Depression and bipolar disorder

Depression and bipolar disorder are very commonly seen in general medical practice and both are under-recognized and sometimes inappropriately treated. In one study, 15 percent of patients visiting an urban general practice were found to be currently experiencing clinical depression and another five percent were diagnosed as bipolar—only half of both groups had received any mental health treatment in the past year. Further, a full quarter of these depressed patients actually had bipolar disorder.

Those experiencing bipolar disorder were more likely to have suicidal thoughts, low self-esteem, co-existing alcohol abuse as well as a lifetime history of hallucinations and inpatient psychiatric care. Of the bipolar patients who had received some treatment, half reported recent treatment with an antidepressant medication while most did not receive a mood stabilizer in conjunction with it. This is not appropriate because antidepressants alone are not recommended for the treatment of bipolar disorder. While they may alleviate the depressed phase, they can often send a patient spiraling into a manic phase, which is just as dangerous.

It is disheartening to find two such treatable conditions are so often unrecognized and either untreated or inappropriately treated. Since approximately one in five people will experience some form of depression during their lifetime, it is important for the medical community as well as the general population to be aware of the signs and symptoms of depression and the availability of effective treatment.

Depression involves more than simply feeling blue. While persistent sadness is a hallmark symptom, there are other ways to identify the condition. Sadness out of proportion with what is going on in the individual’s life, disrupted sleep patterns, appetite changes, weight gain or loss, social withdrawal, loss of interest in once enjoyable activities, decreased sex drive, irritability, physical complaints such as frequent headaches or back pain and suicidal thoughts are all common symptoms of depression.

Bipolar disorder can look just like depression as one of its phases is depression. Careful diagnosis by a medical professional is important, but some things to be aware of include a history of at least one episode of mania. When an individual experiences a manic episode, it usually involves a combination of symptoms including feelings of excessive euphoria, abnormal feelings of power and confidence, increased energy, racing thoughts, extreme irritability, uncharacteristically bad judgment, increased sexual drive, less need for sleep and restlessness. A manic individual’s behaviour can be impulsive, reckless and sometimes dangerous. All of these need not be present to make the diagnosis. It is the variability in the presence and severity of these symptoms that make this diagnosis tricky.

Patients with bipolar disorder should almost always be seen by a psychiatrist. This is often a difficult disorder to treat and may require frequent changes in medication. The diagnosis is difficult and is usually associated with other psychiatric disorders including drug and alcohol abuse. It should not be taken lightly.

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About the Author

Paul Latimer has over 25 years experience in clinical practice, research, and administration.

After obtaining his medical degree from Queen's University in Kingston, Ontario, he did psychiatric training at Queen's, Oxford and Temple Universities. After his residency he did a doctorate in medical science at McMaster University where he was also a Medical Research Council of Canada Scholar.

Since 1983 he has been practicing psychiatry in Kelowna, BC, where he has held many administrative positions and conducted numerous clinical trials.

He has published many scientific papers and one book on the psychophysiology of the functional bowel disorders.

He is an avid photographer, skier and outdoorsman.

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The views expressed are strictly those of the author and not necessarily those of Castanet. Castanet does not warrant the contents.

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