Worse or "wired" when taking antidepressants. The patient often complains of feeling "antsy," unable to sleep, or more agitated on conventional antidepressants. Numerous failed antidepressant trials; apparent "tolerance" to antidepressants not overcome with increased dosage (pseudotolerance); and antidepressant-induced "switching" into
mania or cycle acceleration may be reported.
Hypomania, hyperthymic temperament,* or mood swings by history. Periods of
elevated mood or energy often do not fit formal DSM-IV criteria for hypomania;
eg, some may last only a day or two. Mood lability in younger patients may be
even more dramatic and poorly demarcated.
Irritable, hostile, or showing mixed features during the presenting depression.
Some patients may show one or more hypomanic features (eg, racing thoughts)
even while depressed.
Psychomotor retardation appears to be more common in bipolar I depression than in unipolar major depression; however, several studies note that psychomotor agitation
is more common in bipolar II than in unipolar major depression.
Loaded family history, either for mood swings, frank bipolar disorder, or affective
illness in general. A family history of comorbid mood disorder and alcoholism may
also point toward bipolarity.
Abrupt onset and/or termination of depressive bouts, or relatively brief depressive episodes (less than 2 to 3 months). Some patients will also report a brief burst of
increased energy or subthreshold hypomanic symptoms immediately before the
onset of depression.
The author expresses his appreciation to Nassir Ghaemi, MD, and Jim Phelps, MD, for their suggested modifications of the original mnemonic. The present version represents the author's own conclusions, however.
