Bipolar Disorder combines depression with episodes of mania or hypomania with more frequently occurring depression. Unipolar depression refers to those suffering only depression. Individuals may only suffer from recurrent bouts of depression for some time before an initial manic attack which creates confusion in establishing the correct diagnosis.
Subtle differences exist between unipolar depression and bipolar depression. In Bipolar Disorder symptoms of depression generally occur at an earlier age, are of shorter duration and occur more frequently than in unipolar depression. Not uncommonly bipolar depression may be associated with a greater incidence of excessive sleep, emotional lability and weight instability.
Manifestations of depression in bipolar disorder include a low or irritable mood, fatigue, and lack of ability to concentrate. Other symptoms include indecisiveness, loss of energy, change in weight and sleep patterns. Many lose interest or pleasure in previous enjoyable activities.
Genetic inheritance plays a major role in Bipolar Disorder. Onset typically appears during the late teenage years which impacts on normal development and function. Bipolar Disorder increases the risk of suicide, substance abuse and academic, behavioral or interpersonal difficulties.
Factors increasing the risk of suicide include Bipolar 1 Disorder, predominant depression, being a single parent, rapid cycling and experiencing coexisting borderline personality disorder. Women attempt suicide more often, but men actually complete suicide more frequently. A previous attempt remains the most common risk factor. Often a precipitating event such as interpersonal conflict acts as the watershed moment.
Death occurs at a younger age in Bipolar Disorder than in the general population. Suicide accounts for only a fraction this problem.
Treatment remains an issue lacking in uniformity. Improperly treated, Bipolar Disorder may worsen in trajectory. Initial assessment includes determination of whether the individual poses a physical threat to themselves or others in which case hospitalization may be required.
Mania generally is addressed by a mood stabilizer. Popular in this group are lithium, valproate and carbamazepine. An increasing tendency relies on anti-psychotics to treat mania. Often a combination of agents appears necessary. Standard antidepressants remain out of favor for the depression of Bipolar Disorder due to the fear they might precipitate a manic attack. Anti-psychotic therapies are the current preferred drugs for Bipolar Depression but they may be associated with a long list of adverse effects.
