Bipolar Disorder

Learn About Bipolar Disorder

Depressed? Could it be Bipolar Disorder?

People with depression feel down, sad, or blue, often losing interest in most things. They have low energy, poor mental stamina, and may be guilt-ridden and suicidal. By contrast people with bipolar disorder may have episodes of mania, characterized by euphoric or irritable mood, impulsive poor judgment, rapid thoughts and speech, and grandiose or paranoid beliefs. One might wonder what depression and mania have to do with each other; but in people with bipolar disorder mania and depression can alternate, and in some cases are co-occurring or mixed. In patients whose depression is accompanied by irritability, restlessness, racing thoughts, and impulsivity the diagnosis of bipolar disorder with mixed states must be considered, and for good reason – the treatment of depression uncomplicated by bipolar features, or unipolar depression, is fundamentally different from that of bipolar depression.

Bipolar depression with mixed states is not the only bipolar form of depression. The depression may alternate, or cycle, with periods of mania or a muted form of mania called hypomania, conditions referred to as Bipolar Type I and Type II, respectively. If the mania and hypomania are themselves the irritable rather than euphoric type, or the illness is of the mixed states type, the diagnosis of Bipolar Disorder may be overlooked entirely. And this can have substantial consequences, as treating bipolar depression as if it is unipolar depression can make the condition worse rather than better.

If it is so important to distinguish bipolar from unipolar depression, how is this done? As is true for any disease, making a diagnosis begins with gathering history. Given that people in a depressed state of mind tend to view their history as depressive, they may miss the hallmarks suggesting bipolar disorder. Therefore, interviewing a corroborator, someone who knows the patient well, usually a friend, spouse, or other relative, will improve the likelihood that an accurate diagnosis will be made. Family history can also be helpful, as bipolar disorder runs in families, or more accurately, any family history of any serious mental disorder makes it more likely that a depression is of the bipolar rather than unipolar type. Finally, clues can be gleaned from the patient’s experience with treatment – especially if the depression seems to fail to respond to antidepressant trial after antidepressant trial. In fact, one of the major reasons antidepressants fail is that the depression under treatment is actually of the bipolar rather than unipolar type.

So how is it that the treatment of bipolar and unipolar depression differ? While the foundation of the medical management of unipolar depression is antidepressants, for bipolar depression it is a mood-stabilizer, such as lithium. Further, treating bipolar depression with antidepressants without a mood stabilizer, as might occur if the bipolarity is not recognized, can induce a worsening of the illness and impart treatment resistance. That is why the first step in the diagnosis of depression is to ensure that the illness isn’t bipolar.

If you believe you are being treated as a unipolar depressive when you might be bipolar, the first step is to talk with your doctor and share your concerns. It can also be helpful to seek a second opinion. In fact, doctors themselves will often recommend this if their treatment does not seem to be having the intended and expected response.

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