Bipolar disorder is one of the most commonly misdiagnosed mental illnesses. About 70 of people with bipolar disorder are originally misdiagnosed and about a third of those people go 10 years before getting the correct diagnosis. This is important because bipolar disorder requires specialized treatment that typically includes both antidepressants and mood stabilizers as well as psychotherapy. So treatment for the wrong condition–typically depression–can actually end up making bipolar disorder worse.

The reason bipolar disorder is so often misdiagnosed is because the depressive episodes often look very much like depression. These episodes last for weeks or months and include symptoms such as depressed mood, irritability, fatigue, inability to concentrate, sleeping too much, loss of interest in things you used to enjoy, weight changes, aches, and thoughts of suicide or death. A doctor would ordinarily look at these symptoms and diagnose depression.

People sometimes go to the doctor when they feel depressed or sick–some people experience depression as headaches, body aches, or chest pain–but they rarely go when they feel especially good. They might not even mention these “good moods” to their doctor. However, these good moods might be the clue that distinguishes bipolar disorder from major depression.

Some people with bipolar disorder experience intense manic episodes that may include delusions of grandeur, paranoia, or a psychotic break. People who experience these intense manic episodes often have to be hospitalized to keep them safe. However, most people don’t have such intense manic episodes and many people experience milder hypomanic episodes. Hypomanic episodes are characteristic of bipolar 2. Many people experience these as exceptionally good moods or a lifting of depressive symptoms. Some people are aware these moods aren’t quite right, but welcome them anyway because they are better than depression and they’re very productive, even if they feel anxious about being slightly out of control. If you’re not quite sure whether you’ve been experiencing good moods or hypomanic episodes, there are really two things that distinguish a hypomanic episode.

Sleep

Probably the most notable way to tell the difference between a good mood and a hypomanic episode is how much sleep you need. Although hypomanic episodes are less intense than manic episodes, they typically have two things in common: you have a lot more energy than usual and you need less sleep. You may only feel like you need a few hours of sleep a night and still not feel tired the next day. No matter how good a mood you’re in, you still need to sleep.

Duration

Another easy way to distinguish a good mood from a hypomanic episode is how long it lasts. Moods typically don’t last more than a few hours but a hypomanic episode will typically last at least a few days and might even last weeks or months.

If you suffer from depression but occasionally experience “good moods” with the above characteristics, talk to your doctor about the possibility you might have bipolar disorder.

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