Some things

​to think about


Or is it the other way around?

Comorbidity in Bipolar Disorder

When it comes to mental health – and bipolar disorder, in particular – comorbidity is extremely common. Psychiatric conditions are commonly see in people with bipolar disorder, including substance abuse disorders, anxiety disorders, eating disorders, and various personality disorders. 

It’s hard to tell sometimes, isn’t it? Whether you’re bipolar or depressed. One minute you’re up, and the next, you’re down… how do you make sense of it? Bipolar disorder is not always the roller coaster ride you’ve heard that it can be – especially when you’re so used to riding the downhill track.

Proper diagnoses and treatment planning are tricky when depression and bipolar disorder coexist. Is it bipolar disorder with a splash of depression? Or is it depression that’s finally remitting?

“Comorbidity is a medical term we use 

when someone has two or more disorders,” 

said bonmente‘s Dr. Riz Ahmad

“Comorbidity can be tricky and sometimes leads to misdiagnoses, 

delayed treatments, and complicated treatment plans.”

There are several reasons someone might develop comorbid mental illnesses. It could be due to genetic factors, environmental stressors, or even the way different disorders interact.

Which came first? Depression or Bipolar?

Honestly, it doesn’t really matter… and we may never know! What matters is finding support and proper diagnosis. Depression is certainly a part of being bipolar, and it may be the only part people experience for the majority of their life. Until that switch flips. 

When psychiatric conditions like depression exist in people with bipolar disorder, it’s difficult to know whether they should be considered separate disorders or expressions of the range of psychopathology present in bipolar disorder.
What we do know is that the coexistence of two or more conditions leaves room for one to influence the course and treatment response of the other. So in the case of depression and bipolar disorder, the efficacy of treatments for bipolar depression is controversial and complex and not as well investigated as it is for unipolar depression.

Comorbidity Can Complicate Things

That’s why it’s essential to get professional help!  Comorbidity complicates treatment in many ways.

1. It can make diagnosis difficult.

One disorder’s symptoms can mimic the symptoms of another. For example, someone with comorbid bipolar disorder and depression may be misdiagnosed as having a major depressive disorder.

2. It can complicate treatment.

Treatment for one condition can make the symptoms of another worse. For example, someone with comorbid bipolar disorder and anxiety may have more severe anxiety symptoms when in a manic or hypomanic state. Or antidepressant use in a person with bipolar may trigger a manic episode. 

Regular evaluation allows your provider to adjust treatment depending on the way a disorder is presenting and its effect on other conditions.

Clinical Challenges of Depression in Bipolar

Depression in bipolar disorder patients is a major clinical challenge associated with increased medical disorders, suicide, and hospitalization rates. Considering that accurate diagnoses of depression as unipolar depression can delay treatment for up to 8 years, this increases the urgency and severity of the challenge.

Many people with bipolar disorder don’t recognize subtle changes and boost in mood, libido, activity, and energy level as clinically significant hypomanic states. For them, it may feel like their depression is finally lifting. About 12–17% of cases of bipolar disorder are not recognized until a mood shifts into mania or hypomania. Given that bipolar people spend more time depressed than manic, they may actually prefer these hypomanic states. Understandably, they may feel ready to get on the uphill track again.

When you aren’t sure where depression ends and bipolar disorder begins, we are here to help. Like we always say, mental health can be messy. We’re here to help sort it all out!

At bonmente, we specialize in helping individuals struggling with depression, bipolar disorder, or both tease apart their symptoms and put together the pieces of their treatment plan. If you are looking for bipolar and depression treatment in Long Beach, don’t suffer in silence. Let’s talk.

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