Can depression at 19 be an early sign of bipolar disorder?

Question

Hello doctor,

I am 23 now, and looking back, I want to understand something about my mental health history. At 19, I had a very severe depressive episode that lasted almost five months. I was put on Escitalopram, which helped, but after about four months, I noticed I was sleeping only three hours, spending recklessly, and talking very fast, which my family found strange.

My psychiatrist at that time increased the Escitalopram dose, thinking the depression was worsening. Now, at 23, I have had three similar cycles, and a new psychiatrist is suspecting bipolar disorder.

My question is:

Can depression starting at 19 be an early sign of bipolar disorder, or were they always two separate episodes?
I read that antidepressants can sometimes trigger mania in bipolar patients. Could Escitalopram have made things worse back then?
I am currently being considered for Lithium, and I am worried about kidney and thyroid side effects long-term. What tests should I be doing regularly if I start Lithium?

Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and am sorry for the distress this has caused.

Your depression at 19 may have been the first manifestation of bipolar disorder rather than a separate condition. Bipolar disorder often begins with depressive episodes, and the “high” or manic or hypomanic episodes can appear later.

Regarding Escitalopram, it does not cause bipolar disorder, but in some individuals, it can trigger or unmask manic symptoms such as reduced need for sleep, rapid speech, and impulsive spending.

The reason your current doctor may suspect bipolar disorder is the pattern of repeated mood cycles, including periods of low mood and elevated energy, which is consistent with bipolar illness.

Lithium is a very effective mood stabilizer for controlling such mood swings and is generally safe when properly monitored. Before starting Lithium, baseline tests typically include kidney function and thyroid function. After starting treatment, regular monitoring is important: Lithium blood levels are usually checked every few months, while kidney and thyroid function are typically monitored every six to 12 months.

Overall, your symptom pattern can fit bipolar disorder that has become clearer over time, and antidepressants may have revealed the elevated mood phase. Lithium, when appropriately monitored, is considered a reliable and well-established treatment option.

I hope this helps you.

Thank you.