When is depression likely to indicate Bipolar illness?
Bipolar illness can only be finally diagnosed when the patient actually has a hypomanic or manic episode, but certain factors increase the index of suspicion. In particular, rapid onset of depression and especially rapid progress to severe symptoms, is a highly suspicious pattern. Similarly, rapid response of a severe illness is a significant warning sign. A family history of Bipolar illness, or a personal history of mild mood swings (especially any indicator of hypomanic swings) are also warning signs. It is very useful to ask all patients with depression if they have ever had a night or a number of nights in which they did not need much sleep, and felt energetic and fine all the next day. Having no actual need for sleep, as distinct from not sleeping, is a unique symptom. This is different to people who cannot sleep for whatever reason, or who choose not to sleep, to socialise or to complete certain tasks; the vast majority of people feel tired the next day as a result of such a deci
