A Shifty Beast in the Ring: Is This Bipolar Depression
Okay—a lot of you have been at this for a long time—going toe-to-toe with depression—round after round after round. And this monster is still beating you down. Today, I’m going to invite you back into the corner of the boxing ring, and we’re going to have a little talk about how to revise the strategy of attack. Because the opponent you’re facing in the ring may not really be the monster you thought it was. It may be another beast altogether.
Hi! I’m Dr. K, and I’m a psychiatrist based in the Southeast. Today, I’m going to talk about bipolar depression.
This is what you need to know. Bipolar depression is a completely different beast from unipolar depression. Let me give you some background. So, bipolar depression means that a person who is experiencing depression also has experienced or will potentially experience hypomanic or manic episodes. These individuals have two poles to their mood—the depressive pole and the manic or hypomanic pole—hence, the term “bi-polar.” Unipolar depression means that a person who is experiencing depression has not and will not experience manic or hypomanic episodes. These individuals only have one pole to their mood—the depressive pole—hence, the term “uni-polar.”
Now this is the tricky part, bipolar and unipolar depression can look a lot a like. So much alike, in fact—that mental health providers more likely than not miss the diagnosis of bipolar depression and misdiagnose it as unipolar depression. This is a problem. A major problem. Why? Because the strategies for attack these mental illnesses are completely different from each other.
You might ask, “Well my goodness, Dr. K—why is the diagnosis of bipolar depression so easily missed? Well, like I said, it can look a lot like unipolar depression, but there are other reasons why. Unipolar depression is more common than bipolar depression. Also, people with bipolar disorder is primarily a depressive disorder, because people have far more depressive episodes than manic or hypomanic episodes. When they first visit a health care provider for treatment of depressive symptoms, they may have only experienced depressive episodes up that point. They may have not experienced any episodes of mania or hypomania—yet. Yet. Their genetics may have them preloaded to experience a bipolarity to their mood, but at the point they come into care by a physician, only the depressive beast has reared its head—the manic or hypomanic phase hasn’t showed itself just yet.
So, these are some ways to help figure out if the depression you or your loved one are experiencing may actually be bipolar depression:
Age of onset with the first episode of depression. If a person presents with depression at an early age—before age 25, this might be an indicator that the person has a brewing bipolar disorder.
If there is a strong family history of mental illness, especially if there is a history of bipolar disorder or completed suicide or multiple family members with ADHD, then this could be an indicator that you’re dealing with a bipolar depression rather than a unipolar depression. Individuals with a parent, child, or sibling with bipolar disorder are at an eight times greater risk of developing bipolar disorder compared to the general population. The majority of patient with bipolar disorder do NOT have family history of bipolar, but family history of bipolar is currently the greatest known risk factor for developing bipolar disorder.
If depressive episodes are associated with hypersomnia rather than insomnia—or sleeping too much or all the time instead of problems falling or staying asleep, then you might be dealing with bipolar depression.
If depressive episodes are associated with eating excessive amounts of food rather than decreased or poor appetite then you might be dealing with bipolar depression.
If you have had multiple depressive episodes—five or greater, then you might be dealing with bipolar depression.
Another indicator—you or your loved one have tried multiple antidepressant medications with mediocre results or no results at all. If that’s the case, bipolar depression might be in the boxing ring.
If mood episodes are associated with four A’s--anxiety, agitation, angry or irritable or aggressive, or attentional disturbance---then it may indicate the presence of a bipolar disorder. These are called “mixed states” where a person with bipolar disorder are experiencing both depressive and manic or hypomanic symptoms at the same time. And let me tell you why this matters---mixed states are considered to be a particularly high-risk state for suicide.
That being said, my very strong suggestion is this: if the criteria I just listed describes you or your loved one, seek out the care of a licensed mental health provider and don’t drag your feet. The tips I have here are not meant to be a substitute for advice from your own health care provider, but I would like to encourage you to seek care as soon as possible. Bipolar disorder is associated with a 20-30 times higher suicide risk than that of the general population, BUT bipolar disorder is a treatable disorder. People with this disorder can go on to thrive and be an absolute gift to the world around them. They just need continued treatment and support. But this is the kicker—treatment for bipolar depression is completely different than treatment for unipolar depression. In the case of bipolar depression, there are mood stabilizing medications that are specifically FDA approved for this condition. Traditional antidepressants do NOT have FDA approval for treatment of this condition and may do more harm than good. In fact, traditional antidepressants may worsen anxiety, irritability, and agitation or may even trigger a manic or hypomanic episode.
You’ve got to know who you’re in the ring with. You’ve got to know your opponent. Is it unipolar depression, or is it bipolar depression? These are two completely different beasts, and you’ve got to have the appropriate strategies for attack for each. I encourage you, find a mental health provider ASAP to help to determine the true identity of your opponent.
I’m Dr. K and this has been Mental Health | Plain Speak, and remember “Be kind, for everyone you know is fighting a hard battle.”
