The differences will be extreme enough that people around you may notice that something is wrong. Depressive symptoms in someone with bipolar disorder are like those of someone with clinical depression. They may include extended periods of sadness and hopelessness. You may also experience a loss of interest in people you once enjoyed spending time with and activities you used to like. Other symptoms include:. Abnormal physical characteristics of the brain or an imbalance in certain brain chemicals may be among the main causes.
As with many medical conditions, bipolar disorder tends to run in families. If you have a parent or sibling with bipolar disorder, your risk of developing it is higher. The search continues for the genes which may be responsible for bipolar disorder.
Researchers also believe that severe stress, drug or alcohol abuse, or severely upsetting experiences may trigger bipolar disorder. These experiences can include childhood abuse or the death of a loved one. A psychiatrist or other mental health professional typically diagnoses bipolar disorder. The diagnosis will include a review of both your medical history and any symptoms you have that are related to mania and depression.
A trained professional will know what questions to ask. They may be able to answer questions about your behavior that you may not be able to answer easily or accurately. If you have symptoms that seem like bipolar 1 or bipolar 2, you can always start by telling your doctor.
Your doctor may refer you to a mental health specialist if your symptoms appear serious enough. A blood test may also be part of the diagnostic process. There are no markers for bipolar disorder in the blood, but a blood test and a comprehensive physical exam may help rule out other possible causes for your behavior. Doctors usually treat bipolar disorder with a combination of medications and psychotherapy.
Mood stabilizers are often the first drugs used in treatment. You may take these for a long time. Lithium has been a widely used mood stabilizer for many years. During an episode of depression, you may have overwhelming feelings of worthlessness, which can potentially lead to thoughts of suicide. If you're feeling suicidal, read about where to get urgent help for mental health.
If you're feeling very depressed, contact a GP, your care co-ordinator or speak to a local mental health crisis team as soon as possible. Find a local NHS urgent mental health helpline.
You could also call NHS if you're not sure what to do or if you cannot speak to your local NHS urgent mental health helpline. If you want to talk to someone confidentially, call the Samaritans free on You can talk to them 24 hours a day, 7 days a week. Or visit the Samaritans website or email jo samaritans. You may feel very creative and view the manic phase of bipolar as a positive experience. But you may also experience symptoms of psychosis , where you see or hear things that are not there or become convinced of things that are not true.
The high and low phases of bipolar disorder are often so extreme that they interfere with everyday life. Attrition resulted from withdrawal of consent, an inability to locate or contact the subject, and death. A total of mood episodes were observed during follow-up.
The median number of mood episodes per subject was 4 range, The mean SD number of episodes per subject was 5. Initially, we examined time to recovery without regard to mood episode type, ie, the different types of episodes were analyzed collectively. Table 2 displays the proportion of subjects recovering from each of the first 5 successive recurrent mood episodes. There were subjects who had at least 1 recurrent mood episode. The Figure shows the corresponding survival curves for the duration of the first 5 recurrent mood episodes based on cumulative recovery probabilities Kaplan-Meier estimates.
The quartiles for duration of mood episode for each of the first 5 prospectively observed mood episodes were also examined. Another set of analyses examined time to recovery from each type of bipolar I mood episode. Table 3 shows the quartiles for the duration of the different types of mood episodes.
The median duration of major depressive episodes, the most common type, was The median duration of major cycling episodes was approximately 3 to 14 times longer than that of episodes of pure depression or pure mood elevation, and the median duration of mixed major cycling episodes was approximately 4 to 20 times longer.
One-fourth of the mixed major cycling episodes lasted more than 7 years The cycling mood episodes major cycling, 94 mixed major cycling, and 28 minor cycling were composed of 4 possible component mood states: depression major or minor depression , mood elevation mania or hypomania , mixed state concurrent depression and mood elevation , and euthymia lasting less than 8 consecutive weeks. During these cycling episodes, the mean SD durations were 84 weeks median, 23 weeks for depression, 28 76 weeks median, 7 weeks for mood elevation, 8 52 weeks median, 0 weeks for mixed states ie, more than half the cycling episodes did not include a mixed state , and 11 44 weeks median, 2 weeks for euthymia.
The association between the hypothesized predictors and the probability of recovery from a mood episode was analyzed with a mixed-effects grouped-time survival model. In addition, mood episode type was significantly associated with the probability of recovery. The mixed-effects model examined within-subject variability in time to recovery from one mood episode to the next without regard to mood episode type.
The model yielded an intraclass correlation coefficient of 0. We examined the number of major depressive episodes and manic episodes that were treated with somatic therapy for at least 4 consecutive weeks or, in the case of episodes lasting less than 4 weeks, those that were treated for the entire duration of the episode. For subjects with a study intake diagnosis of 1 unipolar major depressive disorder, 2 schizoaffective disorder, major depression, or 3 bipolar II disorder, the treatment analyses did not include mood episodes that occurred prior to the first prospectively observed episode of mania.
The results describe the duration of bipolar I mood episodes and factors significantly associated with the probability of recovery from a mood episode.
The mixed-effects model Table 4 provided a number of clinically relevant results. First, the probability of recovery from a mood episode with severe onset was significantly decreased compared with the probability of recovery from a mood episode with less severe onset. This finding raises the possibility that mood episodes with severe onset may be more difficult to treat.
Future treatment studies or secondary analyses of archival randomized controlled trial data should examine whether severe onset moderates recovery from mood episodes. The mixed-effects model and other survival analyses Table 3 also demonstrated that there are clinically meaningful and statistically significant differences in the probability of recovery from different types of mood episodes. In particular, major cycling and mixed major cycling episodes were much longer than other types of mood episodes, consistent with previous studies showing that cycling episodes are associated with poorer outcomes compared with episodes of pure major depression or pure mania.
The low intraclass correlation coefficient of 0. For example, the intraclass correlation coefficient will be low if mood episode duration progressively decreases over time or if mood episodes are initially shorter, then longer, then shorter again. In addition, it will be low if mood episode duration progressively increases over time. The kindling model, which predicts among other things that mood episode duration will increase from one episode to the next, 33 is thus one of many competing explanations for the low intraclass correlation coefficient.
This raises the possibility that there is a subgroup of subjects with kindling that can be identified and clinically characterized. The Figure shows that the rate of recovery was fairly consistent across multiple episodes. Similar results were previously obtained in a case-register study that used hospitalization as a proxy for mood episodes. Subsyndromal symptoms were defined as 1 or 2 symptoms of a mild degree and no impairment of psychosocial functioning.
The previous study 35 counted a week with subsyndromal symptoms as a week in which the subject was affectively ill, whereas the present study did not consistent with the procedures specified by Research Diagnostic Criteria 9.
This may have yielded a sample that was predisposed to have fewer depressive episodes during follow-up compared with the number of depressive episodes that occur in the general bipolar I population. During prospective follow-up lasting up to 25 years, the mean number of mood episodes per subject in our study was 5. In evaluating this number, it is worth noting certain aspects of the methods. First, the definition of recovery from a mood episode was relatively rigorous: at least 8 consecutive weeks with 2 or fewer mood symptoms of a mild degree and no impairment in psychosocial functioning.
Second, alternating syndromes of depression and mood elevation separated by less than 8 consecutive weeks with euthymia were counted as a single cycling mood episode. In other studies, these alternating syndromes are usually counted as separate mood episodes regardless of how little time, if any, elapses between the offset of one syndrome and the onset of the next consistent with the DSM-IV 10 and the International Statistical Classification of Diseases and Related Health Problems , 10th revision The third issue is subject selection.
Some studies recruit patients from bipolar disorder specialty clinics and may thus enroll subjects who are more resistant to maintenance treatment and therefore more vulnerable to recurrences. By contrast, the Collaborative Depression Study is strictly an observational study—treatment is not controlled by anyone associated with the study and subjects are free to pursue treatment anywhere or to forego treatment.
One limitation is that there may be other types of mood episodes beyond the ones described in this article, eg, atypical depression.
Another limitation is the absence of subjects with bipolar II disorder, who may be quite vulnerable to mixed states. In addition, some subjects were recruited closer to onset of the illness than others. Also, the time that elapsed between assessments initially 6 months and subsequently 12 months may have introduced recall bias and limited the accuracy of the results.
The diagnosis of hypomania required a minimal duration of 1 week. More so, there is evidence that an adequate threshold is 2 days. Another limitation is that treatment was not controlled and may not have been optimal.
When scheduling your daily tasks, be sure set aside enough time for resting and relaxing. Being too busy can exacerbate depressive symptoms and cause frustration.
Doing the things that make you happy can alleviate your depressive symptoms. Researchers believe certain types of exercise can help alleviate the symptoms of depression. This includes low- to moderate-intensity walking, jogging, or biking. For best results, experts say you should exercise at least three to four days per week for 30 to 40 minutes at a time. Being alone can increase the symptoms of depression. Get involved in social activities, such as local book clubs or athletic teams.
Spend time with friends and family or chat with them regularly on the phone. Having the support of friends and loved ones can help you feel more comfortable and confident. However, doing so can help alleviate your symptoms. Similarly, yoga or meditation may be new to you, but they can be beneficial during depressive episodes. These activities are known for being relaxing.
They can make it easier for you to cope with the stress or irritability you may be experiencing. It can be helpful to join a support group for people with bipolar disorder. A group gives you the opportunity to meet other people with the same condition and to share your experiences during depressive episodes. Ask your mental healthcare provider about support groups in your area.
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