Proven Pharmacological Treatment Options
Despite the devastating impact of bipolar depression on life, there has been a dearth of knowledge about its underlying etiology and the development of therapeutic strategies especially in its acute phase . Today, we only have three different approved agents to choose from: OFC, quetiapine , and lurasidone . summarizes the proven studies of above three agents in acute bipolar depression .
How Are Antipsychotic Medications Used In Treating Bipolar Depression
Studies have shown that some antipsychotic drugs can also treat bipolar depression.
Quetiapine is used for the short-term treatment of bipolar depression. Another option is olanzapine with fluoxetine .
The atypical antipsychotic lurasidone can be taken alone or with lithium or valproate for treating bipolar depression. Cariprazine , a treatment for bipolar disorder, may also be an off-label option.
These medications work by affecting receptors for chemicals in the brain that help regulate mood and behavior.
Your doctor will weigh the pros and cons of the available medications to help you get relief from the bipolar depression without the risk of mania or drug interactions.
Depression Anxiety & Bipolar Disorder
Know the Difference
Life events, relationships, job stress, financial or family problems affect us in many ways. Oftentimes these issues can be triggers for anxiety or depression. If these feelings become extremely intense and impact everyday life or our quality of life, it can become very hard to address the issues that prompted these feelings to begin with.
Sometimes being depressed can cause anxiety and the reverse is also true. Feeling anxious can cause depression if your anxiety is getting in the way of your activities. There can also be an underlying cause such as bipolar disorder. So how do you sort through your feelings to determine how best to deal with them?
The first steps in seeking treatment are to acknowledge your feelings, determine if you can, what triggers the feelings and being open and candid with a professional you trust. Your general practitioner may be able to do an evaluation or recommend a psychiatrist or psychologist specially trained in these areas. It is important that your practitioner sees you regularly to determine if the medication prescribed is right for you. A visit with your provider frequently would be reasonable and effective depending on the severity of your symptoms.
Symptoms of Depression
- Persistently feeling sad, anxious or empty
- Feelings of hopelessness like theres no way out
- Lack of interest in activities you would usually enjoy
- Difficulty sleeping, concentrating, focusing
- Changes in your appetite or weight
Symptoms of Anxiety
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Coping With Bipolar Depression
Dr. Daramus suggests some strategies that can help you cope with bipolar depression:
- Monitor your symptoms: Track your symptoms on a chart. It can help you identify the first signs of a new depressive episode, whether your medication is working, and what coping skills are helping you the most.
- Create a safety plan: Bipolar depression is dangerous and has to be taken seriously. Rates of suicide and self-harm are very high, so you absolutely do need a plan for what to do if those urges ever happen. Have a safety plan and share it with your therapist, prescriber, and some supportive friends and family members.
- Stay in touch with your healthcare provider: Make sure you report any symptoms or side effects youre experiencing to your healthcare provider. Dont stop taking your medications without discussing it with them first.
- Seek support: During a depressive episode, you may find yourself withdrawing from people and isolating yourself. However, its important to surround yourself with loved ones and seek their help when you need it.
- Stay active: Try to stay active and get some exercise every day. Go for a walk, jog, swim, or bike ride, or do any other activity you prefer.
What Is Bipolar Disorder
Bipolar disorder is a lifelong mood disorder and mental health condition that causes intense shifts in mood, energy levels, thinking patterns and behavior. These shifts can last for hours, days, weeks or months and interrupt your ability to carry out day-to-day tasks.
There are a few types of bipolar disorder, which involve experiencing significant fluctuations in mood referred to as hypomanic/manic and depressive episodes. However, people with bipolar disorder arent always in a hypomanic/manic or depressive state. They also experience periods of normal mood, known as euthymia.
Manic episodes
A key feature of bipolar I disorder is manic episodes. To meet the criteria for bipolar I disorder, you must have had at least one manic episode in your life for at least a week with or without ever experiencing a depressive episode.
Mania is a condition in which you have a period of abnormally elevated or irritable mood, as well as extreme changes in emotions, thoughts, energy, talkativeness and activity level. This highly energized level of physical and mental activity and behavior is a change from your usual self and is noticeable by others.
People with certain types of bipolar such as bipolar II disorder experience hypomania, which is a less severe form of mania. It doesnt last as long as manic episodes and it doesnt interfere with daily functioning as much.
Depressive episodes
- Feelings of worthlessness and hopelessness.
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Diagnosis Of Anxiety Disorders Vs Bipolar Disorders
Bipolar disorder and anxiety disorders have specific criteria for diagnosis. There might be some overlap in the signs of a disorder, which can complicate the diagnosis between the two. However, a comprehensive review of someones background and medical history can route out the constellation of signs and symptoms into a diagnosis.
Adhd And Bipolar Disorder
Data from the National Comorbidity Study suggests that, among people with ADHD, almost 20% report having some form of bipolar spectrum disorder. These patients not only have inattention, impulsivity, and hyperactivity, but also the severe mood swings and/or prolonged downturns associated with bipolar disorder.
In treating patients with comorbid ADHD and bipolar disorder, clinicians have historically been concerned about the possibility that stimulant treatment might induce or exacerbate bipolar mania. Thus, a mood stabilizer, if not already part of the treatment plan, should be introduced to minimize the chances of triggering mania.
The bigger challenge, as we have come to understand bipolar disorder better, has to do with the persistent depressive states that affect patients with both bipolar disorder and ADHD. Because stimulants dont significantly improve the mood of patients with bipolar depression, I suggest treating bipolar depression first and saying to your patient, Once your mood is more stable and/or youre no longer as depressed then we can address your cognitive difficulties, your inattention, your problems with sustaining effort.
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How Do The Cns Depressants Help With Bipolar Disorder Depression
Central nervous system depressants, which include the benzodiazepines, act on neurotransmitters to slow down normal brain function. CNS depressants are commonly used to treat anxiety and sleep disorders and may be an effective alternative or adjunctive therapy in some bipolar patients with acute mania.
Some commonly used benzodiazepines include clonazepam , lorazepam , alprazolam , and diazepam . These drugs all can be addictive and can cause sluggish thinking. They generally should be used only to treat agitation or sleep problems during the acute phase of the illness and not as long-term medications. They typically should be tapered off rather than stopped abruptly, in order to minimize the risk of drug withdrawal.
Common Symptoms Of Depression
- deep feelings of sadness or hopelessness for a long period of time
- having little to no interest in activities that were once enjoyable
- difficulty focusing, remembering things, and making decisions
- restlessness or irritability
- eating too much or too little
- sleeping too much or too little
- thinking or talking about death or suicide
- attempting suicide
- an overly joyful or outgoing mood for an extended period of time
- intense irritability
- talking quickly or rapidly transitioning between different ideas during a conversation
- racing thoughts
- picking up many new activities or projects
- difficulty sleeping due to high energy levels
- impulsive or risky behavior
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Antipsychotic Medications For Bipolar Disorder
If you lose touch with reality during a manic or depressive episode, an antipsychotic drug may be prescribed. They have also been found to help with regular manic episodes. Antipsychotic medications may be helpful if you have tried mood stabilizers without success. Often, antipsychotic medications are combined with a mood stabilizer such as lithium or valproic acid.
Antipsychotic medications used for bipolar disorder include:
What Residential Treatment Was Like
Choosing residential treatment, I truly believe, saved my life. It was my brother who helped push me in that direction. He saw that I wasnt functioning, especially after I got fired from a third job. I asked him for money for rent, and he suggested I needed some more thorough treatment.
I knew he was right and had known it for some time. I had resisted the idea of going to a treatment center for a lot of reasons, but I finally felt like I had no other choice. One of the first things the staff did for me in treatment was confirm my two diagnoses and sort out my medication.
I found out how complicated it is to treat bipolar disorder and anxiety disorder with the right medication. I had been using antidepressants off and on for years, but it turns out that that worsened my mood swings. We switched to mood stabilizers and it made a huge difference.
My personal therapist also helped me learn more about my mental health conditions and how they interact. Being aware of how one can trigger and worsen the other has been powerful. I also worked in small groups with other residents. I learned so much from them as we supported each other.
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Bipolar Disorder Vs Anxiety Disorder
Bipolar disorder is a mental health condition that severely affects someone’s mood. Also known as manic depression, bipolar disorder sees people experience extreme episodes of depression and mania .
Anxiety disorder is a persistent feeling of worry or uneasiness, often connected to certain scenarios like social events, a trauma in your past or your health. While we all feel anxiety at some point in our lives, people with anxiety disorders will experience persistent symptoms of anxiety over many weeks and months.
It is not uncommon for someone with bipolar disorder to have a co-existing anxiety disorder. For a person with these co-occurring conditions, it is crucial they get the correct diagnosis so that they are able to access the right treatment for both disorders, and manage them effectively.
More Than Half Of People With Bipolar Also Have An Anxiety Disorder Just As Symptoms Overlap So Do Coping Techniques Here Are Six To Try Today
Unraveling the symptoms of anxiety from those of bipolar can be a bit tricky, especially when you are diagnosed with both bipolar and an anxiety disorder. Fortunately, the wellness strategies for addressing those overlapping symptoms of overwhelm, stress, and fear are not only similar but also generally good for your mind, body, and soul. Here are a few ideas to lower those stress levels and free your thoughts to focus on the here and now.
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Bipolar Depression With Anxiety: What Treatments Work
Bipolar depression with anxiety is a common combination. About 75 percent of people with bipolar II disorder have at least one anxiety disorder . Anxiety disorders like generalized anxiety disorder , social anxiety disorder, and panic disorder are the most common disorders that occur alongside bipolar II disorder further, symptoms of these anxiety disorders are more likely to flare during a period of bipolar depression than an episode of mania. Given that bipolar depression with anxiety occurs quite frequently, its important to know more about these conditions, how this combination can affect people, and what treatments work.
Anxiety greatly influences someones experience with bipolar depression, including the symptoms they experience and how they respond to treatment. Both disorders worsen each other. Episodes of depression and anxiety are longer and more severe than when they occur on their own. The long-term outlook is worse, too, largely because it can be harder to treat comorbid anxiety and bipolar depression.
Two Ways To Have Anxiety With Bipolar Disorder
There are basically two ways you can have anxiety with bipolar disorder. First, it can be a symptom of the bipolar disorder itself. Secondly, you can have a separate anxiety condition in addition to bipolar disorder. In medical lingo, that is called a co-morbid condition . It means both conditions are present, and thus implies that anxiety is a separate condition, not coming from the bipolar disorder itself.
These two ways of looking at anxiety have important implications. If the symptoms are coming from bipolar disorder itself, then they should get better when the bipolar disorder gets better. But if they are coming from a condition, they could persist even when the bipolar disorder improves.
If your anxiety is really a separate condition, its going to require a separate treatment. And that really complicates things, because very often the recommended treatment for the anxiety condition could be an antidepressant medication and antidepressant medications can make bipolar disorder worse! .
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The Difference Between Anxiety Depression And Bipolar Disorder
Obtaining a diagnosis is the first step in seeking mental and behavioral healthcare. Once you understand your specific mental health condition, you can obtain the support you need to thrive. However, it can be tricky to understand the nuances between the many diagnoses, especially when discussing anxiety, depression, and bipolar disorder.
Heres how to distinguish between these common conditions.
What Should I Do If I’m Currently Taking An Antidepressant
First, and most importantly, don’t panic! DO NOT stop taking your antidepressant suddenly, as this can be dangerous. Talk to your doctor about slowly tapering off the antidepressant. The tapering process should be done very slowly, usually over the course of several months, in order to reduce adverse withdrawal effects.
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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.
How Does Anxiety Affect Bipolar Disorder
Both bipolar disorder and anxiety are treatable, manageable conditions. However, it is important to distinguish between the two, as this will affect the type of medication and therapy a healthcare professional will prescribe.
When a person has both conditions, they may find their anxiety affects the symptoms of bipolar disorder. This could
Although anxiety and bipolar disorders have some similarities, they have distinct sets of symptoms and diagnostic criteria.
However, some symptoms suggest a person may have co-occurring anxiety. They include:
- A persistent, intense feeling of nervousness: This can include worrying, anxiety, and panic attacks. A person may also avoid taking part in activities. These symptoms persist during manic and depressive episodes.
- Sleep and anxiety problems: People may find they have issues sleeping even when they are not in a manic state. They may feel persistently anxious despite receiving treatment.
- History of symptoms: Some people may have lived with anxiety and bipolar disorder symptoms from childhood and adolescence.
Learn more about the symptoms of anxiety and bipolar disorder here.
If someone has an anxiety disorder in addition to bipolar disorder, a doctor should diagnose and treat the conditions together.
When a doctor, psychiatrist, or psychologist is developing a persons treatment plan, they will take multiple factors into consideration. Usually, medication and therapy form the basis of the treatment plan.
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Who Is At Risk For Bipolar Type 2 Disorder
Bipolar disorder is highly genetic. Those with a first-degree biological family member with bipolar disorder are at the highest risk of developing the disorder. Having a family history of bipolar disorder also is a strong predictor of developing it.
Others who should be screened for bipolar disorder include those for whom antidepressants are not effective or that worsen mood symptoms and those who frequently experience depression that is interrupted by periods of feeling better than good. Also, teenagers between the ages of 13 and 18 who experience frequent depression should be screened for bipolar disorder.
Bipolar disorder is highly heritable, with genetic influences contributing 60%â80% to the risk.
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Controversy Surrounding Antidepressant Use
In terms of the efficacy of antidepressants in BD-D, several reviews and meta-analyses have come to differing conclusions, likely reflecting differences in statistical techniques and inclusion criteria and pointing towards a need for further investigation. Two of the most recent meta-analyses found no significant benefit of adding antidepressants to mood stabilisers for the treatment of BD-D. In agreement with these findings, the STEP-BD trial, which included 4360 patients, found that adding antidepressants to mood stabilisers did not result in better clinical outcomes than those achieved with mood stabilisers alone. In contrast, naturalistic studies suggest that there is likely a sizeable subgroup of patients who respond to a mood stabiliser plus an antidepressant with no increase in switching. Interestingly, there is more consistent evidence of benefits when antidepressants are added to SGAs. Whether this reflects additive effects of antidepressants combined specifically with SGAs or some other factors is unknown. A separate meta-analysis comparing different antidepressants found no significant difference in rates of clinical response between antidepressants, but it did report lower switch rates for bupropion when compared with sertraline, venlafaxine and desipramine. Importantly, the analysis concluded that the results are significantly limited by lack of high-quality studies.
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