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Alternative names Return to top
Depression in bipolar disorder; Manic-depressive disorder - depressed phaseDefinition Return to top
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 Return to top
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 Return to top
Some of the symptoms that characterize the depressive phase:Signs and tests Return to top
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 Return to top
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.
Antipsychotics may also be needed in the acute phase to achieve fast relief of symptoms if a manic person has lost touch with reality (become psychotic). Antianxiety agents, such as Klonopin, can also be used.
A mood stabilizer is often used as maintenance therapy to relieve symptoms and prevent the onset of mood swings. Other anti-convulsants (such as Carbamazepine or Gabapentin) may also be used as mood stabilizers.
In some cases, antidepressants are added to a mood stabilizer, but this must be done with caution because some antidepressants can trigger mania in people with this disorder.
In one type of manic depression (Bipolar II), people experience primarily depression which alternates with periods of slightly elevated mood which are not full-fledged mania.
Such people may be wrongly diagnosed as having depression alone (unipolar depression) and be given antidepressants without mood stabilizers, which can cause problems with mania or manic-like states in some cases.
In severe cases, electroconvulsive therapy (ECT) may be used to treat persistent depression. ECT is a psychiatric treatment that produces a brief central nervous systemseizure by means of an electrical current.
Modern ECT is a far cry from the treatment depicted in the movies as a form of punishment or mind control -- it is conducted under anesthesia and studies have repeatedly found that it is the most effective treatment for depression which hasn't responded to medications.
Psychotherapy may also be needed for emotional support during the depressive phase. Cognitive/behavioral therapy has been found to be the most effective "talk therapy" for depression.
Support Groups Return to top
The stress of illness can often be helped by joining a support group where members share common experiences and problems.Expectations (prognosis) Return to top
For some people, treatment with a mood stabilizer has reduced recurrence of symptoms, including depression. However, the disorder is usually life-long.
Complications Return to top
Calling your health care provider Return to top
Call your health care provider if:
Prevention Return to top
Awareness of risk may allow early diagnosis and treatment. Good sleep may be crucial to preventing exacerbations.
Update Date: 5/18/2002 Updated by: Yvette Cruz, M.D., Department of Psychiatry, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.
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Page last updated: 28 October 2004 |