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Diagnosing Bipolar Disorder Can be Challenging

What is Bipolar Depression?

Now let’s talk about those depressions, the flip side of bipolar disorder. In one way, there is nothing to distinguish bipolar depression from “unipolar” depression, from mild to severe, with similar suicide rates of about 15 percent. But now we’re beginning to discover that bipolar depression may be an entirely different animal, involving different biological processes and treatments.

Sadly, the depressive side of bipolar disorder has been overlooked by the experts. As 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.”

Rapid-Cycling Bipolar Disorder

The course of the illness is speeded up in some people, so that they are known as rapid-cyclers, who can go up and down and back again, sometimes in a matter of hours. Since rapid-cyclers represent a moving target, treatment is difficult. Antidepressants can induce mania, and antimania medications can induce depression. Analyzing a Stanley Foundation trial, Robert Post MD of the NIMH observed in Bipolar Disorder: “This still left some 30-40 percent of our patients inadequately responsive.”

Then there are those with “mixed states,” who can be up and down at the same time, with agitated depression or dysphoric mania. Some people with unipolar depression can also experience some of these symptoms, and here is where depression gets especially dangerous, for if one is feeling suicidal while in an agitated or manic state, then one has the energy to carry out the deed.

Bipolar Disorder is Not Just Up and Down

These ups and downs – the manic highs and the depressive lows – are what define bipolar disorder, and many authorities are content to leave it at that, as if our brains were simple pendulums swinging from one extreme than the other. But the mind, as well as bipolar, is far more subtle and insidious – and occasionally beneficent – than that.

Diagnosing Bipolar Disorder Can be Challenging


Psych Central Staff

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APA Reference
Psych Central. (2020). Diagnosing Bipolar Disorder Can be Challenging. Psych Central. Retrieved on October 1, 2020, from https://psychcentral.com/lib/diagnosing-bipolar-disorder-can-be-challenging/
Scientifically Reviewed
Last updated: 17 Jan 2020 (Originally: 17 May 2016)
Last reviewed: By a member of our scientific advisory board on 17 Jan 2020
Published on Psych Central.com. All rights reserved.