When is depression not depression?
Could your low mood be bipolar disorder, ADHD or something else?
By Professor Steven Marwaha, Consultant Psychiatrist, Birmingham Psychiatry Clinic
Most people who feel persistently low have depression, and it often responds well to talking therapy, antidepressants, or both. But sometimes what looks like depression turns out to be something else, or depression is only part of the picture. When that happens, standard treatment may help only partly, or not at all. Getting the diagnosis right matters, because the treatment can be quite different.
Signs it may be more than depression
It's worth asking for a specialist opinion if any of these sound familiar:
You've tried two or more antidepressants, at proper doses for long enough, and you're still not well.
Antidepressants made you feel worse in an unusual way, for example agitated, wired, unable to sleep, or with racing thoughts.
Your low periods come and go in distinct episodes, sometimes with spells when you feel unusually energetic, confident or productive.
You feel low because you don't seem to be able to do everyday things as easily as others
A close relative has bipolar disorder, or a history of severe mood problems.
You've struggled with focus, restlessness or disorganisation for as long as you can remember, not just when your mood is low.
Bipolar disorder: the most commonly missed diagnosis
People with bipolar disorder usually spend much more time depressed than "high". They also tend to seek help when they're low, not when they're feeling good. So bipolar disorder is often diagnosed as depression at first, and the correct diagnosis can take 8-10 years from the first onset of symptoms.
The clue is usually in the past: periods of hypomania. These are days or weeks when you needed much less sleep without feeling tired, talked more, had lots of ideas, spent more, took more risks, or felt unusually confident. Many people don't see these spells as a problem, and some remember them as their best times. That's one reason they get missed.
This matters because antidepressants on their own may not help bipolar depression, and can sometimes trigger agitation or mood swings. Treatments that stabilise mood are needed.
Other conditions that can look like depression
Adult ADHD. Long-standing problems with concentration, restlessness and organisation can lead to frustration, low self-esteem and low mood. Treating the depression alone leaves the ADHD untreated.
Physical health problems. Thyroid disorders, anaemia, low vitamin B12 or D, sleep apnoea and some medications can all cause tiredness and low mood. These are usually checked with simple blood tests.
Anxiety, trauma and PTSD. These can show up mainly as low mood, poor sleep and withdrawal.
Alcohol or drug use. These can cause or worsen depression, and are easy to overlook.
Hormonal changes, for example around the perimenopause.
Long-standing emotional difficulties, where mood changes quickly in response to relationships and stress.
Often more than one of these is present at the same time.
How a specialist assessment helps
A full psychiatric assessment looks at your whole history: how your mood has changed over the years, what treatments you've tried and how you responded, your family history, and your physical health. The aim is a clear diagnosis and a treatment plan that fits it. That might mean a change of medication, a referral for a specific therapy, or reassurance that you're already on the right track.
Professor Marwaha is an expert in mood disorders and his research work and NHS work are focused on these disorders and helping people recover. He is the Director of a specialist mood disorders service in Birmingham
Seeing Professor Marwaha
Initial assessment: 1 hour, £510. Follow-up appointments 30 minutes, £230.
In person in Edgbaston (Harborne Road) or at the Priory Hospital, Barnt Green, including evening appointments. Remote video appointments are available across the UK.
Health insurance: recognised by Aviva, Vitality, WPA, AXA Health, Allianz and Onebright. Check with your insurer and get an authorisation number before booking.
You can refer yourself, or ask your GP or therapist to refer you.
To book: call or WhatsApp 07459 675 324, email info@bhampsychiatryclinic.co.uk, or make an appointment online.
This article is general information, not a diagnosis. If you're worried about your mood, speak to your GP. If you're in crisis or thinking about harming yourself, call NHS 111 and select the mental health option, contact Samaritans on 116 123, or call 999 / go to A&E in an emergency.
Comments