Bruce Fountain - Licensed Marriage and Family Therapist  

Bruce A. Fountain
101 Redlands Blvd
Suite 200
Redlands, CA 92373
(909) 792-9797

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Unresponsive Depression May Be Bipolar Disorder


Manic-depressive disorder is now called bipolar disorder, which implies moods at polar opposites. The classic type, or Bipolar I, would consist of mania at one end of the pole and depression at the other. Mania is a distinct period of elevated, expansive or irritable mood, inflated self-esteem, grandiosity, decreased need for sleep, flight of ideas, distractibility, an increase in goal-oriented activity, and excessive involvement in pleasurable, high risk activities. Depressed mood is somewhat self-explanatory but can be complicated by irritability, anger, and anxiety. However, bipolar disorder doesn't always present itself in this manner.

Taking a broader look at a bipolar spectrum may help patients get relief from unresponsive depression and anxiety. The diagnostic manual of the American Psychiatric Association has set specific criteria that must be met in order for a diagnosis to be made. What happens when a patient has a few of the criteria or a mood that has never met the criteria for a manic episode? Bipolar II is a possible diagnosis when there has never been a manic episode and Bipolar Disorder Not Otherwise Specified is a category for disorders that do not meet the threshold criteria for Bipolar I or II but have some of the symptoms and characteristics. Making a diagnosis of bipolar disorder can be difficult.

Any diagnosis must be made carefully, but this one can be especially stigmatizing. Extra caution must be exercised. To complicate matters, mental health experts cannot agree definitively on the disorder. Some believe it is over-diagnosed, leading to overuse of medication and others argue it is under-diagnosed, preventing some people from getting the right treatment. Symptoms don't always follow the diagnostic guidelines but they do seem to follow distinct patterns.

Someone may have had several episodes of depression and have been treated successfully with antidepressant medication. At some point however, the medication stopped working or seemed to make things worse. Others have depressed episodes consisting of sudden drops into depression followed by an abrupt return to normal mood. They may be aware of the cyclic nature of their moods but have never had a manic episode. As a result, family, friends and sometimes mental health professionals, unintentionally reinforce that the absence of a manic episode precludes a diagnosis of bipolar disorder.

Others experience severe anxiety but can manage the depressive episodes. They sleep 10 sometimes 14 hours a day. When they are awake, they can't sit still. They pace and can't think clearly . Their thoughts race and they feel as if they are “coming out of their skin”.

Many people exhibit extreme irritability. Anger is out of proportion to the events that started it and is highly dependent on the behaviors of others.

For some, the most obvious symptom is severe insomnia, sleeping only 2-3 hours per night for days. After falling asleep fairly easily, they wake up after 2-4 hours. Sleep is fragmented for the rest of the night.

Some experts have identified factors associated with bipolar disorder that are suggestive of bipolar but not definitive. They are called soft signs and must be considered as flags that might point to bipolar disorder. They are derived from the work of Drs. Goodwin and Ghaemi and presented in an easy to understand format on an excellent website,, maintained by Dr. James Phelps. The website is exceptionally helpful for anyone interested in the bipolar spectrum.

The following is a partial list of soft signs of the bipolar spectrum disorders. 1. Repeated, brief episodes of depression with the first one appearing before age 25. 2. A first degree relative with bipolar disorder. 3. When not depressed, a personality with a little more energy than average. 4. Increased appetite, excessive sleeping, extremely low energy. 5. Taking an antidepressant causes severe irritability and difficulty sleeping. 6. Three or more antidepressants failed to work. 7. Postpartum depression.

Bruce A. Fountain, MS is a licensed marriage and family therapist. He has a practice in Redlands, CA and can be reached at (909) 792-9797 or via e-mail at © 2006-2010