Depressive symptoms are especially common in bipolar female patients with comorbid alcohol abuse. The phenomenological and therapeutic course of bipolar disorder is significantly affected by comorbid SUD. 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.
Bipolar disorder may increase the risk of other conditions. According to the National Institute of Mental Health, this includes thyroid disease, migraine, heart disease, diabetes and obesity. In fact, when people with bipolar disorder take certain antidepressant medications, their symptoms may worsen. Their mood may become unstable and they may have an increase in the frequency of manic episodes.
If F hasn't had a manic episode yet, these medications may cause you to experience one. These could be constructed specifically with the goal of capturing the genetic differences between unipolar and bipolar depression, rather than the polygenic scores for each condition alone. Mood stabilizers, antipsychotics, antidepressants and anxiolytics are the types of medications prescribed for bipolar disorder, sometimes in combination with each other. All available pharmacological treatments used for bipolar depression have limited efficacy and are at risk of adverse metabolic or neurological effects.
On the other hand, people who use drugs or alcohol may not be correctly diagnosed with bipolar disorder if their symptoms are attributed to substance use and not to the underlying bipolar disorder. The clinical approach to addressing comorbidity problems in patients with bipolar disorder is similar to that of other medicine, and the physician must perform pattern analysis, determine what is substantial and what deserves attention, and then determine whether to adopt a sequential or hierarchical approach to conditions. identified. There is no specific diagnostic test available to help your doctor determine if you have bipolar disorder or depression.
Mood change associated with antidepressants and transition from unipolar major depression to bipolar disorder. If you have new symptoms (such as mania) or symptoms that worsen after you start taking these medications, this may indicate that you have bipolar disorder rather than depression. The tension continues between clustered mood syndromes and the separation of several depressive and bipolar subtypes, and considering a “spectrum of disorders ranging from more or less pure depression to archetypical EB”, leading to profound therapeutic ambiguities (Cuellar et al. The greater severity of mood episodes in people with comorbid anxiety disorders is also reflected in the longer duration of these episodes, particularly depressive ones, and in the higher rates of chronicity in EB with anxiety disorders.
Family data suggest that baseline polarity is possibly an inherited trait and may identify separate genetic subtypes of bipolar disorder (EB) (. Depressive episodes are common at the onset of bipolar disorder, as shown in retrospective and prospective studies. Clinical responses to antidepressants in 1,036 acutely depressed patients with major bipolar or unipolar affective disorders. On the one hand, genome-wide analyses point to a significant correlation in genetic responsibility for major depression and bipolar disorder; on the other hand, clinical differences give hope that their differentiation at the genetic level will also be possible.
The possible post-hoc fallacy, assuming that an antidepressant has been effective, must be weighed against the supposed natural duration of a depressive episode, which in prebipolar depression can be quite brief with abrupt compensation. If a person has a first-degree relative with bipolar disorder or a history of manic episodes, they have a higher risk of suffering from bipolar disorder. . .
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