Bipolar disorder - depressed
Key points
- Depression in bipolar disorder is a mood disorder characterized by mood swings from mania (exaggerated feeling of well-being, energy, and confidence in which a person can lose touch with reality) to depression with the current or most recent episode of illness characterized by depression.
- The disorder usually appears between the ages of 25 and 35 and affects men and women equally.
- The two (manic and depressed) may appear together, in a "mixed" phase.
- A history of mood swings, and an observation of current behavior and mood are important in the diagnosis of this disorder.
Alternative names
Depression in bipolar disorder; Manic-depressive disorder - depressed phase
Definition
Depression in bipolar disorder is a mood disorder characterized by mood swings from mania (exaggerated feeling of well-being, energy, and confidence in which a person can lose touch with reality) to depression with the current or most recent episode of illness characterized by depression.
Causes, incidence, and risk factors
The disorder usually appears between the ages of 25 and 35 and affects men and women equally. The cause is unknown, but hereditary and psychological factors may play a role.
People with relatives that have bipolar disorders or depression are at greater risk. There are no other known risk factors for the disease itself, but lack of sleep may predispose one to a recurrence of symptoms.
Symptoms
Some of the symptoms that characterize the depressive phase:
- Loss of self-esteem
- Withdrawal
- Helplessness
- Fatigue
- Inability to feel pleasure
- Difficulty concentrating or making decisions
- Loss of appetite or increased appetite
- Insomnia or hypersomnia
- Suicidal thoughts
In the manic phase:
- Increase in goal directed activities
- Flight of ideas or racing thoughts
- Inflated self-esteem
- Decreased need for sleep
- Talkativeness
The two (manic and depressed) may appear together, in a "mixed" phase.
Signs and tests
A history of mood swings, and an observation of current behavior and mood are important in the diagnosis of this disorder. It is important to know if there is a family history of manic-depressive illness.
A physical examination, a history of medical problems, and current medications are important to rule out other potential causes of the symptoms.
Treatment
Hospitalization may be required during an acute phase of either mania or depression to control symptoms, and for the safety of the patient. Mood stabilizers, such as valproic acid (depakote, which is also an anticonvulsant) and lithium carbonate are usually the first line of treatment.
Written and revised by
Gerald Hurowitz, M.D.
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