CME Feature: Clinical Advances In Bipolar Disorder

Managing Bipolar Depression: Best Practices and Emerging Therapies

Resources

Novus Medical Education and The Doctor's Channel are pleased to partner with the Depression and Bipolar Support Alliance to provide content and resources for this educational initiative.

Nearly six (6) million adult Americans are affected by bipolar disorder. It usually begins in late adolescence (often appearing as depression during the teen years), although it can start in early childhood or later in life. An equal number of men and women develop this illness (men tend to begin with a manic episode, women with a depressive episode), and it is found among all ages, races, ethnic groups, and social classes. The illness tends to run in families and appears to have a genetic link. Like depression and other serious illnesses, bipolar disorder can also negatively affect spouses and partners, family members, friends, and coworkers.

Bipolar disorder differs significantly from clinical depression, although the symptoms for the depressive phase of the illness are similar. Most people who have bipolar disorder talk about experiencing "highs" and "lows"—periods of mania and depression. These swings can be severe, ranging from extreme energy to deep despair. The severity of the mood swings and the way they disrupt normal life activities distinguish bipolar mood episodes from ordinary mood changes.

When people experience symptoms of both a manic and a depressive episode at the same time, they're said to be experiencing a mixed state (or mixed mania). They have all of the negative feelings that come with depression, but they also feel agitated, restless and activated, or "wired." Those who have had a mixed state often describe it as the very worst part of bipolar disorder.

Symptoms of Mania: The "Highs" of Bipolar Disorder

  • Heightened mood, exaggerated optimism and self-confidence
  • Excessive irritability, aggressive behavior
  • Decreased need for sleep without experiencing fatigue
  • Grandiose thoughts, inflated sense of self-importance
  • Racing speech, racing thoughts, flight of ideas
  • Impulsiveness, poor judgment, easily distracted
  • Reckless behavior
  • In the most severe cases, delusions and hallucinations

Symptoms of Depression: The "Lows" of Bipolar Disorder

  • Prolonged sadness or unexplained crying spells
  • Significant changes in appetite and sleep patterns
  • Irritability, anger, worry, agitation, anxiety
  • Pessimism, indifference
  • Loss of energy, persistent lethargy
  • Feelings of guilt, worthlessness
  • Inability to concentrate, indecisiveness
  • Inability to take pleasure in former interests, social withdrawal
  • Unexplained aches and pains
  • Recurring thoughts of death or suicide
Bipolar Depression

As you can see from the list above, the symptoms of bipolar disorder's "low" period are very similar to those of unipolar depression. That's why the "lows" of this illness are sometimes referred to as "bipolar depression." These lows are one thing that most mood disorders have in common.

People with bipolar disorder experience bipolar depression (the lows) more often than mania or hypomania (the highs). Bipolar depression is also more likely to be accompanied by disability and suicidal thinking and behavior.

It's during periods of bipolar depression that most people get professional help and receive a diagnosis. In fact, most people with bipolar disorder in the outpatient setting are initially seen for—and diagnosed with—unipolar depression.

Studies show that, in the primary care setting alone, 10-25 percent of those diagnosed with unipolar depression may actually have bipolar disorder. And the percentage is even higher in the psychiatric setting. And incorrect treatment for bipolar disorder can actually lead to episodes of mania and other problems. Learn more about bipolar depression in our brochure, Mood Disorders and Different Kinds of Depression.