Can Bipolar Disorder and Depression Coexist?

Depressive symptoms are especially common in people with Bipolar Disorder & comorbid alcohol abuse. Learn more about how Bipolar Disorder & Depression can coexist & how to diagnose it.

Can Bipolar Disorder and Depression Coexist?

Depressive symptoms are especially common in female patients with bipolar disorder and comorbid alcohol abuse. Substance Use Disorder (SUD) can significantly affect the phenomenological and therapeutic course of bipolar disorder. Depression in patients with bipolar disorder (EB) is associated with excess morbidity, mortality from concurrent general medical disorders, and a high risk of suicide. People with EB are at a higher risk of developing medical disorders such as diabetes or metabolic syndrome, and cardiovascular disorders, and their mortality rates are several times higher than those of the general population or other psychiatric disorders.

The Standardized Mortality Ratio (SMR) for suicide with EB is more than 20 times the rates of the general population and exceeds the rates of other major psychiatric disorders. Suicide is strongly associated with mixed (agitated-dysphoric) and depressive phases, decreased time and hospitalization. Lithium may reduce suicide risk in EB; clozapine and ketamine require further 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 such as thyroid disease, migraine, heart disease, diabetes, obesity, etc.

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 a person hasn't had a manic episode yet, these medications may cause them to experience one. 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. 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. The physician must perform pattern analysis to determine what deserves attention and then decide 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 can help diagnose if a person has bipolar disorder rather than depression.

If new symptoms (such as mania) or symptoms that worsen after taking these medications occur, this may indicate that you have bipolar disorder rather than depression. Genome-wide analyses point to a significant correlation in genetic responsibility for major depression and bipolar disorder. 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. 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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