Could Your Depression Be Bipolar Disorder?

Imagine wading through severe depression for years, taking medication after medication, with no relief. Now, envision discovering that what you were facing was not major depression but bipolar disorder. Sara Schley shares her journey through these woods in her book Brainstorm: From Broken to Blessed on the Bipolar Spectrum. Once given the correct diagnosis, Sara recovered. She shares her journey to raise awareness of bipolar II disorder, a sometimes unrecognized source of severe depression.

Is Bipolar II Disorder Underdiagnosed?

Bipolar disorder is a mood disorder associated with highs and lows. In the case of bipolar II disorder, those highs do not reach the "manic" level of bipolar I disorder. Still, the lows can be devastating. As this version of bipolar disorder is not usually associated with the soaring symptoms of bipolar I, the hypomanias in bipolar II are trickier to detect.

A meta-analysis found that bipolar disorder may be, on average, diagnosed five years after onset (Scott et al., 2022). For those living with bipolar II disorder, the delay is likely longer. The time between bipolar disorder's beginnings and recognition can potentially represent years of suffering and damage to one's life course.

In particular, a sizable proportion of those struggling against treatment-resistant depression are later diagnosed with bipolar disorder.

The marked depressions of bipolar II often spur individuals to reach out for help. Yet, the subtle highs usually feel similar to health with an improved mood and productivity. Hypomania can sometimes be a welcome respite after depression, and clients often are not aware that this could be part of an illness. Mental health professionals might also neglect to rule out hypomania adequately.

Treating Bipolar Disorder

Yet, the identification of bipolar disorder is critical. Medication and psychotherapy treatment for bipolar disorder differs quite a bit from major depression. Some medications utilized to treat major depression can trigger negative mood shifts in individuals with bipolar disorder (Gomes et al., 2022). In addition, many of the medications that can be effective in interrupting the bipolar cycle are not used for other kinds of depression.

Repeated trials of medications that are not effective are exhausting and can wear at a person's sense of hope.

From a psychotherapy standpoint, Interpersonal Social Rhythm Therapy (ISPRT) is a psychotherapy that has been shown to benefit individuals with bipolar disorder (Steardo et al., 2020). ISPRT focuses on regulating sleep patterns and improving relationships. This intervention is rarely offered to those with major depression.

It is essential that providers routinely rule out bipolar disorder when approached by clients presenting with depression. Utilizing instruments like the Bipolarity Index may also help predict individuals with depression who are at risk of developing bipolar disorder (Aiken et al., 2015).

With appropriate identification and intervention, many living with bipolar disorder recover.