McMan’s Depression and Bipolar Web is a great site hosting articles written by John McManamy, a medical journalist who also has bipolar disorder. Among his archives is this story about the prominence of depression in bipolar disorders.

Only in recent years has research shown that people with bipolar disorders spend more time depressed than manic or hypomanic – his article cites research that finds people with Bipolar 2 spend 37 days depressed for every one day hypomanic, and another study indicating that Bipolar 1 spend 32% of weeks depressed and 9% of weeks manic.

Michael Thase MD of the University of Pittsburgh observed at the 2002 American Psychiatric Association annual meeting: “Although manic episodes are often more the emergent and notorious phase of bipolar affective disorder, depressive episodes last longer, are typically harder to treat, and result in the high ultimate risk of suicide.”

The article also talks about some of the differences between bipolar depression and unipolar depression; sad facts considering that most people are misdiagnosed with unipolar depression first and it often takes many years (he quotes an average of 11.4 years for Bipolar 2) to be correctly diagnosed – and then treated – as bipolar.

The difference in treatment is often how the right diagnosis is discovered, since antidepressants can trigger hypomania and mania. But it takes professional care involving more than a quick checkup, and that asks the right questions. Observation over time to identify cycles, and during periods a person feels great (due to hypomania/mania) and so is ironically less likely to seek help, is important. Psychotherapists, who do spend this kind of time with their clients, may be an important front-line contact compared to a psychiatrist who may only spend 15 minutes with someone every six months (which is currently all that many HMOs will cover) or a family doctor not trained to look for the symptoms. Ultimately they work together.

Clients must be proactive, too – tracking symptoms over time can bring bipolar cycles to light (see Electronic Mood Charts), which helps professionals make the right diagnosis.

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    Last reviewed: By John M. Grohol, Psy.D. on 26 Mar 2006
    Published on PsychCentral.com. All rights reserved.