Bipolar Disorder: Warning Signs

People with bipolar disorder often have cycles of elevated and depressed mood that fit the description of "manic depression." When a person's illness follows this classic pattern, diagnosing bipolar disorder is relatively easy.

But bipolar disorder can be sneaky. Symptoms can defy the expected manic-depressive sequence. Infrequent episodes of mild mania can go undetected. Depression can overshadow other aspects of the illness. And substance abuse can cloud the picture.

Taken together, these factors make bipolar disorder surprisingly difficult to diagnose. A few facts about bipolar disorder you may not know:

• As many as 20% of people complaining of depression to their doctor actually have bipolar disorder.
• About half of people with bipolar disorder have seen three professionals before being diagnosed correctly.
• It takes an average of 10 years for people to enter treatment for bipolar disorder after symptoms begin. Partly, this is due to delays in diagnosis.

Bipolar Disorder Is Often Mistaken for 'Just' Depression

People with bipolar disorder are frequently misdiagnosed as having only depression. In bipolar II disorder, the milder form, manic episodes are mild (called hypomania) and can pass by unnoticed. Depression episodes, meanwhile, outnumber manic episodes by about 35 to 1 in people with bipolar II disorder.

Depression also usually outweighs mania in bipolar I disorder by about three episodes to one, although the more severe mania in bipolar I generally is easier to identify.

Major depression [often referred to as unipolar depression] is different from bipolar disorder II [bipolar depression] in that unipolar depression has no intervals of hypomania while bipolar II has intervals of hypomania.

Bipolar Disorder and Substance Abuse Go Hand in Hand

Substance abuse usually complicates the diagnosis and treatment of bipolar disorder. Substance abuse is bipolar disorder's partner in crime. Nearly 60% of people with bipolar disorder also abuse drugs or alcohol. Those who abuse substances usually have more severe or poorly controlled bipolar disorder.

Substances like alcohol and cocaine can also cloud the picture in bipolar disorder. For example, people high on cocaine can appear manic when they're not. Many people with bipolar disorder use drugs and alcohol as a way of coping with their bipolar symptoms. In turn, substance abuse may make bipolar episodes (mania and depression) more frequent or severe.

Is Your Teenager Bipolar?

Bipolar disorder commonly begins to show itself in the late teens. Bipolar disorder in the teenage years is serious; it's often more severe than in adults. Adolescents with bipolar disorder are at high risk for suicide.

Unfortunately, bipolar disorder in teens frequently goes undiagnosed and untreated. Partly, this is because while symptoms may begin in adolescence, they often don't meet the full criteria for bipolar disorder.

Symptoms of bipolar disorder in teens may be unusual -- not a straightforward "manic depression." Attention deficit hyperactivity disorder (ADHD), anxiety disorders, and substance abuse are often also present, confusing the picture.

Some symptoms that suggest a teenager might have bipolar disorder are:

• Anger and aggression
• Rebelliousness
• Easy tearfulness, frequent sadness
• Irritation
• Impulsive behavior
• Moodiness
• Confusion and inattention

Other potential symptoms include feeling trapped, overeating, excessive worry, and anxiety.

It's important to remember that these symptoms can occur in many healthy teens and adults. The time for concern is when they form a pattern over time, interfering with daily life. Children with symptoms that suggest bipolar disorder should be seen by a psychiatrist or psychologist.