Bipolar disorder often misdiagnosed as depression or anxiety, study suggests


Ups and downs are a normal part of life, but for people with bipolar disorder, ups and downs take on a whole new meaning.

Bipolar disorder is sometimes glamorized for the creativity and genius that often accompanies its symptoms. Abraham Lincoln, Ludwig Von Beethoven and Robin Williams were all said to have struggled with some form of bipolar disorder and each accomplished great things. Yet anyone with the diagnosis will attest to the fact that it is no laughing matter.

What is bipolar disorder?

Bipolar disorders are generally characterized by manic, abnormally high periods followed by severely depressed periods. Diagnostic classification depends on symptoms, family history and genetics, according the American Psychiatric Association’s 2013 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

The DSM-5 divides bipolar illness into two types, Type I and Type II, based on these and other specific criteria. A diagnosis of Type I is made after one or more manic or mixed episodes and at least one major depressive episode. A Type II diagnosis is made after one or more major depressive episodes and at least one episode of hypomania. Bipolar disorder tends to run in families.

Fortunately, there are ways to manage bipolar disorder that can allow those affected to live long, fulfilling lives. Accurate diagnosis and management are crucial for controlling symptoms and preventing adverse events from occurring. According to a new study, many patients with bipolar disorder may have been misdiagnosed with depression.

Over 2 percent of the U.S. population has been diagnosed with a bipolar disorder, of which only about 55 percent are receiving treatment. Due to dramatic fluctuations in mood, energy and activity, daily functioning is a challenge for those affected. Feeling low brings people into treatment more so than feeling high. Therefore, bipolar disorder is easy to miss in the office setting because often only depressive symptoms are reported, so the person making the diagnosis does not get the full clinical picture required to make an accurate diagnosis.

Study findings

An interesting study was recently conducted of volunteers being treated with antidepressants in general practice offices in the U.K. to see if they had bipolar disorder or not. The 232 participants were being treated with antidepressants for a diagnosis of depression, anxiety or both and were between 16 and 40 years of age. Those who were prescribed antidepressants for other reasons or had other circumstances that prevented them from participating were excluded. They completed questionnaires and underwent a diagnostic interview to screen them for bipolar disorder.

Study results indicated that 7.3 percent of volunteers had undiagnosed bipolar disorder. The authors adjusted the data for differences between their sample and a national database, and concluded the prevalence to be 10 percent, or 1 in 10.

Getting the right treatment

Accurate diagnosis is important because the treatment for bipolar disorder differs from that of depression or anxiety. Medical treatment for bipolar disorder includes mood stabilizers, anti-convulsants and atypical antipsychotics. For acute episodes, use of benzodiazepines and sleep medications, which are usually prescribed, is controversial. There is some evidence that antidepressants may increase the risk of suicide in bipolar patients.

Management of bipolar disorder also includes nutrition, exercise and adequate sleep habits. Psychotherapy, group support and strategies like cognitive behavioral therapy should also be included. Newer technologies, like pharmacogenetic testing, eliminate trial and error in finding the right medical regimen. Neurofeedback and experiential therapy are also beneficial for patients with bipolar disorder. The right diagnosis and specialized treatment are the first steps toward regaining control and building a brighter future.

About us

Students who experience troubling symptoms of depression, anxiety or bipolar disorder sometimes simply need proper stabilization and treatment. White River Academy treats boys ages 12 through 17 with substance abuse, mental health problems and dual diagnosis. We use state-of-the-art diagnostic assessment and treatment to provide optimal physical and mental health to all of our students. To find out more about specialized programs at White River Academy, please call our 24/7 helpline.

About the author

Dana Connolly, Ph.D., translates current research into practical information. She earned her Ph.D. in research and theory development from New York University and has decades of experience in clinical care, medical research and health education.

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