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Elisa Goldstein, Ph.D.Elisha Goldstein, Ph.D.
A blog about mindfulness, stress-reduction, psychotherapy and mental health.

Is it Depression or Bipolar Disorder?

Elisha Goldstein, Ph.D. Updated: Jun 3rd 2010

questioningAccording to a Stanley Foundation Bipolar Network survey of 258 of its bipolar patients, people who are diagnosed with bipolar disorder experiences depression three times more than mania despite medication. Allan Swann, M.D. of the University of Texas has said that people with bipolar depression are more likely to experience depression more often, earlier and see more substance abuse issues.

Interestingly enough, the DSM-IV fails to distinguish between unipolar and bipolar depression, even though this might be critical to actually differentiating between the diagnoses.

It often takes years to diagnose bipolar disorder after an initial misdiagnosis of depression.

Anyone who has ever gone to therapy for years only to learn later that they've been misdiagnosed feels a great sense of loss and anger. However, it's important to note that even in that time, there may have been a sense of connection or skills integrated that may still have served that person.

Nevertheless, it would be a wonderful gift for more people to focus on the differentiating factors so professionals could more accurately diagnose bipolar disorder should it be there.

Most therapists think they need to see an episode of mania in order to diagnose bipolar disorder and in a recent study presented at the American Psychiatric Association's annual conference, Charles Bowden, MD, of the University of Texas Health Science Center in San Antonio, said otherwise.

He said there are 5 factors associated with Bipolar Disorder to watch out for.

These include:

  • A family history of mania
  • Having at least two mood episodes in the past
  • Experiencing initial psychiatric symptoms before the age of 30
  • Experiencing extreme mood swings
  • Experienced mixed states with symptoms of mania and depression occurring together

Unfortunately, there's not a whole lot of research out there working toward this differentiation, but my guess is that is going to pick up.

This is certainly not a perfect science as there are so many factors involved, but the better we understand it, the more likely we are to save a lot of suffering.

What's been your experience with the diagnosis of bipolar disorder?

Please share your thoughts, stories and questions below, your interaction provides a living wisdom for us all to benefit from.

Elisha Goldstein, Ph.D.

Elisha Goldstein, Ph.D. is a clinical psychologist in private practice in West Los Angeles and is author of the upcoming book The Now Effect, co-author of A Mindfulness-Based Stress Reduction Workbook, Foreword by Jon Kabat-Zinn, author of the Mindful Solutions audio series, and the Mindfulness at Work™ program currently being adopted in multiple multinational corporations.

Check out Dr. Goldstein's acclaimed CD's on Mindful Solutions for Stress, Anxiety, and Depression, Mindful Solutions for Addiction and RelapsePrevention, and Mindful Solutions for Success and Stress Reduction at Work. -- "They are so relevant, I have marked them as one of my favorites on a handout I give to all new clients" ~ Psychiatrist.

If you're wanting to integrate more mindfulness into your daily life, sign up for his Mindful Living Twitter Feed. Dr. Goldstein is also available for private psychotherapy.

Reader Comments
Discuss this issue below or in our forums.

MDD vs Bipolar diagnoses - George - Aug 20th 2014

It took 40 years for my mood disorder to be definitively diagnosed as Bioplar-II, with rapid-cycling. In retrospect, it should have been obvious to any clinician who had performed a competent historical workup. Sadly, there is no standard for triage, initial diagnosis or followup. It's pretty much whatever the doctor feels like doing.

It's clear now from analyzing my written correspondence from the period, that I exhibited initial symptoms in the military at a very specific time. My mood and behaviors were noted in my medical record and my commanders changed my duties to reflect these changes.

To this day, the VA refuses to recognize or initiate a differential diagnosis for my MDD and Bipolar. When I pressed the point, one my psychiatrist told me to seek treatment from another doctor - he fired me! The second psychiatrist also adamantly refused to review my history and arrived at a MDD diagnosis in less than 45 minutes or Q&A.  None of these interviews utilized a formal or structured diagostic method. All were patronizing, dismissive, authoritarian, and superficial.

The VA doctors steadfastly refuse to examine medical records from my previous psychatrists and psychotherapists.  On two occasions I have been "switched" to manic with inappropriate medications. However, that has had no effect on their diagnosis.

Psychiatry ned to join the 21st century and become an evidence-based scientific discipline.  I believe the NIMH has made similar recommendations, and hs formally rejected the DSM-V for it qualitative approach.


don't agree with the 5 factors - Linda - Jun 5th 2010

I don't agree with the 5 factors described for contributing to a diagnosis of Bipolar.

I believe it is a very complicated illness to begin with and the medications given for it can make the bipolar an extremely more dysfunctional illness to treat.

It is essential to educate and advocate for ourselves with any illness and it is very important to work with a professional in the observation, diagnosis and treatment of Bipolar.

And what makes it worse .... - Graham Nelson - Jun 5th 2010

And what makes it worse is that such a misdiagnosis often results in doctors prescribing anti-depressants that make the BP much worse, causing ultra ultra rapid (Ultradian) cycling of moods.  Indeed, it might be worse still because one study I have found recorded on The Net suggests prolonged exposure to certain anti-depressants, such as Prozac, may cause the Ultradian BP state to become permanent.

What a difference a friend makes - Mary - Jun 4th 2010

Depression and Bipolar Disorder are very common mental illnesses and should be taken seriously. If you have a friend who may have Depression or Bipolar Disorder you can help them by giving them support. I work with SAMHSA and the What A Difference A Friend Makes program. To find out ways you can help a friend, please visit

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