Can Depression Turn Into Bipolar Disorder?

Depression and Bipolar Disorder

bipolar-disorder.jpg
Credit: Don Bayley/Getty Images

Can depression turn into bipolar disorder? No, depression can't turn into bipolar disorder. However, it is quite possible that your symptoms may be misdiagnosed as depression and then later correctly diagnosed as bipolar disorder. In fact, according to a 2010 study headed by Dr. Charles Bowden of the University of Texas Health Science Center in San Antonio, about one-third of people who are initially diagnosed with depression may actually be suffering from bipolar disorder.

But, how is it possible that so many people can be misdiagnosed? It's quite simple really. Bipolar disorder is a mental disorder in which a person experiences alternating periods of depression and mania.  During periods of mania, a person may feel quite good, experiencing an elevated mood and high energy.  Compared to the lows of depression, these symptoms may not feel like a problem so the patient doesn't report them to his doctor. In addition, it may be that manic episodes occur only infrequently, with gaps as long as several years occurring in between them, or they may be quite mild when they do occur. It may only be when these mood swings become problematic for the patient that he finally obtains an accurate diagnosis and proper treatment of his illness. Dr. Bowden further notes that it can be difficult, even for an experienced psychiatrist, to diagnose some cases, especially if mood swings are infrequent or less severe compared to periods of depression.

Another factor which complicates the accurate diagnosis of bipolar disorder is the fact that certain psychiatric illness having overlapping symptoms. For example, certain symptoms such as problems with concentration and sleep can be present in both depression and bipolar disorder. If a clinician doesn't delve deep enough into the patient's history, she may come away with the mistaken impression that the patient is suffering from depression rather than bipolar disorder.

Further complicating matters is the fact patients may also have a problem with substance abuse. In these cases, symptoms may be blamed on the effects of the abused drugs and or alcohol rather than the underlying mental illness.

Unfortunately, antidepressants – which are the treatment of choice for depression – may not be appropriate for some patients with bipolar disorder. According to Dr. Donald Hilty, who authored a 2006 review of bipolar disorder in adults, when these individuals take antidepressant medications, their mood may become even more unstable with them experiencing more frequent mood swings and worsening mania. These patients should be on mood-stabilizing drugs, according to Hilty.

To reduce the risk of misdiagnosis, experts have suggested the following possible steps for clinicians to follow:

  • Careful history taking - Since relying on the patient's own reports can be problematic, it can be helpful to get reports from friends and family who may have observed the patient. They may notice abnormal moods or behavior which the patient himself if not aware of. In addition, it can be helpful for the clinician to make a special point to ask about the symptoms associated with mania, such as elevated mood, irritability or reckless behavior.
  • Diagnostic instruments - Tools such as the Mood Disorder Questionnaire, the Bipolar Spectrum Diagnostic Scaleand the Hypomanic Personality Scale can be helpful in screening for bipolar disorder because they focus on questions about potential mania and hypomania symptoms and can open up avenues for further inquiry that may increase the chances of arriving at a correct diagnosis.
  • Careful followup - Close observation of the patient through mood charting can be quite useful in detecting hypomania and mood swings. It can also help the clinician identify any adverse reactions to antidepressants which might be indicative of bipolar disorder.

Despite your doctor's best efforts, however, mistakes do get made. The best thing that you can do as a patient to ensure that you get the correct diagnosis and treatment is to be as accurate and detailed as you can in reporting your symptoms. And, if you feel that you may have been misdiagnosed, you should open up a dialogue with your doctor and express your concerns. It is vitally important for your well-being that you are receiving proper and effective treatment.

Sources:

Hilty, Donald M et. al.  "A Review of Bipolar Disorder in Adults."  Psychiatry.  3.9 (2006) :  43-55.

Perlis, Roy H.  "Misdiagnosis of Bipolar Disorder."  American Journal of Managed Care.  11 (2005) : S271-S274.

Singh, Tanvir and Mohammad Rajput.  "Misdiagnosis of Bipolar Disorder."  Psychiatry.  3.10 (2006) : 57-63.

Continue Reading