I cover a significant challenge in clinical psychiatry: distinguishing and treating unipolar vs. bipolar depression. A recent inpatient case prompted me to revisit the question of whether an antidepressant-induced manic episode could have been predicted, and more broadly, whether our traditional diagnostic split makes sense at all.

I walk through a real-world clinical scenario: a patient with many years of recurrent depressive episodes, no clear history of hypomania or mania, and no obvious risk factors, who flipped into a manic episode after being started on an antidepressant. I explore why the DSM categorization often collapses under closer biological and clinical scrutiny.

Rather than viewing depression through a binary diagnostic lens, I argue for a risk-based, probabilistic, natural-course approach that better reflects the biology—and better protects patients from iatrogenic harm.

This might be a bit controversial, let me know what you think by leaving a review or emailing me at [email protected]

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