Bipolar disorder is often difficult to diagnose for a number of reasons. The most common reason is that the symptoms of bipolar depression are very difficult to distinguish from those of major depression. Many of the symptoms are actually the same. As a matter of fact, the DSM-IV does not distinguish between these forms of depression. However, many health care professionals argue that there are differences.
There is only a small body of literature to support this theory, but research is gaining momentum. In the meantime, those who are diagnosing and treating these disorders must rely on a patient's history of manic episodes to establish a diagnosis of bipolar disorder.
One possible tool may be WHIPLASHED. Dr. Ronald Pies, a clinical professor of psychiatry at Tufts University, has compiled this mnemonic, which he believes may help practitioners recognize those symptoms that are more likely to indicate bipolar depression over major depression. There is no data to support the use of this tool, but it could serve as a starting point or a reminder for doctors to consider the possibility of bipolar disorder when evaluating a patient.
“I have developed a mnemonic device that brings together several clinical, pharmacological, and familial ‘fingerprints’ of bipolarity. The WHIPLASHED mnemonic has not yet been field-tested for its predictive or prescriptive validity -- it simply represents a compendium of my own clinical experience and my synthesis of the research literature.”
W H I P L A S H E D
- Worse or "wired" when taking antidepressants
- Hypomania in the patient’s history
- Irritable
- Psychomotor retardation or agitation
- Loaded family history
- Abrupt onset or termination of depressive bouts
- Seasonal or postpartum pattern
- Hyperphagia and hypersomnia
- Early age at depression onset
- Delusions, hallucinations or other psychotic features
Pies, R. (2007, March 1). WHIPLASHED: A mnemonic for recognizing bipolar depression. Psychatric Times.
