Is increased libido an atypical symptom of bipolar depression? An interesting case

Decreased libido is recognized as one of the vegetative symptoms of depression. Increased libido has not been acknowledged as one of its symptoms, neither has it been reported, particularly in depressed bipolar patients.

We hereby report a case of atypical presentation of increased sexual function in a patient in depressed phase of bipolar II thereby querying the fact, whether increased libido is actually an unrecognized atypical symptom of bipolar depression.

A 48-year-old male presented with mood swings whereby his sexual function was increased during his depressive phase. Antidepressant, mood stabilizer, and antipsychotic medication were administered. Electroconvulsive therapy (ECT) was offered for augmentation therapy.

When sexual dysfunction is not identified, there is a risk of misdiagnosis and mismanagement.

Patient did not attain full remission with medication. Compliance with medication was an issue, most probably due to the sexual side effects. The patient refused ECT.

This case highlights atypical presentation of high libido in a patient in the depressive phase of bipolar II disorder. The uncommon presentation of a common illness posed a diagnostic challenge and complicated the subsequent management. It was concluded that increased sexual function deserves further consideration as a symptom of bipolar depression.