My previous article "How a Psychiatrist Treats Depression: A Peek Behind the Curtain" discusses the experience of seeing a psychiatrist for the first time. However, not every patient who comes to my office for an initial evaluation with depression has major depressive disorder. Some people suffering from depression may have (or think that they have) bipolar disorder.
In brief, as a psychiatrist, when a new patient presents for evaluation and treatment, I always conduct a detailed patient interview to collect a thorough history. The patient will find that we have a wide ranging discussion. At times it will be open-ended and at other times it can be very structured. My training has taught me to evaluate for specific diagnostic criteria (nuances in the patient's story) to differentiate between many possible diagnoses. Many of these "differential diagnoses" present with seemingly similar symptoms to an untrained eye. A proper diagnosis is essential for developing a treatment plan that optimizes outcomes. You can read more about an initial evaluation in my previous articles.
In my experience, one of the most difficult and critical diagnostic considerations is differentiating unipolar from bipolar depression in a patient who presents to the clinic with severe depression. What makes this most challenging is that patients with both bipolar disorder (bipolar depression) and major depressive disorder (unipolar depression) can present with depression that looks, feels and appears to be identical.
Therefore, when a patient presents to my office with depression, I ALWAYS rule out bipolar disorder.
- Distinct periods of three to four days (or longer) when the patient's mood has been consistently elevated or irritable
- During these periods they went without sleep (or with very little need for sleep).
- Increased energy (despite getting little or no sleep)
- Increased risk taking behaviors (gambling, spending money they do not have, brief sexual encounters)
- Talking fast/thinking fast
- Feeling more distracted than normal
- Feeling on top of the world and starting a lot of projects
- Younger age of onset of depression (younger than age 20)
- Sleeping and eating more during the episode of depression
- A first episode of depression with a postpartum onset (soon after having a baby)
- A family history of bipolar disorder
- A history of not responding well to traditional antidepressants
- A history of multiple episodes of depression (greater than 6)
If you have a family member or a friend who you think needs to get help with their mood, please share this article with them. One of the most important things is understanding the difference between mental illness and wellness. The more we talk about mental health the way we talk about physical health, the more we can decrease the stigma and shame that often impedes those in our communities from getting the help that they need. Please share your stories, join the discussion and stay tuned!
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