Depression is a major part of bipolar disorder. We spend three times the amount of time in depressive phases than manic phases, so it’s important to be able to recognize symptoms of depression and be able to treat them effectively. Because so much time is spent in a depressive state versus a manic state, almost 70% of bipolar patients are misdiagnosed with major depressive disorder or unipolar depression in the onset of their illness. Many patients remain so, even after having a manic episode. What’s more, people who suffer from bipolar disorder are less likely to experience typical depression and more likely to experience atypical depression (AD), meaning there is even more distinction from major depressive disorder that can be recognized in order to receive a correct diagnosis.
So, what is atypical depression and why is it important? Atypical depression is just another category of depression. Think postpartum depression or seasonal affective disorder as other categories. The reason it’s considered atypical is because the symptoms do not match what is often considered “typical” depression, most notably trouble sleeping, trouble eating and weight loss. With atypical depression patients most often sleep more than ten hours a day and will gain weight. There are also other distinctive traits including social impairment due to fear of rejection. It is not considered atypical because it’s uncommon. About 40% of patients with depression, including myself, have atypical depression, so it’s actually quite common.
More fun things about atypical depression? There are physical symptoms: often times patients will experience a “heaviness” in their bodies. You know those lead aprons they use for x-rays? Imagine putting a few of those over your body and trying to lift your arms, legs, head, whatever. That’s what it feels like. Patients also report having more frequent and longer episodes than in other categories of depression, but have the ability to feel better temporarily due to a life event.
Does this sound familiar? If you have bipolar disorder, it’s likely. You’re more likely overall to have bipolar disorder when you have atypical depression versus if you have major depressive disorder or unipolar depression. About two-thirds of bipolar patients have atypical depression, so they seem to be closely tied.
One reason this incredibly important is that symptoms of AD can appear as much as eight years earlier than those with other types of depression. Most start developing symptoms in their teen or early-twenties. Think about that for a minute. Let’s say you’re a teenager, we’ll go with 16, and you start exhibiting atypical depression symptoms. You’re agitated, you’re moody. You sleep a lot, you eat a lot and you’re especially worried about social situations. I’d be willing to bet that most people would assume this was part of normal teenage behavior- a phase to be grown out of. So you get into your twenties and realize that it’s not going away and you may need to seek help. (Yay for you!) You go to the doctor and get a diagnosis of depression and are put on anti-depressants. Not only may this not work, but it could potentially make things worse. So around your mid-twenties this depression develops into full-blown bipolar disorder. You’re unlikely to receive a proper diagnosis and treatment until you’re 30. You’ve spent almost half your life with an illness that wasn’t being treated when it could’ve been.
One more statistic to help that settle in. Patients with atypical depression are significantly more likely to attempt suicide than patients with other types of depression, and those are the ones we know about.
What kind of difference could be made in people’s lives if we could figure this out earlier? How can we make it better?
Physicians hold the crux of the responsibility. It’s up to them to look for and catch these symptoms. Sure, bipolar disorder is considerably more rare than major depressive disorder or anxiety disorder, but that does not mean the potential for other mental illnesses should be overlooked, especially with new research pouring out about detecting bipolar disorder at an earlier age. Once the correct diagnosis is made, the treatment has to match. I realize that physicians are people and people make mistakes. Healthcare is hard, but we rely on you.
For families of those with psychological illnesses, please recognize the struggle. You don’t have to cave in to every whim of your family member, but we do need a little more patience and understanding. We don’t do it on purpose. If we go through this together, we’ll both end up healthier and happier.
For you, the patient, be your own advocate. If you feel like you’re not getting the treatment you need, know your options and ask for it. It may be up to your doctor(s) to diagnose you and give you options, but ultimately it’s up to you. You know yourself and you know what works and what doesn’t. Remember it’s a fluid state. What works now may not work later. Keep seeking it out. The right doctor will want to go through this process with you.
Overall, don’t be too hard on yourself. Sometimes the best you can do is make it through the day, and that’s enough.