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.
29 comments
May 15, 2017 at 8:40 AM
Rick
I don’t envy your field. What’s the difference of depression and the blahs?
May 15, 2017 at 12:26 PM
Urspo
Yikes! That is worth another entry to itself.
Sorting through ‘depression’ vs. ‘blah’ is my first step; the second step is about unipolar vs. bipolar depression.
May 15, 2017 at 9:31 AM
earnestlydebra
Very interesting. I thought it clarified me as seasonal unipolar – though, then I also see risky behavior – just lacking the element of elation. LOL I’d be curious of your experience on people managing this without medication. I don’t trust pharma any further than i can throw them – plus, wonder how I’d discern my own thinking and truth, versus a medicated truth. I can see how some would benefit greatly, where others might be able to avoid potential side effects. I guess that’s where a professional is needed for discernment.
May 15, 2017 at 12:27 PM
Urspo
There is good data that shows Cognitive Behavioral therapy (done right) combined with good exercise (regular) and nutrition (challenging) works just as well as Rx in the treatment of depression. I always try to steer patients to do the most conservative of options first.
May 15, 2017 at 2:46 PM
earnestlydebra
That sounds like a very wise and professional approach. I’m sure you must be very good at what you do. I have a friend who was treated with a combination of things and I feel like I lost her years ago.
May 15, 2017 at 11:51 AM
Old Lurker
I think it is fair to say that bipolar disorder broke my heart.
You think it is the depression that is the worst, but the mania is way more difficult for others.
May 15, 2017 at 12:28 PM
Urspo
Yes you are correct. Studies show despite the periods of euphoria, bipolar depression is more problematic and arguably more sorrowful to the patient than having unipolar depression.
May 15, 2017 at 2:17 PM
Jim
Very interesting. Question: is there any connection between ‘post surgical depression’ or ‘postpartum depression’ as what you just described?
May 15, 2017 at 8:20 PM
Urspo
Both are situational depressions that result of the complexity of events. Neither one is bipolar or unipolar per se but these two conditions can certainly show up/act up after surgery or pregnancy. Longitudinal history makes the diagnosis.
May 15, 2017 at 3:26 PM
David
One of my law school professors is Bipolar and managed well for 20 years, until he could no longer take Lithium. A few years ago he crashed hard, and had to take time off from teaching. He speaks freely about his illness and how it has impacted his life and his work. I didn’t really understand depression, until I spent a day listening to people with depression describe the profoundness of the feelings.
May 15, 2017 at 8:19 PM
Urspo
Poor fellow. This can hit anyone.
May 15, 2017 at 4:50 PM
mcpersonalspace54
When I read your post, I could not help but think about my own situation. A son with schizophrenia and my former wife with depression and drug abuse. Mental illness is difficult on everyone, including family members. Hats off to you for the job that you do for your patients and their families.
May 15, 2017 at 8:18 PM
Urspo
It’s a nasty disease indeed. It is not just something a person can pick themselves up by their boot straps.
May 15, 2017 at 5:04 PM
Steven
Great wealth of information shared here!
May 15, 2017 at 8:18 PM
Urspo
Tis but a summary – succinct but I hope enough to get the gist, makes a point, and satisfy the Spo-fan who asked for it.
May 15, 2017 at 5:14 PM
Willym
A very sincere thank you for this.
May 15, 2017 at 8:17 PM
Urspo
You are welcome
So much of Medicine is education and awareness.
May 15, 2017 at 10:22 PM
Kato
I like your description. It is very clear and respectful. Could I share it with a few friends?
Gee I hope my boys don’t go down the bipolar rollercoaster. I hope the resilience I’m trying to instill in them; and the ability to talk about hard emotions – will be enough to immunise them against any predispositions they may have. And I really hope they don’t self medicate with mind altering addictive substances.
Oh to be able to give them opportunities where they can test their boundaries and learn from their mistakes without being scarred or mollycoddled. Whilst keeping stable myself and having meaning outside of being a mother.
I recently had a birthday and caught myself reflecting how glad I am to be alive.
May 17, 2017 at 8:37 PM
Urspo
Thank you!
By all means share this. What I said here is nothing patented it is conventional wisdom and standard stuff. Knowledge is power
May 17, 2017 at 11:20 AM
NIFP
Thank you for the information! I was visiting my mother for Mother’s Day, and didn’t see this until today. It is difficult to resist interfering with my relative’s treatment, but from what you have described I wonder if he may still be having episodes of mania, based on behaviors his wife has told me about. I will send her a link to your post. For all I know he has been on lithium and couldn’t tolerate it, or perhaps he isn’t “garden-variety”. Thanks, again.
May 17, 2017 at 8:36 PM
Urspo
You are welcome. I hope this answered your question
May 17, 2017 at 5:22 PM
truthspew
Considering we’re just starting to get the vaguest inkling of what goes on in the brain with the use of FMRI etc. it’ll be a long time before we figure why some people are bipolar, unipolar, etc.
May 17, 2017 at 8:36 PM
Urspo
It is a work in progress. It is exciting for me to be in this field
June 9, 2017 at 6:08 AM
Computer
I didn’t really understand depression, until I spent a day listening to people with depression describe the profoundness of the feelings. A very sincere thank you for this.
June 9, 2017 at 6:48 PM
Urspo
Thank you
June 25, 2017 at 1:06 AM
markmhamann
Thank you
By all means share this.
July 13, 2017 at 3:24 AM
charlesdoliver
By all means share this. Thank you
July 25, 2017 at 5:41 AM
jeffreydhairston
Thank you
By all means share this.
By all means share this.
August 14, 2017 at 5:35 AM
maxlcrepeau
I didn’t really understand depression, until I spent a day listening to people with depression describe the profoundness of the feelings. Thank you