How Effective Are Antidepressants for Bipolar?

Bipolar disorder is a type of mood disorder. The English name is Bipolar Disorder (BP).

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2018-03-29 11:03 My emotion is the seesaw of ice and fire2018-03-29 11:03

Emotional out-of-control constitutes his illness, and the native family is the root of the illness. He was deeply lonely and completely helpless. His efforts struggled to no avail. His social network also disintegrated, and friends, lovers, and family members followed. There is even resentment and dislike. ... more

Basic Information

nickname: bipolar disorder
English name: bipolardisorder, BP
English alias: Bipolaraffectivedisorder

Visiting department: Department of Psychology
Common causes: The etiology of bipolar disorder is unknown, and many biological, psychological and social environmental factors are involved in its pathogenesis.
Common symptoms: Depressive episode, manic episode, mixed episode

Causes of Bipolar Disorder

The etiology of bipolar disorder is unknown, and many biological, psychological and social environmental factors are involved in its pathogenesis. Biological factors are mainly related to heredity, neurobiochemistry, neuroendocrinology, and neural regeneration. Psychological vulnerability is closely related to bipolar disorder. Stressful life events are important socio-psychological factors. However, the above factors do not work alone. At present, it is emphasized that the interaction between genetics and environment or stress factors, and the occurrence time of such interactions, have an important impact on the occurrence of bipolar disorder.

Clinical manifestations of bipolar disorder

The clinical manifestations of bipolar disorder can be divided into depressive episodes, manic episodes or mixed episodes according to the characteristics of the episodes.

Depression

Bipolar depression episodes are difficult to distinguish from the clinical symptoms and biological abnormalities of unipolar depression episodes. Bipolar depression is often overlooked because of its atypical manifestations. Correct diagnosis of bipolar depression is a prerequisite for reasonable treatment. There are obvious differences in the treatment options and prognosis of the two. The differences between the two are mainly:

(1) Demographic characteristics Gender The prevalence of women with unipolar depression is almost twice that of men, but the gender difference is not obvious among patients with bipolar disorder; Age The average age of onset of bipolar disorder is 30 years old, and unipolar depression It is 40 years old, the former is significantly earlier than the latter, especially the onset of depression before the age of 25 is an important predictor of bipolar depression; Compared with unipolar depression, family transmission in patients with bipolar disorder (especially bipolar I) is more closely related to genetic factors.

(2) Characteristics of depressive episodes Characteristics of disease course Compared with unipolar depression, bipolar depression has more rapid onset, shorter duration, and frequent recurrent episodes; Symptom characteristics Bipolar depression is different from the symptoms of unipolar depression. Features include Emotional instability, irritability, psychomotor aggression, thinking competition / crowding, increased sleep, obesity / weight gain, inattention, more suicidal ideas and comorbid anxiety and substance abuse (tobacco, alcohol, Drugs, etc.).

2. Manic episode

(1) Rising mood I feel good, elated all day, elated, smiles, and has a certain infectivity, often resonating with people around me, causing bursts of laughter. Although some patients have a high mood, they are emotionally unstable and unpredictable, sometimes joyous and sometimes angry. Some patients are characterized by anger, irritability, and hostility, and may even show disruptive and aggressive behavior, but often quickly become angry or apologize immediately.

(2) Thoughtfulness, quick response, turbulent thoughts, many plans and goals, feeling that my tongue is racing against thoughts, and words can't keep up with the speed of thoughts, words are increasing, talking endlessly, mouths are floating, dancing and dancing, even with dry mouth Dry tongue, hoarse voice, still have to talk, keep your mouth open, the content is unrealistic, often change the theme; everything, pretentious, domineering, not forever.

(3) Increased activities. Energetic, tireless, wide-ranging, fast-moving, busy, and nosy, but often foolhardy, do nothing, do whatever you want, regardless of the consequences, often profligate, generous, in order to attract the eye to over-modify yourself Publicity, imperiousness, good teacher, likes to show off others, flirtatious, often go in and out of entertainment venues, attract bees and butterflies.

(4) Physical symptoms His face is ruddy, his eyes are bright, his heart rate is accelerated, and his pupils are dilated. Reduced sleep needs, difficulty falling asleep, early awakening, disturbed sleep rhythms; hyper appetite, overeating, or irregular eating due to being too busy, coupled with excessive consumption leading to weight loss; increased interest in the opposite sex, hypersexuality, and no sexual life control.

(5) Other symptoms: Attention cannot be concentrated and lasting, and it is easy to be transferred by the influence of the external environment; memory is enhanced, and the disorder is changeable; when the attack is extremely severe, the patient is extremely excited and agitated, and may have transient, fragmentary auditory hearing, behavior disorder Pointlessly, accompanied by impulsive behaviors; can also lead to conscious disturbances, illusions, hallucinations, and inconsistent thinking, called delirium mania. Most patients lose their awareness early in the disease.

(6) Hypomanic episodes Manic episodes with milder clinical manifestations are called hypomania. Patients may have a mood state that is high for at least several days, be energetic, have increased activity, have a significant sense of self-consciousness, lack of concentration, Nor can it last, mild splurge, increased social activity, increased libido, and reduced sleep needs. Sometimes it is irritable, arrogant, and arrogant, but not accompanied by psychotic symptoms such as hallucinations and delusions. It has a slight impact on the social function of patients, and some patients sometimes do not reach the level of affecting social function. The average person is often not easy to detect.

3. Mixed attacks

It means that the symptoms of mania and depression appear at the same time in one episode, which is relatively rare in clinical practice. It usually occurs when the mania and depression are rapidly phased. For example, a man with a manic episode suddenly turned into depression, and then returned to mania a few hours later, giving the impression of "mixing." However, this mixed state generally lasts for a short time, and most of them transition to the manic phase or the depressive phase more quickly. Manic symptoms and depressive symptoms are atypical during mixed episodes and are easily misdiagnosed as schizoaffective disorder or schizophrenia.

Bipolar disorder examination

Physical examination (including neurological examinations) is used to rule out bipolar disorder that may be caused by physical illness or substance dependence. Some patients with bipolar disorder (especially women) may have hypothyroidism, so thyroid function testing should be done. Those who are over-excited and poorly eaten should pay attention to understanding of water, salt metabolism and acid-base balance. Psychological tests, neurochemical tests, neuroelectrophysiology, and brain imaging are available for reference. The blood concentration of the drug is measured during the treatment to ensure efficacy, monitor toxic and side effects, and adherence to treatment.

Bipolar disorder diagnosis

The diagnosis of bipolar disorder should be determined mainly based on medical history, clinical symptoms, course characteristics, physical examination and laboratory examination, and comparison of relevant diagnostic criteria for mental illness. Diagnosis of typical cases is generally not difficult. The current international diagnostic standards are ICD-10 and DSM-IV. However, any kind of diagnostic criteria will inevitably have its limitations. Close clinical observation, grasping the main symptoms of the cross-section of the disease and the characteristics of the longitudinal course of disease, and scientific analysis are the reliable basis for clinical diagnosis.

Bipolar disorder treatment

Treatment principle

(1) Individualized treatment principles Need to consider the patient's gender, age, main symptoms, physical condition, whether to use drugs in combination, first or relapse, previous treatment history, and other factors, choose the appropriate drug, starting from a lower dose, according to Patient response titration. During the treatment process, it is necessary to closely observe the treatment response, adverse reactions, and possible drug interactions to make timely adjustments to improve patient tolerance and compliance.

(2) Comprehensive treatment principles Comprehensive measures such as drug therapy, physical therapy, psychological therapy, and crisis intervention should be adopted to improve efficacy, improve compliance, prevent relapse and suicide, and improve social function and quality of life.

(3) Long-term treatment principle Since bipolar disorder recurs in a cyclical manner almost throughout life, the frequency of its occurrence is much higher than that of depressive disorder. Therefore, the long-term treatment principle should be adhered to. The purpose of treatment in the acute phase is to control symptoms and shorten the course of the disease; the purpose of treatment in the consolidation phase is to prevent the recurrence of symptoms and promote the recovery of social functions;

2. Drug treatment

The main treatments are antimanic drugs lithium carbonate and antiepileptic drugs (valproate, carbamazepine, lamotrigine, etc.), which are also known as mood stabilizers. For patients with significant agitation, antipsychotics can be combined, including classic antipsychotics haloperidol, chlorpromazine, and atypical antipsychotics olanzapine, quetiapine, risperidone, ziprasidone, Aripiprazole and others. Severe patients can be combined with improved electroconvulsive therapy. For refractory patients, clozapine combined with lithium carbonate can be considered. Pay attention to adverse drug reactions and interactions during treatment. For patients with bipolar depression, in principle, the use of antidepressants is not recommended, because it is likely to induce manic episodes, rapid cycling episodes, or cause chronic depression symptoms. For those with severe depressive episodes or even accompanied by significant negative behaviors, depressive episodes The overwhelming majority of the disease course and those with severe anxiety and obsessive-compulsive symptoms can consider combining antidepressants with short-term therapy on the basis of adequate mood stabilizer therapy. Once the above symptoms have resolved, antidepressants should be reduced or discontinued as soon as possible .

3. Physical therapy

Acute severe manic episodes, severe negative bipolar depression, or refractory bipolar disorder can be treated with modified electrical tics (MECT), but the drug dose should be appropriately reduced. Repeated transcranial magnetic stimulation (rTMS) treatment may be considered for mild to moderate bipolar depression.

Bipolar disorder prevention

Follow-up studies found that patients who had recovered from drug therapy had a higher recurrence rate within 1 year after discontinuation, and the recurrence rate of bipolar disorder was significantly higher than that of unipolar depression, which were 40% and 30%, respectively. Taking lithium salt prophylactic treatment can effectively prevent the recurrence of mania or depression. Psychotherapy and social support systems also play a very important role in preventing the recurrence of this disease. Patients should be relieved or relieved of excessive psychological burden and pressure as much as possible, help patients to solve practical difficulties and problems in life and work, and improve patients' ability to cope. And actively create a good environment for it to prevent recurrence.