I ran across this slide in the Psychiatric Times Bipolar Disorder Information Center. I think it neatly illustrates why so many of the people I talk with, particularly people with bipolar 2, find it hard to understand the diagnosis.
- Patients with bipolar I disorder spent slightly less of their time in depression – they experienced depression roughly 67% of the time that they were having mood symptoms.
- Patients with bipolar II disorder spent almost all of their time in depression. 93% of the time they were having mood symptoms they were depressed.
What defines bipolar disorder and makes it different from other conditions are the energized states of hypomania or mania, but what makes bipolar so disabling for many people is the depression.
Days and weeks and months of depression stretching on and on, and why is my doctor so preoccupied with those brief moments of hypomania which are just a respite from depression. In fact, aren’t they really just normality?
And then consider the patient whose experiences are only slightly unusual and to his had at most one or 2 hypomanic episodes.
Really, the doctor is obsessed with hypomania, why not just give me that antidepressant?
REFERENCES
- Judd LL, Akiskal HS, Schettler PJ, et al. The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry. 2002;59(6):530-537.
- Judd LL, Akiskal HS, Schettler PJ, et al. A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Arch Gen Psychiatry. 2003;60(3):261-269.