Bipolar is more than a label

23-year old Jennifer was in today with husband Todd and step-daughter. Despondent, she had just just dropped all of her college courses and has not slept for 2 weeks. I thought we were making progress only 3 weeks ago when we found the proper combination of medications to clear her migraine headaches...even figuring out that her perfume was a trigger. But now she has not slept, her weight is slipping away and her anorexic patterns are returning. She finally admits to her depressed feelings, though it goes completely against her religious faith and her attempts to generate the gratitude and joyfulness that her cognitive brain understands to be true. Because of her lack of sleep I am suspicious of bipolar depression, and if I put her on a typical SSRI antidepressant such as Prozac or Zoloft, I could trigger a manic episode. I downloaded the Goldberg Screen for Bipolar Depression from the internet and administered the screening questions. She is positive for 11 out of 12 questions. I think she is bipolar, presently depressed, and in danger of serious anorexia. I will get her in to a psychiatrist as soon as possible. Unfortunately, the health care system is broken in that I can not refer her directly to someone. The psychiatrist will only accept an appointment made by the patient, so tomorrow I will need to call to make sure she has an appointment.