I became irritable and agitated on my antidepressant. My doctor believes I have become "hypomanic." What does that mean?

Manic-depressive disorder, or bipolar disorder, can only be diagnosed if someone has a history of at least one manic (bipolar I) or hypomanic (bipolar II) episode. Sometimes, a person's first episode of a mood disorder is that of depression; therefore a possibility exists of a depressed individual really having bipolar disorder. The likelihood of this occurring increases if there is a family history of bipolar disorder. If a person with depression actually has bipolar disorder, an anti-depressant may trigger the onset of a hypomanic or manic mood state. This is why bipolar depressed persons usually require a mood stabilizer when taking an antidepressant.

Becoming irritable or agitated on an antidepressant, however, is not diagnostic of a manic episode. These are not uncommon side effects that can occur in nonbipolar depressed persons. If you become agitated after starting an antidepressant, your doctor will want to stop the antidepressant. Further inquiry into past personal and family history of past hypomanic or manic episodes should occur. Once the antidepressant is stopped, your agitation should resolve. If it does not, then bipolar disorder is more likely present. If resolved, another antidepressant can be tried, because the agitation will not necessarily occur with another medication. If it does occur again, then a mood stabilizer may be necessary in conjunction with an antidepressant.

I have been diagnosed with a mild depression. Does that mean a quicker recovery?

Several types of depression exist. Each is characterized by a specified symptom presentation. The most common types of depression are major depressive disorder, dysthymic disorder, and bipolar depression. Major depressive disorder is given a qualifier of mild, moderate, or severe, depending on the number of symptoms and the degree of disability. In a mild major depression, treatment is essentially the same as for a moderate to severe depression, but the response[1] to the treatment may not necessarily be better. Certainly, the required interventions may not be as intense as those used for a severe depression (e.g., hospitalization or more frequent therapy). Dysthymic disorder is also considered a mild type of depression, but its course is more apt to be chronic; thus recovery may be more difficult from someone who has a discrete episode of major depression. In particular, some individuals with dysthymia have a major depressive episode as well (called "double depression"[2]), which may complicate the treatment. Although dysthymia is not associated with the same degree of morbidity and mortality as major depression, it does cause distress and even functional impairment and thus affects a person's well-being. Dysthymic disorder is generally treated the same as a major depression, but, again, treatment interventions may not need to be as intense, depending on the level of functional impairment. For example, hospitalization is not necessary for dysthymic disorder. In terms of time to recovery, it typically takes 4to6 weeks for depression to remit once medication therapy is initiated. It may take longer if psychotherapy is the only intervention. The type of depression present does not signify the likelihood of response to treatment, although it may impact the prognosis. For example, bipolar depression may require longer maintenance treatment than one episode of major depression.

  • [1] referring to at least a 50% reduction but not complete cessation of all symptoms associated with a specific mental illness, such as depression.
  • [2] the co-occurrence of a major depressive episode with dysthymic disorder.
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