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 cunning. 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 misuse can also 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.
• Many of those with bipolar disorder have seen more than one healthcare professional before being diagnosed correctly.
• It often takes many years for people to be treated for bipolar disorder after symptoms begin. This is partly due to delays in diagnosis.

Bipolar disorder is often mistaken for 'just' depression

People with bipolar disorder are frequently misdiagnosed as only having depression. For example, in bipolar II disorder the manic episodes are mild (called hypomania) and may pass by unnoticed.

Bipolar disorder and substance

Substance abuse usually complicates the diagnosis and treatment of bipolar disorder. Some of those people with bipolar disorder also misuse drugs or alcohol. Those who misuse 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 of suicide.

Unfortunately, bipolar disorder in teenagers frequently goes undiagnosed and untreated. This is partly 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 could have bipolar disorder are:

• Anger and aggression
• Rebelliousness
• Easy tearfulness, frequent sadness
• Irritation
• Impulsive behaviour
• 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 teenagers and adults. The time to worry 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.