Although clinicians and the public have become more aware of the prevalence of depression, little attention has been paid to improving recognition of bipolar disorder. The recognition of bipolar disorder is essential because it requires different treatments than are used for major depressive disorder. However, the diagnosis of bipolar disorder should be considered in any patient with major depression because these patients can have depressive episodes characterized by signs and symptoms identical to those of major depressive disorder (Keck & Susman, 2003). .
The diagnosis of bipolar disorder should include interviews to examine symptoms, family history, a longitudinal course of illness, and treatment response (Manning, 2003). Two symptoms specific to bipolar illness are mania and hypomania, defined as periods of abnormally expansive or an irritable mood that represents distinct changes from usual functioning. This often includes an abrupt switch from a depressed state to one of elevated mood or vice versa, and typically last one to three days. Family history is a critical diagnosing tool as bipolar illness is highly heritable. As Manning has noted, "by way of gestalt, the pedigree of a bipolar patient will often be "ugly," with large numbers of relatives depressed, anxious, addicted, or acting out in some way" (p.S9). Bipolar disorders typically appear by age 25, but unipolar conditions appear later. Bipolar depressions are abrupt in onset, prolonged, and usually more severe than unipolar depressions (Manning, 2003). Recent scientific literature suggests treatment-emergent hypomania/mania as specific to bipolar illness. "Treatment-emergent manic symptoms strongly suggest the presence of bipolar illness, and clinicians should query patients taking antidepressants about such symptoms, especially early in treatment and after dosage increase," asserted Manning (2003). Although overnight recoveries would be a welcomed thought, management is all that can be expected from this lifelong illness.