Skip to main content

You Asked: What is Bipolar Depression?

A bipolar depression is a depressive episode occurring in context of bipolar disorder. When diagnosing depression, it is imperative to first exclude an underlying bipolar disorder. This is because the medication treatment for bipolar depression differs from that for “unipolar” depression. People with bipolar disorder have manic or hypomanic episodes. These are periods of persistently elevated or irritable mood along with feelings of grandiosity, decreased need for sleep, talkativeness, racing thoughts, increase in sexual drive, increased goal-directed activity, or excessive involvement in risky or impulsive activities.

Individuals with bipolar disorder spend around 40% of the symptomatic time being depressed (Judd et al., 2002). Moreover, people with bipolar disorder are more likely to seek help when they are depressed. Therefore, it is not uncommon for bipolar depression to be misdiagnosed as unipolar depression or major depressive disorder. The consequences of such a misdiagnosis may result in treatment with antidepressants, some of which can cause mood episodes to occur more frequently in people with bipolar disorder (Hirschfeld, 2014). Pointers that suggest a possibility of bipolar disorder are as below (Goodwin & Jamison, 2007; Hirschfeld, 2014):

  •  Family history of bipolar disorder.
  •  Earlier onset of depression (early 20’s).
  •  Multiple past episodes and psychiatric hospitalizations.
  •  Seasonal mood episodes.
  •  Switching into mania or hypomania on antidepressants.
  •  Depressive episodes characterized by increased sleep, increased appetite, and weight gain.
  •  Depressive episodes mixed with hypomanic or manic symptoms.
  •  Depressive episodes with psychotic symptoms such as delusions or hallucinations.


If you have been diagnosed with depression and notice one or more of the above features, complete the Mood Disorder Questionnaire (MDQ), which is available on the Depression and Bipolar Support Alliance website (http://www.dbsalliance.org) or can be googled. The MDQ can correctly identify almost 75% of people with bipolar disorder and also correctly screen out 90% of people who don’t have bipolar disorder (Hirschfeld et al., 2000). Consult your mental health or primary care provider for a more comprehensive assessment if you screen positive for bipolar disorder on the MDQ.

Depression with mixed features: Sometimes people with depression may experience some manic/hypomanic symptoms, but never a clinical manic or hypomanic episode. In such cases, the most likely diagnosis is major depressive disorder with mixed features (American Psychiatric Association, 2013). Recognizing mixed symptoms in context of depression is important as they are a risk factor for future bipolar disorder and make depression less responsive to antidepressants (Hu et al., 2014). 

To learn more about self-management techniques for depression, please refer to the evidence-based bestseller The Complete Guide to Self-Management of Depression: Practical and Proven Methods. This comprehensive and easy-to-read book offers the reader a menu of options to self-manage depression that go above and beyond the traditional approaches to treat depression and includes complementary and alternative medicine approaches, exercise, mindfulness, role of social support, and bright light therapy. Besides therapy techniques, the book also provides an evidence-based overview of the role medications in treating depression - when to take them, how long to take them, when and how to stop them, and what to do when medications stop working.

HARPREET S. DUGGAL, MD, FAPA


REFERENCES:

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.

Goodwin, F. K., & Jamison, K. R. (2007). Manic-depressive illness: Bipolar disorders and recurrent depression (2nd ed.). New York, NY: Oxford University Press.

Hirschfeld, R. M., Williams, J. B., Spitzer, R. L., Calabrese, J. R., Flynn, L., Keck, P. E., Jr., Lewis, L., McElroy, S. L., Post, R. M., Rapport, D. J., Russell, J. M., Sachs, G. S., & Zajecka, J. (2000). Development and validation of a screening instrument for bipolar spectrum disorder: the mood disorder questionnaire. American Journal of Psychiatry, 157(11), 1873-1875.   

Hirschfeld, R. M. (2014). Differential diagnosis of bipolar disorder and major depressive disorder. Journal of Affective Disorders169(S1), S12-S16.

Hu, J., Mansur, R., & McIntyre, R. S. (2014). Mixed specifiers for bipolar mania and depression: highlights of DSM-5 changes and implications for diagnosis and treatment in primary care. Primary Care Companion for CNS Disorders, 16(2), pii: PCC.13r01599. doi: 10.4088/PCC.13r01599. Epub 2014 Apr 17.

Judd, L. L., Akiskal, H. S., Schettler, P. J., Endicott, J., Maser, J., Solomon, D. A., Leon, A. C., Rice, J. A., & Keller, M. B. (2002). The long-term natural history of the weekly symptomatic status of bipolar I disorder. Archives of General Psychiatry, 59(6), 530-537. 

Comments

Popular posts from this blog

Self-Management: A New and Proven Way to Treat Depression

What is self-management?
You probably have heard the term “self-help” and may have also read a few self-help books. Most self-help books on depression focus on acute treatment of depression based on a particular model of therapy, usually the Cognitive-Behavioral Therapy (CBT). While the self-help approach tries to address a condition using a focused treatment modality over a short period of time, self-management is learning new ways to manage an illness over a longer period of time. In other words, self-management is using the resources and learning the skills to “positively manage” an illness (Lorig et al., 2006). Lorig and colleagues (2006) further elaborate on self-management; it is a “management style” wherein you are a positive self-manager who not only uses the best treatments provided by healthcare professionals, but also approach your illness in a proactive manner on a daily basis, leading to a more healthy life. For example, good self-managers of diabetes, besides taking medic…

Feeling Depressed? Change these 11 Negative Types of Thoughts

People with depression often have negative or irrational beliefs, which continue to fuel their depressive thinking. According to the cognitive model of depression, the emotions in depression such as sadness, guilt, hopelessness, worthlessness, helplessness, anger, frustration, and anxiety are triggered by a dysfunctional thought process. This dysfunction involves misinterpretation or misattribution of situations, past events, memories, and even feelings leading to irrational thoughts – also called cognitive distortions – that in turn perpetuate depressive symptoms. These irrational thought patterns are described below:

1. All-or-None Thinking: This type of irrational thinkingis also called black-and-white thinking or dichotomous thinking. This is thinking in extremes or absolutes with no consideration for any alternatives in between the extremes. For example, if you get a below-average performance evaluation and feel that you will never get a good performance evaluation in the future, …

Problem Solving: A Proven Way to Treat Depression

If you are human, you will have problems. Having problems means that you are normal and solving them means you are a happy normal! Genuine problems such as not being able to pay your bills on time or not knowing how to go about furthering your education are best addressed by problem-solving and not by cognitive techniques such as challenging your irrational thoughts. Problem-solving therapy is an effective treatment for depression, but has received little attention as most popular books on self-help of depression heavily rely on cognitive-behavioral techniques (Kirkham et al., 2015). The problem-solving steps are described next (Martell et al., 2010; Nezu et al., 1989). Problem-solving steps
1.Define the problem in clear and specific behavioral terms, i.e., what specific behavior needs to be addressed or changed. You will be able to generate better solutions for a specific problem such as, “I have been postponing paying my bills for last two weeks and feel overwhelmed whenever I try to…