Bipolar III is a hypomanic manic or manic response to antidepressants while being treated for unipolar depression (Williams, 2006). Bipolar III is not presently recognized by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR). The DSM-IV-TR recognizes that individuals who experience a hypomanic or manic episode due to antidepressants should not be classified in the bipolar disorder spectrum (Williams, 2006) but should be described as manic or hypomanic episode associated with antidepressants (Wada et al., 2006). However, some believe that the development of manic episodes associated with the exposure to medications should be subcategorised as bipolar III (Akiskal et al., as cited in Williams, 2006).
Bipolar III differs from bipolar II as the hypomania or mania in bipolar III is specifically triggered by the first time antidepressant exposure (Williams, 2006). This phenomenon can transpire even if the individual has no prior history of bipolar disorder nor experienced a hypomanic or manic episode in their life time (Williams, 2006).
Bipolar II is characterized by spontaneous mood changes with one or more major depressive episodes and at least one manic episode with an early onset, beginning in the teens or early twenties (Yatham et al., 2005).
A “switch” from a depressive state to a hypomanic or manic state while being treated with antidepressants for acute unipolar depression occurs in 3-10% of people being treated (Williams, 2006). This phenomenon can transpire even if the individual has no prior history of bipolar disorder nor experienced a hypomanic or manic episode in their life time (Williams, 2006).
Regardless of the classification of the disorder, it is important for professionals to recognize predisposing factors along with signs and symptoms of hypomania and mania, so that the person affected by the disorder can receive the appropriate aid. Individuals who present with depression and have an early age of onset, atypical depressive expression, hyperthymic temperaments, and a family history of bipolar disorder may possess an increased risk for developing mania symptoms with antidepressant treatment (Williams, 2006).
Since therapists usually meet with their clients on a more regular basis than other health care providers they may be more likely to notice hypomanic or manic symptoms (Williams, 2006). Symptoms may include inflated self esteem, grandiosity, irritability, decreased need for sleep, flight of ideas, increased speech, distractibility, increased sexual activity, and increased spending (Yathan et al., 2005).
To conclude, it is essential for the therapist to fully support the client in their treatment and must keep within their scope of practice in regards to medication advice. Therefore, a collaborative approach with medical professionals such as the family physician or psychiatrist would thereby reduce harm and provide the client with the best possible care (Williams, 2006).
- Wada, K., Sasaki, T., Jitsuiki, H., Yoshimura, Y., Erabi, H., Hada, Y., Yamashita, M. (2006).
Manic/Hypomanic Switch During Acute Antidepressant Treatment for Unipolar Depression.
Journal of Clinical Psychopharmacology, 26, 512-515.
- Williams, L. (2006). A Family Therapist’s Guide to Bipolar III: Antidepressant-Induced Mania
or Hypomania. The American Journal of Family Therapy, 34, 343-353.
- Yatham, L. N., Kennedy, S. H., O’Donovan, C., Parikh, S., MacQueen G., McIntyre, R., Sharma,
V., Silverstone, P., Alda M., Baruch, P., Beaulieu, S., Daigneault, A., Milev, R., Young, T.,
Ravindran, A., Schaffer, A., Connolly, M., & Gorman, C. P. (2005). Canadian Network for
Mood and Anxiety Treatments (CANMAT) guidelines for the management of patients with
bipolar disorder: consensus and controversies. Bipolar Disorders,7(3), 5-69.
Brenda Leonard, RN, BScN, M.A.
Counsellor – Anxiety, depression, stress, relationship & interpersonal
difficulties, grief and loss, gender issues, post-traumatic stress