Currently, bipolar disorder can only be diagnosed on the basis of clinical symptoms. We have not yet found imaging or blood biomarkers for bipolar disorder, but this will be a focus of research in the coming years.
Bipolar disorder age of onset
The age of onset in bipolar disorder is typically said to be around the age of 30-35, but this is actually the age of diagnosis. There is, in fact, a long delay in diagnosis: it is not uncommon for there to be a gap of 10 years between the first symptoms and diagnosis. The first symptoms therefore emerge far earlier than diagnosis, and usually begin in the patient’s twenties. Certain forms begin in adolescence, sometimes with a different pattern of symptoms. Others are diagnosed much later, at the age of 50 or 60, often during an episode of persistent depression.
Identifying manic or hypomanic phases
An accurate diagnosis relies on detecting manic or hypomanic phases. There are also what are known as unipolar disorders, such as recurrent depression, during which there are repeated episodes of depression with no manic episode. There is therefore no such thing as unipolar disorder with manic phases, in contrast to bipolar disorders.
A single manic or hypomanic episode is therefore enough to make a diagnosis, and to confirm a risk of another manic or depressive episode.
However, although the diagnosis is determined by manic episodes or hypomanic episodes, it is often the depressive episodes that are the most frequent and last the longest in a person with bipolar disorder.
Historically, the focus has long been on manic episodes, which are the more visible and more characteristic symptoms of the disease, even though the hallmark of bipolar disorder is the dominance of depressive disorders that cause particular suffering in patients. When the disorder speaks for itself.
Sometimes diagnosing bipolar disorder is unambiguous, and there are no other suspected psychiatric or mental health disorders. .
This can happen when the patient is initially treated for a manic or hypomanic episode.
Some patients also report seasonal fluctuations that affect their behaviors and their psychological balance. There is even scientific evidence of a link between variations in exposure and mood. For example, a hypomanic episode that happens every spring may suggest bipolar spectrum disorder.
It is also common for patients to report episodes of depression after a (sometimes very short) hypomanic episode, as if the episode in question had used up all the patient’s energy and the depressive episode was an aftereffect.
Diagnosing bipolar disorder: current steps
The patient most commonly seeks treatment for depression, but a range of other symptoms indicate bipolar disorder. When bipolar disorder is suspected, it is very important to seek support from people close to the patient, like their family, friends or spouse. Although most of the time patients are well aware of their condition when they are depressed, during a manic or hypomanic episode there can often be anosognosia. This is where a patient is unable to recognize their symptoms during those episodes. Similarly, depressed patients often have great difficulty remembering their manic or hypomanic episodes.
As well as investigating manic or hypomanic episodes, it is also important to look for any family history of bipolar disorder.
There is a genetic component to this condition. Death by suicide can be caused by an overly rapid and uncontrolled response to antidepressants, or ineffective antidepressants during depressive episodes, and can also be indicative of bipolar disorder diagnosis.
When the disorder begins at a very young age, it can be easier to detect. The specific characteristics of manic-depressive episodes sometimes make it possible to move towards a diagnosis, even if there is still uncertainty.
The next step is differential diagnosis to confirm or rule out bipolar disorder. In other words, to ensure, through this diagnosis, that the patient’s symptoms are not caused by other factors.
Other factors that may rule out bipolar disorder include:
- Use of narcotics such as cocaine, with effects similar to hypomanic phases.
- Neurological or hormonal conditions such as thyroid problems that can present with similar symptoms.
Note that these are also often co-morbidities rather than genuine alternative diagnoses.
For example, bipolar disorder is often associated with other psychiatric disorders such as anxiety, attention disorders with or without hyperactivity, or addictive disorders.
Patients with bipolar disorder may also suffer from other non-psychiatric disorders, which may themselves aggravate the existing disorders. One example of this is obstructive sleep apnea syndrome.
