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Ask the expert

Somebody I know has been diagnosed as bipolar II. Could it be a misdiagnosis?

Yes. Sometimes people are diagnosed with rapid cycling bipolar disorder, which means that their mood is always fluctuating. However, we often confuse emotional volatility with bipolar disorder. Somebody who has mood swings is not necessarily bipolar. Somebody who has mood swings might have them because they see everything in an exaggerated way—because they have histrionic or borderline personlities or are extremely anxious. That is very different from a bipolar disorder where you have mood fluctuations that are less related to circumstances.

It depends on how bipolar II is diagnosed. People with bipolar II usually suffer from less severe depression and mood elevation than we see in classic bipolar disorder. Sometimes mood elevation occurs when people take antidepressants. As they come out of their depression, their mood becomes a little higher than it had been normally. Sometimes, people suffering from depression can have mood swings based on the way they react to their environment. They are very hyperactive and sensitive. Depression can also combine with some of the personality problems referred to earlier (where people are very emotional and sensitive to rejection, fall in love quickly, fall out of love quickly, are very happy one day and not so happy the next). That combination may appear to be bipolar II disorder, but is more likely to be a combination of depression and something else. The best way to tell is to get to know people over time. Usually bipolar II disorder changes take place over a long period of time and the pattern recurs. If your mood swing changes in one day, it's not the same as being depressed for six months, then up for three months, as you would more likely see in bipolar disorder.
-Mimi Israël, MD

What are the chances of a child being diagnosed as bipolar, if a parent is bipolar?


Is it true that, if you have bipolar disorder, your chances of having Alzheimer’s disease increase?

There is potential damage that can be done to the brain through repetitive episodes of depression; it will start affecting your brain to the point where the concentration is not as good as it used to be, etc. Sometimes, it could be the dosage of the medication, and so we look at that too. Are there more risks to developing Alzheimer’s disease? Vasavan Nair, MD, at the Douglas, has been working on this for years and years, and he is not convinced that this is the case at all. There is no proof.

-Serge Beaulieu, PhD, Mini-Psych School 2009

What are the consequences of diagnosing a patient who has bipolar disorder as simply unipolar depression?

The consequences would be exposing that person to a treatment that will not necessarily give great results. There is also the issue of bipolar disorders being a spectrum and not a yes/no diagnosis. I tend to see a lot of patients who have had five, six, seven, even ten depressions in their life. Huge ones, treated with ECT sometimes. Then they are sent to me because they are having another episode of depression. When you have this repetitive pattern, you have to start asking yourself what you are treating: a unipolar depression or a variant of bipolar depression? Maybe it’s just that nobody saw or prove that there were any hypomanic or manic symptoms before.

-Serge Beaulieu, PhD, Mini-Psych School 2009

Is there any difference in the prevalence of bipolar disorder among different ethnicities?

Bipolar disorder is a very democratic disease. I see patients coming in Mercedes, and I see patients coming in by foot or on bicycle, I see poor people, I see people who are multimillionaires. I see women and men in the same ratio, and I see it in all cultures. But, there are cultural differences in the way behaviours are interpreted and perceived. In this case, we ask the family and the friends who have the same culture, same tradition, same points of reference. Easy.

-Serge Beaulieu, PhD, Mini-Psych School 2009

Is it possible to detect bipolarity in children and if so, from what age?

Research conducted in Montreal and Canada has shown that bipolar disorders are quite rare before the age of 16. This does not mean that bipolar disorders do not exist in children; I treated an 11-year-old child who presented with a profile that was clearly manic. In the United States, there has been a current of thought in the past 10 years that bipolar disorders could appear in children between the ages of 6 and 12, especially if the biological parents also suffered from bipolar affective disorder. We have to be very careful because it is difficult to determine whether a child has bipolar disorder, bipolar depression, or something else. The other problem is that the treatment is lithium, which causes a lot of side effects. We need to carefully consider putting a child of 7 or 8 on this kind medication for life. We try to delay medication and manage the problems in some other way.
- Johanne Renaud, MD, Mini-Psych School 2010

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