Classic, Intense Symptoms Not Always Present in People With Bipolar Disorder
by6 Mark Frye, M.D., Psychiatry, Mayo Clinic, Rochester, Minn.
Medical Edge from Mayo Clinic
July 24, 2009

DEAR MAYO CLINIC:

Two years ago, I went through an extremely traumatic situation. Since then, I have had mood swings, but no severe lows. I'm taking medications for post traumatic stress disorder (PTSD) and depression, but they haven't helped. Could what I'm experiencing be bipolar disorder? Is there a definitive way for doctors to diagnose bipolar disorder? If that is what I have, is medication my only treatment option?
ANSWER:
Yes, it is possible that you have bipolar disorder. Your mood swings after a traumatic event and lack of response to medications are clues that your diagnosis may be incorrect.

The classic symptoms of bipolar disorder, also called manic-depressive illness, are alternating emotional highs (mania) and lows (depression). In mania, people may feel overly happy, agitated, jumpy or irritable. They may need less sleep than normal, or make unusually risky decisions about money, work and relationships. Depression in bipolar disorder appears with typical depression symptoms, such as a loss of interest in normal activities, sadness, feelings of emptiness, difficulty concentrating and thoughts of suicide.

Increasingly, research suggests that people with bipolar disorder don't always have the classic and intense symptoms. Symptoms can vary from severe to mild. Cyclothymia, the term for a mild form of bipolar disorder, includes mood swings, but the ups and downs are not as severe as those of full-blown bipolar disorder. Some patients have mixed state bipolar, where symptoms of mania and depression occur at the same time. For anyone with bipolar disorder, mood swings can occur every few days, every few weeks, or every few months.

We now know that, early in the disease, bipolar mood swings can be linked to a major stress. Those stresses can be negative, like a death in the family or job loss, or positive, perhaps marriage or a promotion. Symptoms can include those you've described -- mild mood swings without severe depression.

Because it's not a straightforward illness, bipolar disorder is often misdiagnosed. The most important diagnostic tool is an in-depth interview with a care provider to discuss health history and possible signs and symptoms of the illness. The clinician should cover family history, too. Bipolar disorder has a genetic component and often runs in families.

Considerable research is under way on other diagnostic tools. But, so far, bipolar disease can't be diagnosed with a brain scan, a blood test or paper-and-pencil tests.

That said, you might find it helpful to review a mood disorder screening questionnaire, available at Depression and Bipolar Support Alliance.

While the questionnaire is not a diagnostic tool, your answers may help your provider determine a diagnosis.

Medications are a critical part of bipolar disorder treatment. Several categories of medications are used, including mood stabilizers, anti-seizure medications, anti-psychotic medications, and at times, antidepressants. Sometimes, the first medication prescribed for a patient might not work. Several trials of different medications are not unusual prior to arriving at an appropriate drug treatment regimen.

Outside support and psychotherapy, which could be individual, group or family therapy, are important elements of treatment and disease management.

I recommend that you see a psychiatrist or other care provider to discuss your symptoms and to revisit your diagnosis and treatment plan. If you have depression and PTSD, perhaps different medications or doses would help. Everyone responds to medications differently. By the way, you can have both bipolar disorder and PTSD.

If the correct diagnosis is bipolar disorder, it's important to seek appropriate treatment. Without treatment, the disease can progress, with more intense phases of mania and depression that can, at a minimum, interfere with daily activities, work and interpersonal relationships. --

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