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Dr. Goldberg, Confirmation via Med Response?
RogueFemale2 posted:
No respectable psychiatrist would make a diagnosis of a complex psychiatric disorder based on a patient's response to a medication, alone (or at least I WANT to believe that is true), but to what degree does medication response help to support or even confirm a suspected diagnosis, when considered alongside other symptoms?

I limped through several years of what doctors thought was "just" recurrent agitated depressions before a psychiatrist finally tried Depakote during a hospitalization several years ago. My response to that medication was so dramatically positive that, as my doctor told me later, it helped to bolster his suspicions that my mood and motor issues fell within the bipolar, rather than unipolar, spectrum. All I know is that when I took antidepressants alone, my mind seemed to grow more and more crowded, while the addition of a mood-stabilizer calmed things down almost immediately--and has, with adjustments, kept things calm for well over a decade. Is medication response, then, a strong(ish) indicator when it comes to the diagnosis of cases of bipolar disorder that are not clear-cut and textbook-tidy? Or is medication response fairly low on the list of things a doctor considers when settling on a likely diagnosis?

(I don't post often, but it always seems that when I do, I have a diagnosis-related question. Sorry for the redundancy--but I am fascinated about the process by which these complex diagnoses are teased out, though I'm sure I over-think such things anyway.)

Joseph F Goldberg, MD responded:
Dear Karen, Generally speaking, medication responses are quite diagnostically nonspecific, particularly because one medicine can have numerous effects, none of which usually reveal information about the disease state. If you were wheezing and a doctor gave you an albuterol inhaler and your breathing improved, the response would say nothing about whether your wheezing was caused by asthma or pneumonia or an allergic reaction. If your headache improves with Tylenol, that doesn't clinch the diagnosis of a tension headache (versus, say, a brain tumor headache). Depakote treats seizures and migraine but if it helps your depression that doesn't mean your depression was caused by an underlying migraine or seizure spectrum disorder. Drug response can be consistent with a diagnosis (if your sore throat gets better with amoxicillin, it was more likely strep than influenza), but that's just corroboration. Som take drug response with a grain of lithium. Dr G
RogueFemale2 replied to Joseph F Goldberg, MD's response:
Yes, thank you. The question of suggestive corroboration is what I was thinking of. Appreciate it.