Bipolar affective disorder (BAD) is a cyclical illness, alternating periods of depression, normality, or mania. These periods are rarely “rapid cycling” and should not be confused with mood changes that occur throughout the day (as people usually end up doing).
Although there are different characteristics, depending on the type of this mental disorder, some symptoms may be similar to common symptoms in anyone's daily life, and it is necessary to know how to differentiate the signs of mood disturbance resulting from the disease.
It is normal for everyone to encounter stress, conflicts, joy, sadness, and anxiety, but there are limits to what is considered normal and when these “normal feelings of every human being” become “symptoms of a mental illness”.
What Is Bipolar Depression?
Bipolarity or depression? Although the disease carries references to both, it is necessary to make the distinction. Bipolar depression is characterized as a “Bipolar affective disorder”.
This disorder is characterized by two or more episodes in which the subject's mood and activity level are profoundly disturbed, with this disorder consisting on some occasions of an elevation in mood and increased energy and activity (hypomania or mania) and in others, a lowering of mood and reduced energy and activity (depression)”.
Bipolar depression itself is defined as “the current episode corresponding to the description of a mild or moderate depressive episode, with at least one well-proven hypomanic, manic or mixed affective episode having occurred in the past”, according to the Department.
What Is the Transition Between Mania And Depression Like In The Disorder?
What draws the most attention to Bipolar Affective Disorder is the person's ability to transition between two mood states. And, to ensure understanding, at this point, it is important to differentiate between humor and affection.
Effects are unstable, oscillate between happy and sad, and refer to the person's momentary state of mind. This is normal for everyone.
For example, if we win something we wanted, we would be very happy. However, if something bad happens, we would be sad.
Mood tends to be more stable, perennial, and lasting and its extremes are elation (euphoria) and depression, which are linked to the disposition for life.
Therefore, if we eventually have several good things happening, we tend to have a higher mood.
In bipolarity, the oscillation occurs between mood states, that is, there is a change in the disposition towards life.
Causes of Bipolar Depressive Disorder
Bipolar disorders do not yet have a known origin. Therefore, there are only indications of what can cause this condition. It is possible to point out biological and environmental factors as the main factors.
Regarding the first, the disorder may be the result of a dysregulation of neurotransmitters in the brain, such as norepinephrine and serotonin. Furthermore, stressful and traumatic events are identified as potential triggers of the disease. Episodes can also occur due to the use of drugs, such as amphetamines and cocaine.
Bipolar Depression: Symptoms
Knowing the symptoms of bipolar depression is important to better understand the disorder. Identifying the problem is easier and, therefore, people can seek professional help quickly.
Check out the symptoms of bipolar depression below:
Manic episodes
- Euphoria
- Agitation
- Irritability
- Distraction
- Impulsiveness.
Episodes of depression
- General lack of interest
- Fatigue
- Excess or lack of sleep
- Weight gain or loss
- Deep sadness.
Bipolar Disorder In Women
According to statistics, bipolar disorder type I occurs with equal frequency in men and women, and type II disease is more often diagnosed in women. It is also known that the female course of the disease is characterized by rapid cycles and mixed episodes. Comorbid pathologies often include eating disorders, borderline personality disorder, alcohol or drug addiction, and abuse of psychotropic drugs. Women are more susceptible to somatic diseases such as migraines (intense headaches), thyroid pathologies, diabetes, and obesity.
For women, a special technique is being developed to alleviate this disorder, since from adolescence to menopause there are specific hormonal changes that must be taken into account. In addition, psychotropic substances that should stabilize the condition may adversely affect the intrauterine development of the fetus if the woman is pregnant. They note that in the first trimester of pregnancy, this disorder occurs in a milder form, but after childbirth, they often have to deal with postpartum depression. Thus, at each stage of development of the female body, a competent doctor must review and adjust the treatment regimen. Often, in the treatment of women, a complex method is used, combining drug therapy and cognitive-behavioral or interpersonal therapy with a psychotherapist. This approach gives the fastest results.
How Is Bipolar Disorder Depression Diagnosed?
To assess the situation of bipolar depression, the doctor will carry out an assessment, as well as analyze the person's history. In addition, blood and urine tests may be performed to rule out other disorders.
“the diagnosis of bipolar disorder is based on specific lists of symptoms (criteria). However, people with mania may not describe their symptoms accurately because they think there is nothing wrong with them. Therefore, the doctor often needs to obtain information from the family.”
Treatment of Bipolar Depression
Mood stabilizers
The data available in scientific research indicates that, among the classic mood stabilizers, lithium has the greatest antidepressant efficacy and is the first option for the treatment of mild and moderate depressive episodes in people with TB. Carbamazepine and valproate do not have robust antidepressant effects, according to the results reported so far.
Antidepressants
Efficacy in the acute phase
The question of the use of antidepressants in the treatment of bipolar depression has been the subject of recent discussions, but few studies with a significant population sample have been carried out to date. There is no evidence about the greater or lesser effectiveness of different antidepressants in the treatment of bipolar depression. Currently, the choice for one or another substance lies in the risk of association with hypomanic/manic episodes. According to review articles and expert consensus, selective serotonin reuptake inhibitors (SSRIs) and bupropion are considered the “first option” antidepressants for the treatment of bipolar depression. Monoamine oxidase inhibitors (MAOIs) and venlafaxine are alternatives, especially in cases where there is no satisfactory response to SSRIs or bupropion. Tricyclic antidepressants present a high risk of “cycling”, and their use should be avoided in these cases.
Effectiveness in the continuation and maintenance phase
Continuing antidepressants after remission of an acute episode of depression is another controversial issue. Some authors suggest its continuation for a period of two to six months, highlighting that more severe episodes may require a longer continuation phase. Others adopt a more restrictive stance, suggesting continuation for a period of three months after remission. This controversial issue involves the risk of cycling, on the one hand, and the risk of a depressive relapse when antidepressant withdrawal, on the other.
Mania associated with antidepressant use
There are several reports in the literature of the occurrence of manic symptoms associated with treatment with antidepressants. Individuals with a “depression-mania-euthymia” pattern of evolution, with a history of multiple exposures to antidepressants, a history of abuse or dependence on alcohol or other psychoactive substances, and a history of cycling, would be at greater risk of presenting cycling associated with the use of antidepressants.
Therefore, in this patient profile, the use of antidepressants should be avoided. There is still no consensus regarding the duration of continuation treatment with antidepressants. This decision must be individualized for each patient, taking into account, for example, the pattern of recurrences, the history of cycling associated with antidepressant use, and the severity of the episode. Among the new anticonvulsants, lamotrigine is the one with the greatest amount of evidence of antidepressant efficacy, including in the monotherapy treatment of depressive episodes in type I bipolar patients.
Antipsychotics
Antipsychotic medications are commonly used to treat bipolar depression, especially during depressive episodes with psychotic features. They help stabilize mood and reduce hallucinations and delusions. Some commonly prescribed antipsychotics include olanzapine, quetiapine, risperidone, and lurasidone.
Psychotherapy
Cognitive behavioral therapy (CBT) and interpersonal therapy (IPT), among others, are effective in helping individuals with bipolar depression understand and manage their condition. They focus on identifying triggers, developing coping strategies, and improving interpersonal relationships.
Electroconvulsive (ECT)
ECT may be considered in cases of severe bipolar depression or those that do not respond to other treatment options.
Lifestyle changes
Maintaining a stable daily routine, appropriate to the circadian rhythm, getting adequate sleep, exercising regularly, practicing stress management techniques, and having a solid support system are fundamental to effective care for bipolar depression.
How People with Bipolar Disorder Depression Can Help Themselves?
The person most interested in their well-being is the person who is sick. A person with Bipolar Disorder or Depression has a lifelong illness that remains under control with appropriate treatment.
No one can force you, except in situations that put your safety or that of others at risk. Therefore, if you have Bipolar Disorder or Depression:
- Commit to treatment – discuss questions with your doctor, the effectiveness of medications, possible side effects, and intolerance to these effects
- Maintain a sleep routine – changes in sleep or a reduction in total sleep time can destabilize the disease; talk to your doctor if you need to change your sleeping habit
- Avoid alcohol and drugs – in addition to interacting with some medications, they also act on the brain, increasing the risk of destabilizing the disease; if you have insomnia or restlessness, do not self-medicate – talk to your doctor
- Avoid other substances that can cause fluctuations in your mood, such as excessive coffee, drinks, cold medicines, anti-allergic drugs, or painkillers – they can trigger a new episode of the disease
- Face symptoms without prejudice – discuss them with your doctor;
More Things to do
- Remember: you are fine for taking your medication; If you stop taking it, even after 5 or 10 years, symptoms may return without warning. It is necessary to remain alert for the appearance of the first signs, such as insomnia and irritability
- There is evidence that the more attacks of the disease a person has, the more they will continue to have and the severity increases. Therefore, try to actively participate in the treatment
- Discover your initial symptoms of a new depressive or manic crisis – take note and notify your doctor immediately
- Take advantage of periods of well-being to rediscover how you are; what feelings of sadness, joy, and disposition are like, and how you deal with your problems
- The more you know about the disease, the better you can control the symptoms in the early period. Protect yourself: avoid potential risk stimuli, such as important decisions, sex without condoms, ambitious projects, and expenses – put your plans on paper and wait to execute them when you rebalance; try to channel hyperactivity or negative ideas into physical or manual activity; if you are depressed, give yourself a push, as the initiative is low
- Seek and accept help from family and friends when you realize you cannot take care of yourself alone.
- It is common to want to stop treatment, either because everything is going well, or because it is not working. Try to talk to other people with the same problem, who have already gone through it. Remember what your suffering was like; Discuss with the family whether it would be worth seeking a second opinion about the diagnosis and treatment.
Bipolar Disorder Can Worsen Due to Incorrect Treatment
Inadequate treatment presents a series of risks for the patient, including worsening of the disease. “If the bipolar patient is depressed and only uses antidepressants, their condition will worsen significantly, possibly progressing to a manic turn (coming out of depression and going into mania) or developing into the so-called mixed state (depression and mania). simultaneously). These conditions are very serious, with a high risk of injuries, suicides, and psychiatric hospitalizations”,
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