Why It Can be Difficult to Diagnose Bipolar Disorder

Some people with bipolar disorder can go years before arriving at an accurate diagnosis.

People who have bipolar disorder often live with the illness for many years before they’re properly diagnosed and treated.

Medically reviewed in January 2022

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 people who have from bipolar disorder often live with the illness for many years before they’re properly diagnosed and treated.

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 help during a depressive episode—while the high energy and bursts of creativity common in manic episodes are sometimes a welcome relief. The trouble is, if diagnosed and treated for depression alone, antidepressants can make symptoms worse.

Understanding symptoms
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

Episodes of depression last for at least two weeks. Manic episodes last for at least a week, but these can 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

Some people with bipolar disorder experience what are called hypomanic episodes, which are shorter in duration (typically 4 days) with symptoms that are less intense.

Getting an accurate diagnosis
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 healthcare provider 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."

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 treatment with a healthcare provider, there are effective treatments that can lead to a happier, more balanced life.

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