Depressive episodes can include symptoms such as lack of energy, low motivation, and loss of interest in daily activities. Mood episodes last for days to months at a time and may also be associated with suicidal thoughts. Treatment usually lasts a lifetime and often involves a combination of medications and psychotherapy. Depression in patients with bipolar disorder (EB) presents significant clinical challenges.
As the predominant psychopathology even in treated EB, depression is associated not only with excess morbidity, but also with mortality from concurrent general medical disorders and a high risk of suicide. In EB, the risks of medical disorders, such as diabetes or metabolic syndrome, and cardiovascular disorders, and the associated mortality rates, are several times higher than those of the general population or other psychiatric disorders. SMR for suicide with EB exceeds 20 times the rates of the general population and exceeds the rates of other major psychiatric disorders. In EB, suicide is strongly associated with mixed (agitated-dysphoric) and depressive phases, decreased time and hospitalization.
Lithium may lower suicide risk in EB; clozapine and ketamine require more testing. The treatment of bipolar depression is much less researched than unipolar depression, especially for long-term prophylaxis. The short-term efficacy of antidepressants for bipolar depression remains controversial and they are at risk of clinical worsening, especially in mixed states and with rapid cycles. Evidence of the efficacy of lithium and anticonvulsants for bipolar depression is very limited; lamotrigine has long-term benefits, but valproate and carbamazepine are not adequately tested and carry a high teratogenic risk.
Evidence is emerging of the short-term efficacy of several modern antipsychotics (such as cariprazine, lurasidone, olanzapine-fluoxetine and quetiapine) for bipolar depression, even with mixed characteristics, although they are at risk of adverse metabolic and neurological effects. Depression is part of the cycle of major ups and downs that come with bipolar disorder. It prevents you from feeling like yourself and can make it difficult to do the things you need or want to do. Bipolar disorder is characterized by extreme mood swings.
These can range from extreme highs (mania) to extreme lows (depression). If you have bipolar disorder, you may have episodes of depression more often than episodes of mania, or vice versa. To meet the criteria for bipolar I disorder, you must have had at least one manic episode in your lifetime for at least one week, with or without having experienced a depressive episode. Report of the International Society for Bipolar Disorders (ISBD) working group on the use of antidepressants in bipol disorders.
All available pharmacological treatments used for bipolar depression have limited efficacy and are at risk of adverse metabolic or neurological effects. The debate over Kraepelin's broadly inclusive concept of manic-depressive illness (MDI) continued until 1980 with a first formal separation of a distinct bipolar disorder (EB) with mania from non-bipolar major depressive disorder (MDD) in the DSM-III (Trede et al. In summary, cariprazine, lurasidone and quetiapine, as well as olanzapine-fluoxetine, are effective in acute bipolar depression, albeit with some risks, and require more testing to determine the long-term prophylactic effects against bipolar depression. As the leading unresolved illness in treated EB, bipolar depression is associated with excessive morbidity and mortality due to concurrent general medical disorders and a very high risk of suicide.
There is widespread concern that antidepressant treatment for bipolar depression risks becoming a potentially dangerous agitation or mania, especially in BD-I (Bond et al. Bipolar disorder used to be called by other names, such as manic depression and manic-depressive 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. Factors associated with relapse after a response to electroconvulsive therapy in unipolar versus bipolar depression.
Sometimes, a person may experience symptoms of bipolar disorder that don't match the three categories listed above, which are known as “other specific and unspecified bipolar and related disorders.”. MDD, leaving bipolar depression as one of the main challenges for psychiatric therapy (Goodwin et al. The person may not feel like anything is wrong, but family and friends may recognize changes in mood or activity levels as a possible bipolar disorder. Surprisingly, well-designed controlled trials of antidepressants for acute bipolar depression are few, varying in size and quality, and yielding inconsistent results (Table (Vázquez et al.
The evidence for carbamazepine for short- or long-term use for bipolar depression is very limited (Table), and controlled trials with other anticonvulsants are lacking in EB (Reinares et al. . .
