Dual Diagnosis - What Is It and Why It Is Necessary
You will only hear about the dual diagnosis when you look for ways on how to treat depression or the trending bipolar disorder. The term dual diagnosis is used to refer to a person that is suffering from various mood disorder like the ones aforementioned and even those with problems on drugs or alcohol. A person that has dual diagnosis means that they have two separate illnesses and each of these illnesses has its treatment. It must be planned carefully since the situation and needs depends from one case to another.
Many people today are afraid of hearing the words ‘bipolar disorder’ and the term ‘dual diagnosis’ because they feel that they are beyond repair. However, treatment is available for people suffering from such type of disorder. They are not flaws of character or even moral weaknesses. They affect anyone – it doesn’t choose which person must be affected by it, whether it is by ethnicity, economic background, age or gender. According to studies pertinent to disorders, it shows half of the population are suffering from depression or bipolar disorder. Some are even into alcohol and drug abuse.
The concept of dual diagnosis emerged more than 20 years ago, but even with all the studies and research conducted by well-established scientists, the whole idea still doesn’t sit well in the medical field, even if the whole thing is very simple. However, it is a very effective method, and many medical practitioners can prove it. It means that dual diagnosis is a treatment for people that are suffering from a psychiatric disorder and abuse of drugs and alcohol.
You can be treated with a dual diagnosis if you are addicted to alcohol, drugs, sex or gambling. It can also be a combination of these things. And at the same time, you also get psychiatric problems such as bipolar disorder, schizophrenia, depression, eating disorders, panic disorder or borderline personality disorder and many others. Those who are highly functioning yet has alcohol abuse can also be affected with a mood disorder. Crack addicts may also suffer clinical depression. Even a bulimic can also suffer from bipolar disorder.
Self-medication with depression
In some cases with those that are suffering from mood swings, they use drugs or alcohol as a means for them to mask out the symptoms associated with it. For example, if the mind of a person is racing due to mania, drinking alcohol can slow this process down. If he or she is going through an intense hopelessness or sadness due to depression, taking in a drug may help him feel hopeful or happy for a short period. Self-medication like this one may look like it will help, but it can only make it worse instead. After the effects of the drugs or alcohol wear off, the symptoms get worse than before. It is the reason why doctors do not recommend self-medication because it can cause mood disorder on the patient to stay undiagnosed for long periods of time.
Symptoms of depression and Bipolar disorder
It is important to know the symptoms of mood disorders so that you will know when to look for help. Self-diagnosis is impossible. You’ve seen a lot of people that try to justify their depression as bipolar, but that doesn’t work that way. Only a professional health care worker can do that, and they are the ones that can treat the mood disorder. Bipolar disorder is the medical term used when the mood of the person switches between mania and depression.
The following symptoms are signs of depression. A person is only diagnosed with depression when he or she has five or more in the list below. It includes the loss of interest or pleasure or feelings of sadness. There are also times when the symptoms can interfere with the daily life of the person, too. Patients diagnosed with most of these must seek a health care professional right away.
- Gets irritated easily, angry
- Anxiety, worry
- Cries a lot or feels sad most of the time
- Major changes in sleeping patterns or appetite
- Indifference, pessimism, feels like not a single thing in life is ever going to go right
- Unexplained pains and aches all over the body
- Always feel exhausted, loss of energy
- Has no concentration or has difficulty making decisions
- Feelings of worthlessness, guilt, and hopelessness
- Recurring thoughts of suicide or death
- Is not able to enjoy the things, doesn’t have any interest in socializing
When an individual has 3 or more of the following symptoms, even including that irritable, excited or even energized mood for one week or more, he or she may be experiencing a manic episode and must seek a health care professional right away. It can also be when the symptoms are already interfering with the individual’s life.
- Easily gets irritated
- Increased mental or physical activity with a lot of energy
- Extreme self-confidence and optimism
- Poor judgment and impulsiveness
- Racing thoughts and racing speech
- Decreased need for getting any sleep without even feeling tired
- Aggressive behavior
- Shows reckless behavior done like doing major business decisions, spending sprees, sexual promiscuity and careless driving
- When in severe cases, he or she experiences delusions, wherein the individual thinks of things that aren’t true. He or she also experience hallucinations, which he or she sees or hears things that aren’t supposed to exist
The importance of treating both alcohol/drug abuse and mood disorder
Both illnesses need treatment. Or, else, one illness gets worst if left untreated. Also, there is a high probability of getting a full recovery a lot faster. It would be much easier for the patient to go back and have a productive life.
Why is it important to stay sober and clean during treatment?
Mixing drugs or alcohol with the medication during treatment can have threatening and serious effects. A lot of medications, especially with OTC medications, can interact with drugs or alcohol in unfavorable ways. There is also the likely possibility that you will benefit from talking therapy in the situation wherein you are under its influence.
Common Medications Used During Treatment
Lithium is the first known mood stabilizer used on patients who are suffering from bipolar disorder. Mood stabilizers are known to aid in controlling the lows and highs of this particular illness. Lithium is the most well-known, not to mention the oldest mood stabilizer. It is no wonder why it is considered the cornerstone of the treatment on both depression and mania. While it can help bipolar depression, it is not that effective on rapid cycling or mixed episodes of bipolar disorder. It takes from 1 to 2 weeks for Lithium to take its full effect.
This drug has side effects, and the common ones are:
- Thyroid problems
- Stomach pain
- Weight gain
- Excessive thirst and often increased urination
- Vertigo, nausea
- Concentration and memory problems
When taking lithium, it is important for patients to go through regular blood tests to make sure the dose prescribed to them is in its effective range. Too high of a dosage poses a great risk to the individual. When you take it for the first time, the doctor will check the blood levels at least once a week. When they’ve found the right dose, and they see that the levels are going steady, you are still required to go through blood tests but this time for every 2 or 3 months since various things can affect the lithium levels in your body. Even changing lithium to a different brand can affect the blood levels, too.
Anticonvulsant mood stabilizers
People who are suffering from epilepsy use this treatment. However, patients diagnosed with bipolar disorder can make use of anticonvulsant mood stabilizers since they have shown to alleviate the manic symptoms and even reduce the mood swings.
One of them is the Valproic acid, also referred to as valproate or Divalproex, it highly affects on getting the mood stabilized. The common brand names are Depakene and Depakote. It is often the first option taken when it comes to mania, rapid cycling or mixed mania and when the patient also experiences delusions or hallucinations. If the patient can’t tolerate the side effects associated with lithium, this is a good medication option for treating bipolar disorder.
Common side effects of Valproic acid:
- Weight gain
Other medications include:
- Topiramate (Topamax)
- Lamotrigine (Lamictal)
- Carbamazepine (Tegretol)
The antidepressants are not freely prescribed nor are they shared with a public audience. Why? There should be extreme caution when using such type of medication.
But one thing that antidepressants have is that they are not that effective treatment for bipolar disorder. There has been mounting evidence that shows how antidepressants are not that effective in treating bipolar depression. It was a major study backed by the National Institute of Mental Health which showed that the addition of an antidepressant to the mood stabilizer did not yield any results unlike just using the mood stabilizers alone.
Another effect showed that it could trigger mania in individuals that have bipolar disorder. Combine mood stabilizer such as lithium or valproic acid with antidepressants when giving treatment. Without the mood stabilizer, it will only elicit a manic episode.
Antidepressants are also shown to increase the mood cycling. Many professionals and experts believe that through time, using antidepressants on people who have bipolar disorder comes with a mood destabilizing result, thus increases the frequency of depressive and manic episodes.
If a patient loses touch with their reality during a depressive or manic episode, the doctor may prescribe an antipsychotic drug. They are proven to help improving regular manic episodes. The antipsychotic medications are really helpful when the individual did not have any success with the mood stabilizers. Sometimes the antipsychotic medications are used together with one mood stabilizer like valproic acid or lithium.
Some of the known antipsychotic drugs include:
- Clozapine (Clozaril)
- Ziprasidone (Geodon)
- Aripiprazole (Abilify)
- Risperidone (Risperdal)
- Quetiapine (Seroquel)
- Olanzapine (Zyprexa)
The common side effects of these medications include:
- Sexual dysfunction
- Weight gain
- Blurred vision
- Dry mouth
Benzodiazepines are prescribed to patients while waiting for the mood stabilizers to kick in, but this I only did so when the antidepressant or mood stabilizer has started to work on the body. This drug helps relieve many symptoms associated with insomnia, agitation, and anxiety.
The calcium channel brokers are used traditionally in treating hypertension and heart problems because of its mood stabilizing effect. They come with fewer side effects compared with most of the mood stabilizers, but they are often not effective, depending on the patient taking them. But the calcium channel brokers are the best option when anticonvulsants or lithium is intolerable.
Thyroid medication is used on individuals with bipolar disorder because sometimes they’ve got abnormal levels of the thyroid hormone, especially with the rapid cycles. There are times when doctors may use thyroid medication during the treatment regimen, especially when using lithium.
Medications are not enough
And this is why there is treatment along with the medications to foresee that the drug treatments work double time on the patient and at the same time the patient is undergoing their kind of treatment.
You maybe joining a support group, or the doctor will ask you to visit him or her again depending on the findings. The providers of your treatment are very aware that you are undergoing dual diagnosis. Treatment of the mood disorder may have psychotherapy or counseling, drug treatments, and even DBSA support groups wherein patients with bipolar disorder can share their experience openly when living with bipolar disorder or depression. If you are an addict of drugs or alcohol, your doctor may suggest that you have to be check in to a treatment center or hospital so that you can get treated closely with any withdrawal symptoms. After the withdrawal treatments, you will be treated for addiction, too. It may include an outpatient or residential drug or alcohol treatment center, a group that focuses on living life without the substances or alcohol dependency. Through these groups, patients get to learn how others can stop their drug abuse or drinking, how they were able to cope with their urges and cravings to use or drink more and how they can live comfortably without the influence of drugs and alcohol.