last updated 3/25/2024
The question
Do you, or someone you care about, have depression plus:
- Post-traumatic stress disorder (PTSD)
- Attention-deficit hyperactivity disorder (ADHD)
- Generalized Anxiety Disorder (GAD)
- “Borderline” (supposedly a “personality disorder”, terrible term) …
… or a Mixed State?
Why you can’t tell
Look at the overlap in this graph. (Blue checks are symptoms of the depression part a possible combination with one of these other diagnoses). Obviously the committee that was working on one diagnosis were not able to run across the hallway and discover that the committee working on a different diagnosis were including the same symptoms on their list (“oh, you have that? We have that one too!”)
Solution
There’s another way to establish “Is this a Mixed State?”. Instead of relying entirely on symptoms, look at other factors that suggest you’re might have some “bipolarity” (meaning that your depression is in the middle of the mood spectrum, not the plain-depression end).
Four features are common in people who have obvious bipolar disorders, so these features can serve as markers of bipolarity in people with depression. You’ll see these features repeatedly on this website, because they are one way to get a sense of “how much bipolarity do you have?”
- Family history: other people in the family, over generations, have some sort of extreme mood thing (and, others may have very notable creativity and accomplishment)
- Early onset of depression: before age 30, especially between puberty and about age 21
- Episodic course: not just one episode of depression
- “Antidepressant mis-adventures“: something really weird happened after starting an antidepressant, usually within a few doses but occasionally much later (longest I ever saw was 7 years).
When one or more of these features are present, then all those overlapping symptoms in the checkmarks-table above are more likely to be part of a Mixed State. These four features are examined in the MoodCheck questionnaire that helps you figure out “how much bipolarity do you have?” If you haven’t taken that yet, and have come this far, probably best to go do a MoodCheck right now.
For a more careful discussion of making a decision when diagnosis is uncertain (there’s a brief repeat of the information from this page), see the Mixed States page; or Mixed State: Treatment Approaches.