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 sneaky. Symptoms can defy the expected manic-depressive sequence. Infrequent episodes of mild mania or hypomania can go undetected. Depression can overshadow other aspects of the illness. And substance abuse can 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.
About half of people with bipolar disorder have seen three professionals before being diagnosed correctly.
It takes an average of 10 years for people to enter treatment for bipolar disorder after symptoms begin. This is caused in part by delays in diagnosis.

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Bipolar Disorder Is Often Mistaken for ‘Just’ Depression
People with bipolar disorder are frequently misdiagnosed as having only depression. In bipolar II disorder, the milder form, manic episodes are mild and can pass by unnoticed. Time spent with depression symptoms, meanwhile, outnumbers time spent with hypomanic symptoms by about 35 to one in people with bipolar II disorder.

Time spent with depression symptoms also usually outweighs time spent with mania symptoms in bipolar I disorder by about three to one, although the more severe mania in bipolar I generally is easier to identify.

Major depressive disorder — often referred to as unipolar depression — is different from bipolar disorder II — also called bipolar depression — in that unipolar depression has no intervals of hypomania while bipolar II does have intervals of hypomania.

Anyone evaluated for depression should also be evaluated for a lifetime history of manic or hypomanic episodes.

Bipolar Disorder and Substance Abuse Can Go Hand in Hand
Substance abuse often complicates the diagnosis and treatment of bipolar disorder. Substance abuse is bipolar disorder’s partner in crime. Some studies show that as many as 60% of people with bipolar disorder also abuse drugs or alcohol. Untreated substance abuse can make it virtually impossible to manage the mood symptoms of bipolar disorder if both disorders are present. It can also be hard to make a confident diagnosis of bipolar disorder when someone is actively abusing substances that cause mood swings.

Substances such as alcohol and cocaine can also cloud the picture in bipolar disorder. For example, people high on cocaine can appear manic when they’re not, or have a depression “crash” when the drug wears off. Some people with bipolar disorder use drugs and alcohol as a part of the impulsivity and recklessness of mania. Others may have an independent substance use disorder, which requires its own treatment. Substance abuse may make bipolar episodes (mania and depression) more frequent or severe, and medicines used to treat bipolar disorder are usually less effective when someone is using alcohol or illicit drugs

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In this article
Bipolar Disorder Is Often Mistaken for ‘Just’ Depression
Bipolar Disorder and Substance Abuse Can Go Hand in Hand
Does Your Teenager Have Bipolar Disorder?
Does Your Teenager Have Bipolar Disorder?
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 for suicide.

Unfortunately, bipolar disorder in teens frequently goes undiagnosed and untreated. Partly, this is because while symptoms may begin in adolescence, they often don’t meet the full diagnostic criteria for bipolar disorder.

Symptoms of bipolar disorder in teens may be unusual — not a straightforward “manic depression.” ADHD, anxiety disorders, and substance abuse are often also present, confusing the picture.

Some symptoms that suggest a teenager might have bipolar disorder are:
Uncharacteristic periods of anger and aggression
Grandiosity and overconfidence
Easy tearfulness, frequent sadness
Needing little sleep to feel rested
Uncharacteristic impulsive behavior
Moodiness
Confusion and inattention
Other potential symptoms that may indicate the presence of a psychiatric disorder requiring evaluation may include feeling trapped, overeating, excessive worry, and anxiety. Other possible diagnoses in addition to bipolar disorder that should be considered in the setting of symptoms such as these include unipolar (major) depression, anxiety disorders, substance use disorders, adjustment disorders, attention deficit hyperactivity disorder, and personality disorders such as borderline personality disorder.

It’s important to remember that these symptoms can occur in many healthy teens and adults. The time for concern is when they form a pattern over time, interfering with daily life. Children with symptoms that suggest bipolar disorder should be seen and evaluated by a psychiatrist or psychologist.