Depression: Bipolar or unipolar?
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Depression: Bipolar or unipolar?

Bipolar Symptoms

One kind of bipolar test involves simply asking the patient if they have had any periods where their mood was euphoric (high or up) or irritable. In fact, asking about a history of this one bipolar symptom is the primary method by which clinicians are supposed to make a diagnosis of bipolar disorder.

But there are a number of problems with relying exclusively on this kind of bipolar test. These are discussed in detail in my book on bipolar disorders . For now, readers should know that periods of increased activity and productivity (getting more done than usual) are more reliable markers for bipolar disorder than periods of euphoric or irritable mood. Other bipolar symptoms that doctors and therapists should look for include periods of:

  • Decreased need for sleep
  • Increased talking or faster, louder speech that others find hard to interrupt
  • Increased sociability
  • Being argumentative or more easily frustrated, irritated, angered
  • Excessive spending, risky or foolish business ventures, increased alcohol or drug use, saying or doing things that reflect poor judgment
  • Racing or crowded thoughts
  • Distractibility
  • Increased sex drive or sexual indiscretions

Depressive symptoms that suggest the possibility of bipolar disorder

There are two specific kinds of depressive symptom clusters that should alert clinicians to the likelihood of bipolar disorder. One of these is mixed depressive and the other is atypical depressive. Mixed depressive episodes occur when someone has a few bipolar symptoms (mania or hypomanic symptoms) mixed in with mostly depressive symptoms. The most common bipolar symptoms to occur in mixed depressive episodes are racing thoughts, agitation, distractibility, talkativeness, and increased sex drive. Atypical depressive episodes are marked by oversleeping or overeating (typical depressive symptoms are insomnia and loss of appetite).

Course characteristics of bipolar disorder:

A bipolar test or assessment for bipolar disorder should include an evaluation of the so-called course characteristics of a person’s illness. That is, what the illness has looked like over time. Course characteristics that suggest bipolar disorder are a child, adolescent or young adult onset of depression (as many as one-half of children with no history of bipolar symptoms (hypomania) may go on to develop bipolar disorder). Depressed adolescents and young adults who have hallucinations (seeing or hearing things that are not real) or delusions (false beliefs) are especially likely to later develop bipolar disorder. Rapid onset of symptoms and a 3 month or less duration of depression suggest bipolar disorder. Unipolar depression comes on slowly and generally lasts 6 to 12 months without treatment. Other course characteristics, such as a post-partum onset of depression and winter depression followed by summer hypomania are discussed in my book on bipolar disorder.

Order Brian Quinn Ph.D's Latest book " Wiley Concise Guides to Mental Health: Bipolar Disorder"

Family histories that suggest bipolar disorder

A bipolar test should include some assessment of family history. Obviously, a family history of bipolar disorder in someone who is depressed should suggest the possibility of bipolar illness. But so should a family history of creativity and success (hypomania can make people very productive and successful) as well as a multigenerational history of significant mood problems. A family history of suicide is another marker for bipolar disorder.

Other psychiatric disorders that are common in bipolar disorder

Although people with unipolar depression can be troubled with panic attacks, obsessive-compulsive disorder, social phobia, substance abuse, gambling, binge-eating, and explosive tempers, these are all more common in people with bipolar disorder. The diagnosis of bipolar disorder should especially be considered in cases where someone meets diagnostic criteria for several psychiatric disorders at the same time. For instance, it is not unusual for women with bipolar disorder to have panic attacks, substance abuse and binge-eating.

Response to antidepressant medications

An accidental kind of bipolar test can occur when patients with bipolar disorder are misdiagnosed with depression and given antidepressant medication. Any of the following peculiar reactions to an antidepressant should suggest the possibility of bipolar disorder:

A sudden increase in energy along with a decreased need for sleep and the ability to get a lot done.
Sudden and dramatic improvement followed by repeated recurrence of depression in spite of dose increases or trials of different antidepressants. New or increased irritability, explosive temper, agitation or suicidal thoughts. Not getting better or getting only partially better in spite of having tried 3 or more depression medications.

The material provided is for your information only. It cannot be used to definitively diagnose or treat any illness or condition, including bipolar disorder. If you believe you may have unipolar or bipolar depression, consult a licensed mental health professional.

More information on bipolar disorder and its treatment please read my latest book,
" Wiley Concise Guides to Mental Health: Bipolar Disorder".

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