Is it Depression or Bipolar?

 

Thanks to Kitt O’Malley, who posted this before me. And thanks to Michael Pipich for the wonderful information.

Are You Just Depressed or Is It the Onset of Bipolar Disorder?

Michael G. Pipich, MS, LMFT

About two-thirds of people with bipolar disorder are misdiagnosed with other mental health problems before bipolar is discovered.[1] Among those individuals, a significant majority are given a diagnosis of major depression. Most people with a major depressive disorder that is unrelated to bipolar disorder (typically known as non-bipolar depression or unipolar depression) can be treated safely and effectively with a combination of antidepressant medications and psychotherapy. But when people with undetected bipolar are treated this way, a host of mental health problems can occur, making the underlying bipolar condition much worse.

It’s understandable that someone may not immediately be given the bipolar diagnosis if their first mood swing begins in a depression mood zone. This seems particularly true of people who have bipolar II disorder. And sometimes, there may be more than one depressive episode before a manic or hypomanic episode happens in a person with bipolar.

If you’re wondering about whether you may have depression or the beginning of bipolar, there are some keys to keep in mind when seeking treatment.

First of all, when assessing if your depression is a part of bipolar, know that bipolar disorder has distinct genetic foundations. In other words, it runs in families and is passed through family genes. So if you suspect that any family members may have had bipolar disorder, it’s important to inform your doctor or therapist when entering treatment. If the information is available, a thorough family mental health history can really support a proper bipolar diagnosis. Unfortunately, such information isn’t always asked for, so be prepared to volunteer all that you know during an evaluation or treatment session.

Next, your personal history of mood swings should be explored. If you’ve had severe ups and downs during childhood or adolescence, these may be more than the common tumult of growing up. They may instead be early expressions of bipolar disorder. It’s especially important to review periods of hyperactivity, bouts of unexplained rage, self-harm, or suicidal thoughts or actions that could have occurred at any time in life. There certainly may be other explanations for these, such as early life trauma or severe loss and grief experienced during these formative years. But if explosive behaviors or deep depression occurred at different times, especially with little or no provocation, it can point to underlying bipolar disorder.

Usually, most people with bipolar who seek treatment on their own are currently or recently depressed, or are experiencing consequences of untreated bipolar disorder. Any history of mania or hypomania is less obvious, however. And often, bipolar patients will either not understand manic symptoms or will avoid discussion about them. If you have had at least one occurrence in your life of intense euphoria, excitability, unexplained energy and creativity, avoidance of sleep, or impulsive behaviors, inform your treatment professional. But also bear in mind that mania and hypomania may be marked by intense periods of irritability and agitation, know as dysphoria. This is in contrast to the euphoria that most people think about with bipolar mania. Often a dysphoric type of manic or hypomanic episode can be mistaken for the kind of agitation seen in major depression. This can mislead the course of treatment to focus only on depression, while missing the full bipolar condition.

This brings us to the most important part of knowing whether you have depression or bipolar onset. According to the Diagnostic and Statistical Manual of Mental Disorders (5^th edition), if a patient is given an antidepressant medication, and it produces manic symptoms, the person is then diagnosed with bipolar disorder.[2] While this is a very clear indication of bipolar, how the mania surfaces in the individual may take different forms. For example, a person in a depression mood zone can improve early in the treatment, and as a result, may not show manic symptoms right away. Any slight improvement may provide a hopeful sign that treatment is working, but when the person starts to get worse because of emerging mania—especially if it’s dysphoric—the unwitting response may be to apply more antidepressant medication. Now we have some real problems.

So, if at some point in your treatment, an antidepressant medication makes you feel more agitated, more irritable, more aggressive, or you start to experience hyperactivity or greater impulsivity, tell your treatment professional right away. This could be the start of a manic episode that is revealing a previously undiagnosed bipolar disorder. Even more importantly, any increase in suicidal thoughts or possible psychotic symptoms, such as hallucinations, should be reported immediately, as these can be life-threatening. Any antidepressants will either likely be eliminated at this point, or possibly paired with a mood stabilizing or antipsychotic drug to keep a lid on mania.

With bipolar finally recognized, bipolar medications can be introduced to decrease manic-type symptoms, while keeping depression in check. Alongside medications, it’s important to have therapy focus on the unique challenges facing people with bipolar disorder. Major depression is frequently considered an acute condition because it often can resolve in time, so medications may be discontinued at some point, along with a shorter overall approach to therapy. But bipolar disorder is a lifelong condition. Even though its symptoms can come and go in episodes, the genetic nature of the condition means the bipolar patient will need continuing care through the lifespan.

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[1] Hirschfeld R. M., Lewis, L., & Vornik, L. A. (2003). Perceptions and impact of bipolar disorder: How far have we really come? Results of the National Depressive and Manic-Depressive Association 200 survey of individuals with bipolar disorder. Journal of Clinical Psychiatry, 64(2), 161–174.

[2] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author, 128-130.

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Michael G. Pipich, MS, LMFT is a psychotherapist and author of Owning Bipolar: How Patients and Families Can Take Control of Bipolar Disorder, (Citadel Press, Sept 2018). He practices in Denver, Colorado, and can be reached at MichaelPipich.com.

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212-258-2413

When PMS & ADHD Pair Up!

When PMS & ADHD pair up, people nearby had better make themselves scarce. Go run errands, work on an outdoor project, visit the library . . . just get away from the woman with the fiery mood!

I say this because I am that woman some months. Right now, in fact, I’m dealing with this pair of clashing hormonal and mental hurricanes. I’ve told my husband some terribly awful things. I’ve alienated my step child. I’ve thrown a glass and have angrily folded/put away three large loads of laundry. That was all in the last hour. Lord help me. Lord help them.

I’m not saying there weren’t reasons why I responded negatively but it shouldn’t have been to the degree I reacted. I know these things intellectually but can’t physically stop the feelings – and have been trying to stay away from loved ones so I don’t hurt them further.

I’ve only known I had ADHD for a few months, and this is the first month the disorder has clashed with a bout of PMS. It feels awful. Like I have no control of my emotions or actions.

I’ll spend the day in my room with a book and ipad. And probably some cookies. Hopefully the cats don’t make me mad . . . Only Kidding!

Lord help us all ~

Bipolar Disorder – Need to Know Info!

 

STABILITY  of moods. That is what the majority of people with Bipolar Disorder seek.

 

(thanks to healthtap.com for the following for questions and answers below)

Dr. William Drescher answers:

What causes bipolar disorder?

Multifactorial So far no one has established a genetic link with bi-polar disorder, and many have tried. It is certainly true that it runs in families, but that can be a result of the family environment. There is a reasonable theory that the manic episodes are a way of combating the depressive feelings and that both are the result of chronic internal stress leading to depletion of neurotransmitters.

What exactly is Bipolar Disorder? One or more episodes of abnormally elevated energy/mood/cognition, with or without 1 or more Depressive episodes. The symptoms are severe enough to interfere with daily functioning or cause significant distress.

 

What are some treatments for bipolar disorder?

Bipolar main treatment is mood stabilizers. Other medications are added depending on presentation, such as anxiety meds, antidepressants, antipsychotics. Also Psychotherapy.

 

Dr. Byron Law-Yone answers:

Can anti-depressants help with bipolar disorder?

Yes but …. They must be used carefully. they can sometimes cause a switch from depression to mania. Mood stabilizer meds are the most important and antidepressants can be added if depression cannot be controlled by mood stabilizers alone.. Some believe that there is no role for antidepressant use in bipolar depression. Talk to your psychiatrist about this very important topic.

 

Dr. William Holmes answers:

My mom has bipolar disorder, so am I likely to get it later?

Possibly If your mother has bipolar disorder you are at a higher risk of having the same problem compared to the general population. At the same time, there is no guarantee that you will have bipolar disorder.

 

Dr. Bernadette Onuoha answers:

What are some examples that might help me recognize Bipolar Disorder?

Mood swings. Bipolar disorder as the name implies involves highs and lows in mood. Period(s) of depression with at least one episode of mania ie euphoria, insomnia, racing thoughts sexual/financial indiscretions etc.

 

Dr. Neil Liebowitz answers:

How can you tell if you have Bipolar Disorder or just a weird personality?

Level of function. Bipolar disorder is a serious disorder that affects your level of function and has dramatic cycles of energy shifts that last days to months.

 

Dr. Jerold Kreisman answers:

What are some discussions that can help demonstrate to someone that he has Bipolar Disorder?

Ask about how mood changes affect usual routine functions–staying up for days at a time without sleep, not feeling the need to eat, being hypersexual, spending too much, taking on too much responsibility, noting increasing anger and impulsivity.

 

I realize this is, by far, not a complete list of questions/answers about this subject. If you question whether you have a mood disorder, please visit a doctor. Remember . . . only an M. D. can prescribe meds, so an actual psychiatrist is helpful to find. Some only handle medications for patients. Others offer counseling, as well. Meds may be miracle drugs for some. For others, not so much. Counseling has been shown to be helpful, as well. Be proactive, and if you can’t muster the energy to help yourself, ask a loved one to help, but you must be completely honest with him/her about the severity of your symptoms. Don’t waste your life by staying in an abyss of depression or an uncontrollable mania.

Life can be better ~