Antidepressants For Bipolar Disorder

  • Batoul Salamah Bachelor’s degree in Pharmacy from Damascus University\Syria
  • Rajni Sarma MBBS, MD from North-Eastern Hill University, India

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When you hear that someone has bipolar disorder, you may think that they have two personalities, or maybe they are two different people in one body. Well, there’s a bit of truth in this assumption, and we have to recognise that this disorder, like many others, is prevalent among us and must be understood correctly.

What is bipolar disorder?

Bipolar disorder was formerly called manic-depressive illness or manic depression, and it’s a mental health condition in which the patient suffers from uncontrollable and unusual shifts in mood, energy, concentration, and activity levels; these changes make it hard for the patient to live a normal day-to-day life.1

Types of bipolar disorder

There are three main types of this condition:1

Bipolar 1

  • The patient here must have manic episodes that should last at least 7 days and almost every day for most of the day, or manic symptoms that are so severe that the patient needs immediate medical care.
  • In some cases, the patient might suffer from depressive episodes as well, which last for at least 14 days.

Bipolar 2

This type is defined by a pattern of depressive and hypomanic episodes, whereas the hypomanic episodes are less severe than the manic ones in bipolar 1.

Cyclothymia

In this type, there must be recurrent depressive and hypomanic episodes for two years or more, but these episodes aren’t severe enough to be defined as bipolar 1 or 2. Although cyclothymia isn’t as severe as bipolar 1 and 2, it can seriously impact the patient’s life.2

There are four other subtypes of bipolar disorder:2

Rapid cycling bipolar

It’s characterised by having bipolar 1 or 2 with four or more depressive, manic or hypomanic, or mixed episodes within a year.

Bipolar with mixed features

The patient here, in addition to having bipolar 1 or 2, suffers from mixed episodes, like experiencing depression and mania or hypomania at the same time or shortly after each other.

Bipolar with seasonal pattern

In this type, the mood episodes of the patient with bipolar 1 or 2 get affected by specific seasons or times of the year.

Unspecified bipolar

The symptoms of this type don’t meet any other diagnostic criteria of the other types.

What causes bipolar disorder?

There has been no exact known cause of bipolar disorder until now. There are, however, several factors that contribute to this condition, these are:3

Genetics

There is no responsible gene for this condition, but bipolar disorder has been linked to genetics because when a family member has it, this raises the risk of other members having it.

Triggers

Various stressful situations or circumstances can trigger this condition, like:2

  • Relationships breakdown
  • Suffering from traumas, such as the death of a loved one
  • Physical, emotional, or sexual abuse
  • Some physical illnesses
  • Sleep disturbances
  • Overwhelming daily life problems such as study, work, money, or relationships
  • Some medications can cause mania or hypomania as side effects. Also, alcohol and recreational drugs can cause these symptoms in addition to depression.

Chemical imbalance in the brain

Neurotransmitters (such as noradrenalin, serotonin, and dopamine) are the chemicals that are responsible for controlling the brain’s function. There is some evidence that when there is an imbalance of one or more of these neurotransmitters, a person may develop certain symptoms of bipolar disorder.

Symptoms of bipolar disorder

The symptoms differ between the manic, hypomanic, and depressive episodes:2

Manic and hypomanic episodes

These two episodes are very similar, yet they differ in some points, like the fact that mania is more severe, lasts longer, and often requires hospital treatment. The symptoms include:

  • Feeling: You might feel joyful, excited, irritated, confident, easily distracted, very energetic, and very focused
  • Behaviours: You might be more active and talkative, friendly or rude, spend unusual money, and take risks
  • After the end of a manic or hypomanic episode, you might feel unhappy, ashamed, tired, and not remember everything

Depressive episodes

  • Feelings: You might feel down, upset, lacking confidence, guilty, worthless, like you can’t concentrate, agitated, and suicidal
  • Behaviours: You might have trouble sleeping and eating, misuse drugs or alcohol, think about upsetting things, avoid contacting people, and be less physically active
  • Some people might suffer from psychotic symptoms such as delusions and hallucinations.

Bipolar disorder diagnosis

There are several tools to diagnose bipolar disorder:4

  • Physical exam and lab tests
  • Psychiatric assessment
  • Mood charting: a daily record of your moods
  • Bipolar disorder criteria: The health provider monitors your symptoms and sees if they meet the condition’s criteria
  • In children and teenagers, the diagnosis is harder because their symptoms have different patterns, and they’re usually diagnosed with other mental health conditions like attention-deficit/hyperactivity disorder (ADHD) or behavioural problems.

Treatment of bipolar disorder

Bipolar disorder is, unfortunately, a lifelong disease, yet it can be managed with the correct and suitable treatment, and that is usually achieved by a combination of medication and psychotherapy.5

Psychotherapy

It’s also called talk therapy, and it consists of several therapies that help you acknowledge your emotions, behaviours, and thoughts to improve them:

  • Psychoeducation: In this procedure, mental health professionals teach the patients about their mental health conditions and all their aspects.
  • Interpersonal and social rhythm therapy (IPSRT): This therapy helps patients improve their moods by comprehending and working on their biological and social rhythms.
  • Family-focused therapy: This therapy focuses on the importance of the family in helping its patient.
  • Cognitive behavioural therapy (CBT): The professionals here help the patients understand how their thoughts affect their actions.

Medications

They play an essential role in managing bipolar disorder. It includes:

Mood stabilizers

They’re used to manage manic and hypomanic episodes, such as lithium, valproic acid, divalproex sodium, carbamazepine, and lamotrigine, and the most commonly used mood stabilizer is lithium.

Neuroleptic medications (antipsychotics)

They’re prescribed along with mood stabilizers, and they help with both manic and depressive episodes, such as cariprazine, lurasidone, the olanzapine-fluoxetine combination, and quetiapine.

Antidepressants

  • Although bipolar disorder patients suffer from depressive episodes and the thought of being treated with antidepressants seems logical, the treatment with these medications is still debatable. There have been a lot of studies to examine the effectiveness of antidepressants as adjunct therapy with mood stabilizers, and the results didn’t agree on a specific outcome.6

Complications of bipolar disorder

This condition, if left untreated, can lead to more serious and longer-term mood changes. Episodes of depression, for example, may last up to 12 months, and manic episodes may last up to 6 months. Patients can also be at a higher risk of substance abuse (alcohol or drugs), anxiety, diabetes, heart and cardiovascular conditions, weight problems, and suicidal thoughts.10

Bipolar disorder prevention

There isn’t a specific approach to preventing bipolar disorder, yet most patients can manage it successfully by following the correct treatment. It’s important, if you have a family history of bipolar disorder, to be aware of early warning signals because it’s better to start the treatment as early as possible.10

Summary

Bipolar disorder is a serious condition that could cause dangerous symptoms and make the life of the patient hard. The most important thing for the patient is to realize their condition and how it affects them because this will help them manage it more easily.

References

  1. Bipolar disorder - National Institute of Mental Health (Nimh) [Internet]. [cited 2024 Jan 24]. Available from: https://www.nimh.nih.gov/health/topics/bipolar-disorder
  2. mind [Internet]. 2022. About bipolar disorder. Available from: https://www.mind.org.uk/information-support/types-of-mental-health-problems/bipolar-disorder/about-bipolar-disorder/
  3. nhs.uk [Internet]. 2021 [cited 2024 Jan 24]. Overview - Bipolar disorder. Available from: https://www.nhs.uk/mental-health/conditions/bipolar-disorder/overview/
  4. Bipolar disorder - diagnosis and treatment - Mayo Clinic [Internet]. [cited 2024 Jan 24]. Available from: https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/diagnosis-treatment/drc-20355961
  5. Cleveland Clinic [Internet]. [cited 2024 Jan 24]. Bipolar disorder. Available from: https://my.clevelandclinic.org/health/diseases/9294-bipolar-disorder
  6. Gitlin MJ. Antidepressants in bipolar depression: an enduring controversy. International Journal of Bipolar Disorders. 2018;6(1): 25. https://doi.org/10.1186/s40345-018-0133-9
  7. Zhang Y, Yang H, Yang S, Liang W, Dai P, Wang C, et al. Antidepressants for bipolar disorder: A meta-analysis of randomized, double-blind, controlled trials. Neural Regen Res [Internet]. 2013 Nov 5 [cited 2024 Jan 24];8(31):2962–74. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4146170/
  8. Vieta E. Antidepressants in bipolar i disorder: never as monotherapy. American Journal of Psychiatry. 2014;171(10): 1023–1026. https://doi.org/10.1176/appi.ajp.2014.14070826
  9. Aug 3, information 2023 | For more, Goldhawk contact B. UBC News. 2023 [cited 2024 Jan 24]. Modern antidepressants may reduce risk of relapse for patients with bipolar depression. Available from: https://news.ubc.ca/2023/08/03/modern-antidepressants-may-reduce-risk-of-relapse-for-patients-with-bipolar-depression/
  10. Australia H. Bipolar disorder [Internet]. 2023 [cited 2024 Jan 24]. Available from: https://www.healthdirect.gov.au/bipolar-disorder

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Batoul Salamah

Bachelor’s degree in Pharmacy from Damascus University\Syria
Associate’s degree in Health Sciences from the University Of the People\United States

Batoul has significant expertise in various domains of pharmacy. For instance, she worked in several community pharmacies, where she worked directly with patients. She worked as a senior pharmaceutical representative as well, where she worked directly with doctors and physicians. And currently, she’s working as a freelance medical writer, where she puts her humble expertise into helping people get the correct information about their health and how to take care of it.

my.klarity.health presents all health information in line with our terms and conditions. It is essential to understand that the medical information available on our platform is not intended to substitute the relationship between a patient and their physician or doctor, as well as any medical guidance they offer. Always consult with a healthcare professional before making any decisions based on the information found on our website.
Klarity is a citizen-centric health data management platform that enables citizens to securely access, control and share their own health data. Klarity Health Library aims to provide clear and evidence-based health and wellness related informative articles. 
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