed.

Interesting that you were diagnosed with bipolar, was the possibility of ADHD discussed, and if it was, how did they determine that it was bipolar and not ADHD?

I was diagnosed with ADHD, with the possibility of bipolar, and also have a sweet tooth for stimulants, both legal and not (I'm basically fuelled on caffeine, nicotine, and amphetamines).

I've also never heard of modafinil being prescribed as a treatment for bipolar disorder either, do you happen to have any resources on this?

There are plenty of psychiatric disorders that are demonstrably structural in nature, such as schizophrenia (likely genetic, lifelong and incurable), but there are plenty of others that seem to be a disorder in the contents of your brain rather than its structure. An example is depression, where people seem to be able to think themselves into depression and think themselves out of it.

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