Depression before or after mania in Bipolar Disorder?

[Triquetrum]

MTB: Bipolar disorder typically starts with depression.
FA: In Bipolar disorder, depressive symptoms always occur eventually.

Which is correct?

The reason I ask is because antidepressants can lead to increased mania; so I guess timing of depression (and therefore, treatment) is important.

Thanks,

[drssbaz]

Both statements are correct.
While Bipolar typically begins with an episode of depression even a single episode of mania qualifies as bipolar because it will eventually be followed by depression.
It is for the same reason that unmasking of mania is listed as SE of some of the anti-depressant drugs. In practice, it more often than not does unmask the mania in patients. In fact, a lot of cases of bipolar come to light only after starting anti depressants.
Hope that helps!

[Ayman Qasrawi]

It does matter, Bipolar I can be diagnosed with an episode of mania, so:

Depression then mania = Bipolar I

Mania then depression = Bipolar I

Mania only = Bipolar I