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Resource: The Great Diagnosis Struggle

*This is one of a series of posts we are planning for our readers to use as a tool to help someone in their life better understand the tenets of mental health.

pills in doctor's hands

“The struggle is real…”

I am sure we have all heard this in some form or another in our lives. Granted, it is typically meant to be a funny add-on to something we find difficult. Applied to diagnosing a person’s mental illness?

Real. Life.

Admittedly, I took one psychology class in college and I only did so because my other option was biology to fill a life science credit. I figured an intro class wouldn’t be too awful, and to be honest I had one major takeaway from an entire semester’s worth of material: there is no clear answer when diagnosing someone’s mental illness.

This may sound sketchy but I have a scenario for you. If you get into a car accident and glass from the windshield cuts into your knuckles a doctor or paramedic will treat your lacerations by cleaning them, possibly stitching them and bandaging them. In that same car accident you break your leg, and a doctor determines it needs a cast or surgical fix to begin the process of healing. Pretty simple, right?

Now apply the concept to your brain a.k.a. the mysterious organ rattling around in your skull. Depression is not a darkened spot on an MRI and schizophrenia isn’t a tear in the frontal lobe. It is a process, one which can be daunting if you are looking for a fix in five minutes.

brain model

The Mayo Clinic gives four ways depression can be diagnosed including a physical exam – sometimes depression can be linked to a physical problem – and something called the DSM-5 or the Diagnostic and Statistical Manual of Mental Disorders. 

The DSM was first published in 1952 and the most recent edition was released in 2013.  The 947 page tome “is a manual that reflects current state of knowledge and consensus among leaders in the field.” The use of the manual helps physicians determine, given the current understanding of what the brain is up to, what a patient is living with and therefore how to proceed.

Which is where things get even trickier.


Actual treatment is an issue. On Is This Adulting? we hear Steven talk plenty about his m-m-m-meds adjustments and how there has been highs and lows with each one. Each mental illness does not have a single drug to treat it. For example, a brief list of medications used to treat depression are (and buckle in, folks):

Selective serotonin reuptake inhibitors (SSRI)

         Citalopram (Celexa)

         Escitalopram (Lexapro)

         Fluoxetine (Prozac)

         Paroxetine (Paxil, Pexeva)

         Sertraline (Zoloft)

         Vilazodone (Viibryd)

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

         Duloxetine (Cymbalta)

         Venlafaxine (Effexor XR)

         Desvenlafaxine (Pristiq, Knedezla)

         Levomilnacipran (Fetzima)

Atypical antidepressants

         Bupropion (Wellbutrin XL, Wellbutrin SR, Aplenzin, Forfivo XL)

         Mirtazapine (Remeron)

         Nefazodone, Trazodone and Vortioxetine (Trintellix)

Tricyclic antidepressants

         Imipramine (Tofranil)

         Nortriptyline (Pamelor)

         Amitriptyline, Doxepin, Trimipramine (Surmontil)

         Desipramine (Norpramin)

         Protriptyline (Vivactil)

Monoamine oxidase inhibitors (MAOIs)

         Tranyclypromine (Parnate)

         Phenelzine (Nardil)

         Isocarboxazid (Marplan)

         Selegiline (Emsam)

pile of papers

Based on the amount above you may be thinking, “well, there’s only 22 options” but unfortunately some of the medications can be combined. I’m not going to do the math, but basically there are too many possibilities as far as finding the correct medicinal cocktail.

And that list was only for depression.

The real scary part comes in when you realize it might get worse during the journey to get better. You have to talk to one or more doctors about the mental illness you live with which can be daunting. You have to go through the motions of trying a medication and dealing with the highs, lows and possible side effects to figure out what works best for you. Finally, you have to get passed the hurdle of knowing you may be dependent on these medications for the foreseeable future, and not beat yourself up if you forget to take a dose every now and then.

To get down right to it: diagnosing is hard. Treating is hard. Stick through it though because once you and your doctors are comfortable with where you are mentally, you can focus on thriving.

Emily Ridener

A few words about me

There are quite a few mottos I like to sling around including but not limited to, “Life is short, eat the cupcake,” “What would Wednesday do?” and perhaps most importantly, “What’s so great about normal?” I don’t approve of people who put others down because society has taught us they are “less” and I choose to use my words to share truth, do no harm, and combat ignorance.