Major depression is part of the DSM-IV criteria for swinging bipolar, but the next edition of the DSM may have to revisit what constitutes the downward aspect of this illness. At present, the DSM-IV criteria for major unipolar depression pinch-hits for a genuine bipolar depression diagnosis. On the surface, there is little to distinguish between bipolar and unipolar depression, but certain “atypical” features may indicate different forces at work inside the brain.
According to Francis Mondimore MD, assistant professor at Johns Hopkins and author of “Bipolar Disorder: A Guide for Patients and Families”, talking to a 2002 DRADA conference, people with bipolar depression are more likely to have psychotic features and slowed-down depressions (such as sleeping too much) while those with unipolar depression are more prone to crying spells and significant anxiety (with difficulty falling asleep).
Because bipolar II patients spend far more time depressed than hypomanic (50 percent depressed vs one percent hypomanic, according to a 2002 NIMH study) misdiagnosis is common. According to S Nassir Ghaemi MD bipolar II patients have 11.6 years from first contact with the mental health system to achieve a correct diagnosis.
The implications for treatment are enormous. All too often, bipolar II patients are given just an antidepressant for their depression, which may confer no clinical benefit, but which can drastically worsen the outcome of their illness, including switches into mania or hypomania and cycle acceleration. Bipolar depression calls for a far more sophisticated medications approach, which makes it absolutely essential that those with bipolar II get the right diagnosis.
This bears emphasis: the hypomanias of bipolar II – at least the ones with no mixed features – are generally easily managed or may not present a problem. But until those hypomanias are identified, a correct diagnosis may not be possible. And without that diagnosis, your depression – the real problem – will not get the right treatment, which could prolong your suffering for years.