For this sharepost I thought I'd discuss a couple of issues relating to diagnostic boundaries. The first issue relates to people who are receiving medication normally prescribed for bipolar disorder but can only ever recall being depressed. The second relates to people diagnosed with unipolar depression who wonder if they might actually be bipolar - a question recently asked by ‘sick1997'.
Let's take each in turn. Why might a person who can only ever recall being depressed be taking medication normally prescribed for bipolar disorder? This one should be fairly straight forward. A diagnosis of bipolar disorder can only be made if the person has experienced at least one episode of hypomania or mania. And there's the rub - it should be straight forward but diagnosing hypomania moves us into blurry territory.
Arguably, a person with recurring unipolar depression may feel energized and almost high on normality when those precious and elusive moments come their way. Might that be confused with hypomania? Then again, lithium is not only used in the treatment of bipolar disorder, it can be used as a kind of catalyst for other antidepressants in cases where depression appears treatment resistive.
So what of the person diagnosed with depression who wonders if they may actually have bipolar disorder? In some ways the same rules apply. How do we know whether the periods of relief from depression simply elevate the mood to a rare and unusual place? Happiness is a natural part of the human condition. People starved of this most elemental quality surely have the right to immerse themselves in it when it comes their way?
The definition of hypomania goes along the lines of, ‘a distinct period of persistently elevated, expansive, or irritable mood, lasting at least four days, that is clearly different from the usual non depressed mood.' Moreover, an episode of hypomania is distinguished from ‘normal happiness' by its persistence and the fact that it doesn't change in the light of circumstance (good or bad). When compared to someone who is almost permanently depressed the concept of normal happiness is something quite difficult to measure or quantify. Then again, most people have relatively consistent lives that do not contain much in the way of particularly good or bad news that might arise during a few days of hypomania. Establishing what is appropriate in terms of mood is a fiercely subjective issue.
Doctors have variously been accused of being under-sensitive to diagnosing bipolar disorder and, more recently, over-sensitive. There's little doubt that screening and diagnosis remains patchy and is not always effective. So, this sharepost is a recognition of the problems that both patients and clinicians have in working together in order to settle on an appropriate diagnosis. Secondly, while I see the importance of sensitivity to circumstances, I suggest we shouldn't be in too much of a hurry to pathologize happiness, creativity and expansive moods.
Published On: March 05, 2010
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