Bipolar disorder is an affective disorder with several complexities that can hinder diagnosis and treatment. By further understanding bipolar disorder, you can have an easier time recognizing the symptoms and working with practitioners to find an effective treatment plan.
The presentation of both depressive and manic episodes can vary between people or within the same person. Many people recognize bipolar disorder when it is the stereotypical "Type I" presentation, which includes episodes of severe depression alternating with "full-blown" mania. Depressive episodes in bipolar disorder are not always severe. Dysthymia is a chronic, less-severe form of depression that may be seen in bipolar individuals. Some people have a lengthy history of dysthymia with episodes of severe depression superimposed on their dysthymic mood (double depression).
As for mania, hypomania is a less severe form of mania that does not present as the reckless and erratic behavior seen in a true manic episode. Some people may also experience mixed-manic or agitated depressive episodes, in which irritability and anxiety are profound symptoms. Mood-congruent psychotic features may also be present in people with bipolar disorder.
Misdiagnosis Is Common
One of the major hindrances in an accurate diagnosis of bipolar disorder is that it is often misdiagnosed as unipolar depression. People with bipolar disorder may only recognize problems in their mental health and daily functioning when they are depressed. This leads to seeking help during depressive episodes, not during manic, hypomanic, or mixed-manic episodes. In severe cases of mania, the person may be reckless and not even realize their own destructive behaviors.
For less severe hypomanic and mixed-manic episodes, the person many be functioning at a normal or elevated pace and feel like they are in a good place. Even when they are in treatment during manic episodes or periods of a balanced mood state, mental-health professionals may not recognize the drastic extremes in mood, or the person may simply skip appointments when they are not depressed. All of these factors can make it difficult to pin down an appropriate diagnosis for years or even decades.
Misdiagnosis Can Be Dangerous
Along with the delay in proper treatment, misdiagnosing bipolar disorder as unipolar depression often means people with bipolar disorder are treated with antidepressants alone. Unfortunately, monotherapy with antidepressants can be dangerous. Not only do antidepressants alone increase the likelihood of switching from a depressed to a manic state, but in some cases antidepressant monotherapy may increase the risk of suicidal ideation, suicide attempts, and psychosis.
Another concern with affective disorders in general, but especially bipolar disorder, is substance use and abuse. People with bipolar disorder may self-medicate with alcohol during depressive episodes to numb emotional pain. With manic episodes lies the increased risk of experimentation with "harder" drugs, such as opiates, LSD, and methamphetamines. The longer a person with bipolar disorder remains without an accurate diagnosis and effective treatment, the more there is an increased risk of engaging in risky behaviors.
Treatments Can Help Patients Thrive
Once a diagnosis of bipolar disorder is made, a rigorous attempt to find an effective treatment plan begins. The first-line approach often varies between psychiatrists. Mood stabilizers are typically the first medication given for bipolar disorder. There are several mood stabilizers available, with the most common being lithium and valproic acid. Of the mood stabilizers available, lithium can be one of the most difficult in terms of finding the right dosage and making dosage adjustments throughout therapy. Lithium levels must be monitored regularly to achieve effective blood serum levels without reaching toxic levels. Valproic acid requires monitoring, but not to the extent that lithium does.
Mood stabilizers may be used alone, but they are often used in combination with other classes of medications. Since mood stabilizers can be viewed as a way to balance the scale of bipolar disorder, practitioners typically view how far the scale goes in one direction or another as a way to judge which medications to add. For example, if someone with bipolar disorder is treated with a mood stabilizer but continues to have more depressive symptoms, an antidepressant would be added. Conversely, if their symptoms lean more toward a manic or mixed-manic state, an antipsychotic would be added. Some psychiatrists tend to forego mood stabilizers as a first-line treatment and start their bipolar patients on a combination of antidepressants and antipsychotics to target both sides of the scale.
Many people with bipolar disorder face a lifelong challenge of finding the right diagnosis and trying new treatments as symptoms change. Although the road is not always easy, a better understanding of bipolar disorder and an increased availability of treatments has made living and thriving with bipolar disorder a reality.
If you are in need of treatment for bipolar disorder or suspect you do, contact a psychiatric practice such as Comprehensive Behavioral Health Associates Inc.