The parents in our study identified depressive symptoms
before mania symptoms, and it has been noted by
Carlson & Meyer (2006) that there is considerable difficulty
associated with differentiating mania from comorbid
symptoms, rages, sequelae of maltreatment and typical
developmental phenomena. They noted that if the first
episode is depressive in nature, it often takes a number of
years before mania declares itself. Emotion regulation is an
issue during normal adolescent development, which complicates
the process of distinguishing the symptoms of
bipolar disorder, particularly symptoms of mania. Thase
(2006) has noted that depressive episodes are more numerous
and last longer than manias and are frequently misdiagnosed,
and the correct diagnosis is often not made until
there has been a treatment-emergent affective switch.