When Better is Not Well in Bipolar Disorder and Depression

bipolarLast week, the Depression and Bipolar Support Alliance (DBSA) hosted a forum entitled “Better is Not Well 2014”, in Chicago, IL.  I do not live in Chicago, so fortunately, they streamed the 90-minute event online where I was able to view it from home.

The purpose of the forum was to discuss the issue of raising treatment expectations; of taking patients from simply “surviving symptoms to creating thriving lives.”  The forum moderator and presenter, Allen Doederlein, opened the discussion by listing some of the negative consequences of living with residual mental illness symptoms.

When we’re not all the way well we are:


– at greater risk of relapse
– at greater functional impairment
– more likely to have co-occurring life-threatening conditions (heart disease, diabetes, etc.)
– at greater risk to die by suicide

So, with these negative risks, why do we settle for better instead of striving for wellness? Panelist, Dr. William S. Gilmer, M.D., Clinical Professor in the Department of Psychiatry at Northwestern University, who has specialized in the treatment of depression and bipolar disorder for more than 24 years, said the following.

We have lower expectations because we:


– feel like we’ve won just because we can get out of bed now
– don’t want to set ourselves up for disappointment
– don’t want to rock the boat or lose what we’ve gained by messing with the current treatment regimen
– see a little bit of mood dysregulation as the “new normal”

What does “better but not well” mean?

Dr. Gilmer suggests that lack of “wellness” means that “subsyndromal symptoms” are present. Subsyndromal symptoms are either one or two severe symptoms OR lots of mild ones. Either way, the symptoms do not meet the threshold of being considered an illness state but they are still there, causing discomfort and some impairment.

“Wellness is not just the absence of sickness.” ~ Panelist, Dr. Judith Cook, PhD, an internationally recognized authority on mental health services research

How do we go from better to well?

Panelists’, including two consumers with bipolar disorder, suggestions include:
– utilization of measurement-based outcomes in symptom evaluation to better track wellness levels*
– better optimization of medication dosage and therapy frequencies
– not settling for better; striving for wellness
– discussing wellness with your psychiatrist; if he or she will not listen find a new one

*DBSA has a wellness tracker app available.
Better is Not Well 2014 Videocast

What is your definition of wellness?  What would it look like or does it look like in your life?

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