Hi Dr. Gorman, I have battled anxiety and depression a good portion of my life. With medications I have always managed the depression and anxiety and have never missed work due to either condition. Recently however, I had what I will refer to as a breakdown at work and have been off almost five months. My family physician diagnosed depression, but when the medications she prescribed were not working, she sent me to a psychiatrist who diagnosed me with bipolar and major depressive disorder.

Did the depression or anxiety manifest these other two conditions? I realize they are all "mood disorders" but I am wondering if they are linked or if they are all separate conditions - meeting separate of one another, or was I pre-disposed to these two conditions because of the depression and anxiety I've experienced in the past?

Thanks.

Thank you for this question, as it is a common experience. The depression and anxiety did not cause bipolar disorder. Depression is the most common experience for patients with bipolar disorder and major depression (the name for a depression that is severe enough, or accompanied by enough biological features like sleep, energy, sexual and thinking disturbances to warrant medication). If someone presents with a major depression and anxiety, the usual assumption is that the patient is not bipolar, but unipolar.

Signs of bipolar depressions include: earlier age of onset; higher prevalence of accompanying anxiety symptoms; increased chance of feeling stimulated, agitated or “speeded up” while on antidepressants; family history of bipolar disorder; non-response to antidepressants or psychotherapy for the depression; previous history of hypomania or mania (lot's of energy, reduced need for sleep, agitation, risky behavior, racing thoughts, enhanced self esteem, increased activity levels).

Some experts have argued that there is a relationship between unipolar (less severe mood disorder) and bipolar (more severe mood disorder and more complicated to treat). These experts argue that these conditions are on a continuum, and I would agree with them. The only predisposition is that each episode of depression and anxiety increases the likelihood that another episode will occur. An excellent book to read as a better description of bipolar disorder from a patient's perspective is “An Unquiet Mind ”, by Dr. Kay Jamieson.