Q:  What if Diagnosis is Incorrect? 

I have a girlfriend that I think has been incorrectly diagnosed with bipolar disorder. She is on medication such as Effexor (VENLAFAXINE HCL), and I don’t think that it is good for her to be taking this medication if it is not necessary.  What can happen if she takes this medication and she doesn't have bipolar disorder? Will it cause any problems? Is there any natural method for dealing with manic depression, aside from medication, such as diet changes? I would greatly appreciate any input you can give me on this topic.

Dear John -- 
I don’t think that it is good for her to be taking this medication either; or at least, there would be some cause for concern if she did indeed have bipolar disorder and that was all she was taking for it, as few people with bipolar disorder can take an antidepressant alone and do well, especially over the long haul.  But, to respond to your questions: 

1. What if she takes it and doesn't have bipolar disorder?  Well, if she has depression, it might help.  Too bad it hammers sexual function in the majority of people who take it, which might be part of your concern.  

2.  Is there a natural method for dealing with bipolar disorder?  How about if we look for the method that has the least risk and the best possible outcomes in terms of control of symptoms?  Would it make much difference, "natural" or otherwise (I suppose we could include cost), if one approach was clearly the best on that scale?  

Unfortunately, if she really has bipolar disorder (you could have a look at the questionnaire approach to the diagnosis, and see what you think; but read the "how do you score" carefully) she may need some serious treatment; that is, the consequences of not treating can be pretty huge for a lot of people.  That includes effects on your relationship.  So I'd urge you to support whatever treatment she might need, for whatever she has -- although looking at all treatment approaches and comparing their benefits and risks, as you are doing, is a fine idea.  I fear you'll find that "natural" approaches to bipolar disorder have no clear evidence of effectiveness, and generally even less evidence about their risks, especially long term (the same is true, but less so, for medications; but at least we have something to go on there).  

By contrast, if her mood problem is not bipolar, there are some alternatives that have good evidence for effectiveness.  For clearly seasonal depression, light therapy can help at least half of people who so suffer.  For plain depression (there are at least several such types), exercise has been repeatedly shown to work well, as well as an antidepressant in a recent study.   That study is so great, so substantial, I'm copying the abstract here: 

Psychosom Med 2000 Sep-Oct;62(5):633-8

Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months.

Babyak M, Blumenthal JA, Herman S, Khatri P, Doraiswamy M, Moore K, Craighead WE, Baldewicz TT, Krishnan KR.

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.

OBJECTIVE: The purpose of this study was to assess the status of 156 adult volunteers with major depressive disorder (MDD) 6 months after completion of a study in which they were randomly assigned to a 4-month course of aerobic exercise, sertraline therapy, or a combination of exercise and sertraline. METHODS: The presence and severity of depression were assessed by clinical interview using the Diagnostic Interview Schedule and the Hamilton Rating Scale for Depression (HRSD) and by self-report using the Beck Depression Inventory. Assessments were performed at baseline, after 4 months of treatment, and 6 months after treatment was concluded (ie, after 10 months). RESULTS: After 4 months patients in all three groups exhibited significant improvement; the proportion of remitted participants (ie, those who no longer met diagnostic criteria for MDD and had an HRSD score <8) was comparable across the three treatment conditions. After 10 months, however, remitted subjects in the exercise group had significantly lower relapse rates (p = .01) than subjects in the medication group. Exercising on one's own during the follow-up period was associated with a reduced probability of depression diagnosis at the end of that period (odds ratio = 0.49, p = .0009). CONCLUSIONS: Among individuals with MDD, exercise therapy is feasible and is associated with significant therapeutic benefit, especially if exercise is continued over time.

Dr. Phelps

Published June, 2001