Can clinical depression develop into bipolar disorder?

[Superhal]

Sorry if this is the wrong forum.

I have two questions:

1. Are these two psychological disorders related to each other, like the common cold and pneumonia, where one is a more serious form of the other?

or

2. Is it much more likely that the bipolar disorder was the real condition and it was mis-diagnosed as depression? What are the chances of bipolar disorder being diagnosed as depression?

Thanks in advance.

[thelurkinghorror]

Two is more likely. Some people can have extremely slow cyling bipolar, and be in a depressive stage for some time. Also, bipolar II can frequently be diagnosed as depression, as it presents hypomania, which may be seen as a normal affect to others.

As for number one, both disorders are highly related and likely have similar neural underpinnings. However, some bipolar persons may not respond to antidepressants or it may make them worse. One theory I have heard (don’t know how current it is) is that for some, depression is a “crash” that follows the “high” of elevated mood. So to treat it you reduce mania, and not raise depression like you would with unipolar depression.

[Alpine]

Here’s a short article from the NIH, 8/17/10.

Many Depressed People Have Mild, Brief Episodes of Mania

From the article:

“This study really helps consolidate an idea that’s been around for a while, which is that there’s a broad continuum – ranging from pure unipolar depression to classic bipolar depression,” said Dr. Gregory Simon, a psychiatrist and mental health researcher at the Group Health Research Institute in Seattle.

[Carol_the_Impaler]

I don’t know if this answers your question, but it appears that some people who may look depressed are actually bipolar. I don’t know if they develop into bipolar, or if they get correctly re-diagnosed.

Fromhere, a checklist for soft bipolar/bipolar spectrum disorder (that is to say, bipolar that looks more like unipolar depression that the marked highs and lows of bipolar I):

@www.psycheducation.org

Here’s the list of items which are found with bipolar disorder more often than you would expect by chance alone. This list is adapted from a landmark article by Drs. Ghaemi and Goodwin and Ko. (Drs. Goodwin and Ghaemi are among the most respected authorities on bipolar diagnosis in the world. This important article is online).

1 The patient has had repeated episodes of major depression (four or more; seasonal shifts in mood are also common).
2. The first episode of major depression occurred before age 25 (some experts say before age 20, a few before age 18; most likely, the younger you were at the first episode, the more it is that bipolar disorder, not “unipolar”, was the basis for that episode).
3. A first-degree relative (mother/father, brother/sister, daughter/son) has a diagnosis of bipolar disorder.
4. When not depressed, mood and energy are a bit higher than average, all the time (“hyperthymic personality”).
5. When depressed, symptoms are “atypical”: extremely low energy and activity; excessive sleep (e.g. more than 10 hours a day); mood is highly reactive to the actions and actions of others; and (the weakest such sign) appetite is more likely to be increased than decreased. Some experts think that carbohydrate craving and night eating are variants of this appetite effect.
6. Episodes of major depression are brief, e.g. less than 3 months.
7. The patient has had psychosis (loss of contact with reality) during an episode of depression.
8. The patient has had severe depression after giving birth to a child (“postpartum depression”).
9. The patient has had hypomania or mania while taking an antidepressant (remember, severe irritability, difficulty sleeping, and agitation may – but do not always – qualify for “hypomania”).
10. The patient has had loss of response to an antidepressant (sometimes called “Prozac Poop-out”): it worked well for a while then the depression symptoms came back, usually within a few months.
11. Three or more antidepressants have been tried, and none worked.

I thought I read on that site that kids who are depressed have a greater chance of developing into bipolar spectrum disorder, but I’m not finding it right now. I’ll look some more.

Anecdotally, I was diagnosed as depressed from age 20 (although I’d clearly been depressed since I was a very young child). At the age of 40, my diagnosis was changed to bipolar spectrum disorder and I was changed from taking SSRIs to taking a mood stabilizer (lamictal). I was mostly oscillating from mildly depressed to really depressed every day, with generally one day a month I was really “high” (relatively). IOW, in a really good mood, loved everyone, very positive and optimistic, loved ALL the music on my iPod… But 29 out of 30 days I was ranging between degrees of depressed.

Of the list above, 1, 2, 4, 5, 6, 9, 10, and 11 describe me. After years of taking Lexapro, I was finding that it just wasn’t working anymore and went to see a new psychiatrist. What really stuck out for her was the consistent one day per month great mood, the fact that I’ve taken at least 10 different anti-depressants, and that I always responded quickly and strongly to a new anti-depressant (like, within 24 hours when I was put on Celexa). Zoom! I feel grrrrrrrrrreat!

So, I’m a case where it would appear as if my unipolar depression developed into bipolar, but I may have been bipolar all along.

[salinqmind]

I think they’re two different things, but related, may co-exist, and for some reason are hard to diagnose quickly.

(that said, if my depression at this point of my life had eventually turned into bi-polarity, I should, reading stories on this site, be enjoying droves of men chasing after me in a fever of longing to bang/marry/save me :dubious:. Instead, I trudge along in a depressed funk, unnoticed, being boring and all.)

[Superhal]

@niblet_head

Anecdotally, I was diagnosed as depressed from age 20 (although I’d clearly been depressed since I was a very young child). At the age of 40, my diagnosis was changed to bipolar spectrum disorder and I was changed from taking SSRIs to taking a mood stabilizer (lamictal). I was mostly oscillating from mildly depressed to really depressed every day, with generally one day a month I was really “high” (relatively). IOW, in a really good mood, loved everyone, very positive and optimistic, loved ALL the music on my iPod… But 29 out of 30 days I was ranging between degrees of depressed.

Just to clarify: so you switched from depression meds (that didn’t work after a while) to bipolar meds, and the switch worked? (Therefore, if the treatment for bipolar worked, that must have been the true diagnosis?)

[Carol_the_Impaler]

You are correct, sir. I assume, as you do, that the diagnosis is correct since the meds seem to be working. But I’m jotting that question down to ask my psychiatrist next week.

[TriPolar]

There are varying methods of arriving at the diagnosis for clinical depression and bipolar disorder. These methods and the diagnosis itself, as well as the results of treatment are all highly subjective. Depression in general is characterized in terms of low mood, dissatisfaction, fatique, pessimism and the like. Usually manifested as a continuing condition. Bipolar is a newer term for manic-depressive, where a person cycles back and forth between depression and mania. Symptoms of mania include irritability, high energy, inability to sleep, impulsivity, and the like. Bipolar disorder may be diagnosed even if one only one of the states fits the symptomology, but the cycling occurs. After all, each state may be described as relative to the other. None of these diagnoses need be tied to a physiological cause, and response to certain types of medication may in the end determine the diagnosis. Whichever symptoms are identified, they may range from mild, to serious. In many cases diagnosed as depression, the symptoms will dissapate in a short time span, without treatment.
There is a general problem is the field of psychological/psychiatric/mental disorders. These are usually ‘soft’ sciences, where cause and effect relationships cannot be established and diagnosis is highly subjective. But there is still a level of consistency found in the description of symptoms and result of treatment. There is a great deal of controversy over the efficacy of various treatments. But serious case clearly require medical intervention.
Similar disorders that may overlap or cause misdiagnosis include obsessive-compulsive disorder, borderline personality disorder, and various forms of anxiety disorder.
If you are worried that you have any of these disorders, remember people tend to have changes in mood. A few days of feeling down, or over-stimulated may be normal. The usual measure is to evaluate whether any condition causes a problem in your life. If it does, you should talk to a professional. You don’t have to jump into the medication game though. Almost all medications will have detrimental effects, and if they are not beneficial, or the detriments exceed the benefits, you probably won’t be gaining anything. Many milder cases can be resolved by behavioral changes. Stop drinking or taking drugs, leave bad situations, get more sleep, take a vacation, get a new job, etc… IMHO good mental health professionals will usually look at those methods first.

BTW: IANA mental health professional, but I am TriPolar.

[BigT]

Wow. I didn’t even know tripolar disorder existed. Manic dysphoria sounds a lot worse than the usual depressive dysphoria. And is there no depressive euphoria (i.e. being calm and happy)?

[Eats_Crayons]

@Superhal

Just to clarify: so you switched from depression meds (that didn’t work after a while) to bipolar meds, and the switch worked? (Therefore, if the treatment for bipolar worked, that must have been the true diagnosis?)

Not necessarily. Meds aren’t quite that specific. For example, my bipolar symptoms netted me a prescription for a medication most commonly used to treat schizophrenia. I’m not schizophrenic, the medication just happened to be effective for people who are primarily hypomanic. Some people also sit at one end of the spectrum barely cycling at all. I was primarily hypomanic and my depressive state was more like an emotional flatline. So I mostly had mania but very rarely what most people would describe as “depression”.

[Inigo_Montoya]

@BigT

Wow. I didn’t even know tripolar disorder existed. Manic dysphoria sounds a lot worse than the usual depressive dysphoria. And is there no depressive euphoria (i.e. being calm and happy)?

I’ve noticed that I have two distinct cycles. One is my energy level and the other is my mood. They’re both more or less annual.
High mood/high energy: Manic–I’m invincible and always right, very productive at work. Very personable but not much fun to be around for extended periods. Prone to visual & auditory hallucination, probably due to lack of sleep. (January)
High mood/low energy: what you’d call depressive euphoria. Pretty happy, fun to be around (April-ish)
Low mood/low energy: depression–mostly sad, bleak outlook, unmotivated, unable to sleep more than about 4 hours a night
(July)
Low mood/high energy: super depressed, actively self-destructive, spend time in closets, very prone to delusion & paranoia (November)

Those states are where I am typically given the time of year, but about once or twice a month I’ll spend a few days in what seems to be a random place. Usually it’s a day or so of refreshing mania followed by about a week of crushing depression. I’ve learned to relate to moods as physiological things–such as a leg cramp, irregular heartbeat, etc–and force myself to ignore how I feel and instead act as reasonably as I can according to objective observations. It’s hard. It means I can’t allow myself the pleasure of confidence, and I have to ignore gnawing paranoia.

As for the OP, I carried a diagnoses of seasonal affective disorder to depression for a while. But eventually it became clear there was something else going on. In retrospect the mania was there all along, but I had always assumed feeling that way was normal. Once I realized “normal” is much less exciting I started to manage things more effectively. Of course, the ‘scars’ of the disorder are always apparent in how I relate to others, my personal sense of right and wrong, what I perceive as appropriate, etc.

Oops…my narcissism is showing.

[Zulema]

I was just wondering the same thing. I know a person who seems to be bipolar right now. From everything I know about her she was fine until someone in her immediate family died three years ago.

I’ve read that grief can push people into clinical depression. Can that depression then turn into bipolar disorder?

[Alpine]

I think that’s still unanswered, SP2263.

Here is another quote from the article I linked to above that suggests it’s possible, looking at heredity:

Merikangas and her colleagues analyzed data from a survey of more than 5,000 U.S. households. They found that people with subthreshold hypomania have higher rates of anxiety and substance abuse and more depressive episodes than depressed people who don’t exhibit manic behavior. What’s more, they were just as likely to have a family history of mania as people with bipolar disorder, which suggests that they may be at a higher risk of developing full-blown bipolar disorder down the road.

//
If we’re going to talk personal experience, mine is strikingly similar to niblet_head’s. I was diagnosed with major depression, but after years of having SSRIs “poop out” on me, my doctor shifted me over to mood stabilizers. I did some detailed charting of my moods and energy, which really pointed up the cycles, and then watched them flatten out as the meds took effect. Unfortunately, the level of “flat” is on the depressed side of the line. The work continues.
//

[irishgirl]

Here’s the thing-

A single episode of mania or hypomania gives you a diagnosis of BPD. You do NOT have to have ever had ANY depressive symptoms to be diagnosed with BPD if you have symptoms of mania or hypomania. There is no such diagnosis as unipolar mania.

A single episode of depression is diagnosed as unipolar depressive disorder- up until your first manic or hypomanic episode, when you’ll get your BPD diagnosis.

So you can have years of low mood and a diagnosis of depression, up until your first manic episode, when you’ll get your BPD diagnosis and mood stabilisers instead of anti-depressants.

Depression is much, much more common than mania or BPD. Not least because people have many more reasons to be sad (although an irritable, psychotic mania is about as far from “happy” as it is possible to get).

A lot of this, of course, is because a lot of psychiatry is about arbitrarily identifying clusters of symptoms as “diseases”.

But, yes I do know of people who have been misdiagnosed as having personality disorders or schizophrenia when in actuality they have been manic for years, and who have had dramatic improvements in their lives with the addition of Lithium or Depakote.