Depression has the same symptoms whether it is part of Major Depressive Disorder
(unipolar depression) or the depressive side of Bipolar Disorder.
A person can have bipolar disorder but rarely manifest the manic side of the BD (formerly called manic-depression).
Antidepressants can work to reduce symptoms of depression of unipolar depression. However, they can set off a manic episode in bipolar depression.
see this article:
Reckless behavior (including her "affairs") are very typical of mania, as are other forms of recklessness (driving, spending, gambling).
Perhaps she had signs of mania before this incident and nobody understood what the symptoms were.
The "official" (DSM-IV psychiatric "bible" of criteria) has the following criteria for mania:
1) inflated self-esteem or grandiosity
2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
3) more talkative than usual or pressure to keep talking
4) flight of ideas or subjective experience that thoughts are racing
5) distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6) increase in goal-directed activity (at work, at school, or sexually) or psychomotor agitation
7) excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
C) The symptoms do not meet criteria for a Mixed Episode
D) The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
E) The symptoms are not due to the direct physiological effects of a substance or a general medical condition.
If the doctor had picked up on this she would never have been given the antidepressants without a mood stabilizer such as lithium, or an antipsychotic drug such as Zyprexa and Halodol.
With the hysterectomy also comes the change in hormonal balance. Everything is tied together.
Since bipolar can lead to suicide it is better to try to control it and find a happy medium between no drugs and an out of control patient, and an overly drugged zombie like patient.
Mania is hard to treat without drugs. Good diet, no caffeine, no aspartame, plenty of sleep are starters but may not be enough, even with a great psychotherapist.
To address you last comment, let me tell you about one of my two supervisors during my internship.
He was a young, very effective psychiatrist, and had been the chief resident in psychiatry at a major teaching hospital. He was brilliant, steady, effective, and beloved.
HE HAD BIPOLAR DISORDER. He was under treatment by his own psychiatrist. I saw him for hours every day with patients. He was always steady and solid. He took his medications everyday.
When a new bipolar patient would come into his office he would say, with a smile, "Welcome to the club".
I tell this to instill hope and confidence.
I am not a big promoter of psychotropic drugs, but sometimes they make a huge difference.
I hope this information and encouragement is helpful. Hopefully they will find a good combination of therapy and she will return.
I shall keep you in my prayers.
Elliott, MAE, LPCC, NCC, CCMHC