I got a request from a Spo-fan (who is well over four feet) to write about bipolar depression. Here are some basics.

Clinical depression comes in various types. “Unipolar” depression is the mood condition in which people go between states of depression and feeling OK/normal (rather than feeling happy). “Bipolar depression” as the name suggests means sometimes the moods go up and beyond ‘OK” into what is sometimes referred to as mania. In a manic mood state the person often feels euphoric with high energy; they sometimes feel they can do anything. They often do reckless activities such as driving too fast, spending money, or sexually act out – all in ways they would not do in a calmer mood. In a bipolar depression there is often irritable and labile mood swings, talking too loud a/or too fast, and little or no sleep.

The old term for bipolar depression is manic-depression. Either term is used by patients but clinicians tend to use the former.

Discriminating unipolar from bipolar depression is quite challenging, for the mood conditions fall on a spectrum rather than in clear either/or categories. I spend a lot of my job trying to figure out a patient’s depression type. Sometimes it takes years before someone is properly diagnosed with a bipolar depression, having had first a long time of being diagnosed and treated as unipolar. It makes a crucial difference to get the right diagnosis, for the treatments  are different. If I give a person with bipolar depression the wrong type of medicine, the prescription could actually make them worse or manic.

Alas, people don’t fall cleanly into clean either/or categories; bipolar depression is seldom clear cut. When I was trained only thems with ‘classic’ manic periods – followed by depressive states – were diagnosed ‘bipolar’. Now we know the majority of bipolar patients do not fit into this classic definition.

Sometimes a patient tells me once upon at time they took an antidepressant and it made them worse. This is a sign for me to sit up and consider the possibility of a bipolar type depression.

Lithium used to be the one and only Rx for bipolar depression. There are many others now, although lithium remains the ‘gold standard’. It’s a tough medication to take, and thems with ‘atypical’ or ‘mixed states’  or ‘rapid cycling’ types of bipolar depression don’t respond to lithium as well as ‘garden-variety manic depression” viz. clear and clean manic episodes.

It used to be people with bipolar depression were missed and underdosed. Now the pendulum has swung the other way and too many moody/irritable unipolar depressed folks are being diagnosed with bipolar type depression. Ironically, thems with true bipolar depression are still not being identified and treated.

There are no good physical exam findings or brain scans or blood work tests to make the diagnosis easy (at least not yet). There are some relatively good screening tests a doctor can do to help screen for such. In the end it is the history and timeline – and an expert like Urs Truly (hohoho) – to make the diagnosis. Even then I have to be mindful do I have the proper diagnosis or not.

Advertisements