Depression In Overall Morbidity
Of note, overall time in depressive phases of BD, and duration of depressive episodes are much greater than in mania or hypomania . Moreover, morbidity has been surprisingly high in BD despite supposedly effective treatment. Indeed, BD patients averaged 45% of time ill during long-term follow-up, and depression accounted for 72% of time-ill, and somewhat more with BD-II than BD-I .
Table 1 Depressive morbidity in clinically treated bipolar disorder subjects.
Lithium Treatment And Suicide
An association of reduced risk of suicides and attempts during long-term treatment with lithium in BD is supported consistently by most , but not all studies . At least 10 placebo-controlled, randomized trials not specifically designed with suicide risk as the primary outcome measure, but involving more than 110,000 person-years of risk, found five- to sixfold reductions in suicidal acts . Based on such studies, several expert reports recommend long-term lithium treatment to limit risk of suicidal behavior in BD patients .
Summary Of Findings Regarding Cognitive Styles During Remission
Some methodological issues must be attended to in the study of cognitive vulnerabilities in bipolar disorder, particularly variability in depression history. In studies that have failed to account for these issues, the evidence for negative cognitive styles among persons with remitted bipolar disorder is quite limited. However, when researchers have focused on just those persons with a history of depression or have used schema activation procedures, findings have suggested that bipolar disorder in remission is characterized by a depressive cognitive style.
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How To Cope With An Episode Of Depression
Learning to identify what you feel may be the first step toward developing coping skills for what you may think is a depression attack.
Are you experiencing depression symptoms that seem to have come out of nowhere? Or is what youre feeling more similar to anxiety or panic?
If youre not sure, or need support working on self-awareness and managing your symptoms, consider talking with a mental health professional. Besides helping you explore what you feel, they can also recommend a plan that works for your specific case.
If youd like to work on self-care as well, mindfulness is an evidence-based strategy that may help you manage both anxiety and depression symptoms.
Mindfulness and meditation can also help you decrease the chance of panic attacks and intense depression episodes.
How Does Bipolar Disorder Affect People
At times, people with bipolar disorder go through depression. Other times, they go through manic moods. They may have normal moods in between.
When they go through depression, people with bipolar will:
- have a sad or irritable mood that lasts for at least 2 weeks
Added to that, they may:
- feel hopeless or worthless
- use poor judgment, do things they shouldnt do
- try risky behaviors
- think of themselves in inflated ways or think they have superpowers
Going through these two types of extreme moods is hard on a person. Bipolar moods can make it harder to get along well with others. It can be a challenge to succeed at goals.
Bipolar can cloud peoples judgment and lead them to take unsafe risks. It can cause problems they didnt expect and didnt intend. Some people might be more likely to self-harm or try suicide. They may drink alcohol or use drugs.
Thats why it matters to get the right diagnosis and treatment for bipolar moods. It can help reverse or prevent problems like these.
Moods dont have to run a persons life. With treatment, people with bipolar can learn to manage their moods and symptoms. This helps them feel and do better in things that matter to them.
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Key Points About Mood Disorders
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A mood disorder is a mental health class that health professionals use to broadly describe all types of depression and bipolar disorders.
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The most common types of mood disorders are major depression, dysthymia , bipolar disorder, mood disorder due to a general medical condition, and substance-induced mood disorder.
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There is no clear cause of mood disorders. Healthcare providers think they are a result of chemical imbalances in the brain. Some types of mood disorders seem to run in families, but no genes have yet been linked to them.
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In general, nearly everyone with a mood disorder has ongoing feelings of sadness, and may feel helpless, hopeless, and irritable. Without treatment, symptoms can last for weeks, months, or years, and can impact quality of life.
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Depression is most often treated with medicine, psychotherapy or cognitive behavioral therapy, family therapy, or a combination of medicine and therapy. In some cases, other therapies, such as electroconvulsive therapy and transcranial stimulation may be used.
What Are The Signs And Symptoms Of Bipolar Disorder
The defining sign of bipolar I disorder is a manic episode that lasts at least one week, while people with bipolar II disorder or cyclothymia experience hypomanic episodes.
But many people with bipolar disorder experience both hypomanic/manic and depressive episodes. These changing mood states dont always follow a set pattern, and depression doesnt always follow manic phases. A person may also experience the same mood state several times with periods of euthymia in between before experiencing the opposite mood.
Mood changes in bipolar disorder can happen over a period of weeks, months and sometimes even years.
An important aspect of the mood changes is that theyre a departure from your regular self and that the mood change is sustained for a long time. It may be many days or weeks in the case of mania and many weeks or months in the case of depression.
The severity of the depressive and manic phases can differ from person to person and in the same person at different times.
Signs and symptoms of manic episodes
Some people with bipolar disorder will have episodes of mania or hypomania many times throughout their life others may experience them only rarely.
Signs and symptoms of a manic episode include:
Most of the time, people experiencing a manic episode are unaware of the negative consequences of their actions. With bipolar disorder, suicide is an ever-present danger some people become suicidal in manic episodes, not just depressive episodes.
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Living With Bipolar Disorder
Bipolar disorder can be a condition of extremes. You may be unaware of changes in your mood and behaviour during phases of mania or hypomania.
After the episode is over, you may be upset by your out-of-character behaviour. But at the time, you may believe other people are being negative or unhelpful.
Some people with bipolar disorder have more frequent and severe episodes than others. Staying in a job may be difficult. Relationships may also become strained. There’s also an increased risk of suicide.
During episodes of mania and depression, you may have strange sensations. For example, hearing or smelling things that aren’t there . There are treatments that can help with these experiences.
People with bipolar disorder may also believe things that seem irrational to other people . These are symptoms of psychosis or a psychotic episode.
What Risks And Complications Can Bipolar Disorder Cause
There can be complications and risks for people who live with bipolar disorder. But these risks can be lessened with the right support and treatment.
What about suicide and self-harm?
You might have an illness where you experience psychosis, such as schizophrenia or bipolar disorder. Your risk of suicide is estimated to be between 5% and 6% higher than the general population.
You are more likely to try to take your own life if you have a history of attempted suicide and depression. It is important that you get the right treatment for your symptoms of depression and have an up to date crisis plan.
There is also research that suggests you are 30% – 40% more likely to self-harm if you live with bipolar disorder.
What about financial risk?
If you have mania or hypomania you may struggle to manage your finances. You may spend lots of money without thinking about the effect that it may have on your life.
You could make a Lasting Power of Attorney. This is a legal process. This means that you pick someone that you trust to manage your finances if you lack mental capacity to manage them by yourself.
You can work with your carer and mental health team. You can form an action plan. This can say what they can do if you have a period of mania or hypomania and you start to make poor financial decisions.
What about physical health risk?
What about alcohol and drugs risk?
If you want advice or help with alcohol or drug use contact your GP.
What about driving risk?
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Bipolar Disorder: Symptoms & Causes
Bipolar symptoms include sudden, extreme changes in mood. The causes of bipolar disorder are ultimately unknown, though it appears to be the result of a chemical imbalance in the brain. Bipolar disorder likely has a genetic component, as the condition often runs in families.
Bipolar disorder is characterized by the presence of manic or hypomanic episodes. A manic episode is defined as a period of elevated feelings and impulsive behavior. Hypomania is a less severe form of mania. During a manic episode, a person may exhibit the following bipolar disorder symptoms:
- Impulsive or high-risk behaviors
These episodes may occur with or without depressive episodes that feature many of the same symptoms of major depressive disorder.
Another possible sign of bipolar disorder is psychosis. While not every person with bipolar disorder will experience a psychotic episode, many do. Psychotic episodes involve experiencing delusions or hallucinations.
Why Is Bipolar Disorder No Longer Called Manic
In the last few decades, the medical world, especially the field of psychiatry, has intentionally made a shift from using manic-depressive illness or manic depression to describe bipolar disorder. There are several reasons for this shift, including:
- Healthcare providers used to use manic depression to describe a wide range of mental health conditions. As mental health condition classification systems, including the Diagnostic and Statistical Manual of Mental Disorders , have become more sophisticated, the new term bipolar disorder allows for more clarity in diagnosis.
- Theres a lot of stigma and negativity associated with the terms manic and mania, especially due to the use of maniac. Similarly, people use the term depression casually to describe periods of sadness that dont qualify as clinical depression. Using bipolar disorder takes the focus away from these two words. Bipolar disorder is more of a clinical, medical term and less emotionally loaded than manic depression.
- The term manic depression excludes the cyclothymic or hypomanic versions of the condition.
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Dysphoric Mania Is Bipolar Depression With Bipolar Mania
When bipolar depression combines with the energy of mania, the result is called dysphoric or mixed mania. Unlike the upbeat, happy mood of euphoric mania, dysphoric mania is energized depression. It is vocal, abusive, and loud due to the mixture of the negative depression thoughts and the energy of mania. Dysphoric mania is especially dangerous when a person is suicidal, as the sluggishness of weepy depression can be energized by mania and the decision to harm the self or others can become very active.
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What Is The Treatment For Mania Hypomania And Depression
You can check what treatment and care is recommended for bipolar disorders on the National Institute for Health and Care Excellence website.
NICE produce guidelines for how health professionals should treat certain conditions. You can download these from their website at:
The NHS doesnt have to follow these recommendations. But they should have a good reason for not following them.
What medications are recommended?
Mood stabilisers are usually used to manage mania, hypomania and depressive symptoms.
The mood stabilisers we talk about in this factsheet are:
- Certain benzodiazepine medication
Mania and hypomaniaYou should be offered a mood stabiliser to help manage your mania or hypomania. Your doctor may refer to your medication as antimanic medication.
If you are taking antidepressants your doctor may advise you to withdraw from taking them.
You will usually be offered an antipsychotic first. The common antipsychotics used for the treatment of bipolar disorder are:
If the first antipsychotic you are given doesnt work, then you should be offered a different antipsychotic medication from the list above.
If a different antipsychotic doesnt work, then you may be offered lithium to take alongside it. If the lithium doesnt work you may be offered sodium valproate to take with an antipsychotic. Sodium valproate is an anticonvulsive medication.
Sodium Valproate shouldnt be given to girls or young women who might want to get pregnant.
- Fluoxetine with Olanzapine
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How Do Doctors Diagnose Bipolar Disorder
Theres no blood test or medical test for bipolar disorder. To diagnose bipolar, a mental health doctor meets with you. They ask questions about your moods, thoughts, feelings, and health. They ask about how youre doing in your life and problems youre having. They listen and talk with you, and with your parent. They also check for other conditions that can cause mood symptoms. This can take a few visits.
If a doctor finds that you have bipolar, they will talk more about it with you. They will explain the treatment plan that can help you.
Other Treatments And Suicide
Evidence is growing that the glutamate NMDA-receptor antagonist ketamine and its active S-enantiomer can exert rapid, short-term reduction of suicidal ideation along with rapid reduction of symptoms of depression, including in BD patients, although effects on suicidal behavior are uncertain . There is considerable uncertainty about how to continue use of racemic or S-ketamine following initial benefits, and some concern that its discontinuation may provoke adverse clinical responses . ECT often appears to be lifesaving in suicidal emergencies but lacks evidence of sustained antisuicidal efficacy . Other methods of external electrical or magnetic stimulation of brain, vagal nerve stimulation, and deep brain stimulation are being investigated or introduced for the treatment of otherwise treatment-resistant depression but remain to be tested adequately for specific effects on suicidal behavior, particularly in BD.
Additional interventions of potential value include emergency hospitalization as well as psychotherapies, in particular cognitive-behavioral, dialectic, and interpersonal methods, which can improve depressive symptoms and may reduce suicidal risk . However, results from studies of psychosocial interventions may be limited by the self-selection of patients who adhere to such prolonged treatments.
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Effective Outreach To Bipoc Communities
DBSA has long understood that mood disorders affect people of all ages, races, ethnic groups, and social classes. To continue to expand its mission of providing hope and support to people living with mood disorders, DBSA wants to equip its chapter network and support groups with the necessary tools to reach more underserved communities that have experienced long-standing inequities that have hindered access to mental health services and created significant disparities in the quality of mental healthcare.Watch the session
Antidepressants And Mood Switching
There is widespread concern that antidepressant treatment for bipolar depression risks switching into potentially dangerous agitation or mania, especially in BD-I . Such risk is more associated with the long-term BD course-pattern of depression followed by mania before a stable interval than the opposite . However, it is difficult to distinguish spontaneous from antidepressant-associated switching in BD, mean rates of which are similar . Though it is plausible to expect mood-stabilizing and antipsychotic drugs to prevent mood-switching with antidepressants, required randomized comparisons are lacking . Trials of antidepressants have found little difference in risk of new mania between antidepressants and placebo, with or without a mood-stabilizer included, although exposure times were short . However, one study found that switching in BD was 2.8-times greater within 9 months after adding an antidepressant, but not if a mood-stabilizer also was used , and switching risk was increased in the rare long-term trials with an antidepressant included in treatment .
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Types Of Bipolar Disorder
The APA classifies bipolar disorder according to the type, duration, and severity of a person’s mood episodes. According to fifth edition of the APA’s Diagnostic and Statistical Manual of Mental Disorders , there are five different types of bipolar disorder a doctor may diagnose you with:
Other specified bipolar and related disorder, together with unspecified bipolar and related disorder both used to fall under the category of bipolar disorder not otherwise specified in the DSM-IV. The “not otherwise specified” category, however, was removed and broken out into these two condition names in the DSM-5.
Summary Of Biological Facets
Genetic evidence suggests that one can disentangle the biological vulnerability to mania from that of depression. Comparisons of bipolar and unipolar depression are not common, but nonetheless, some data is available. Functional imaging studies suggest remarkable parallels in that both bipolar and unipolar depression are characterized by increased activation of the amygdala and other limbic regions when individuals are exposed to sad stimuli . At a neurotransmitter level, bipolar and unipolar depressive episodes are characterized by similar levels of dopamine and serotonin. When matched for number of recurrences, bipolar II depressive episodes are associated with comparable levels of norepinephrine to unipolar depressive episodes. Despite the many parallels, one set of striking differences emerges. Studies of both intracellular mechanisms and sleep deprivation suggest that people with a lifetime history of mania may have deficits in the ability to regulate neurotransmitters in the face of a challenge. Such regulatory deficits would be expected to be manifested in more rapid course changes, as well as increased vulnerability to environmental challenges. We turn towards a review of course parameters and psychosocial triggers next.
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Misdiagnosis And Taking Charge Of Your Care
Diagnosis is an integral part of treating a mental health condition, but sometimes finding the correct one can be a challenging process. In this session we will focus on how mood disorder diagnoses are made, factors that lead to misdiagnosis, and ways peers can take an active role in their mental health care.Watch the session