Having two or more psychiatric diagnoses at the same time occurs for at least half of those diagnosed with a mental illness. As with other illnesses, it’s important to understand the full picture to find the best treatment.
Lisa’s family doctor diagnosed her with depression but her symptoms didn’t improve with the prescribed antidepressant. Her doctor had her complete some questionnaires that confirmed the depression diagnosis and also determined Lisa had an anxiety disorder, so her doctor suggested she increase the antidepressant dose. Lisa shared this information with her best friend who expressed a strong opinion, stating, “I think you’re being over-medicated. How do you go to your doctor with one diagnosis and leave with two? Are you sure she knows what she’s doing?”
Lisa had started to feel much better soon after her antidepressant dose was increased, but her friend’s comments made her second guess herself and her doctor, so she stopped the antidepressant. Within weeks, her mood and anxiety were much worse, so Lisa went to her local emergency room, where she waited for 12 hours before being assessed. “It was a terrible experience,” Lisa recalled. “I wish I had stuck to the plan I made with my doctor, but I also wish I didn’t need medication at all.”
This fictional story is incredibly common and it speaks to the lack of knowledge regarding the importance of correctly diagnosing and fully treating the symptoms of a mental illness. In this blog, I will unpack the concerns raised by Lisa’s friend and explain why her family doctor ultimately gave her the correct advice.
Psychiatric comorbidity – to have two or more psychiatric diagnoses at the same time – occurs for at least half of those diagnosed with a mental illness.
While Lisa’s friend expressed shock about her having two psychiatric diagnoses at the same time, this is actually pretty much the norm with many illnesses! High cholesterol, diabetes and hypertension commonly co-occur and we don’t ignore any one of them because it seems like too many diagnoses – we know it’s important to treat every disorder to avoid a serious outcome, like a heart attack or stroke. Psychiatric illnesses are no different.
The most common psychiatric comorbidity is major depressive disorder (MDD) co-occurring with an anxiety disorder. About 85% of people diagnosed with MDD have anxiety symptoms. Sometimes, those anxiety symptoms are so consistent, persistent, and impairing that they are referred to as an anxiety disorder.
Anxiety disorders include generalized anxiety disorder, panic disorder and social anxiety disorder. While the DSM-5 no longer categorizes obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) as anxiety disorders, both are associated with significant anxiety and both commonly co-occur with MDD.
At some time during their illness, 90% of people diagnosed with an anxiety disorder will have comorbid MDD.
For bipolar disorder (BD), comorbidity is the rule. Studies have found that nearly 70% per cent of people with BD have at least one comorbid psychiatric diagnosis, most frequently anxiety disorders, substance use disorders and ADHD.
Here are the top reasons why the correct diagnosis, including identifying comorbid conditions, is essential.
Lisa’s doctor gave her the best possible guidance by identifying not only the depression but also a comorbid anxiety disorder. Fortunately, antidepressants are prescribed for both anxiety and depression symptoms, when they are distressing and significantly impact an individual’s functioning in their usual roles (e.g., at home, work, school or socially).
By choosing an antidepressant that helps depression and anxiety symptoms and increasing the dose when her symptoms didn’t fully resolve, Lisa quickly started to feel better.
However well-meaning, by undermining Lisa’s confidence in herself and her doctor, her friend’s uninformed comments had a seriously detrimental impact on Lisa’s health, prolonging her journey towards recovery.
Dr. Diane McIntosh is a psychiatrist, innovator, educator, author and speaker. She is a passionate advocate for better mental health care, and a champion for all who suffer from mental health challenges.
See Diane’s other posts on choosing medication.
This blog post is part of a series looking at the state of our mental healthcare system and ways we can create sustainable change to improve quality and outcomes for anyone impacted by mental illness.
What’s it like to live with OCD? Dr. McIntosh talks to Nadia, a mother of two, about how she’s coping with the challenging and sometimes alarming symptoms of Obsessive Compulsive Disorder. Summary of “This is OCD”, Episode 2 of the PSYCHEDUP Podcast.
In episode 1 of the PSYCHEDUP podcast, Canadian four-time Olympic rower and mental health advocate Silken Laumann talks to Dr. Diane McIntosh about her battle with depression. This post a summary of that episode.
There’s something about flipping the page on the calendar from December to January. For many of us, the beginning of a new year represents a clean slate. So, if you find yourself in the mood to take that time to pause and reflect after the holidays, here are a few tips on making smart New Year’s resolutions.
Dr. Diane McIntosh is a psychiatrist, innovator, educator, author, and speaker. She is passionate advocate for better mental health care, and a champion for all who suffer from mental health challenges.
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