Misdiagnosed for 14 years: Why bipolar disorder is mistaken for depression

Kimberley Atkinson spent fourteen years believing she had depression. The diagnosis seemed to fit. Since her teenage years, her moods had swung unpredictably, her emotional regulation had been fragile, and the depressive episodes felt like drowning—days lost to bed, unable to face the world. Antidepressants were prescribed. She took them, hoping they would anchor her. They didn't, not really, but the framework of depression held. It explained what was happening to her.

Then her thinking became erratic. She began having delusional ideas. Her speech accelerated. She grew intensely irritable. One night while studying for a PhD at the University of Edinburgh, she drove to London after seeing a news report about someone in trouble, convinced she was the only person alive who could save them. She became certain her moods were causing bad weather. Her friends and family watched with alarm. Eventually she was admitted to a psychiatric ward against her will. It was only then, during that involuntary hospitalization, that psychiatrists looked past the depression diagnosis and saw what had been there all along: bipolar disorder.

Kimberley's story is not unusual. Research suggests that as many as one in five people diagnosed with severe or recurrent depression may actually have bipolar disorder. Yet patients in the UK typically wait nearly a decade between first reporting symptoms and receiving the correct diagnosis. Professor Danny Smith, chair of psychiatry at the University of Edinburgh, told the BBC that the problem is systematic: health professionals are not screening adequately for the symptoms that distinguish bipolar from depression—specifically, they are not asking about mania or hypomania, and they are not exploring family history. The Royal College of Psychiatrists and the charity Bipolar UK back his call for urgent updates to screening guidance. They argue that better screening could be life-saving, because the medications used to treat depression often make people with bipolar disorder more unwell.

Jacqui Armstrong's experience mirrors Kimberley's in its duration and its cost. Now sixty-four, she began taking antidepressants as a teenager and spent more than thirty years being treated for depression. During those decades, she was hospitalized multiple times, attempted suicide, and even received electroconvulsive therapy—a treatment using electrical current to induce a controlled seizure. She worked as a teacher in a primary school and later a nursery, all while struggling through episodes so severe she could not climb stairs. She described herself as broken, as a failure. But the signs of bipolar were always present. Alongside her frequent depressions, she experienced episodes of hypomania—periods of unusually high energy, activity, and mood, less severe than full mania but still distinct. She would suddenly feel confident and sociable, her mind flooding with ideas, her diary filling with plans. Then she would, as she put it, energize herself into a breakdown. It was only during her final hospital admission, more than thirty years after first seeking help, that a psychiatrist asked if she had ever experienced hypomania. She was then assessed further and diagnosed with bipolar II.

The distinction between bipolar I and bipolar II matters for diagnosis. Kimberley experienced a full manic episode—a break from reality—which led to her bipolar I diagnosis. Jacqui's hypomania episodes, while real and disruptive, were less severe, placing her in the bipolar II category. Experts say bipolar II is harder to catch precisely because it involves more frequent depressive periods and the elevated mood states are less dramatic. A person experiencing hypomania might simply seem unusually energetic or productive, not obviously unwell. A GP confronted with a patient describing depression will naturally focus on that symptom. As Smith noted, patients do not typically arrive at their doctor's office saying they are too energetic and need very little sleep.

The scale of underdiagnosis is significant. About one in one hundred people receive a bipolar diagnosis during their lifetime, according to current figures. But research suggests the true prevalence is closer to one in fifty. Smith attributes the gap to the fact that existing UK guidelines already recommend screening for mania and hypomania, yet this screening is routinely not happening. Updated and better-publicized screening tools are needed, he said, because the current system is failing. The long delays between first symptom and correct diagnosis suggest a systematic failure in how primary care identifies the condition.

Both Kimberley and Jacqui were prescribed various antidepressants over years with little or no benefit. Neither was ever asked about mania until they reached the point of hospitalization. Now, both describe their lives after diagnosis as transformed. Kimberley works full-time as an assistant psychologist for the NHS and has not had a manic episode since being sectioned four years ago. Jacqui has called the last few years her happiest in a long time. She has raised two children, had a career, and now, for the first time, feels properly herself. Smith emphasizes that bipolar disorder is highly manageable when diagnosed correctly—people with proper treatment can build normal families and successful careers. The cost of missing the diagnosis, however, is measured in years of suffering, inappropriate medication, hospitalizations, and in some cases, suicide attempts. The question now is whether the health system will act on what experts already know: that better screening, implemented urgently, could spare others from the years of chaos that Kimberley and Jacqui endured.