Do you really have depression? Could you have a very common yet seriously undiagnosed form of bipolar disorder? Is your depression not improving? A surprising number of people are suffering with what clinicians often call treatment-resistant depression – in which their mood and thinking just isn’t returning to normal. Do you find that:

  • Your depression is not improving with talking therapies
  • Your depression is not improving or getting worse with medication
  • Antidepressants are not working anymore or making you more agitated
  • You are experiencing problematic side effects from antidepressants
  • Treatment just hasn’t helped?

If so, you may actually have a form of bipolar disorder, not depression.

In public discussions of mental health it’s a fact that often goes unreported, but a surprising proportion of people who have been told they have depression actually have undiagnosed bipolar disorder. For instance, one American study found that 40% of participants diagnosed with major depression had symptoms of hypomania too. Some other studies have indicated that the actual rate of bipolarity in major depression may be nearer to 50%. In Cardiff, across 27 GP practices, it was found that more than 50% of those diagnosed with major depression had subthreshold bipolar disorder.


But I can’t have bipolar, you might say. I’m not manic for weeks at a time. This is something the bipolar experts here at The London Psychiatry Centre are used to hearing. Media representations of bipolar spectrum disorder tend to reflect what clinicians call bipolar I (the classic form). This classic form is characterised by episodes of mania that substantially affect functioning for at least a week in duration, and periods of depression for at least 2 weeks at a time, either of which may include psychosis.

Bipolar II on the other hand, is marked by episodes of milder elevation of mood and energy (hypomania) that last for four days or more. During these episodes of hypomania, people with bipolar II can still function, though their behaviour may be more disinhibited, and they may have a decreased need for sleep. In bipolar II, episodes of depression can be equally as severe as in bipolar I and last two weeks or longer. Sadly, bipolar II is frequently misdiagnosed as depression, when doctors don’t ask about hypomania and patients don’t report it because they can still function during these spells. But there’s a third type of bipolar disorder and you’ve probably never heard of it. Subthreshold bipolar disorder – a common mental health problem that you’ve never heard of.

This is the most misunderstood classification of bipolar disorder: Subthreshold Bipolar Disorder, also known as Bipolar Disorder Not Otherwise Specified, or Unspecified Bipolar Disorder. It frequently goes misdiagnosed, but as the World Health Organisation asserts, based on international mental health research with more than 60,000 people, it is actually the most common form of bipolar disorder. In fact people with a subthreshold bipolar disorder actually make up around 55-60% of all bipolar sufferers.


Subthreshold bipolar disorders come in different forms. By definition, they are bipolar disorders that don’t meet the thresholds of bipolar I or II. So for example, some people experience spells of mania for under the week-at-a-time bipolar I threshold, or periods of hypomania for under 4 days (the bipolar II threshold). Indeed people with subthreshold bipolar disorder may experience a number of mood changes within a week or even a day.

Subthreshold bipolar disorders are marked by manic symptoms along with depression. The depression in subthreshold bipolar disorder can be just as debilitating as in bipolar I and II. People with subthreshold bipolar can experience:

  • Racing thoughts
  • Agitation
  • Irritability
  • Flight of ideas
  • Being impulsive
  • High sex drive

People with subthreshold bipolar tend to suffer ‘rapid cycling’. Rapid cycling is defined as four or more episodes or mood changes within a year. It can present in all three types of bipolar disorder but frequently, subthreshold bipolar sufferers might undergo several mood changes in the space of a week or even a day. This rapid cycling makes subthreshold bipolar disorder very difficult to treat. And because there are no clear 7 days of mania or 4 days or hypomania as in bipolars I and II, clinicians miss subthreshold bipolar disorder, and by default diagnose it instead as depression. Then, when conventional treatment for depression doesn’t work, the patient is told they have treatment-resistant depression. At that point, a patient will often despair.

One specialist says: “As specialists working at the leading-edge of treatment for bipolar disorders and treatment-resistant depression, we find that by the time patients get to us, they are often at their wit’s end. They have begun to wonder what percentage of depression is untreatable and they may ask us: can some people not get over depression? The good news is with the right treatment, you can feel better. But that can’t happen without the correct diagnosis.”


Subthreshold bipolar disorder is frequently misdiagnosed as depression. Usually, treatment for depression consists of talking therapies like CBT, and antidepressants. But for people whose ‘treatment resistant depression’ is actually bipolar disorder, antidepressants can accelerate mood cycling and make their condition more severe.

Indeed, research has shown that antidepressant use in bipolar patients can be ineffective or harmful, and actually exacerbate bipolar symptoms. And cognitive behavioral therapy, a common first-line treatment for depression, has been shown to be less effective for bipolar sufferers too. CBT is also ineffective in rapid cycling – in fact, rapid cyclers were excluded from the longest and largest CBT study.

Bipolar disorder can cause immense suffering for people who have it. In fact, research from the World Health Organisation has shown that over a lifetime, the disability burden of bipolar disorder is greater than all cancers and every known neurological disease including Alzheimer’s. People with bipolar disorder are at greater risk of early death: almost 4 in 10 die 10 years early from cardiovascular disease and 18% by suicide or mishap. And the condition can greatly affect the quality of relationships and work life.

The truth is bipolar disorders are entirely distinct from unipolar depression and require different treatment. If you have found your depression not improving with medication, it is worth asking if you could in fact be suffering from a bipolar spectrum disorder.


People with bipolar disorder, especially subthreshold bipolar, are frequently misdiagnosed and medically underserved. Conventional treatment for bipolar usually means a mix of three or four different drugs with a burden of associated side effects.

But with the new leading-edge bipolar treatment protocol pioneered and patented by The London Psychiatry Centre, research shows that patients experience minimal – if any – side effects. Evidence-based and with a 96.4% remission rate, the results of our exclusive treatment programme have been described as ‘life-changing’ by patients, as commented on by the Care Quality Commission (CQC).

Patients treated at The London Psychiatry Centre have recovered after years of unsuccessful treatment with multiple drugs. Our treatment involves a combination of precision medicine, mitochondrial treatment, High-Dose Levothyroxine (HDL), and non-invasive treatment rTMS (Repetitive Transcranial Magnetic Stimulation).

Yes, recovery from bipolar disorder is possible. You can find out more about our treatment program here on this site or contact us directly.

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