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How is bipolar depression diagnosed?

John Preston, PsyD
Psychology

There are 2 forms of severe depression: unipolar and bipolar. Making the diagnosis of depression is straight forward, but determining if it is a part of bipolar disorder (BD) can sometimes be a challenge. For the diagnosis of bipolar disorder it requires a history of one depressive episode and one manic episode (for bipolar I) or one depressive episode and one episode of hypomania (for bipolar II). One significant problem is that in 60% of teenagers and adults suffering from BD their first one or two episodes are depression (i.e. the manic side of BD has not yet emerged).

How can unipolar and bipolar depression be identified? This is where 3 issues are important to evaluate. First is family history (blood relatives). BD is known to be genetically transmitted and thus runs in families. Many people do not know if their relatives had BD…especially more distant relatives. However, in families where BD occurs, the following are not uncommon: multiple marriages, psychiatric hospitalizations, severe substance abuse, and/or suicide. Seeing these in relatives certainly does not absolutely imply BD, but this information is important. Secondly, unipolar and bipolar depressions share a number of things common, however if a person is experiencing severe depression and has the following symptoms, BD is suspected: hypersomnia (sleeping a lot, e.g. 10-12 hours a day), extreme fatigue, and/or appetite increase with subsequent weight gain. These symptoms are referred to as atypical depressive symptoms. If a person exhibits these symptoms, BD is likely. 80% of people with atypical symptoms turn out to have BD (BD II is especially common).

Finally those with BD II have severe depressive episodes (and this is when they seek treatment) but are not aware of or do not acknowledge periods of hypomania. Hypomania includes the following: a few days of decreased need for sleep (e.g. sleeping 5 hours a night and yet not feeling tired the next day), heightened feeling of energy, up-beat mood, and a surge of self-esteem. Hypomania comes out of the blue (i.e. not triggered by life events). Periods of hypomania and severe depressive episodes strongly suggest a diagnosis of BD II.

Note: many people suffering from unipolar depression are treated with antidepressants. These drugs often are successful in treating unipolar depression but are generally not effective in treating BD and in some, can make BD worse. Getting an accurate diagnosis is crucial.

 

To add to the above answer, family history of bipolar disorder in close blood relatives, past history of mood symptoms suggestive of mania or hypomania, and mood problems starting at a very young age are higher risk factors of bipolar depression. Unfortunately, there are no blood tests or brain scans yet that can diagnose bipolar disorder.

A doctor will ask a person for a complete description of the symptoms they are experiencing, potentially in the form of a daily journal of moods and activities. The doctor will also review medications to ensure that the symptoms are not resultant side effects. A physical examination and several laboratory tests will confirm that a disease with similar symptoms is not preventing an accurate diagnosis. Finally, a psychological examination in the form of a questionnaire or a study through the cooperation and observations of friends and family will help the doctor properly diagnose a disorder according to the Diagnostic and Statistical Manual of Mental Disorders.

Donna Hill Howes, RN
Family Medicine
Doctors and mental health workers diagnose bipolar depression by asking detailed questions about your mood. Among the symptoms that indicate bipolar depression are the following: a change of sleep patterns, thoughts of suicide, less enjoyment of activities, inability to concentrate, difficulty making decisions, loss of energy, long-lasting sadness, irritability and restlessness, anxiety, guilt, hopelessness, and a change in appetite.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.