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.
Brain Activity While Anticipating A Working
Diagnosing bipolar disorder can be difficult. While it is not hard to distinguish between its two characteristic phasesthe high spirits of mania and the low spirits of depressionit is challenging to tell if someone who reports low mood is suffering from a depressive disorder or is in the depressive phase of bipolar disorder. Indeed, a bipolar diagnosis is only confirmed, clinically, once a depressed patient has experienced at least one episode of mania.
Mania is characterized by elevated mood , racing thoughts, ideas and speech, ill-considered risk-taking, unusually high levels of energy, and a decreased need for sleep. Hypomania, a less intense version of mania, is no less serious and is also a feature of bipolar disorders manic phase. These symptoms are distinctly unlike those experienced during the depressive phase of bipolar disorder or by people suffering from a major depressive disorder. Yet symptoms of depression in themselves are clinically identical in people with depression and in the depressive phase of bipolar disorder.
This diagnostic problem has motivated researchers to search for measurable biological markersaspects of brain activity, for examplethat might differ in depressed patients and patients in the depressive phase of bipolar disorder, perhaps facilitating more accurate diagnosis. Preliminary success has now been reported in such an effort, led by Mary L. Phillips, Ph.D.
The Role Of Screening Instruments
The frequency of misdiagnosis and the challenge of differentiating MDD and BP highlight not only the importance of accurate differential diagnosis but also the need for and appropriate use of reliable diagnostic tools. The MDQ is one of several self-administered instruments developed to improve detection of BP.2 It was intended to be used as a screening instrument, not as the diagnostic measure.2 Unfortunately, some clinicians regard a positive screen result in the MDQ as a presumptive diagnosis.6
There has been a desire to get an easy-to-use bipolar screening tool in the hands of busy clinicians that can quickly and easily be almost a proxy for making a formal diagnosis. But screens are just thatscreens they are not proxies for actual diagnoses. Screens are meant to cast a wide net to not miss true cases they are less focused on excluding false positive cases. When we used the MDQ as a structured interview with patients to clarify their self-reported responses, we found very high positive and negative predictive value of a true bipolar diagnosis. The questions within the MDQ provide an excellent basis for a semi-structured interview with the patient that allows an experienced clinician to clarify and contextualize patients responses. Dr Goldberg
Yes, you have to do a clinical interview after you administer the MDQ, or any other screening tool, because of the modest positive predictive value . Dr Zimmerman
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Cognition During Depressive Episodes
When cognition is assessed during a depressive episode, bipolar disorder, comparable to unipolar disorder, is associated with a negative cognitive style, as measured by the Attributional Style Questionnaire , the Automatic Thoughts Questionnaire , and the Dysfunctional Attitudes Scale . Similar to patients with unipolar depression, patients with bipolar depression exhibit low self-esteem . In addition, attributions of failure are correlated with depression severity in both unipolar and bipolar depression . People with current episodes of unipolar and those with current bipolar depression appear to be comparable on measures of negative attributions about events and interference from negative words on the Stroop color naming task .
In This Video Learn How Doctors Distinguish Between Major Depressive Disorder And Bipolar Disorder
Bipolar disorder might be known for causing two extremes of the mood spectrummania and depressionyet recognizing symptoms of bipolar disorder can still be challenging. Manic episodes often occur infrequently, and some types of manic symptoms may fly under the radar to friends and family. In fact, to an outsider, someones bipolar disorder may seem indistinguishable from depression.
One possible reason for the confusion? Americans are more familiar with what depression looks like. Approximately 6.7 percent of adults in the United States have had at least one major depressive episode, while only 2.8 percent of U.S. adults have had bipolar disorder in the past year, according to the National Institute of Mental Health .
Bipolar disorder is a mental illness that involves both having had an experience of a manic episode, as well as experiencing depressive episodes, says Susan Samuels, MD, psychiatrist at New York-Presbyterian Hospital, Weill Cornell Medicine. Learn more about the types of bipolar disorder here.
How Bipolar Differs from Depression
Since bipolar disorder and depression both include depressive symptoms, the difference really boils down to mania. It only takes one manic episode to classify someone as having bipolar disorder instead of depression.
Not needing sleep
Feeling invincible and on top of the world
Why Knowing the Difference Really Matters
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What Medications Are Used To Treat Bipolar Disorder
Certain medications can help manage symptoms of bipolar disorder. You may need to try several different medications, with guidance from your healthcare provider, before finding what works best.
Medications healthcare providers generally prescribe to treat bipolar disorder include:
- Mood stabilizers.
- Second-generation neuroleptics .
If youre taking medication for bipolar disorder, you should:
- Talk with your healthcare provider to understand the risks, side effects and benefits of the medication.
- Tell your healthcare provider about any prescription drugs, over-the-counter medications or supplements youre already taking.
- Tell your healthcare provider right away if youre experiencing concerning side effects. They may need to change your dose or try a different medication.
- Remember that medication for bipolar disorder must be taken consistently, as prescribed.
Mood stabilizers for bipolar disorder
People with bipolar disorder typically need mood-stabilizing medication to manage manic or hypomanic episodes.
Types of mood stabilizers and their brand names include:
Thyroid gland and kidney problems can sometimes develop when taking lithium, so your healthcare provider will monitor the function of your thyroid and kidneys, as well as monitor the levels of lithium in your blood, as levels can easily become too high.
The following are signs of lithium toxicity . Call your healthcare provider immediately or go to the nearest emergency room if you experience:
Conditions That May Look Like Depression
Here are common mental health and medical conditions that look like depression and how they differ.
Anemia is when you donât have enough healthy red blood cells to carry oxygen to your organs. You may have symptoms like fatigue and weakness, which are also symptoms of depression. And if you donât treat anemia, it may lead to complications including depression.
Thereâs a link between depression and anxiety. Anxiety is sometimes a symptom of depression. Anxiety may also trigger depression. Many people have both depression and anxiety.
Theyâre different conditions, but they have some overlapping symptoms, like nervousness, irritability, problems sleeping, and a hard time concentrating. Your doctor can tell you if you have anxiety, depression, or both.
Attention deficit hyperactivity disorder
If you have ADHD and youâre depressed, you may move, think, and talk more slowly. The stress of living with ADHD may lead to feelings of depression. This is called situational depression, which means itâs happening because of the ADHD challenges. If you treat your ADHD, your depression symptoms may improve.
Chronic fatigue syndrome
Posttraumatic stress disorder
Premenstrual dysphoric disorder
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Cognitive Styles As Predictors Of Depression
Evidence suggests that at least some individuals with bipolar disorder have negative cognitive styles. Although cognitive styles do not appear to be universal among people with a history of unipolar depression, their presence is predictive of relapse . Several studies suggest a similar pattern in bipolar disorder. One such study found that among college students with a lifetime history of either unipolar disorder or a bipolar spectrum disorder, self-referential negative encoding in interaction with negative life events predicted 11.7% of the variance in depressive symptoms one month later . A second study found that Negative Automatic Thoughts, Dysfunctional Attitudes, and less Positive Automatic thoughts predicted increases in depression over time in a bipolar I sample . Finally, low self-esteem has been found to predict increases in depression over time . It appears, then, that negative cognitive styles predict both unipolar and bipolar depression. Nevertheless, none of these studies compared the effects of cognitive variables for unipolar and bipolar depression. Hence, more research comparing the relative effects of cognition on unipolar and bipolar depression is needed.
Its Important To Understand The Major Differences Between Bipolar Depression And Unipolar Depressionand To Help Educate Others About The Distinctions
Most people know what depression looks and feels likea lack of motivation, waking up in the morning with the thought, What is the point of my life? and asking, Is this all there is?
Depression can include a lot of anxiety , obsessive-compulsive disorder symptoms, focus problems, irritation, and sometimes psychosis . Depression symptoms also include crying, catatonic feelings, suicidal thoughts and behaviors, and what I call psychic pain.
This kind of depression can be genetic, called unipolar depression, or situational depression, such as when a person who has always been stable goes into a deep depression after the loss of a loved one.
Bipolar depression is even more complex, in my experience.
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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.
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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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.
Treatment For Bipolar Disorder
Doctors use mood stabilizers to treat bipolar disorder. Antidepressants can make mania worse. They arent a first-line treatment for bipolar disorder. Your doctor may prescribe them to treat other disorders such as anxiety or PTSD. If you also have anxiety, benzodiazepines may be helpful, but you should use caution if you take them due to their risk for abuse. A variety of new antipsychotic drugs are approved and available for the treatment of bipolar disorder and can be effective. If one of these drugs doesnt work, another one might.
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Themes Uncovered By Expert Panel That Could Lead To Diagnostic Missteps
- Ruling out of BP initially by labeling all depressed patients as potentially having BP
- Assumption that TRD is probably misdiagnosed BP without consideration of the many other possible factors that can account for TRD
- Lack of clarity about hallmark symptoms as outlined in DSM-5, which leads to uncertainty in differential diagnosis, due to overlapping symptoms and comorbidity
- Lack of clarity about best predictors of achieving an accurate diagnosis of MDD vs BP and also risk factors that predispose a patient to a bipolar diagnosis
- Overreliance on screening tools to serve as a proxy for diagnosis in lieu of complete clinical assessment and data gathering to fit together the constellation of signs and symptoms
- Discounting of the family history too quickly by inappropriately dismissing it or, conversely, giving it too much weight
- Misinterpretation of the words used by the patient to describe a family members psychiatric history
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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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Who Does Bipolar Disorder Affect
Bipolar disorder can affect anyone. The average age of onset is 25 years, but, more rarely, it can start as early as early childhood or as late as in your 40s or 50s.
Although bipolar disorder affects people assigned female at birth and people assigned male at birth in equal numbers, the condition tends to affect them differently.
People AFAB with bipolar disorder may switch moods more quickly. When people with bipolar disorder experience four or more manic or depressive episodes in a year, this is called rapid cycling. Varying levels of sex hormones and thyroid hormones, together with the tendency for people AFAB to be prescribed antidepressants, may contribute to the more rapid cycling in this population.
People AFAB with bipolar disorder may also experience more periods of depression than people AMAB.
Unipolar And Bipolar Depression: Different Disorders
The prevailing model is that the depressions within unipolar and bipolar disorders are qualitatively different in etiology and phenomenology. This type of duality is exemplified in the DSM diagnostic system, with unipolar and bipolar disorders categorized as separate branches on the mood disorder diagnostic tree. This separate branch includes both mania and bipolar depression on the bipolar âbranch,â rather than depression without mania, depression and mania, and monopolar mania. Drawing on the strong evidence that mania is biologically driven, bipolar depression has been seen as more endogenous than unipolar depression. As a consequence of this dichotomy in the diagnostic nomenclature, research in mood disorders tends to focus on either bipolar disorder as a whole, failing to account for episode polarity in bipolar disorder, or unipolar depression. Few researchers have directly compared unipolar and bipolar depression.
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Important Safety Information About Seroquel Xr
Elderly patients with dementia-related psychosis treated with this type of medicine are at an increased risk of death, compared to placebo . SEROQUEL XR is not approved for treating these patients.
Antidepressants have increased the risk of suicidal thoughts and actions in some children, teenagers, and young adults. Patients of all ages starting treatment should be watched closely for worsening of depression, suicidal thoughts or actions, unusual changes in behavior, agitation, and irritability. Patients, families, and caregivers should pay close attention to any changes, especially sudden changes in mood, behaviors, thoughts, or feelings. This is very important when an antidepressant medicine is started or when the dose is changed. These symptoms should be reported immediately to the doctor. SEROQUEL XR is not approved for children under the age of 10 years.
This is not a complete summary of safety information. Please discuss the full Prescribing Information with your health care provider.