Michael Pipich Guest Post: Are You Just Depressed or Is It the Onset of Bipolar Disorder?

Are You Just Depressed or Is It the Onset of Bipolar Disorder_

This guest post hits close to home. For twenty-one years, from ages eighteen to thirty-nine, I was diagnosed with chronic depression (dysthymia). I’d tell doctors that I was at least cyclothymic, for I my over-productive workaholism led to cyclical depressive crashes. Finally, at thirty-nine years old, I was diagnosed bipolar II. — Kitt

Are You Just Depressed or Is It the Onset of Bipolar Disorder?

Michael G. Pipich, MS, LMFT

About two-thirds of people with bipolar disorder are misdiagnosed with other mental health problems before bipolar is discovered.[1] Among those individuals, a significant majority are given a diagnosis of major depression. Most people with a major depressive disorder that is unrelated to bipolar disorder (typically known as non-bipolar depression or unipolar depression) can be treated safely and effectively with a combination of antidepressant medications and psychotherapy. But when people with undetected bipolar are treated this way, a host of mental health problems can occur, making the underlying bipolar condition much worse.

It’s understandable that someone may not immediately be given the bipolar diagnosis if their first mood swing begins in a depression mood zone. This seems particularly true of people who have bipolar II disorder. And sometimes, there may be more than one depressive episode before a manic or hypomanic episode happens in a person with bipolar.

If you’re wondering about whether you may have depression or the beginning of bipolar, there are some keys to keep in mind when seeking treatment.

First of all, when assessing if your depression is a part of bipolar, know that bipolar disorder has distinct genetic foundations. In other words, it runs in families and is passed through family genes. So if you suspect that any family members may have had bipolar disorder, it’s important to inform your doctor or therapist when entering treatment. If the information is available, a thorough family mental health history can really support a proper bipolar diagnosis. Unfortunately, such information isn’t always asked for, so be prepared to volunteer all that you know during an evaluation or treatment session.

Next, your personal history of mood swings should be explored. If you’ve had severe ups and downs during childhood or adolescence, these may be more than the common tumult of growing up. They may instead be early expressions of bipolar disorder. It’s especially important to review periods of hyperactivity, bouts of unexplained rage, self-harm, or suicidal thoughts or actions that could have occurred at any time in life. There certainly may be other explanations for these, such as early life trauma or severe loss and grief experienced during these formative years. But if explosive behaviors or deep depression occurred at different times, especially with little or no provocation, it can point to underlying bipolar disorder.

Usually, most people with bipolar who seek treatment on their own are currently or recently depressed, or are experiencing consequences of untreated bipolar disorder. Any history of mania or hypomania is less obvious, however. And often, bipolar patients will either not understand manic symptoms or will avoid discussion about them. If you have had at least one occurrence in your life of intense euphoria, excitability, unexplained energy and creativity, avoidance of sleep, or impulsive behaviors, inform your treatment professional. But also bear in mind that mania and hypomania may be marked by intense periods of irritability and agitation, know as dysphoria. This is in contrast to the euphoria that most people think about with bipolar mania. Often a dysphoric type of manic or hypomanic episode can be mistaken for the kind of agitation seen in major depression. This can mislead the course of treatment to focus only on depression, while missing the full bipolar condition.

This brings us to the most important part of knowing whether you have depression or bipolar onset. According to the Diagnostic and Statistical Manual of Mental Disorders (5th edition), if a patient is given an antidepressant medication, and it produces manic symptoms, the person is then diagnosed with bipolar disorder.[2] While this is a very clear indication of bipolar, how the mania surfaces in the individual may take different forms. For example, a person in a depression mood zone can improve early in the treatment, and as a result, may not show manic symptoms right away. Any slight improvement may provide a hopeful sign that treatment is working, but when the person starts to get worse because of emerging mania—especially if it’s dysphoric—the unwitting response may be to apply more antidepressant medication. Now we have some real problems.

So, if at some point in your treatment, an antidepressant medication makes you feel more agitated, more irritable, more aggressive, or you start to experience hyperactivity or greater impulsivity, tell your treatment professional right away. This could be the start of a manic episode that is revealing a previously undiagnosed bipolar disorder. Even more importantly, any increase in suicidal thoughts or possible psychotic symptoms, such as hallucinations, should be reported immediately, as these can be life-threatening. Any antidepressants will either likely be eliminated at this point, or possibly paired with a mood stabilizing or antipsychotic drug to keep a lid on mania.

With bipolar finally recognized, bipolar medications can be introduced to decrease manic-type symptoms, while keeping depression in check. Alongside medications, it’s important to have therapy focus on the unique challenges facing people with bipolar disorder. Major depression is frequently considered an acute condition because it often can resolve in time, so medications may be discontinued at some point, along with a shorter overall approach to therapy. But bipolar disorder is a lifelong condition. Even though its symptoms can come and go in episodes, the genetic nature of the condition means the bipolar patient will need continuing care through the lifespan.


[1] Hirschfeld R. M., Lewis, L., & Vornik, L. A. (2003). Perceptions and impact of bipolar disorder: How far have we really come? Results of the National Depressive and Manic-Depressive Association 200 survey of individuals with bipolar disorder. Journal of Clinical Psychiatry, 64(2), 161–174.

[2] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author, 128-130.


Owning Bipolar: How Patients and Families Can Take Control of Bipolar Disorder by Michael G. Pipich, MS, LMFT. Foreword by Joseph Shrand, MD.
Michael G. Pipich, MS, LMFT is a psychotherapist and author of Owning Bipolar: How Patients and Families Can Take Control of Bipolar Disorder, (Citadel Press, Sept 2018). He practices in Denver, Colorado, and can be reached at MichaelPipich.com.

Press Contact: Janet Appel Public Relations
205 West 54 Street, New York, New York 10019
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Our Beloved Dog Thumper Passed Away

Thumper
Our beloved labradoole Thumper as a puppy and full grown.

Our grief deepens with another loss. This time of our beloved labradoodle Thumper. Our newly adult son grew up with him. We got Thumper when our son was six. Thumper would’ve been twelve this month.

Unfortunately, our younger poodle Coco is showing similar symptoms. Our next door neighbor said she found eight dead rats in her backyard. Apparently, someone is poisoning rodents. Not good.

We back up to a hillside filled with rabbits and rats. Predatory animals, including mountain lions, coyotes, pet dogs and domestic cats, eat poisoned rodents and die.

Trap rodents. Don’t poison them.

Grief — Moving Forward

An Irish Toast: May you be in Heaven a half hour before the Devil knows you're dead.
In Loving Memory of My Father. No Doubt He Made it through the Pearly Gates.

Wednesday my mother gave me artwork and books to remove from her room, the room she formerly shared with my father.

My sister and I grew up with this prayer prominently displayed. I will give the original to my sister to remember our father.

The Arabian horses graced the wall above my father’s desk. I plan to reframe and put them a place of honor in my home.

Green-blue rubbing of three Arabian horses
This rubbing of Arabian horses hung above my Dad’s desk

Yesterday my mother had me take my father’s clothes home with me. She is moving forward.

Dry-eyed, I hugged my mother, articulating what she can no longer say due to aphasia from her stroke. “I miss him, too, Mom. He loved us all so well. We loved him. We miss him.”

More and more lately I’ve cried, both alone and over the phone with my sister.

We are grieving.

 

 

What I’ve Done Recently

Hypomania, Self-Care, Success!

Frustrated, Defeated and Hypomanic

The weekend before last, I was frustrated, overwhelmed, feeling defeated, and mildly hypomanic.

I felt like a failure as a mother, for I hadn’t been able to get my son to take his high school equivalency exams. Told that I make it too easy for him to stay in his bedroom compounded my feeling of guilt.

How could I balance compassion for my son’s severe migraine pain and social anxiety with consequences that forced him to take more responsibility?

Repeated what I’ve told him before (without a hard date): He had to move forward – with school, with helping around the house, with addressing his anxiety, or with work – or he would have to move out.

Now that he’s a legal adult, we’re no longer legally obligated to house and feed him. We don’t intend to kick him out. But, he must move forward and take responsibility as an adult member of the household.

Provider Education, Take Two

The National Alliance on Mental Illness Orange County (NAMI OC) chapter asked me to retrain for the new two-day Provider Education curriculum.

I had served on the Provider Education team that first structured the five-week course content into a two-day format, and we had done it in two days numerous times.

Turns out the “new” curriculum varied very little from what we were teaching. By lunch on that Saturday, I lost my temper. I was insulted.

Explaining that I had a lot going on in my life (mother’s stroke, dad’s death, son’s anxiety), I left with the “new” two-day curriculum binder in hand.

Self-Care

After losing my temper at NAMI OC, I knew I needed a break to pull myself together and bring myself down from irritable hypomania before the International Bipolar Foundation (IBPF) Women’s Mental Health panel discussion on the following Tuesday.

How did I recover? I left. Booked myself into a hotel in La Jolla Sunday through Wednesday and relaxed. Not everyone can do this. I realize that. But, it’s cheaper than psychiatric hospitalization.

Women in Mental Health

On the International Bipolar Foundation’s Women’s Mental Health Panel, I represented the mature women living with bipolar. Mental health activist and actor, Claire Griffiths, represented the perspective of a teenager. Aubrey Good, the Social Media and Program Coordinator of IBPF, represented the young adult perspective.

I had a wonderful time meeting IBPF staff and volunteers and loved being a part of their panel discussion. I hope to do more public speaking events in the future.

Success!

When I returned home Wednesday, my son had showered, dressed, fed himself, and was ready to take his first high school equivalency test. He passed. I never doubted his ability to pass the test.

BIG DEAL: He overcame his anxiety and didn’t get a migraine. Two days later, he took the next test despite migraine symptoms. He took migraine and nausea medications and faced his fear. Again, he passed.

Two down. Two to go. Moving Forward.

Connecting with Online Friends in Real Life

This weekend, Sarah Fader came into town. She managed to connect with several mental health advocates and writers over the weekend.

Sunday, we met with:

I never would have tried to visit so many people in such a short time!

Mini-Family Reunion

Sunday night had the pleasure of meeting my uncle, two of my cousins, their spouses and kids in Anaheim. Family. Love. Great food. Fireworks in the sky. Thank you!

I CAN Do It

Lesson Learned: If I take care of myself, I can achieve more AND so can my son.