Women Diagnosed With Depression May Instead Be Bipolar

Recent findings from a team of Spanish researchers indicate that doctors may need to consider re-diagnosing some depressed women with a mixed form of bipolar disorder that includes simultaneous symptoms of depression and mania. Compared to men with bipolar disorder, women with bipolar disorder have heightened chances of developing simultaneous or overlapping symptoms of mania and depression rather than separate bouts of these extreme changes in mood. In a study published in January 2015 in the journal Psychopathology in Women, researchers from three Spanish institutions assessed the impact of mental health guidelines that allow doctors to diagnose depressed women (or men) with a specific form of major depression, not mixed bipolar disorder, even if they have significant indications of mania.

Bipolar Disorder

Common usage of the term bipolar disorder may lead the general public to believe that there is just one form of this condition, which centers on distinct bouts of severe depression and the extreme state of agitation/overexcitement known as mania (i.e., “manic depression”). However, there are actually several forms of bipolar disorder recognized and defined by the American Psychiatric Association (APA). The popular conception of the condition more or less fits the criteria used to diagnose an illness called bipolar I disorder. A second condition, called bipolar II disorder, also centers on bouts of severe depression; however, instead of experiencing separate episodes of full mania, affected individuals experience episodes of a less extreme state called hypomania. A third form of bipolar disorder, called cyclothymic disorder, centers on less extreme bouts of both depression and mania; however, people with this condition experience much longer cycles of depressed and manic episodes than typically found in other forms of bipolar illness. Other forms of bipolar illness recognized and defined by the APA include conditions called substance/medication-induced bipolar and related disorder, other specified bipolar and related disorder, and unspecified bipolar and related disorder. Additional mental health concerns found with some regularity in people affected by a bipolar condition include substance use disorder (substance addiction and/or abuse), post-traumatic stress disorder (PTSD), an anxiety disorder called social anxiety disorder (or social phobia) and attention-deficit hyperactivity disorder (ADHD).

Mixed Bipolar Symptoms and Women

While most people with a bipolar illness experience separate episodes of depression and mania, some affected individuals experience mixed episodes where symptoms of depression and mania appear at the same time. This mixed symptom profile is especially associated with bipolar I disorder and bipolar II disorder. It can also appear in people dealing with the severe subtype of bipolar illness known as rapid-cycling bipolar disorder, which produces unusually frequent shifts in mood extremes. Statistically speaking, the average woman with a bipolar condition has a significantly higher chance of experiencing mixed depression and mania than her male counterparts.

Depression or Mixed Bipolar Disorder?

In the study published in Psychopathology in Women, researchers from Spain’s Alava University Hospital, University of the Basque Country and Center for Biomedical Investigation in the Realm of Mental Health assessed the possibility that at least some women diagnosed with depression actually have symptoms that would qualify them for a diagnosis of a mixed bipolar condition. Such a difference in diagnosis is possible because current guidelines from the American Psychiatric Association allow doctors to specify a condition called major depression with mixed symptoms in people who have any combination of major depression symptoms and three indications of mania. The researchers preliminarily identified two general symptoms—anxiety and irritability—as the most common distinguishing characteristics of mixed bipolar disorder in women. They also identified a range of more specific problems associated with irritability in a woman affected by a mixed bipolar condition. These problems include panic attacks, phobia-related anxiety symptoms, a generalized sense of unease, loss of energy, recurring bouts of “down” or negative thinking, thoughts of suicide, withdrawal from social situations, decreased mental sharpness and a sense of detachment from the self. The researchers note that, depending on the perspective taken by any given doctor, the symptoms of mixed depression and mania can be viewed as indications of diagnosable depression or diagnosable bipolar illness. They believe that, in at least some cases, the existence of the major depression with mixed symptoms diagnosis may encourage doctors to identify depressive illness in a woman (or man) who may actually be a better fit for a bipolar disorder diagnosis. For this reason, they urge doctors to perform a later follow-up evaluation on any person diagnosed with major depression with mixed symptoms in order to consider the possible presence of mixed bipolar illness.