Bipolar Disorder
S. Nassir Ghaemi, MD
How does depression present in bipolar patients?
Bipolar depression can look different in some ways from unipolar (major) depression.
Symptoms that are more common in bipolar patients than in unipolar depression
include:
- Brief depressions. In bipolar depression, the average length is
three to six months, but in unipolar depression it is six to twelve months.
Some depressions are only 2 to 3 weeks in length. The shorter the depression,
the more likely it is to be bipolar.
- Atypical depression. You may sleep more and eat more as opposed
to typical depressions where patients sleep less and eat less.
- Psychotic depression. You have delusions or paranoid delusions.
Or, you hear voices or see things. Psychotic depression is more common in
bipolar disorder.
- Post partum depression. Compared to unipolar depression, post partum
depression is more common in bipolar disorder.
- Recurrent depression. The more episodes of depression you have,
the more likely you are to be bipolar rather than unipolar. More than 95%
of bipolar patients have recurrent episodes, versus unipolar patients, of
which only two-thirds have recurrent episodes.
- Antidepressant effects. If you've had multiple trials of antidepressants
and they don't work, you could have bipolar disorder. If you experience
mania or hypomania while on an antidepressant, you usually have bipolar
disorder. If you get better on an antidepressant, but then relapse into
recurrent depressions, you may have bipolar disorder.
Also, the earlier the onset of the depression, and the more family history,
the more likely it is that it is bipolar disorder (rather than major depression).
Do the symptoms of bipolar disorder differ much
among people?
Yes, the symptoms differ a lot. People tend to have a classic picture of a
person who is manic and if someone doesn't fit that definition, they think
the person is not manic. That is a big mistake. One third of manic episodes
are euphoric and two-thirds are irritable or a depressed mood. There are also
mixed episodes, which are a depressed mood and an irritable mood at the same
time, with other manic symptoms and depressive symptoms at the same time.
One-half of manic episodes are mixed episodes.
How often do manic or hypomanic episodes occur?
They are almost always recurrent. There is no set number of episodes that
someone may have.
How long does it usually take for someone to be
diagnosed for bipolar disorder?
Twenty years on average. It tends to take ten years for a patient to get help.
Nineteen years old is the mean age level of onset. So, someone may develop
bipolar disorder at 19 years old, and then it takes him or her 10 years to
seek help, so the person is 29 years old. Then it takes another ten years
for the person to actually get diagnosed with bipolar disorder. Patients are
usually diagnosed first with major depression.
© 2001 Families for Depression Awareness
