In the article from May 2025, “Time to rethink hospitals”, Pedro offered a forward-thinking perspective on potential improvements to conditions during hospital stays and the discharge process. In this article, Pedro shares reflections and personal experiences with bipolar disorder and the process that led to the diagnosis. What exactly is what when it comes to symptoms of bipolar disorder and side effects of antidepressant medication? Can one mask the other? And is prevention even possible?
Written by Pedro Monzó
One of my reflections concerns the process leading up to a diagnosis—the fine line that can determine whether or not you receive a diagnosis—and the question of whether so-called bipolar disorder even exists as a disease, or whether it is rather a series of unfortunate circumstances that lead to the condition.
Bipolar disorder has a high heritability—between 60% and 80%. Genetic factors can account for up to 80% of the risk of developing the disorder. The genes do not in themselves cause bipolar disorder, but they increase vulnerability, especially in combination with stressful environmental factors such as severe stress, prolonged childhood trauma, sleep deprivation, or substance abuse.
Genetic vulnerability + stress = risk of developing the disorder
With that in mind, it almost seemed as if I was predestined to receive a diagnosis. My mother had been diagnosed with manic depression. At the same time, I myself had experienced periods of work-related stress, sleep problems, occasional substance use, and perhaps also unresolved trauma.
I had all the ingredients to win the bipolar lottery.
I had all the ingredients to win the bipolar lottery. But I didn’t know it. I was actually living a fairly normal life – until I suddenly began living a different life, one that wasn’t so ordinary.
The First Severe Depression
My first episode led to a severe depression that lasted nearly a year. It marked the beginning of psychiatric and psychological treatment, the start of medication, and the “official” confirmation of my diagnosis.
Today, nearly 20 years later, I still haven’t fully accepted that diagnosis. I keep coming back to the question of genetic predisposition and whether I could have handled that first episode differently—and perhaps better.
When I look back on my life, I’ve faced different kinds of challenges that I wasn’t equipped to handle, either practically or emotionally.
Is prevention possible?
The questions arise:
What if, back then, I had had more knowledge about the consequences of medication and had said no? What if there had been a community of people in the same situation whom I could have talked to? What if, even back then, I had known about tools like meditation or mindfulness, which I later began to practice?
Could I then have avoided my diagnosis?
Conversely, I remember that first long depressive period as extremely painful, with many sleepless nights and intense anxiety over an extended period. I couldn’t see a way out, and I’m not sure I would have had the strength to get through that phase without medication.
At the time, it seemed like the only option.
Can medication influence the diagnosis?
I’ve also wondered how medication might influence the path toward a diagnosis.
Imagine a patient—in this case, myself—with severe depression who starts seeing a psychiatrist and is prescribed antidepressants. After a few months, when the desired effect isn’t seen, the dose is increased. This time, the medication works. After a few weeks, the patient begins to feel better. In fact, so much so that he develops a hypomanic phase.
Hypomania is a state in which one feels unusually well, with increased energy, creativity, and social drive—but unfortunately also with excessive elation (euphoria) and lack of sleep, among other symptoms.
After a while, the patient’s mood drops again briefly, and once more it is decided to increase the dose of antidepressants. And yet again—a few weeks later—a hypomanic phase occurs.
At this point, a diagnosis of bipolar disorder type II is made, because two criteria are met:
- Severe depression
- Two hypomanic episodes
And it is at this point that I wonder whether these mood swings, caused by the medication, are what led to this diagnosis.
That said, these are merely reflections. I do not question the work of the professionals. My treatment was closely monitored by both a psychiatrist and a therapist, who were in close contact with each other. I trusted my caregivers and felt safe. They were an important part of my team for many years—in fact, my therapist still is.
Genetic predisposition – the whole package?
Another reflection concerns heredity and why it affects some family members more than others.
The obvious answer is that it comes down to the degree of genetic influence, as with so many other illnesses. But at the same time, another question arises: research bias.
Most people who receive a diagnosis have a family history. But we don’t know if the reverse is also true: how many people with a family history actually develop the disorder?
We haven’t studied siblings or other relatives who aren’t diagnosed to the same extent.
When I was 5 years old, my mother was hospitalised for about a year. During that entire time, I lived with my uncle and aunt far away. I have almost no memories from that time, and surprisingly, no feelings of sadness or fear associated with it either. I hardly ever saw my parents, and I had limited contact with my two older siblings.
How did that affect them? Is experiencing something like that as a 5-year-old the same as experiencing it as a 10-year-old? Can experiences like that have an impact on a later diagnosis?
Am I perhaps still, in a way, searching for the mother I lacked back then?
It almost sounds like the beginning of a novel – but again: these are merely reflections.
The reality is probably that we share a certain percentage of DNA, but that each of us inherits different combinations. Maybe it was just me who drew the full genetic package.