Depression and Bipolar Disorder

Bipolar disorder is defined by recurring mood swings between two different mood states: depression and mania. Depression in bipolar disorder is diagnosed using the same criteria for major depression apart from bipolar mania. However, obtaining an accurate diagnosis, and the subsequent treatment, for bipolar depression is more complicated than for depression alone.

Diagnosis

• The Diagnostic and Statistical Manual for Mental Disorders (DSM) states that the symptoms of depression must be evident most of the day, nearly every day, for two consecutive weeks. The symptoms include a depressed mood, diminished interest in activities, agitation, low energy, fatigue, feeling worthless, lack of concentration, and thinking about death or attempting suicide. Additionally, people with depression may gain or lose weight, eat more or less, and sleep too much or have a hard time sleeping.

Depression in Bipolar

• Depression in bipolar disorder can manifest differently from the DSM criteria. There are different types of bipolar disorder and in the mixed type, depression and mania occur at the same time. This creates a confusing picture where the mood and behavior reflects the low energy of depression and the high energy of mania. Depression in bipolar disorder can last for days, months, or the mood swings can cycle rapidly. Adults with rapid cycling have at least four episodes a year. Children and adolescents with bipolar disorder can have such rapid cycling that both mania and depression are evident several times during one day. The result can be a constant state of irritation or agitation in which it is hard to distinguish the depression.

Medical Treatment

• Several different types of antidepressants---with different ways of working and potential side effects---are available, but antidepressants are used with caution because they can trigger a swing to mania. For this reason, antidepressants are usually used together with a mood stabilizer. Lithium is the first choice mood stabilizer because it has a long successful history. If the depression is mild, then lithium may be the only medication needed. Antipsychotic medications such as Abilify, Zyprexa, Risperdal, Geodon, and Seroquel, may also be used to help control symptoms of irritation, anger, and aggression.

Psychotherapy

• Researchers from the University of Colorado tested the use of psychotherapy in 293 patients with bipolar disorder. Their results, published in the Archive of General Psychiatry, stated that 64% of the patients receiving psychotherapy, together with medication, had higher and more rapid recovery rates. They tested three therapies: Family, cognitive behavioral, and interpersonal and social rhythm.

  Family therapy is effective in helping family members to understand the disease, learn to recognize signs of mood swings, and find ways to support their member with bipolar disorder. Cognitive behavioral therapy focuses on teaching the person with bipolar disorder how to recognize negative thought patterns and misperceptions, see their effect on behavior, and learn new ways to cope. Interpersonal and social rhythm therapy teaches how to stabilize normal sleep/wake cycles and better manage relationships.

Factors

• Bipolar disorder can't be cured, but depression symptoms can be managed through a treatment program that includes adherence to a medication schedule, therapy, maintenance of daily routines, and attention to a healthy lifestyle. Keeping a daily diary of moods, behaviors, and events is an important tool. It can be used to track information about mood episodes that may be forgotten over time and helps to identify triggers that cause a mood swing. Lifestyle choices---healthy diet, exercise, avoidance of alcohol and drugs---are also important factors because they stabilize moods and ensure self-care even through severe mood swings when basic care may otherwise be ignored.