Have you ever wondered if you really have bipolar disorder and not major depression? Did you know there are signs that can point to bipolar disorder outside of what we normally consider to be the diagnostic symptoms of bipolar disorder? And did you also know that few doctors take these types of signs into account? If you feel like you have bipolar disorder but have been diagnosed with major depression, you’ll want to know about these signs because diagnosis directly affects treatment, and treatment directly affects you getting better.
Do You Really Have Bipolar Disorder — The Diagnostic Symptoms of Bipolar Disorder
I’m not going to go through all the standard diagnostic symptoms of bipolar disorder outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) here. However, if you’d like to orient yourself to these symptoms, click here, and for the difference between bipolar I and bipolar II, please see here.
What I will say is this: I believe in a spectrum model of bipolar disorder. This basically means that you can not fit the exact criteria for bipolar disorder as outlined in the DSM-5 and still actually have bipolar disorder. This is because bipolar disorder seems to occur on the spectrum. On one end is unipolar depression (or major depressive disorder), where a person experiences depression and absolutely no other symptoms. On the other end of bipolar disorder type I, where a person suffers from “classic” bipolar disorder with all the appropriate symptoms of mania and depression and meets the minimum times for both (it’s one week minimum for mania and two weeks minimum for depression). Now, bipolar II is closer to the bipolar I end as they experience major depressive symptoms (for two weeks minimum) and hypomanic symptoms (for four days minimum).
Next to that, though, is bipolar “other” (technically called “other bipolar and related disorder” and previously known as bipolar not otherwise specified [bipolar NOS]). Bipolar other is for people who have a bipolar mood pattern but don’t fit into bipolar I or bipolar II exactly. For example, if you have all the symptoms for bipolar II but only experience hypomanias that are two days long and not the minimum of four, you have bipolar other. Not surprisingly, diagnosing bipolar other is very hard as it could look like many things. It takes a skilled clinician to put a person into this category properly.
(Beside bipolar other and closer to depression is cyclothymia, by the way.)
Bipolar, Not Depression — Experiences Suggestive of Bipolar Disorder
There are elements of a person’s mood or experiences that while not documented in the DSM-5 are suggestive of bipolar disorder. This is because these experiences are found disproportionally in people with bipolar disorder.
These experiences include:
- Depression with profound anxiety — For some people with bipolar disorder, anxiety is actually the most debilitating symptom and hardest to weather. According to PsychEducation.org, “Many say they feel as though they just have too much energy pent up inside their bodies. They can’t sit still. They pace. And worst of all, their minds ‘race’ with thoughts that go over and over the same thing to no purpose. Or they fly from one idea to the next so fast their thoughts become ‘unglued,’ and they can’t think their way from A to C let alone A to Z.” A person with depression and profound anxiety, then, may actually have bipolar disorder.
- Depression with irritable episodes — I’ve written before about bipolar and anger and bipolar and irritability — anger as a symptom not being in the DSM-5 and irritability as a symptom being there. However, many people will tell you that these episodes in bipolar disorder do rise to the level of anger or even rage. Thus, depression with these rage-type episodes is suggestive of a bipolar disorder diagnosis.
- Depression that doesn’t respond to antidepressants or where antidepressants frequently stop working — This one is fairly self-explanatory. In this case, sometimes antidepressants don’t work at all, and the person suffers side effects only. The person might also face negative effects of antidepressants like agitation and insomnia. In other cases, antidepressants work for a while and then stop. When this happens with several antidepressants, it may indicate underlying bipolar disorder.
- Depression with periods of severe insomnia — In this case, severe insomnia might be periods of only 2-3 hours of sleep per night for days. The person desperately wants and needs more sleep but can’t get it (unlike in hypomania/mania, wherein you feel like you don’t need it). This pattern over time may be indicative of bipolar disorder.
Bipolar, Not Depression — Soft Signs of Bipolar Disorder
While the above patterns may indicate bipolar disorder, there are other “soft” signs that may also suggest a bipolar diagnosis. Again, these signs are found disproportionally in people with bipolar disorder and are suggestive of a bipolar diagnosis but are not specific diagnostic factors, per se.
Soft signs that you have bipolar disorder, not depression, are:
- Repeated episodes of depression (at least four; seasonal shifts common)
- When the first episode of depression occurs young, before age 25 (although some say before 20 or even 18)
- A first-degree relative (such as a parent, sibling, etc.) has bipolar disorder
- When not depressed, mood and energy are a bit higher than the average person (known as a “hyperthymic” personality)
- Atypical depression symptoms present (this means increased hunger, increased sleep [hypersomnia], extremely low energy, mood reacts to outside events)
- Episodes of depression are brief (less than three months)
- Experience(s) of psychosis
- Postpartum depression
- Hypomania/mania induced by taking an antidepressant
Why Do the Soft Signs of Bipolar Disorder Matter?
If you actually should have a diagnosis of bipolar disorder but, instead, have one of, say, major depressive disorder, the chances are, you’re not going to get better. That’s because the treatment for each is different. If your psychiatrist sees these suggestive experiences or soft signs of bipolar disorder and has a suspicion that you may actually have bipolar disorder, this may drastically affect your treatment. This new treatment may have a greater chance of making you better. This makes considering these bipolar patterns essential for those that aren’t getting better with other diagnoses.
Do You Have Bipolar, Not Depression If You Have Soft Signs of Bipolar?
Some people are easy to diagnose with bipolar disorder, and others are very difficult. If you fall into the latter category, only an experienced, specialized psychiatrist will likely do a good job at diagnosing you. If you have several soft signs of bipolar disorder or experiences suggestive of bipolar disorder and you’ve been diagnosed with something else (probably depression) and aren’t getting better, you should look into a bipolar diagnosis. If you’re having trouble getting your psychiatrist to consider it, go to the resource found at the end of this article and print it out for your psychiatrist. It was written by a doctor, so your psychiatrist is more likely to pay attention to it.
But remember, these are soft bipolar signs we’re talking about, so while they may inform diagnosis and treatment, they may not indicate bipolar disorder. People are complex, and there could be other explanations for what you’re experiencing. That’s why you need the most experienced, specialized psychiatrist you can find. You want someone who sees bipolar disorder all day long as they’re the ones who can rule it in or out as a possibility far more successfully than the average psychiatrist who may be treating a wide range of illnesses. And remember, there are mood disorder clinics as well that can provide highly specialized consultations, and that information can be used by your average psychiatrist. Basically, the rule is, the more treatments you have failed, the more likely it is that you need a more specialized assessment and treatment plan.
So, you may not have bipolar disorder, even with several of the soft signs or experiences being present; then again, then again, you may so, don’t hesitate to insist on a second opinion or a specialized consultation. Remember, doctors work for you, and your health is worth it.
For More Information on Bipolar Diagnosis
If you want to know more about bipolar diagnosis, see my on-demand masterclass called What You Need to Understand About a Bipolar Diagnosis.
What Was This Article Based On?
This article was based on the information provided by Jim Phelps MD at PsychEducation.org. Dr. Phelps is a psychiatrist who has specialized in bipolar disorder for many years and has earned tremendous respect from me. His whole article is here.
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