Is it “Depression” or is it “Bipolar”?

Is It “Depression” or is it “Bipolar”?
By Dr. Daniel Pistone

I have put both in quotes because the story is complicated; and I am not—for your sake, reader—entering that discussion here.

But I will keep the unscientific dichotomy in order to avoid confusing you, and because the points I will try to make for your benefit can be done anyway. So, I am interested in telling you here the dangers of a diagnosis of “depression” and the indiscriminate use of antidepressants.

First of all, not everyone who feels depressed warrants a diagnosis of “depression;” there are other considerations.

Secondly, “depression” is not one illness. In short, and in order to warn you, certain types of depression do not benefit from antidepressants. Far more serious yet, certain forms of “depression” can and are made worse by the use of antidepressants, both in the short and long run.

This is true for depression with mixed features (too often misdiagnosed as “depression with anxiety”).

Most importantly, bipolar depression; antidepressants don’t only fail in these cases, they make matters worse. If we consider only the short term, the effects aren’t as grave. But the long term is what matters most, even when antidepressants are discontinued. As a piece of information to take into account, years of follow up on thousands upon thousands of patients diagnosed with depression have shown that at the very least 40% of them wound up developing a manic episode (the obvious: they actually had bipolar, usually treated with a number of antidepressants to no avail). In fact, bipolar illness most often starts with a depressive episode, accounting for such drastic numbers of misdiagnoses. Statistics show that it takes an average of 10 years before bipolar illness is diagnosed correctly (most often initially considered “depression”).

So, a few tips for you to consider and assess if your “depression” might actually be the bipolar type:

If you have depression and a well established family history of bipolar or “manic depressive illness,” then your depression is likely a phase of bipolar illness and you should not be exposed to antidepressants.

If your depression had its onset before age 25, or if it has a post-partum onset, you should avoid antidepressants.

About 15 other “red flags” exist that could point to bipolar illness in “depression,” one of them being the characteristics of the depression. Only psychiatrists check for these; others in the medical field are most often not even aware of them.

Finally, I cannot overemphasize enough the advice that you seek a psychiatrist to diagnose and treat your possible depression. After all, would you seek a psychiatrist for abdominal pain, hypertension, goiter, etc.? Or a surgeon to treat your cold?

Unfortunately, too many mental health workers “diagnose” “depression” all the time (mostly misdiagnose).

This is not surprising. After all, why would someone be required to graduate from medical school and then complete an accredited psychiatric residency to become a psychiatrist?

We haven’t talked about “short and long term” consequences, but I hope the above suffices for you, reader, to get the idea: trust your psychiatric problems to a psychiatric graduate, a physician like any other medical specialty.

PS: In order to understand the “unipolar-bipolar” issue, I highly recommend you go to The Psychiatry Letter and read “Understanding Manic-Depressive Illness.” I hope you never need psychiatric care, but I hope the above will help you think twice before you make a decision if you ever do.

(Dr. Daniel Pistone, MD ( has been practicing psychiatry for over 20 years. He has worked as a Diplomat for the Argentine Boards of Internal Medicine and Critical Care Medicine and for the American Board of Psychiatry and Neurology . Moreover, he has worked with CMCH, Roseville, CA, Pee Dee Mental Health, Florence, SC(Locum) and Neurology Consultants of the Carolians Research, Charlotte, NC. Recently, he has associated with Savant Care (, a team of mental health professionals, psychiatrists and therapists to help patients recover from their mental disorders and lead a happy life.)