Think of this post as a coda to the piece I published a day or two ago, on whether or not your unipolar depression may be bipolar waiting to happen. The piece drew from Goodwin and Jamison's 2007 "Manic-Depressive Illness," which identified a class of unipolars whose patterns of recurrence strongly resembled those found in bipolar.
The piece also drew on a 2005 study by the Swiss psychiatrist Jules Angst, which found that over the course of time an alarming percentage of those diagnosed as unipolar morphed into bipolar.
Dr Angst, who is in his late-eighties and still going strong, is one of the original proponents of making the distinction between unipolar depression and bipolar disorder. In fact, it was Dr Angst who coined the term unipolar back in the 1960s.
But at the same time, though. Dr Angst has always recognized the overlap between the two conditions. According to Dr Angst, if we were to relax the threshold criteria for hypomania (mania lite), bipolars would comprise four or five or six percent of the population, instead of one or two.
The catch, though, is these microscopic distinctions are likely to sail straight over the heads of even the most diligent clinicians. The real point is that hypomania as we currently define it goes widely unrecognized in the unipolar population, namely:
- The light end of hypomania too closely resembles "normal."
- Depressed patients have a difficult time recalling when they ever felt normal, much less better than normal.
- Even if doctors do have something to go on, they tend to err on the side of diagnosing for unipolar depression.
How bad is the problem? According to Dr Angst, in an editorial in the International Journal of Bipolar Disorders in 2013: "DSM major depressive disorder " includes about 40% of hidden bipolars."
Translation: There is a strong likelihood that you have been diagnosed with the wrong illness.
Before you panic, ask yourself:
How are your depression treatments working for you? Maybe it's time to have a second look. Diagnostics is a complex undertaking, but you are already holding the major clues. Here are some of the indicators, which represent the distilled wisdom of experts well-familiar with the overlap between unipolar and bipolar:
- A history of past depressions. This points to bipolar-like recurrence and cyclicity.
- Age at first onset. Teens or early twenties is when bipolar usually first manifests. Unipolar depressions tend to materialize later.
- Family history: It's not just your weird Aunty June. Your totally awesome brother or sister may be hiding something from you.
- Lack of response to antidepressants. This is the big one. Your doctor may have tried you on one antidepressant after another, to no avail. They may have made you worse. At any rate, you have lost confidence in them.
None of these are signs in themselves that you have bipolar, but they will definitely give your psychiatrist something to go on.
It would also be helpful to bring a loved one to your next appointment. You may not recall that time you launched into your Chris Rock routine during a meeting with your kid's teacher and principal, but your loved one certainly will.
Do your own research, talk it over with a competent psychiatrist. There may be some hard decisions ahead. Have courage. You are on your way "
John McManamy is the award-winning author of Living Well with Depression and Bipolar Disorder.