In a recent piece directed at my readers with bipolar, I noted that for many people unipolar depression is bipolar waiting to happen. Too often, people with bipolar get misdiagnosed with depression. You could be one of them. Let’s investigate:
In May this year, the American Psychiatric Association published the latest version of it’s diagnostic bible - the DSM-5. Unfortunately, the DSM-5 does not address itself to the issue of misdiagnosis. Clinicians seeking guidance are better off checking out a recent article in The Lancet. Ironically, its co-author is the Chair of the DSM-5 Task Force.
David Kupfer is one of the leading mood disorders experts, and his article provides a good indication why. In Dr Kupfer’s view (which accords with other experts), recurrent unipolar depression is a close cousin of bipolar. An illustration from the article tells a thousand words:
The top wave pattern represents bipolar I, characterized by depressive lows and manic highs.
The middle wave represents bipolar II, with the same depressive lows but more moderate (hypomanic) highs.
The bottom wave represents recurrent unipolar depression. Same depressive lows, but this time the “highs” top out at normal.
Do the waves look very similar? Is it fair to say that we are looking at three related conditions with this common feature - depressions that cycle up and down? The downs are the same on all three representations. Only the degree of up remains different, and up is very difficult to calibrate. This is because, according to Dr Kupfer, those with bipolar I only experience manic symptoms 9 percent of the time and those with bipolar II experience hypomanic symptoms just one percent of the time.
Try recalling what it was like when you felt good, when you hardly ever feel good.
According to Dr Kupfer: Bipolar is misdiagnosed as recurrent unipolar depression in 60 percent of those seeking treatment for depression. Only one in five of those experiencing bipolar depression are correctly diagnosed within the first year of seeking treatment. Twenty percent of those with depression develop a manic or hypomanic episode in five years. Many with so-called “treatment-resistant depression” probably have unrecognized bipolar.
So, here you are, dear reader, diagnosed with “depression.” Are you sure? Are you sure that your doctor is sure? The American Psychiatric Association in its 2010 Practice Guideline for treating depression states:
All patients who present for treatment for a major depressive episode should be screened for a past history of manic or hypomanic episodes.
In other words, before a clinician makes a diagnosis of depression, bipolar needs to be expressly ruled out. This requires a thorough examination, generally more than one, preferably with a family member present. Not all psychiatrists do this. General practitioners never do.
So maybe you are saying to yourself: “I can’t be bipolar. I get depressed a lot, but I don’t get those manic highs. Besides, I’m not crazy.”
That may be true. It may be that you simply have depression and that an antidepressant is your medication of choice. But it may be that the way your depressions cycle in and out have an awful lot in common with bipolar. Maybe it’s not bipolar in a strict sense of the term or maybe it is.
Confused? That means you’re not certain, and when it comes to a diagnosis of depression you really need to be certain beyond all reasonable doubt.
There are no easy answers. But you need to be asking a lot of questions.
Published On: July 31, 2013