Side-Effects of Mood Stabilizers and How to Manage Them

What are the side-effects of mood stabilizers and how can you manage them? These are questions you might ask when diagnosed with bipolar disorder and beginning treatment. As the name suggests, mood stabilizers can help to stabilize your mood if you experience episodes of mania and depression. Like all medications, mood stabilizers can have some adverse effects. Let’s look at the common side-effects of mood stabilizers, as well as strategies to help you manage them.

What are the Side Effects of Mood Stabilizers?

Side-effects of mood stabilizers (also known as adverse effects – or AEs) vary, as the chemical make-up of each drug is slightly different. Commonly prescribed medications in this category include:

All mood stabilizers have varying profiles of tolerability, and people will respond to them in different ways. The common side-effects of each mood stabilizer are listed here.

Lithium

  • Nausea
  • Diarrhea
  • Dizziness
  • Muscle weakness
  • Frequent urination
  • Thirst
  • Tremor
  • Weight gain and swelling from excess fluid
  • Worsening of skin disorders, such as psoriasis and acne

Common side-effects of lithium can be managed through tweaks to your dosage, taking your medication at different times of day, staying hydrated and treating skin conditions with topical creams or medications. Your doctor will assess the severity of your symptoms and suggest an appropriate course of action.

When taken over a long-term period, lithium can cause irregular heart rhythms and kidney disease. Your doctor will monitor your heart and kidney functions and take regular blood samples to minimize the risks.  

Carbamazepine

  • Nausea
  • Dizziness/unsteadiness
  • Drowsiness
  • Dry mouth
  • Constipation

While these carbamazepine side-effects are not usually serious, they should still be reported to your doctor. Many of them are manageable with changes to your medication schedule or by adjusting your dosage.

More serious side-effects of these mood stabilizers include worsening depression, suicidal thoughts, severe dizziness, swelling, itching or trouble breathing. Some people who take carbamazepine may experience headaches that don’t go away, abdominal pain, yellowing eyes or skin, irregular heartbeat or vision changes. However, these are extremely rare. You should seek urgent medical help if any of these serious side-effects occur.  

Lamotrigine

The side effects of lamotrigine medications are similar to those of other mood stabilizers, though they may include backache, chest pain, stomach cramps and inflammation of the nose.

Infrequent but more serious side-effects include an altered mental state (such as being easily angered or annoyed, aggressive behavior, confusion and loss of memory). Lamotrigine may also cause an acute skin rash and fever, which can indicate Stevens-Johnson syndrome.

Statistics show that around 10% of people who take lamotrigine or valproate medications will experience a rash. Most of the time, the rash is harmless, but in a small number of people (between 0.08 and 1.3%), this side-effect can be life-threatening. For this reason, if you experience a rash within the first eight weeks of taking lamotrigine, you should immediately see your doctor.

Valproate

  • Nausea, vomiting or stomach pain
  • Dizziness
  • Drowsiness
  • Headache
  • Blurred vision
  • Hair loss
  • Changes in appetite
  • Weight gain

Your doctor may suggest a new diet or exercise regimen to help prevent unwanted weight gain when taking valproate medications. You may also be prescribed anti-sickness drugs to help with the nausea. If the side-effects of this mood stabilizer are severe, your doctor may want to change or adjust your medication.

Less common, more serious side-effects of valproate include severe drowsiness, confusion, easy bruising, unusual bleeding, pinpoint spots under your skin, worsening seizures, flu-like symptoms and chest pain. You should call your doctor immediately if you show signs of allergic reactions or pancreas problems, such as swelling in the face, fever, skin pain, burning eyes, upper stomach pain, loss of appetite or jaundice.

Asenapine

Common side-effects of asenapine medications are similar to those experienced with other mood stabilizers, though they may include restlessness, tingling of the mouth and insomnia. This medication can also cause weight gain.

More serious side-effects may include problems with your nervous system, so you should always report these to a doctor:

  • Drooling
  • Trouble swallowing
  • Shaking (tremor)
  • Feelings of anxiety/agitation
  • A constant need to move
  • Stiff muscles
  • Shuffling walk
  • Muscle spasms or cramping
  • Mask-like expression in the face

Which Mood Stabilizers Have the Least Side-Effects?

All mood stabilizers have potential side-effects, and there is no telling how you will respond to them. The good news is that most side-effects can be managed by optimizing your medication to the lowest effective dose. However, some side-effects of mood stabilizers can be serious, so it’s important to report any adverse effects to your doctor.

All doctors want to prescribe the mood stabilizers with the least side-effects, so it’s important to communicate how you’re feeling to your physician or psychiatrist so that they can help you find the right treatment.

article references

APA Reference
Smith, E. (2021, December 28). Side-Effects of Mood Stabilizers and How to Manage Them, HealthyPlace. Retrieved on 2025, April 30 from https://www.healthyplace.com/bipolar-disorder/bipolar-medications/side-effects-of-mood-stabilizers-and-how-to-manage-them

Last Updated: January 7, 2022

Creating a Social Network Image: Who Are You, Really?

Teenagers and college students are using the social networks to create idealized identities, but is it psychologically healthy?

Students are creating idealized versions of themselves on social networking websites — Facebook and MySpace are the most popular — and using these sites to explore their emerging identities, UCLA psychologists report. Parents often understand very little about this phenomenon, they say.

"People can use these sites to explore who they are by posting particular images, pictures or text," said UCLA psychology graduate student Adriana Manago, a researcher with the Children's Digital Media Center, Los Angeles (CDMCLA), and lead author of a study that appears in a special November-December issue of the Journal of Applied Developmental Psychology devoted to the developmental implications of online social networking. "You can manifest your ideal self. You can manifest who you want to be and then try to grow into that.

"We're always engaging in self-presentation; we're always trying to put our best foot forward," Manago added. "Social networking sites take this to a whole new level. You can change what you look like, you can Photoshop your face, you can select only the pictures that show you in a perfect lighting. These websites intensify the ability to present yourself in a positive light and explore different aspects of your personality and how you present yourself. You can try on different things, possible identities, and explore in a way that is common for emerging adulthood. It becomes psychologically real. People put up something that they would like to become — not completely different from who they are but maybe a little different — and the more it gets reflected off of others, the more it may be integrated into their sense of self as they share words and photos with so many people."

"People are living life online," said Manago's co-author Patricia Greenfield, a UCLA distinguished professor of psychology, director of the CDMCLA and co-editor of the journal's special issue. "Social networking sites are a tool for self-development."

The websites allow users to open free accounts and to communicate with other users, who number in the tens of millions on Facebook and MySpace. Participants can select "friends" and share photos, videos and information about themselves — such as whether they are currently in a relationship — with these friends. Many college students have 1,000 or more friends on Facebook or MySpace. Identity, romantic relations and sexuality all get played out on these social networking sites, the researchers said.

"All of these things are what teenagers always do," Greenfield said, "but the social networking sites give them much more power to do it in a more extreme way. In the arena of identity formation, this makes people more individualistic and more narcissistic; people sculpt themselves with their profiles. In the arena of peer relations, I worry that the meaning of 'friends' has been so altered that real friends are not going to be recognized as such. How many of your 1,000 'friends' do you see in person? How many are just distant acquaintances? How many have you never met?"

"Instead of connecting with friends with whom you have close ties for the sake of the exchange itself, people interact with their 'friends' as a performance, as if on a stage before an audience of people on the network," Manago said.

"These social networking sites have a virtual audience, and people perform in front of their audience," said Michael Graham, a former UCLA undergraduate psychology student who worked on this study with Greenfield and Manago for his honor's thesis. "You're a little detached from them. It's an opportunity to try different things out and see what kind of comments you get.

"Sometimes people put forth things they want to become, and sometimes people put forth things that they're not sure about how other people will respond," he added. "They feel comfortable doing that. If they put something forward that gets rave reviews from people, it can alter the way they view their own identity. Through this experimentation, people can get surprised by how the molding goes."


Is this exploration of identity through these websites psychologically healthy?

"Every medium has its strengths and weaknesses, its psychological costs and benefits," said Greenfield, an expert in developmental psychology and media effects. "Costs may be the devaluing of real friendships and the reduction of face-to-face interaction. There are more relationships, but also more superficial relationships. Empathy and other human qualities may get reduced because of less face-to-face contact. On the other hand, new college students can make contact with their future roommates and easily stay in touch with high school friends, easing the social transition to college, or from one setting to another."

"I hate to be an older person decrying the relationships that young people form and their communication tools, but I do wonder about them," said Kaveri Subrahmanyam, associate director of the CDMCLA, professor of psychology at California State University, Los Angeles, and senior editor of the special journal issue. "Having 1,000 friends seems to be like collecting accessories."

Middle school is too young to be using Facebook or MySpace, Subrahmanyam believes, but by ninth grade, she considers the websites to be appropriate. She recommends that parents speak with their children, starting at about age 10, concerning what they do online and with whom they are interacting. Subrahmanyam notes that some of parents' greatest online fears — that their children will be harassed by predators or receive other unwanted or inappropriate Internet contact — have been decreasing, although parents may not know this.

In her own study in the journal, Subrahmanyam and colleagues Stephanie Reich of the University of California, Irvine, Natalia Waechter of the Austrian Institute for Youth Research and Guadalupe Espinoza, a UCLA psychology graduate student, report that, for the most part, college students are interacting with "people they see in their offline, or physical, lives."

"Young people are not going online to interact with strangers or for purposes removed from their offline lives," she said. "Mostly they seem to be using these social networking sites to extend and strengthen their offline concerns and relationships."

Research shows that adolescents who have discussed online safety with their parents and teachers are less likely to have a meeting with anyone they met online, Subrahmanyam noted.

"The best thing that parents can do is to have a rough idea of what their teens do online and have discussions with them about being safe online," she said.

What does having 1,000 friends do to your relationships with your true friends?

"Relationships now may be more fleeting and more distant," Manago said. "People are relating to others trying to promote themselves and seeing how you compare with them. We found a lot of social comparisons, and people are comparing themselves against these idealized self-presentations.

"Women feel pressure to look beautiful and sexy, yet innocent, which can hurt their self-esteem" she said. "Now you are part of the media; your MySpace profile page is coming up next to Victoria's Secret models. It can be discouraging to feel like you cannot live up to the flawless images you see."

"You're relating to people you don't really have a relationship with," Greenfield said. "People have a lot of diffuse, weak ties that are used for informational purposes; it's not friendship. You may never see them. For a large number of people, these are relationships with strangers. When you have this many people in your network, it becomes a performance for an audience. You are promoting yourself. The line between the commercial and the self is blurring.

"The personal becomes public, which devalues close relationships when you display so much for everyone to see," Greenfield added.


"Who we are is reflected by the people we associate with," Manago said. "If I can show that all these people like me, it may promote the idea that I am popular or that I associate with certain desirable cliques."

Not much remains private.

"You can be at a party or any public place, and someone can take a picture of you that appears on Facebook the next day," Manago said.

However, Graham said, the social networking sites can also strengthen relationships. He also said many people have "second-tier friends that they may have met once but would not have stayed in touch with if not for the MySpace or Facebook networks."

The study by Manago, Greenfield and Graham, along with co-author Goldie Salimkhan, a former UCLA psychology undergraduate major, was based on small focus groups with a total of 11 women and 12 men, all UCLA students who use MySpace frequently.

One male student in the study said of MySpace, "It's just a way to promote yourself to society and show everyone, 'I'm moving up in the world, I've grown. I've changed a lot since high school.'"

How honestly do people present themselves on these sites?

Another male student in a focus group said, "One of my friends from high school, I saw her profile and I was like, 'Whoa, she's changed so much from high school,' and I see her this summer and I'm like, 'No, she's exactly the same!' Her MySpace is just a whole other level."

"Just at the age where peers are so important, that's where social networking — which is all about peers — is very attractive," Greenfield said. "Just at the age where you're exploring identity and developing an identity, that's where this powerful tool for exploring identity is very appealing. These sites are perfectly suited for the expanded identity exploration characteristic of emerging adults."

Another study in the special issue of the journal, conducted by Larry Rosen of California State University, Dominguez Hills, and colleagues Nancy Cheever and Mark Carrier, shows that parents have high estimates of the dangers of social networking but very low rates of monitoring and of setting limits on their children.

Rosen and his colleagues found that a parenting style that is marked by rational discussion, monitoring of children, setting limits and giving reasons for the limits is associated with less risky online behavior by children.

Greenfield advises parents of adolescents not to give their child a computer with Internet access in his or her bedroom.

"But even with a computer in a family room, complete monitoring is impossible," she said. "Children have so much independence that parents have to instill a compass inside them. Seeing what they are doing on the computer and discussing it with them is a good way to instill that compass."

In an additional study in the journal that highlights the beneficial nature of Facebook "friends," Charles Steinfield, Nicole B. Ellison and Cliff Lampe of Michigan State University examine the relationship between Facebook use and social capital, a concept that describes the benefits one receives from one's social relationships. They focus on "bridging social capital," which refers to the benefits of a large, heterogeneous network — precisely the kind of network these sites can support.

Their article argues that there is a direct connection between students' social capital and their use of Facebook, and using data over a two-period, they found that Facebook use appears to precede students' gains in bridging social capital.

They also found that Facebook use appears to be particularly beneficial for students with lower self-esteem, as it helps them overcome the barriers they would otherwise face in building a large network that can provide access to information and opportunity.

"Young people do seem to be aware of the differences between their close friends and casual acquaintances on Facebook," Steinfield said. "Our data suggest that students are not substituting their online friends for their offline friends via Facebook; they appear to be using the service to extend and keep up with their network."

Source: University of California - Los Angeles (2008, November 22). Crafting Your Image For Your 1,000 Friends On Facebook Or MySpace.

APA Reference
Staff, H. (2021, December 28). Creating a Social Network Image: Who Are You, Really?, HealthyPlace. Retrieved on 2025, April 30 from https://www.healthyplace.com/relationships/online-relationships/creating-a-social-network-image-who-are-you-really

Last Updated: March 21, 2022

What Natural Treatments Help Bipolar Depression?

Natural treatment for bipolar depression may help ease bipolar symptoms and help people function better in their lives. Natural treatments, often called complementary or alternative medicine (CAM), include a variety of approaches designed to help bipolar depression by adding to—not replacing—the medication and other treatments someone is already receiving for their illness. Bipolar depression natural treatments have received mixed reviews from professionals and patients alike: some swear by them while others steer clear.

Some people use natural remedies for bipolar depression because they want to enhance their treatment, they feel comfortable with the idea of natural treatment, or they want more control over their own treatment. If you’re considering CAM, it’s important to investigate what’s available and whether the treatments help or harm.

Here, you can explore this non-traditional treatment approach for bipolar depression. First, you’ll find examples of natural treatments. Then, you’ll discover some of the benefits and cautions that are important to consider before starting this type of treatment. Finally, you’ll gain two empowering resources to help you feel confident in your treatment.

Natural Treatments to Help Bipolar Depression

Natural treatments for bipolar depression take multiple forms. Some are behavioral, things you do to improve your bipolar depression. Others are nutritional, dietary supplements that affect your brain.

CAM approaches that involve behaviors and actions include things such as:

Dietary supplements that can help bipolar depression include:

To be sure, there are numerous claims that other supplements help bipolar depression. Most claims are unsubstantiated; therefore, they’re not ready to be added to any reputable list of depression-reducing supplements. Others have been found to be dangerous so are also left off the list. Omega-3’s and inositol have been shown to impact brain chemistry safely and in ways that improve bipolar depression.

Two supplements to avoid in bipolar depression despite publicity to the contrary:

St. John’s Wort is a popular herbal supplement to help major depressive disorder, and SAMe is a widely-used coenzyme. Both do seem to improve symptoms in many people who take it for major depressive disorder. For bipolar depression, though, St. John’s Wort and SAMe can be dangerous. They can induce mania as well as interfere with medications taken for bipolar depression.

Bipolar Depression Natural Treatments: Help and Harm

Treating bipolar depression naturally can bring noticeable, positive changes. The behavioral approaches work very well (like supplements, they impact brain chemistry and function). Natural supplements, when combined with the medication your doctor has prescribed, can improve symptoms by enhancing your medication’s functions and making bipolar depression easier to manage.

Further, many supplements help treat symptoms with few side-effects. This can make people willing to use them regularly, a requirement for supplements to work properly.

Along with the benefits of natural treatments for bipolar depression come cautions against possible harm.  Among these important cautions:

  • “Natural” isn’t the same thing as “safe”
  • Individual differences are significant, and what has been deemed safe for “most” people might not be safe for you
  • Some supplements reduce the effectiveness of prescription medications
  • Some damage the heart, liver, kidneys, and other vital organs
  • While some supplements have few side-effects, others have unpleasant and potentially dangerous side-effects

Much more research is needed for natural treatments to help bipolar depression. Until scientists learn more, always talk to your doctor before using any natural supplement. Also, be sure to notify your doctor of any changes in your mood or general health.

Two useful resources can help you research supplements you may be interested in. Both are comprehensive databases containing facts about supplements and prescription medications.

Arming yourself with information about treating bipolar depression naturally can help you make informed treatment decisions.

article references

APA Reference
Peterson, T. (2021, December 28). What Natural Treatments Help Bipolar Depression?, HealthyPlace. Retrieved on 2025, April 30 from https://www.healthyplace.com/bipolar-disorder/bipolar-depression/what-natural-treatments-help-bipolar-depression

Last Updated: January 7, 2022

Mentally Ill Kids Face Widespread Stigma

Children with mental illness face discrimination and stigma at school and elsewhere.

Children with mental illness may face a double burden -- the condition itself, and discrimination and stigma at school and elsewhere, a new survey shows.

Almost half of U.S. adults polled expected that children undergoing mental health treatment would be rejected at school, and half anticipate that these youngsters will also suffer problems later in life.

At the same time, almost nine out of 10 Americans believe that doctors overmedicate kids with behavior problems.

"It's pretty clear that there's a lot of prejudice and discrimination about children's mental health problems in American culture," said lead researcher Bernice Pescosolido, professor of sociology at Indiana University. "These attitudes and beliefs are very powerful in terms of what happens to kids and their families."

Examining Stigma's Impact on Mentally Ill Children

Pescosolido said she and colleagues began examining attitudes about mental illness after reading news reports that stigma had begun to disappear. These came alongside what she called an "extraordinary tidal wave of [media] response" that was largely critical of changes in the treatment of mentally ill children.

Drugs are being prescribed more often to kids, and psychiatrists are diagnosing illnesses at much younger ages, Pescosolido said. Indeed, there are reports of kids being diagnosed when they are little more than babies.

For this study, her team examined the results of a 2002 survey of almost 1,400 adults; the margin of error was plus or minus four percentage points. The findings are published in the May 2007 issue of the journal Psychiatric Services.

Forty-five percent of those surveyed believed that kids who were undergoing mental health treatment would be rejected by their classmates at school, and 43 percent said that stigma around mental health issues would create problems for them in adulthood.

"No matter what that person attains later in life, this will follow them around," Pescosolido said. "This is classic stigma, when someone is marked and seen as less than (others)."

Stigma Prevents Mentally Ill Children from Getting Proper Care

But stigma also could prevent people from getting the treatment they need, Pescosolido said.

Meanwhile, most of those polled were "very negative about the use of any kind of psychoactive medication for children's mental problems," she said. In fact, 85 percent of people surveyed said kids are already overmedicated for common behavioral problems, and over half (52 percent) felt that psychiatric medication "turns kids into zombies."

Could they be right about kids taking too many medications? "I'm sure there are some [cases], but how much do anecdotal stories really match the reality? I don't think the science is there" to provide answers, Pescosolido said.

She added that there are big differences in how people view the use of drugs to treat physical illness and mental illness. "If your child had diabetes, and you needed insulin, would you wring your hands over that?" the researcher said.

Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Schneider Children's Hospital in New York City, said he encounters bias against the use of psychiatric drugs every day.

"There's a disconnect," he said. "The public is generally looking to embrace evidence-based treatments (for other conditions) yet rejecting pharmaceutical interventions when data suggest it works."

What to do? Pescosolido called for a better mental health care system and more discussion about prejudice and discrimination that targets mentally ill kids.

SOURCES: Bernice Pescosolido, Ph.D., professor, sociology, Indiana University, Bloomington; Andrew Adesman, M.D., chief, developmental and behavioral pediatrics, Schneider Children's Hospital, New York City; May 2007, Psychiatric Services

APA Reference
Staff, H. (2021, December 28). Mentally Ill Kids Face Widespread Stigma, HealthyPlace. Retrieved on 2025, April 30 from https://www.healthyplace.com/parenting/stigma/mentally-ill-kids-face-widespread-stigma

Last Updated: January 27, 2022

Ketamine Treatment for Bipolar Depression: Does it Help

Is Ketamine treatment for bipolar depression a wonder drug, or is it an irresponsible use of a street drug? For many, ketamine is a miracle treatment breakthrough that helps people facing severe bipolar depression, treatment-resistant bipolar depression, and suicidal thoughts that can accompany these serious bipolar episodes. Others are skeptical and point to myriad problems associated with ketamine. Let’s explore the facts about this substance to understand more about ketamine treatment for bipolar depression.

Ketamine at a glance:

  • It only has FDA approval as an anesthetic
  • Ketamine is an anesthetic in both human and veterinary medicine
  • Ketamine is also a street drug, often taken as a party or club drug
  • Ketamine’s chemical structure and the way it acts on the brain are similar to the street drug PCP
  • It can make people dissociate, or detach from reality
  • It’s used as a date rape drug
  • When misused, ketamine can cause impaired learning, memory, and attention; delirium, amnesia, potentially fatal respiratory problems, agitation…and depression

At first glance, ketamine looks horrible. It’s dangerous and does nasty things, including possibly causing depression. How, then, can people use it to treat bipolar depression? When Ketamine is used to treat bipolar depression under medical care, ketamine is not being used as a street drug or an anesthetic. It’s being used as an antidepressant, and it can be a very effective one.

How Ketamine Treatment for Bipolar Depression Works

Ketamine is different from traditional antidepressants. Traditional antidepressants target the neurotransmitters serotonin, norepinephrine, and dopamine. Ketamine blocks glutamate and enhances the brain’s ability to grow and change.

Ketamine blocks the N-methyl-D-aspartate (NMDA) receptor, which seems to be its depression-reducing kingpin. It rebalances glutamate and GABA as well as facilitates the development of new receptors and synapses.

The ketamine-induced activity in the brain leads to the reduction of severe bipolar depression symptoms. Ketamine treatment can bring a host of benefits.

Advantages and Benefits of Ketamine Treatment for Bipolar Depression

Ketamine has a high success rate, with up to 85 percent of people reporting significant improvements in their mood (Depression Alliance, n.d.). This leaves about 15 percent of people unaffected by ketamine treatment, whereas, with traditional antidepressants, approximately 33 percent of users don’t improve.

Not only does ketamine treatment help bipolar depression, but it also does it quickly. While it can take four- to eight weeks to feel the positive effects of traditional antidepressants, ketamine treatment creates relief in a matter of hours.

While ketamine treatment does offer advantages, it has disadvantages, too.

Drawbacks of Bipolar Depression Ketamine Treatment

Researchers have identified certain problems with ketamine use in bipolar depression.

  • There’s only a small difference between a safe and effective dose and a lethal dose
  • Researchers are still trying to find a dose that’s high enough to be effective and low enough to be safe
  • People can experience distorted vision and hearing
  • Tolerance risk; people will need more to have the same effect on depression symptoms
  • Ketamine carries a risk of abuse
  • It may not be safe (or effective) for long-term use
  • Long-term treatment frequency is unknown
  • May always require treatment in a clinic because, as a street drug, it may not be available in pharmacies

Despite these disadvantages, many people are receiving ketamine treatments for bipolar depression and are so happy with the results that they continue with treatment despite the cost.

Receiving Ketamine Treatment

Some psychiatrists offer ketamine treatment as a trial. If you can’t find a psychiatrist who does this, you could go to a ketamine clinic.

Ketamine clinics have begun to spring up nationwide. Many clinics are located in university medical centers and are reputable. Others may be unsafe or unreliable because there’s no oversight or standard of treatment regulating treatment centers.

Treatment involves a ketamine infusion for bipolar depression, which is ketamine delivered intravenously. Nasal sprays, including esketamine aka Spravato (FDA approved for treatment-resistant depression), and others pending FDA approval, may soon be another ketamine treatment method.  Because ketamine’s bipolar depression-relieving effects are temporary, people undergoing treatment need to return every few weeks for another round of treatment.

Because the FDA hasn’t approved ketamine treatment for bipolar depression, insurance typically doesn’t cover treatments. Most people pay out-of-pocket for the treatment, and the cost is hefty. Infusions cost between $400 and $800 each. With treatments occurring every few weeks, ketamine treatments for severe bipolar depression can be over $10,000 each year.

Ketamine treatment for bipolar depression is promising. Early experiences indicate that the treatment, while expensive, is effective and efficient. There are still many unknowns, however:

  • When used long-term, will it be safe and effective?
  • What is the right dosing schedule, amount?
  • How many treatments will be recommended?

The current recommendation is that ketamine treatment for bipolar depression be used only when all other treatments have been unsuccessful. And even then, ketamine treatment should be short-term only, to augment traditional medication while it begins to work. Cautious use may be the most effective and safest approach.

article references

APA Reference
Peterson, T. (2021, December 28). Ketamine Treatment for Bipolar Depression: Does it Help, HealthyPlace. Retrieved on 2025, April 30 from https://www.healthyplace.com/bipolar-disorder/bipolar-depression/ketamine-treatment-for-bipolar-depression-does-it-help

Last Updated: January 7, 2022

Bipolar Depression Symptoms in Men Hard to Deal With

Bipolar depression symptoms in men can be hard to deal with. The symptoms themselves can make functioning seem like an insurmountable challenge. In severe cases, even getting out of bed or off the couch is nearly impossible. But for many men, bipolar depression symptoms aren’t the only challenge. The stigma of facing depression, of admitting that something is wrong mentally and emotionally, keeps a lot of men suffering in silence.

Partly because of the silence surrounding bipolar depression in guys, it can seem as though no one else is dealing with the problem. That’s an illusion created by a lack of conversations about bipolar depression symptoms in males. The reality is that if you’re male and living with bipolar depression, you’re not alone. Depression is a mental health struggle that over six million men in the United States face every year (Depression and Bipolar Support Alliance (DBSA), n.d.).

Because bipolar depression is so difficult to live with and all too common, let’s explore men’s bipolar depression symptoms.

Bipolar Depression Symptoms in Males

Bipolar depression, according to the American Psychiatric Association’s authoritative Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, is one of the mood episodes people with bipolar I or bipolar II disorder experience. The other is mania or hypomania. To be diagnosed with bipolar depression, someone must have at least five of the following symptoms and experience them together for at least two consecutive weeks.

One or both of these:

  • Depressed mood nearly all the time
  • Loss of interest and drastically diminished feelings of pleasure in almost all activities once enjoyed

Three or four (or more) of these symptoms:

  • Exhaustion that doesn’t lift
  • Weight changes (loss or gain) without trying
  • Sleeping too much or too little
  • Feeling agitated or slowed down
  • Difficulty thinking, concentrating, paying attention, and/or making decisions
  • Sense of worthlessness and strong (and misplaced) feelings of guilt

Many bipolar depression symptoms are similar for males and females. Men and women sometimes experience them differently, though.  For example, it’s slightly more common for men than women to experience these bipolar depression symptoms while also in a state of mania.  This blend of mania and depression can be overwhelming, exhausting, and frustrating.

Also overwhelming, exhausting, and frustrating for a lot of men is how to deal with the presence of bipolar depression in their lives.

Ways That Many Men Deal with Symptoms of Bipolar Depression

Cultural norms dictate that men be strong, independent, self-reliant, stable, and possess emotional control. By extension, males tend to associate bipolar depression with character flaws and weakness. Men, therefore, aren’t always willing to admit to struggling—especially emotionally. Many go so far as to actively work to hide their bipolar depression symptoms.

Often, insight into what men are experiencing comes from what they will and will not talk about. While many men are reluctant to talk about their emotions and feelings such as sadness, crying, or generally feeling down, some will talk about feeling bored or unmotivated as well as their loss of interest in certain activities.

Depression symptoms in males often reveal themselves in actions. Extreme irritability, withdrawal from friends, family, and work, and changes in eating and sleeping habits can communicate suffering. Guys often believe that mentioning certain behavioral symptoms and choices rather than feelings is often seen as a more acceptable way to talk about bipolar depression.

Men and Coping with Bipolar Depression Symptoms

Possibly because they are sometimes reluctant to talk about depression, men find ways to cope with their symptoms. Unfortunately, bipolar disorder—both mania and depression—leads to some dangerous coping behaviors. These can include:

  • Alcohol and other substance use and abuse
  • Engagement in dangerous activities (in mania for the thrill; in depression because people don’t always care about their own safety and survival)
  • Over-involvement in work despite fatigue in order to avoid friends and family

Even though it might feel impossible, bipolar depression is treatable. Doctors and therapists will listen without judging as well as keep your information confidential (unless you are expressing suicidal ideation).  Just as with bipolar depression symptoms in women, bipolar depression symptoms in men can gradually diminish to be replaced with a return of happiness and interest in life.

article references

APA Reference
Peterson, T. (2021, December 28). Bipolar Depression Symptoms in Men Hard to Deal With, HealthyPlace. Retrieved on 2025, April 30 from https://www.healthyplace.com/bipolar-disorder/bipolar-depression/bipolar-depression-symptoms-in-men-hard-to-deal-with

Last Updated: January 7, 2022

What Is Bipolar II Disorder? Definition, Symptoms, Treatment

Bipolar II disorder (also known as bipolar disorder type II or bipolar disorder type 2) is a type of bipolar disorder with elevated or irritable moods that differ from those found in bipolar disorder type I (see "What Is the Difference Between Bipolar I and Bipolar II?"). Bipolar disorder type II has a slightly greater prevalence. While approximately one percent of people in the United States will develop bipolar disorder type I in their lifetime, approximately 1.1 percent of people will develop bipolar disorder type II. Some researchers have found these rates to be climbing in recent years, however. More women than men experience bipolar disorder type II.

Bipolar disorder type II is characterized by severe mood episodes, both of an elevated or irritated nature and of a depressed nature. These elevated or irritable moods are called “manias” or “manic moods” in bipolar disorder type I and “hypomanias” or “hypomanic moods” in bipolar disorder type II with “hypomania” literally meaning “less than mania.” Some people would call bipolar disorder type II “soft” bipolar disorder as it contains these less severe “hypomanias.” It should not be inferred, however, that one case of bipolar disorder is less severe than another, overall, simply by its type. There are severe cases of bipolar disorder type I and bipolar disorder type II; it varies by individual.

When a person experiences a specific bipolar mood that meets the diagnostic criteria discussed below, it is known as an “episode.” A person typically experiences three or fewer episodes per year. Episodes can last from days to months if left untreated. Note that some people experience more than three episodes per year and this is known as rapid cycling.

Bipolar II Disorder DSM-5 Criteria

To be diagnosed with bipolar disorder type II, the person must have experienced at least one period of hypomania and at least one period of depression as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). If the person experiences mania, that person qualifies for the bipolar disorder type I diagnosis rather than the bipolar disorder type II diagnosis.

According to Medscape, the DSM-5 defines hypomanic episodes as being an elevated, expansive (unrestrained emotional expression, often accompanied with an overvaluation of one’s importance or significance to others) or irritable mood of at least four consecutive days in duration that also includes at least three of the following symptoms:

  • Grandiosity (an exaggerated belief in one’s importance) or inflated self-esteem
  • Diminished need for sleep
  • Pressured speech
  • Racing thoughts or flight of ideas
  • Clear evidence of distractibility
  • Increased level of goal-focused activity at home, at work or sexually
  • Engaging in activities with a high potential for painful consequences

Other people must be able to observe the mood disturbance the mood can’t be as a result of substance abuse or a medical condition. Hypomanias are not severe enough to cause social or occupational impairment and do not contain psychosis.

According to Medscape, the DSM-5 defines depressive episodes (depressions; major depressions) as, for the same two weeks, experiencing five or more of the following symptoms, with at least one of the symptoms being either a depressed mood or characterized by a loss of pleasure or interest:

  • Depressed mood
  • Markedly diminished pleasure or interest in nearly all activities (also known as anhedonia)
  • Significant weight loss or gain or significant loss or increase in appetite
  • Hypersomnia or insomnia (too much or too little sleep)
  • Psychomotor retardation or agitation (physical and psychological slowing or restlessness)
  • Loss of energy or fatigue
  • Feelings of worthlessness or excessive guilt
  • Decreased concentration ability or marked indecisiveness
  • Preoccupation with death or suicide; the patient has a plan or has attempted suicide

These symptoms must cause significant impairment and distress and must not be the result of substance abuse or a medical condition. The criteria for depressions in bipolar type II are the same as those in bipolar type I.

DSM-5 Bipolar Disorder Type II Specifiers

While hypomanias and depressions are the two required moods for a bipolar disorder type II diagnosis, either mood can actually have additional common features and thus can be further defined by a specifier. Specifiers can be used with either mood type. So, for example, a person could experience a depressed mood with anxious distress or a hypomanic mood with anxious distress.

The available specifiers are:

  • With mixed features – when the diagnosed mood (either depression or hypomania) presents with symptoms of its opposite mood (this is often just termed a “mixed mood”)
  • With anxious distress – when the mood episode occurs with symptoms of anxiety
  • With rapid cycling – when four or more distinct mood episodes (of any type) occur within one year
  • With psychotic features – when the mood episode occurs with the symptoms of psychosis (the presence of delusions and/or hallucinations; delusions are false beliefs held in spite of evidence to the contrary; hallucinations are false experiences involving any sense); psychotic features can occur in bipolar type II depression but not hypomania
  • With catatonia – when the mood episode occurs with a syndrome characterized by muscular rigidity and mental stupor, sometimes alternating with great excitement and confusion
  • Peripartum onset (also known as postpartum onset) – when the mood episode occurs during pregnancy up to four weeks after delivery
  • Seasonal pattern – when the onset and remission of major depressive episodes are at specific times of the year
  • With atypical features – when the depression occurs with a specific combination of features such as oversleeping, a heavy feeling in the arms or legs and mood that improves in reaction to positive events
  • With melancholic features – when the depression occurs with specific depression features such as a lack a reactivity to positive events, significant anorexia or weight loss or depression that’s regularly worse in the morning

Bipolar Disorder Type II Treatment

When a person enters treatment for bipolar disorder type II, an evaluation is done, most importantly, to determine if the person is a danger to themselves or others or in a dangerously unstable state. Examples of this would be if the person is suicidal, homicidal or catatonic. Hypomanias do not typically require hospitalization but severe depressions may.

If a person has a dangerous condition or is unstable, the person will typically require inpatient treatment. Sometimes outpatient treatment is possible even with more severe bipolar symptoms when home support is significant. Day treatment or partial hospitalization where the person lives at home but receives multiple hours per day of treatment is also an option. If no imminent danger or major instability is present, the person can likely be treated on an outpatient basis.

Treatments generally used in bipolar disorder type II include:

  • Medication therapy
  • Psychotherapy
  • Electroconvulsive therapy
  • Lifestyle changes

Medication therapy in bipolar disorder type II is similar to that of bipolar disorder type I. The type of medication chosen will depend on the type of mood episode the person is in at the time. For example, if the person is in a depressed episode, the doctor might prescribe an antipsychotic, an anticonvulsant or a mood stabilizer. (Note that “antipsychotics” are not strictly used for psychosis treatment and “antipsychotic” is simply the drug class name.) Hypomania currently has no Food and Drug Administration (FDA)-approved medication treatments. Instead, doctors generally use treatments that have been approved for mania in the treatment of hypomania.

The following is a list of FDA-approved medications for use in bipolar disorder and the episode type for which they are approved (brand names in brackets):

  • Aripiprazole (Abilify) – For use in mania, mixed episodes and bipolar maintenance.
  • Asenapine (Saphris) – For used in mania and mixed episodes.
  • Carbamazepine Extended Release (Equetro) – For use in mania and mixed episodes.
  • Cariprazine (Vraylar) – For use in mania and mixed episodes.
  • Chlorpromazine (Thorazine) – For use in mania.
  • Lamotrigine (Lamictal) – For use in bipolar maintenance.
  • Lithium – For use in mania and bipolar maintenance.
  • Lurasidone (Latuda) – For use in depression.
  • Olanzapine (Zyprexa) – For use in mania, mixed episodes and bipolar maintenance.
  • Olanzapine/fluoxetine combination (Symbyax) – For use in depression.
  • Quetiapine (Seroquel) – For use in mania and depression.
  • Risperidone (Risperdal) – For use in mania and mixed episodes.
  • Valproate (Depakote) – For use in mania.
  • Ziprasidone (Geodon) – For use in mania and mixed episodes.

While the above are FDA-approved medications, it is common people with bipolar disorder type II to need multiple medications (polypharmacy) to remain stable. Other medications may also be used at a doctor’s discretion.

There are several types of psychotherapy that have been proven to be useful when treating bipolar disorder type II. They include:

  • Prodrome detection therapy – includes education about the early warning signs of a bipolar mood episode and what to do about them
  • Psychoeducation – includes learning about mental illness and bipolar, specifically
  • Cognitive therapy – includes several components including identifying dysfunctional beliefs and medication adherence
  • Interpersonal/social rhythm therapy – includes understanding the importance of routine in daily life
  • Family-focused therapy – includes components of the above therapies but involves all members of the family as well

Electroconvulsive therapy (ECT) can also be used to treat bipolar disorder type II. Electroconvulsive therapy involves running a current of electricity through the brain, causing a seizure, while the person in under general anesthesia.

The following situations are ones in which this treatment type might be chosen:

  • When rapid treatment is required due to the immediate dangers the illness poses to the person (such as in acute suicidality or in the case of food refusal)
  • When the risks of ECT are less than that of other treatments (such as may be in the case where the person is pregnant)
  • When other treatments have been tried and failed
  • When the person with bipolar disorder chooses this treatment type

Electroconvulsive therapy is also attractive when the person has previously had it and experienced a positive response.

Changing one’s lifestyle can also make a very positive change to bipolar disorder type II symptoms. Some of these changes are covered in therapies like family-focused therapy and interpersonal/social rhythm therapy. These lifestyle changes might include:

  • Adding an omega-3 supplement to the diet – this has been shown to help with bipolar depression symptoms
  • Adding an exercise routine
  • Creating a daily routine, particularly in regards to waking up and going to bed at the same time every day
  • Ceasing all alcohol and drug use

Bipolar Disorder Type II Prognosis

Those with bipolar disorder can have repeated relapses throughout the lifespan. This can even happen when on medication as for many, medications do stop working and have to be evaluated at one or more points. Nonetheless, those who stay on medication do have the brightest prognosis. Psychotherapy and social support also improve the prognosis of those with bipolar disorder.

While the initial diagnosis of bipolar disorder type II can be very scary, learning about bipolar disorder, working with qualified mental health professionals and staying adherent to treatment can make managing the illness quite possible.

article references

APA Reference
Tracy, N. (2021, December 28). What Is Bipolar II Disorder? Definition, Symptoms, Treatment, HealthyPlace. Retrieved on 2025, April 30 from https://www.healthyplace.com/bipolar-disorder/bipolar-types/what-is-bipolar-ii-disorder-definition-symptoms-treatment

Last Updated: January 7, 2022

Are Antidepressants Safe and Effective in Bipolar Depression Treatment?

The effectiveness and safety of antidepressants for bipolar depression treatment has been called into question by psychiatrists, researchers, and people living with bipolar depression. In fact, according to Dr. Nassir Ghaemi, director of the Bipolar Disorders Program at Emory University School of Medicine, “The use of antidepressants in bipolar disorder is perhaps the most controversial topic in the treatment of bipolar disorder” (Cascade, et al., 2007). Here’s a peek into the controversy to arm you with information about the safety and effectiveness of antidepressants for bipolar depression treatment.

Antidepressants in Bipolar Depression: What Changed?

Antidepressants used to be the go-to treatment for bipolar depression. They were typically the first medication prescribed, and often they were the only medication used. Then, in 2002, considering emerging studies and negative patient experiences, the American Psychiatric Association (APA) changed its recommendation: antidepressants should not be the first line of treatment; lithium or Lamictal should be used first.

Professional opinion differs regarding whether to follow the APA’s recommendation. It’s not for lack of research; the problem is that different studies yield conflicting information. One study will find, for example, that antidepressants destabilize someone’s mood and lead to rapid cycling of depression and mania or hypomania. However, another study will show that the use of antidepressants alone (called antidepressant monotherapy) helps depression with little risk of inducing mania.

This ambiguity can be frustrating for people living with bipolar depression who just want to feel better, return to normal functioning, and avoid swinging into a manic episode. A consultation with one psychiatrist might lead to a recommendation of antidepressants, but a psychiatrist giving a second opinion might advise that antidepressants be strictly avoided. By informing yourself of the pros and cons, you can avoid feeling caught in the middle between the two sides of the bipolar depression antidepressant debate.

Do Antidepressants Help or Harm? The Advantages and Disadvantages of Antidepressant Treatment in Bipolar Disorder

Using antidepressants for bipolar depression treatment could produce a few different results:

  • Your depression might improve, but the medication might work too well, leading to a manic or hypomanic episode, or a mixed episode which means the return of depression symptoms
  • Your depression might stay the same, unaffected by the medication
  • Your depression might be unaffected and your mood might destabilize, causing mania, mixed episodes, and rapid cycling

Mental health professionals in favor of using antidepressants in helping people with bipolar depression believe that with continued use, antidepressants lower the risk of relapse. Symptoms will go away and stay away because of the way antidepressants work in the brain.

Those that oppose prescribing antidepressants to people fighting bipolar depression believe that antidepressants:

  • Destabilize mood, inducing manic or mixed episodes
  • When paired with a mood stabilizer as often done, are rendered ineffective because the combination of medications cancels each other out
  • Don’t work well on their own or with mood stabilizers

Who Should (and Shouldn’t) Use Antidepressants to Treat Bipolar Depression?

Sometimes people wonder if there are certain groups who should (or shouldn’t) take antidepressants when they have bipolar depression. Because there are so many individual differences and a variety of variables that apply, there isn’t a straightforward answer to this question. This checklist can help you and your doctor decide if antidepressants are a good idea:

  • Have you successfully used antidepressants for bipolar depression in the past?
  • Have you stopped taking antidepressants only to have your symptoms worsen?
  • Are your mood episodes confined to depression and mania/hypomania without mixed episodes and no instances of rapid cycling between mood episodes?

Generally, “yes” answers can indicate that antidepressants might be safe and effective in your bipolar depression treatment. “No” answers could caution against taking antidepressant medications.

If after careful consideration of your personal history and experience with bipolar disorder and treatment, you and your psychiatrist decide that antidepressants will be safe and effective in your treatment, consider these guidelines recommended by a variety of researchers and mental health professionals:

  • Avoid using antidepressants as your sole form of medication
  • Antidepressants should be paired with mood stabilizers or perhaps other medications such as antipsychotics or anticonvulsants

While it appears that there is more evidence against antidepressant use in bipolar depression than in favor of it, the jury is still out regarding the safety and effectiveness of antidepressants for bipolar depression treatment. Studies have been done, but more are needed. Currently, too little evidence is available to declare with certainty that antidepressants are safe or dangerous, effective or ineffective in treating the depression side of bipolar disorder.
 
Perhaps the best thing to do is to be informed and have open conversations with your doctor. Regardless of what prescription medication you take, know yourself and your symptoms, and alert your doctor when something isn’t right. This is a great way to be active in your treatment so you can manage bipolar depression, with or without antidepressants.

article references

APA Reference
Peterson, T. (2021, December 28). Are Antidepressants Safe and Effective in Bipolar Depression Treatment?, HealthyPlace. Retrieved on 2025, April 30 from https://www.healthyplace.com/bipolar-disorder/bipolar-depression/are-antidepressants-safe-and-effective-in-bipolar-depression-treatment

Last Updated: January 7, 2022

Bipolar Depression Symptoms in Women

Bipolar depression symptoms in women can be different than bipolar depression symptoms in men. Both women and men with bipolar disorder I or II can develop bipolar depression, of course, but the way they experience it can vary. Keeping in mind that there are individual differences within genders and that each person’s experience with bipolar depression is unique, let’s explore, in general, what bipolar depression symptoms in women are like.

According to the authority on all mental disorders, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), women are more likely than men to experience bipolar depression. In bipolar I disorder, which occurs at equal rates in females and males, more females than males sink into depression. Further, more women than men are diagnosed with bipolar II, a mood disorder involving hypomania and more depressive episodes than bipolar I.

Females with bipolar disorder spend more time in bipolar depression than their male counterparts. What do these women experience?

Bipolar Depression Symptoms in Females

Bipolar depression symptoms in women are often debilitating. They can occur as a mixed episode right alongside or back-to-back with mania, or they can strike suddenly after a period of mood stability. Either way, they quickly lead to a downward spiral of thoughts, emotions, and behaviors. Women suffering from symptoms of bipolar depression often face:

  • Feelings of utter worthlessness
  • Strong guilt over things she thinks she’s done wrong
  • Isolation and loneliness
  • Feeling hollow, empty, and/or very sad and generally down
  • Apathy—no interest in activities or participation in life
  • Lack of energy so all-encompassing it is often referred to as leaden paralysis
  • Difficulty concentrating and making even simple decisions
  • Unhealthy sleeping and/or eating patterns (too much or too little of either)
  • Recurrent thoughts of death or suicide

While men do develop bipolar depression, and it can be devastating, women tend to experience more depressive symptoms, and they often experience them before they begin having manic episodes. There’s a fundamental difference between the genders that underlies a significant part of the reason: hormones.

Hormones and Bipolar Depression Symptoms in Women

Females’ unique hormonal activity increases the risk of developing bipolar depression, and it also increases the chance of relapse once that depression has entered remission. It’s important to note, however, that while hormones impact the severity of bipolar depression and its frequent recurrence, hormones don’t cause bipolar disorder.

Female hormones that underlie depression are those involved in:

  • Premenstrual syndrome (PMS)
  • Menstruation
  • Menopause
  • Pregnancy

Symptoms of these biological activities are often more intense when a woman has bipolar depression. Additionally, women with bipolar disorder are more likely to have episodes of bipolar depression during menopause.

The hormones and experience of pregnancy and childbirth often intensify bipolar depression. Postpartum depression can be much stronger and more difficult to manage when it’s accompanied by bipolar depression.

Pregnancy hormones have such an impact that women who are pregnant or who have recently given birth are seven times more likely than women without bipolar disorder to be admitted to the hospital because of symptoms of their disorder.  (WebMD Medical Reference, 2016).

Because the hormones of the menstrual cycle, menopause, pregnancy, and childbirth carry risks of worsening bipolar depression symptoms or leading to a new depressive episode, it’s important for women to be aware of how hormonal and mood activities affect them. Knowing how you experience bipolar depression and how your hormones impact your mood can help you take measures to manage both depression and hormones. Experiment to see what makes things better, create a treatment plan, and promise yourself to stick to it even when you don’t feel up to it.

Medication is almost always used to treat bipolar depression (in pregnancy, though, it’s used much less due to risks to the developing baby). It’s often used to treat female hormonal fluctuations as well. Include your medication in your treatment plan to help your brain find stability.

Bipolar depression symptoms in women can be intense and disruptive to life. Fortunately, symptoms can be treated and managed, and women with bipolar depression can live well.

article references

APA Reference
Peterson, T. (2021, December 28). Bipolar Depression Symptoms in Women, HealthyPlace. Retrieved on 2025, April 30 from https://www.healthyplace.com/bipolar-disorder/bipolar-depression/bipolar-depression-symptoms-in-women

Last Updated: January 7, 2022

What Is Bipolar I Disorder? Definitions, Symptoms, Treatment

Bipolar I disorder (also known as bipolar disorder type I and once known as manic depression) is a serious mental illness that affects hundreds-of-thousands of Americans every year. Bipolar I disorder (sometimes spelled bipolar disorder type 1) affects approximately one percent of the population over the course of their lifetime in the United States. This equals three million people in the United States. To put that in perspective, that’s slightly less than the risk of a woman developing bladder cancer in her lifetime or approximately equal to the risk of a man developing stomach cancer in his lifetime.

This type of bipolar disorder is often thought of as “classic” bipolar disorder as its symptoms were the first diagnostically recognized and it’s the kind most frequently portrayed in the media. Bipolar disorder type I is characterized by periods of a highly elevated or irritable mood known as mania alternating with periods of deep, profound depression. People with bipolar disorder type I can also experience periods without mood symptoms or with few mood symptoms. These are known as euthymic periods or euthymia.

Bipolar I Disorder Definition and DSM-5 Criteria

To be diagnosed with bipolar disorder type I, the person must have experienced at least one period of mania and at least one period of depression as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

According to Medscape, the DSM-5 defines manic episodes as at least one week, consecutively, of profound mood disturbance, characterized by elation, irritability, or expansiveness. (These are referred to as gateway criteria.) At least three of the following symptoms must also be present:

  • Grandiosity (an exaggerated belief in one’s importance, sometimes reaching delusional proportions; delusions are false beliefs held in spite of confrontation with contrary facts)
  • Diminished need for sleep
  • Excessive talking or pressured speech
  • Racing thoughts or flight of ideas
  • Clear evidence of distractibility
  • Increased level of goal-focused activity at home, at work or sexually
  • Excessive pleasurable activities, often with painful consequences

The mood disturbance must be sufficient to cause impairment at work or danger to the individual or others. The mood must not be the result of substance abuse or a medical condition.

According to Medscape, the DSM-5 defines depressive episodes (depressions; major depressions) as, for the same two weeks, experiencing five or more of the following symptoms, with at least one of the symptoms being either a depressed mood or characterized by a loss of pleasure or interest:

  • Depressed mood
  • Markedly diminished pleasure or interest in nearly all activities (also known as anhedonia)
  • Significant weight loss or gain or significant loss or increase in appetite
  • Hypersomnia or insomnia (too much or too little sleep)
  • Psychomotor retardation or agitation (physical and psychological slowing or restlessness)
  • Loss of energy or fatigue
  • Feelings of worthlessness or excessive guilt
  • Decreased concentration ability or marked indecisiveness
  • Preoccupation with death or suicide; patient has a plan or has attempted suicide

These symptoms must cause significant impairment and distress and must not be the result of substance abuse or a medical condition.

DSM-5 Bipolar Disorder Type I Specifiers

While manias and depressions are the two required moods for a bipolar disorder type I diagnosis, either mood can actually have additional common features and thus, can be further defined by a specifier. Specifiers can be used with either mood type. So, for example, a person could experience a mania with psychotic features or depression with psychotic features.

Specifiers that can be used are:

  • With mixed features – when the diagnosed mood (either depression or mania) presents with symptoms of its opposite mood (this is often just termed a “mixed mood”)
  • With anxious distress – when the mood episode occurs with symptoms of anxiety
  • With rapid cycling – when four or more distinct mood episodes (of any type) occur within one year
  • With psychotic features – when the mood episode occurs with the symptoms of psychosis (the presence of delusions and/or hallucinations; hallucinations are false experiences involving any sense)
  • With catatonia – when the mood episode occurs with a syndrome characterized by muscular rigidity and mental stupor, sometimes alternating with great excitement and confusion
  • Peripartum onset (also known as postpartum onset) – when the mood episode occurs during pregnancy up to four weeks after delivery
  • Seasonal pattern – when the onset and remission of major depressive episodes are at specific times of the year
  • With atypical features – when the depression occurs with a specific combination of features such as oversleeping, a heavy feeling in the arms or legs and mood that improves in reaction to positive events
  • With melancholic features – when the depression occurs with specific depression features such as a lack a reactivity to positive events, significant anorexia or weight loss or depression that’s regularly worse in the morning

Bipolar Disorder Type I Treatment

Bipolar disorder type I treatment typically starts with a thorough evaluation so as to decide on next steps. The most important part of the assessment is to determine whether the person is a danger to themselves or others or is unstable. Examples of this would be if the person is suicidal, homicidal or psychotic. If a person has a dangerous condition or is unstable, the person will typically require inpatient treatment in a psychiatric hospital. In the case where a person is experiencing bipolar symptoms but has a stable home life, that person may be a candidate for day treatment or partial hospitalization where the person lives at home but receives treatment for multiple hours each day. In most other cases, bipolar disorder type I can be treated in an outpatient setting.

Treatments generally used in bipolar disorder type I include:

Medication used in the treatment of bipolar disorder type I depends on the type of episode the person is having. For example, in an acute manic episode, a doctor might choose from an antipsychotic medication, a benzodiazepine or an anticonvulsant. (Note that benzodiazepines are not Food and Drug Administration (FDA) approved for use in bipolar mania but a doctor may prescribe them if needed.)

The following is a list of FDA-approved medications for use in bipolar disorder and the episode type for which they are approved (brand names in brackets):

While the above medications are approved by the FDA for the given circumstances, it is common for people with bipolar disorder type I to need multiple medications to remain stable. Additional, unlisted medications may also be of use at the doctor’s discretion ("List of Bipolar Depression Medications and Their Side-Effects").

There are several types of psychotherapy that have been proven to be useful when treating bipolar disorder type I. They include:

  • Prodrome detection therapy – includes education about the early warning signs of a bipolar mood episode and what to do about them
  • Psychoeducation – includes learning about mental illness and bipolar, specifically
  • Cognitive therapy – includes several components including identifying dysfunctional beliefs and medication adherence
  • Interpersonal/social rhythm therapy – includes understanding the importance of routine in daily life
  • Family-focused therapy – includes components of the above therapies but involves all members of the family as well

Electroconvulsive therapy (ECT) can also be used to treat bipolar disorder type I. Electroconvulsive therapy involves running a current of electricity through the brain, causing a seizure, while the person is under general anesthesia. This treatment type has been shown to be highly effective in treating acute mania.

The following situations are ones in which ECT treatment for bipolar disorder type I might be chosen:

  • When rapid treatment is required due to the immediate dangers posed by the illness
  • When the risks of ECT are less than that of other treatments
  • When other treatments have been tried and have failed
  • When the person with bipolar disorder chooses this treatment type

Lifestyle changes are generally part of the treatment of bipolar disorder type I. Some of these changes are covered through therapies like psychoeducation and interpersonal/social rhythm therapy. These lifestyle changes might include:

  • Adding an omega-3 supplement to the diet – this has been shown to help with bipolar depression symptoms
  • Exercising
  • Creating a daily routine, particularly in regards to waking up and going to bed at the same time every day
  • Ceasing all alcohol and drug use

Bipolar Disorder Type I Prognosis

Bipolar I disorder is a highly persistent illness with 40-50 percent of people experiencing another episode of mania within two years of their first episode. Even 40 percent of those treated with lithium – considered the gold standard treatment for bipolar disorder type I – go on to have a continuing illness. Additionally, suicide is a real risk with approximately 25-50 percent of people attempting suicide and about 11 percent completing suicide.

While that may sound bleak, many people with bipolar disorder type I do go on to lead happy and productive lives in the community. Medication adherence, therapy, and routine can all go a long way to making that happen.

article references

APA Reference
Smith, E. (2021, December 28). What Is Bipolar I Disorder? Definitions, Symptoms, Treatment, HealthyPlace. Retrieved on 2025, April 30 from https://www.healthyplace.com/bipolar-disorder/bipolar-types/what-is-bipolar-i-disorder-definitions-symptoms-treatment

Last Updated: January 7, 2022