The majority of people with bipolar disorder present to their physician or psychiatrist with a depressive episode rather than a manic or hypomanic episode. In addition, the depressive symptoms of bipolar are often the most frequent and debilitating. However, many patients with bipolar disorder are often misdiagnosed as having depression, anxiety or ADHD. The treatments for these other disorders are different than the treatments for bipolar disorder and can actually precipitate a manic episode. In addition, many patients who are misdiagnosed may suffer with ineffective treatment for years before receiving relief from their illness.
In many cases, the diagnosis of bipolar disorder is clearcut. The patient describes having symptoms of racing thoughts, speaking more quickly, not sleeping for days, or acting inappropriately. However, more often than not, the diagnosis can be very challenging. Below are 5 tips that raise the suspicion of a bipolar disorder diagnosis; however, none of the below symptoms are pathognomonic for bipolar disorder.
1. Early onset 2. Family history of major depression OR bipolar depression 3. Mania or hypomania induced by an antidepressant. 4. Childhood ADHD 5. Abrupt onset of a depressive episode
It can be challenging to diagnose and treat bipolar disorder and yet very rewarding to see your patient get the right diagnosis, the best treatment, and have a better quality of life.
Hirschfeld RM ,Cass AR, Hot DC, Carlson CA. Screening for bipolar disorder in patients treated for depression in a family medicine clinic. J Am Board Family Practice. 2005:18: 233-239
McIntyre, Roger. Differential Diagnosis of Bipolar Disorder. Supplement to Current Psychiatry. Bipolar Disorder. 2011: 3-22.