Experts Call for Improved Screening to Prevent Bipolar Disorder Misdiagnosis

Health professionals in the UK need to improve screening for bipolar disorder, particularly by asking about symptoms like mania and family history, according to Prof Danny Smith, chair of psychiatry at the University of Edinburgh. His call for updated screening guidance is supported by the Royal College of Psychiatrists and the charity Bipolar UK. They assert that better screening could be life-saving, as medications for depression can sometimes worsen symptoms in individuals with bipolar disorder.

Lived Experiences Highlight Diagnostic Challenges

Kimberley, who was told she had depression for 14 years, eventually received a bipolar I diagnosis after a three-month hospital stay. Initially resistant to the diagnosis, she later found that her past symptoms made sense within the context of bipolar disorder, describing her life before diagnosis as "chaotic" but her current life as "stable" due to medication.

Jacqui Armstrong, 64, experienced decades of treatment for depression, including hospital admissions and a suicide attempt, before being diagnosed with bipolar II. Her treatment included antidepressants and even electroconvulsive therapy. Armstrong noted that signs of hypomania—periods of elevated energy, activity, or mood less severe than full mania—were present. These episodes, characterized by increased confidence, ideas, and sociability, often preceded a "breakdown." It was only during a hospitalization for depression that a psychiatrist inquired about hypomania symptoms, leading to her eventual diagnosis over 30 years after she first sought help.

Experts believe bipolar disorder is significantly underdiagnosed, with estimates suggesting that while about one in 100 people receive a diagnosis in their lifetime, the true prevalence could be closer to one in 50. Research indicates that patients in the UK typically wait nearly a decade from the onset of symptoms to diagnosis, pointing to inadequate routine screening for manic or hypomanic symptoms.

Call for Updated Screening Tools

While existing UK guidelines suggest doctors should screen for these symptoms, updated and more widely publicized screening tools are considered crucial because current practice often falls short. "It's understandable because GPs are often confronted with depressed patients and therefore they're very focused on diagnosing depression correctly," Prof Smith explained. "People obviously don't go to the GP and say 'Help doctor, I'm really energetic and I've got lots of ideas and I don't need much sleep.'"

Despite increased public awareness due to high-profile figures sharing their diagnoses, Bipolar UK states that insufficient attention is being paid to the illness, and delayed diagnosis is "costing lives."

Manageability and Recovery

Smith emphasized that bipolar disorder is a "highly manageable" condition with proper diagnosis and treatment, enabling individuals to lead normal lives with families and careers. Both Kimberley and Jacqui shared that they received little benefit from antidepressants but experienced significant improvement after receiving the correct diagnosis and treatment. Kimberley is now working full-time as an assistant psychologist, and Jacqui describes the last few years as her "happiest in a long time," feeling like her true self without embarrassment about her diagnosis.