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Why It’s So Difficult to Diagnose Bipolar Disorder

Why It’s So Difficult to Diagnose Bipolar Disorder

Highs and lows, peaks and valleys, good times and bad -- they're a normal part of life, affecting everything from your mood to the decisions you make. But when mood swings become severe and you find yourself fluctuating from one extreme to the other, that's when you might ask yourself, "Do I have bipolar disorder?" If so, knowing is half the battle and seeking an evaluation should be your next step.

Bipolar disorder can be difficult to diagnose
People who suffer from bipolar disorder often live with the illness for many years before they’re properly diagnosed and treated. According to the National Institute of Mental Health, bipolar disorder affects about 5.7 million Americans 18 and over (2.6% of the U.S. population) with the median age of onset at around 25 years old. But diagnosis can be challenging for a few reasons. One is that some of the condition’s symptoms can be associated with other mental illnesses such as major depression, schizophrenia and Attention Deficit Hyperactivity Disorder (ADHD). Another is that people with bipolar disorder tend to seek a doctor’s help during a depressive episode (the high energy and bursts of creativity common in manic states are sometimes a welcome relief). The trouble is, if diagnosed and treated for depression alone, antidepressants can make symptoms worse.

There are essentially two sets of symptoms that characterize bipolar disorder: depression and mania. Signs of depression may include:

  • Sadness, emptiness
  • No pleasure from daily activities
  • Significant weight loss or gain
  • Inability to sleep at night or stay awake during the day
  • Feelings of worthlessness
  • Inability to concentrate and make decisions
  • Thoughts about death, wanting to die or suicide

Related: Learn how depression differs from bipolar disorder.

Episodes of major depression last for at least two weeks. This is in contrast to manic episodes, which last for at least a week; they vary by intensity and length of the mood swings. Generally speaking, symptoms may include:

  • Exaggerated euphoria
  • High energy
  • Irritability or rage
  • Lack of concentration
  • Decreased need for sleep
  • Changes in appetite
  • Inflated sense of self-esteem
  • Rapid and excessive speech
  • Racing thoughts
  • Impulsivity and poor judgment, which may include excessive spending, sexual promiscuity and reckless driving

In the case of rapid cycling bipolar, a more severe form, people can have faster mood swings up to several times a day.

Related: What are the different types of bipolar disorder?

Getting your symptoms in check
If you feel bouts of depression and mania, it's important to look at your experience over a long period of time to help your doctor better treat you. "Getting a patient's medical history and conducting a structured interview with them is the best way to arrive at a diagnosis," says Thomas Jensen, MD, and medical director of the International Bipolar Foundation. "We have to walk through each symptom of the mood disorder." Your doctor may ask your permission to talk to close friends and family members as well. "If other people can endorse the symptoms, we can arrive at a better diagnosis."

Alternative methods of diagnosis may include brain mapping. "We use a study called brain SPECT imaging that looks at blood flow and activity in the brain,” says Daniel Amen, MD, and founder of Amen Clinics. “It helps us evaluate the underlying biology of patients so we can target treatment more appropriately."

Related: Recognizing triggers of bipolar disorder

Hope and healing go hand-in-hand
Bipolar disorder can be devastating if left untreated. Relationships may become frayed; career opportunities lost. And although it's an illness that requires continued follow-up with your doctor, it’s possible to find a treatment that can help manage depression, mood swings and other symptoms, ultimately leading to a happier, more balanced life.

Medically reviewed in February 2020.

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