How long does antidepressant induced mania last

Is Antidepressant-Induced Mania Possible?

Feeling invincible, impulsive, and endlessly energetic aren’t signs typically linked to depression — unless you may be experiencing antidepressant-induced mania linked to undiagnosed bipolar disorder.

Taking antidepressants may increase your chances of a manic episode in bipolar disorder but also in conditions that don’t typically feature the symptom — for example, major depressive disorder, if you have bipolar disorder that’s gone undiagnosed.

Not everyone taking antidepressants will experience mania.

Mania is a mood episode that presents with symptoms like agitation, elevated mood, and impulsivity. It’s primarily a formal symptom of bipolar disorder.

What are mania and hypomania?

Mania is a state of heightened mood, agitation, and intense physical and mental energy that can lead to major impairment in social or occupational areas of function. It can present in a number of ways, but often involves:

rapid speech
decreased need for sleep
feelings of grandiosity
racing thoughts
irritability
impulsivity
distractibility

Hypomania is a milder version of mania that involves some of the same symptoms but not to the point of causing significant impairment or keeping you from your everyday routine.

Antidepressants may increase the chances of an episode of mania or hypomania in certain people being treated for either unipolar or bipolar depression. That’s why some people say that antidepressants can make bipolar disorder worse. But it isn’t that simple.

While antidepressants are primarily prescribed for the treatment of major depressive disorder (unipolar or clinical depression), they may also be used to treat conditions featuring depressive episodes, like bipolar disorder.

In some cases, antidepressants are also used in the management of chronic pain, anxiety, and chronic insomnia.

Mania or affective switching?

During antidepressant treatment, shifting from an episode of depression to one that involves agitation is known as affective switching.

Some conditions, like bipolar disorder, are naturally characterized by cyclic affective switching. This means that people go through mood episodes in a given period of time. Antidepressant-induced mania isn’t part of the bipolar disorder cycle.

When you live with depression, you don’t go through mood episodes, like in bipolar disorder. Your mood typically stays the same, particularly in untreated depression. This is why mania during depression treatment can be the result of undiagnosed bipolar disorder.

But if you experience antidepressant-induced mania during your depression treatment, do you still have major depression or is it now bipolar disorder? Maybe neither.

Some experts argue that experiencing antidepressant-induced mania can’t be properly classified under current diagnostic criteria for depression or bipolar disorder and should have its own subtype category in the list of diagnoses.

Mania in bipolar disorder

Mania and hypomania are formal symptoms of bipolar disorder.

Mania is not a formal symptom of depression, a condition defined as persistent low mood and inability to experience joy.

You may go through depressive episodes when living with bipolar disorder, but it’s the presence of mania or hypomania that defines this condition.

You can experience bipolar disorder without depression, but you can’t experience bipolar disorder without mania or hypomania.

Who is more likely to experience antidepressant-induced mania?

People already living with bipolar disorder are more likely to experience a sudden episode of mania after taking certain antidepressants. But not everyone with the condition.

A 2018 review of bipolar depression notes that antidepressant-induced affective switching appears more common among people who:

experience depression with mixed features
are on older generation antidepressants
have a history of substance use disorder

You may be more likely to experience antidepressant-induced mania if you:

live with bipolar I disorder
are receiving antidepressant monotherapy
already experience rapid mood cycling

Women, younger people, and those with a family history of bipolar disorder, may have an increased chance of antidepressant-induced hypomania, according to a 2020 unipolar depression review.

Research suggests the use of older generation antidepressants, known as tricyclics, may cause a greater chance of mania compared to modern antidepressant options.

Tricyclic antidepressants include:

doxepin
imipramine
amitriptyline
clomipramine
desipramine
nortriptyline
amoxampine
protriptyline
trimipramine

Antidepressant-induced mania is not considered a common side effect of antidepressants.

According to cross-sectional patient data collected over a 2-year period, the challenges people may experience when taking these medications include:

indigestion
nausea
abdominal pain
diarrhea
constipation
sudden heat stroke
intense sweating

dry mouth
changes in sleeping patterns
diminished sex drive
changes in weight

Different antidepressants may come with side effects more common to their class.

Selective serotonin reuptake inhibitors (SSRIs), for example, are known to have common side effects of dizziness, anxiety, headaches, and restlessness.

There’s no scientific evidence suggesting antidepressants cause or trigger bipolar disorder.

Antidepressants may increase the chance you’ll experience an episode of mania if you have major depressive disorder when you also have bipolar disorder but haven’t yet received a diagnosis.

Experts have not reached a consensus on determining if this experience should lead to a new bipolar disorder diagnosis.

Currently, researchers are considering including a bipolar or depressive disorder subtype that may be specific to antidepressant sensitivity causing a manic episode.

If you’ve been diagnosed with major depressive disorder, experiencing mania is not typical. Any moods related to elation, agitation, or grandiosity may be medication-induced or could mean you also have bipolar disorder.

If you live with bipolar disorder, you can also experience antidepressant-induced mania outside of your cyclic mood cycles.

While antidepressant-induced mania remains diagnostically controversial, mood stabilizers may help prevent this type of affective switching, regardless of the underlying condition.

Article resources

Barbuti M, et al. (2017). Antidepressant-induced hypomania/mania in patients with major depression: Evidence from the BRIDGE-II-MIX study. https://www.sciencedirect.com/science/article/abs/pii/S0165032717300290
Beaupre M, et al. (2020). Antidepressant-associated mania in bipolar disorder: A review and meta-analysis of potential clinical and genetic risk factors. https://journals.lww.com/psychopharmacology/Abstract/2020/03000/Antidepressant_Associated_Mania_in_Bipolar.11.aspx
Bipolar disorder. (2020). https://www.nimh.nih.gov/health/topics/bipolar-disorder
Dailey MW, et al. (2022). Mania. https://www.ncbi.nlm.nih.gov/books/NBK493168/
Gill N, et al. (2020). A review of antidepressant-associated hypomania in those diagnosed with unipolar depression—risk factors, conceptual models, and management. https://www.researchgate.net/publication/340175853_A_Review_of_Antidepressant-Associated_Hypomania_in_Those_Diagnosed_with_Unipolar_Depression-Risk_Factors_Conceptual_Models_and_Management
Gitlin MJ. (2018). Antidepressants in bipolar depression: An enduring controversy. https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-018-0133-9
Patel R, et al. (2015). Do antidepressants increase the risk of mania and bipolar disorder in people with depression? A retrospective electronic case register cohort study. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4679886/
Ramic E, et al. (2020). Assessment of the antidepressant side effects occurrence in patients treated in primary care. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428926/
Table 2 list of antidepressants and their categorizations. (n.d.). https://www.ncbi.nlm.nih.gov/books/NBK36406/table/ch2.t2/

Is Antidepressant-Induced Mania Possible?

Not everyone taking antidepressants will experience mania.

Mania is a mood episode that presents with symptoms like agitation, elevated mood, and impulsivity. It’s primarily a formal symptom of bipolar disorder.

What are mania and hypomania?

rapid speech
decreased need for sleep
feelings of grandiosity
racing thoughts
irritability
impulsivity
distractibility

Hypomania is a milder version of mania that involves some of the same symptoms but not to the point of causing significant impairment or keeping you from your everyday routine.

In some cases, antidepressants are also used in the management of chronic pain, anxiety, and chronic insomnia.

Mania or affective switching?

During antidepressant treatment, shifting from an episode of depression to one that involves agitation is known as affective switching.

But if you experience antidepressant-induced mania during your depression treatment, do you still have major depression or is it now bipolar disorder? Maybe neither.

Mania in bipolar disorder

Mania and hypomania are formal symptoms of bipolar disorder.

Mania is not a formal symptom of depression, a condition defined as persistent low mood and inability to experience joy.

You may go through depressive episodes when living with bipolar disorder, but it’s the presence of mania or hypomania that defines this condition.

You can experience bipolar disorder without depression, but you can’t experience bipolar disorder without mania or hypomania.

Who is more likely to experience antidepressant-induced mania?

People already living with bipolar disorder are more likely to experience a sudden episode of mania after taking certain antidepressants. But not everyone with the condition.

A 2018 review of bipolar depression notes that antidepressant-induced affective switching appears more common among people who:

experience depression with mixed features
are on older generation antidepressants
have a history of substance use disorder

You may be more likely to experience antidepressant-induced mania if you:

live with bipolar I disorder
are receiving antidepressant monotherapy
already experience rapid mood cycling

Women, younger people, and those with a family history of bipolar disorder, may have an increased chance of antidepressant-induced hypomania, according to a 2020 unipolar depression review.

Research suggests the use of older generation antidepressants, known as tricyclics, may cause a greater chance of mania compared to modern antidepressant options.

Tricyclic antidepressants include:

doxepin
imipramine
amitriptyline
clomipramine
desipramine
nortriptyline
amoxampine
protriptyline
trimipramine

Antidepressant-induced mania is not considered a common side effect of antidepressants.

According to cross-sectional patient data collected over a 2-year period, the challenges people may experience when taking these medications include:

indigestion
nausea
abdominal pain
diarrhea
constipation
sudden heat stroke
intense sweating
dry mouth
changes in sleeping patterns
diminished sex drive
changes in weight

Different antidepressants may come with side effects more common to their class.

Selective serotonin reuptake inhibitors (SSRIs), for example, are known to have common side effects of dizziness, anxiety, headaches, and restlessness.

There’s no scientific evidence suggesting antidepressants cause or trigger bipolar disorder.

Antidepressants may increase the chance you’ll experience an episode of mania if you have major depressive disorder when you also have bipolar disorder but haven’t yet received a diagnosis.

Experts have not reached a consensus on determining if this experience should lead to a new bipolar disorder diagnosis.

Currently, researchers are considering including a bipolar or depressive disorder subtype that may be specific to antidepressant sensitivity causing a manic episode.

If you live with bipolar disorder, you can also experience antidepressant-induced mania outside of your cyclic mood cycles.

While antidepressant-induced mania remains diagnostically controversial, mood stabilizers may help prevent this type of affective switching, regardless of the underlying condition.

Article resources

Barbuti M, et al. (2017). Antidepressant-induced hypomania/mania in patients with major depression: Evidence from the BRIDGE-II-MIX study. https://www.sciencedirect.com/science/article/abs/pii/S0165032717300290
Beaupre M, et al. (2020). Antidepressant-associated mania in bipolar disorder: A review and meta-analysis of potential clinical and genetic risk factors. https://journals.lww.com/psychopharmacology/Abstract/2020/03000/Antidepressant_Associated_Mania_in_Bipolar.11.aspx
Bipolar disorder. (2020). https://www.nimh.nih.gov/health/topics/bipolar-disorder
Dailey MW, et al. (2022). Mania. https://www.ncbi.nlm.nih.gov/books/NBK493168/
Gill N, et al. (2020). A review of antidepressant-associated hypomania in those diagnosed with unipolar depression—risk factors, conceptual models, and management. https://www.researchgate.net/publication/340175853_A_Review_of_Antidepressant-Associated_Hypomania_in_Those_Diagnosed_with_Unipolar_Depression-Risk_Factors_Conceptual_Models_and_Management
Gitlin MJ. (2018). Antidepressants in bipolar depression: An enduring controversy. https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-018-0133-9
Patel R, et al. (2015). Do antidepressants increase the risk of mania and bipolar disorder in people with depression? A retrospective electronic case register cohort study. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4679886/
Ramic E, et al. (2020). Assessment of the antidepressant side effects occurrence in patients treated in primary care. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428926/
Table 2 list of antidepressants and their categorizations. (n.d.). https://www.ncbi.nlm.nih.gov/books/NBK36406/table/ch2.t2/

Bipolar disorder - Official website of the FGBUZ KB No. 85 FMBA of Russia

General brief information

Bipolar disorder, also known as bipolar affective disorder (BAD) and formerly as manic-depressive psychosis (PMD). It is a set of mood disorders characterized by marked fluctuations in mood, thinking, behaviour, energy and ability to perform daily activities.

A person suffering from this disorder alternates his state of mind between mania or hypomania - a phase of joy, exaltation, euphoria and grandiosity and depression, with sadness, inhibition and ideas of death. nine0005

Four types of bipolar disorder were defined by severity and alternation of moods over time:

Bipolar I disorder
Bipolar disorder type II
Cyclothymia
Non-specific bipolar disorder

Because bipolar disorder occurs in young people, it has a high social cost. It is the second leading cause of disability worldwide. In addition, those who suffer from it pose a higher risk than the general population of deaths from suicide, homicide, accidents, and natural causes such as cardiovascular disease. nine0005

In type 1, the person alternates between depressive episodes with full manic episodes, and in type 2, he alternates between depressive episodes and hypomanic (less severe) episodes.

The symptoms of this disorder are severe, different from the normal highs and lows of mood. These symptoms can lead to relationship problems, work, school, or even suicide.

During the depression phase a person may experience:

Negative perception of life. nine0014
Inability to feel the pleasure of life.
No energy
Self-criticism.
In extreme cases, suicide.

During a manic phase a person may experience:

Denial that there is a problem.
Sudden change of mood.
Irrational financial decisions.
Feeling of great enthusiasm
Don't think about the consequences of your actions.
Lack of sleep

Although childhood onset occurs, the normal age of onset for type 1 is 18 years and for type 2 is 22 years.

About 10% of bipolar 2 cases develop into type 1.

Although the causes are unclear, genetic and environmental factors (stress, childhood abuse) play a role.

Treatment usually includes psychotherapy, medication, sometimes electroconvulsive therapy may be helpful.

Symptoms

Signs and symptoms of the depressive phase of bipolar disorder include:

Persistent sadness
Lack of interest in engaging in pleasurable activities.
Apathy or indifference.
Anxiety or social anxiety.
Chronic pain or irritability.
Lack of motivation
Guilt, hopelessness, social isolation.
Lack of sleep or appetite. nine0014
Suicidal thoughts
In extreme cases, there may be psychotic symptoms: delusions or hallucinations are usually unpleasant.

Manic symptoms

Mania can occur in varying degrees:

Hypomania

This is the least severe degree of mania and lasts at least 4 days. This does not result in a noticeable decrease in a person's ability to work, communicate, or adapt.

He also does not require hospitalization and does not have psychotic characteristics. nine0005

In fact, overall functioning may improve during a hypomanic episode and is considered a natural anti-depression mechanism.

If an event of hypomania is not accompanied by or precedes depressive episodes, it is not considered a problem if the state of mind is uncontrollable.

Symptoms may last from several weeks to several months.

It is characterized by:

Great energy and activity.
Some people may be more creative, while others may be more irritable. nine0014
A person may feel so good that he denies that he is experiencing a state of hypomania.

Mania

Mania is a period of euphoria and high mood for at least 7 days. If left untreated, a manic episode can last 3 to 6 months.

It is characterized by displaying three or more of the following behaviors:

Talk quickly and smoothly.
Accelerated thoughts.
Agitation.
Light condition. nine0014
Impulsive and risky behavior.
Excessive cash expenses
Hypersexuality.
A person with mania may also experience lack of sleep and inadequate judgment.
On the other hand, maniacs may have problems with alcohol or other substance abuse.

In extreme cases, they may experience psychosis, so that contact with reality is broken, having a high state of mind.

It is common for a manic person to feel incomparable or indestructible and to feel chosen to realize a goal. nine0005

Approximately 50% of people with bipolar disorder experience hallucinations or delusions, which can lead to violent behavior or admission to a psychiatric hospital.

Mixed episodes

In bipolar disorder, a mixed episode is a condition in which mania and depression occur simultaneously.

People who experience this condition may have thoughts of grandiosity while having depressive symptoms such as suicidal thoughts or feelings of guilt. nine0005

People who are in this state are at high risk of committing suicide because they confuse depressive emotions with mood swings or difficulty controlling impulsivity.

Causes

The exact causes of bipolar disorder are unclear, although they are thought to be largely genetic and environmental.

Genetic factors

It is believed that 60-70% of the risk of developing bipolarity depends on genetic factors. nine0005

Several studies have shown that certain genes and chromosomal regions are associated with susceptibility to develop the disorder, with each gene being more or less important.

The risk of bipolar disorder in people with family members with the same diagnosis is 10 times higher than in the general population.

Studies indicate heterogeneity, meaning that different genes are involved in different families.

Environmental factors

Research shows that environmental factors play an important role in the development of bipolar disorder, and psychosocial variables may interact with genetic dispositions. nine0005

Recent life events and interpersonal relationships contribute to manic and depressive episodes.

30-50% of adults diagnosed with bipolar disorder have been found to report abuse or trauma in childhood, which is associated with an earlier onset of the disorder and more suicide attempts.

Evolutionary factors

From evolutionary theory, one might think that the negative effects that bipolar disorder can have on adaptability cause genes not to be selected by natural selection. nine0005

However, there is still a high incidence of BD in many populations, so there may be some evolutionary benefit.

Doctors of evolutionary medicine suggest that high rates of BR throughout history suggest that the change between depressive and manic states suggested some evolutionary advantage in ancestral humans.

In highly stressed individuals, depressed mood can serve as a defense strategy to escape external stress, store energy, and increase sleep hours. nine0005

Mania could benefit from her relationship with creativity, confidence, high energy levels and greater productivity.

Physiological, neurological and neuroendocrine factors

Brain imaging studies have shown differences in the volume of various brain areas between patients with bipolar disorder and healthy patients.

An increase in the volume of the lateral ventricles and an increase in the rate of white matter hyperintensity were found. nine0005

Magnetic resonance studies have shown that there is an abnormal modulation between the abdominal prefrontal region and the limbic regions, especially the amygdala. This will contribute to poor emotional regulation and mood-related symptoms.

On the other hand, there is evidence of an association between early stressful experiences and dysfunction of the hypothalamic-pituitary-adrenal axis, leading to hyperactivation.

Less common bipolar disorder can result from trauma or a neurological condition: brain injury, stroke, HIV, multiple sclerosis, porphyria, and temporal lobe epilepsy. nine0005

The neurotransmitter responsible for regulating mood, dopamine, has been found to increase its transmission during the manic phase and decrease during the depressive phase.

Glutamate increases in the left dorsolateral prefrontal cortex during the manic phase.

Diagnosis

A patient must have at least two episodes of affective disorder to be diagnosed with bipolar disorder. At the same time, at least one of them must be either manic or mixed. For the correct diagnosis, the psychiatrist must take into account the characteristics of the patient's history, information received from his relatives. Currently, it is believed that the symptoms of bipolar disorder are characteristic of 1% of people, and in 30% of them the disease becomes a severe psychotic form. Determination of the severity of depression is carried out using special scales. The manic phase of bipolar disorder must be differentiated from arousal caused by the use of psychoactive substances, lack of sleep, or other causes, and the depressive phase from psychogenic depression. Psychopathy, neurosis, schizophrenia, as well as affective disorders and other psychoses due to somatic or nervous diseases should be excluded. nine0005

Methods of treatment

The main goal of the treatment of bipolar disorder is to normalize the mental state and mood of the patient, to achieve long-term remission. In severe cases of the disease, patients are hospitalized in the psychiatric department. Mild forms of the disorder can be treated on an outpatient basis. Antidepressants are used to relieve a depressive episode. The choice of a specific drug, its dosage and frequency of administration in each case is determined by a psychiatrist, taking into account the age of the patient, the severity of depression, and the possibility of its transition to mania. If necessary, the appointment of antidepressants is supplemented with mood stabilizers or antipsychotics. Antidepressants help to stop depressive states in bipolar disorder. Drug treatment of bipolar disorder in the stage of mania is carried out by normotimics, and in severe cases of the disease, antipsychotics are additionally prescribed. In the stage of remission, psychotherapy (group, family and individual) is shown. nine0005

symptoms of bipolar disorder, how it proceeds, how to find a psychiatrist, diagnosis and treatment

Victoria K.

lives with bipolar disorder

The first signs of the disease appeared in my teenage years, and the psychiatrist diagnosed BAD at the age of 26.

According to WHO, 45 million people worldwide suffer from bipolar disorder. This disease greatly reduces the quality of life: in some periods you are overly energetic and do things that you can regret, in other periods you are not able to get off the couch to do everyday things. nine0005

I will tell you how I have BAD and what I do to cope with the disorder and live like all ordinary people.

Go see a doctor

Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don't write prescriptions, we make recommendations. Relying on our point of view or not is up to you. nine0005

What is Bipolar Affective Disorder?

Bipolar Affective Disorder, or BAD, is a mental disorder with alternating emotional ups and downs in mood. It is affective just because it is associated with violations of the emotional state, that is, mood - in psychiatry, the manifestation and experience of emotions is called affect. Previously, this disease was called manic-depressive psychosis.

Bipolar Disorders - A Physician's Handbook MSD

Why bipolar disorder develops is not exactly known. Among the reasons are heredity, traumatic events, violations of the production of neurotransmitters - substances due to which signals are transmitted between brain neurons. The disease often manifests itself in adolescence or in the period between 20 and 30 years.

How Bipolar Disorder Manifests

BAD usually starts abruptly, followed by periods without symptoms and periods of exacerbations. The peculiarity of the disease is that during periods of exacerbations there are episodes, or phases, with different emotional states that can replace each other in an arbitrary order. nine0005

Bipolar Disorder - Mayo Clinic Blog Article

For example, when the illness escalates, the following conditions may occur.

Mania - a state of elevated or irritable mood. The person feels energetic, actively engaged in something, such as finding a new hobby or even trying to open a business. As a rule, he sleeps little, is self-confident, talkative, he has a lot of ideas, often crazy. Risk sensitivity may decrease - for example, a person invests all the money in a hopeless business or gets into a loan. Hobbies for gambling, extreme sports are not uncommon. At the same time, a person feels great, but often cannot concentrate on one thing, work productively. nine0005

The extreme degree of mania is manic psychosis, when delusions of persecution, hallucinations, excessive activity develop, a person can become dangerous to himself or others.

Hypomania is a kind of mild mania. A person is in a state of emotional uplift, but this uplift is not so pronounced. However, the mood still improves, the need for sleep decreases, the person is creative, relaxed, feels euphoric, and his productivity increases. Although in some people such periods may be accompanied by irritability and a decrease in concentration. nine0005

Depression - low mood, loss of interest in life, fatigue, guilt, indecision, decreased concentration. Sleep and appetite disturbances may occur. Sometimes there are thoughts of suicide, the futility of one's own life.

/bye-depression/

“It reminded me of a strict regime sanatorium”: how much I spent on treating depression

Between exacerbations, a person can return to normal, although it happens that his performance is still reduced. nine0005

Manifestations of the phases of bipolar disorder, according to the National Institute of Mental Health USA

Parameter	Mania	Depression
Mood	Excitement, joy, irritability, resentment	Sadness, depression, emptiness, anxiety, hopelessness
Sleep	Reduced need for sleep	Trouble falling asleep, getting up early or sleeping too much
Appetite	Loss of appetite	Often increased appetite, weight gain
Communication	Talkativeness	Slow speech, forgetfulness
Concentration	Feeling of jumping thoughts, multitasking	Problems with attention and decision making, distraction
Behavior	Risk appetite, runaway spending, promiscuous sex	Lack of pleasure and interest in anything, decreased libido
Subjective feelings	Feeling of self-importance, talent and power	Feelings of worthlessness, suicidal thoughts, suicide attempts

Mood

Excitement, joy, irritability, resentment

Sleep

Decreased need for sleep

Appetite

Loss of appetite

Communication

Talking

Concentration

Feeling of thoughts, multitasking

behavior

Risk, unbridled sex

Subjective sensations

Feeling and power

Depression

Mood

Sadness, depression, emptiness, anxiety, hopelessness

Sleep

Trouble falling asleep, getting up early or sleeping too much

Appetite

often increased appetite, weight gain

Communication

Slow speech, forgetfulness

Concentration

Problems with attention and decision-making, Disperionity

behavior

Lack of pleasure and interest in something, decrease in libido

Subjective feelings

Feelings of worthlessness, suicidal thoughts, suicide attempts

There are two main types of bipolar disorder according to how the disease manifests itself:

When there was at least one manic episode and depressive episodes recur.
When there are periods of depression and at least one episode of hypomania, but without full mania.

Bipolar Disorder - National Institute of Mental Health USA

I just have bipolar affective disorder type 2. This means that there are no full-fledged manias, but there are hypomanias and severe depressions.

Hypomania is a very cool time for me. You can do everything: get a second degree, run a marathon, learn English, go on an unplanned trip. And so for several months during which you do not sleep, do not eat, acquire new friends, start novels, end old relationships. You feel all sensations in the maximum range. During the day, it can throw several times from tears and the desire to die to incredible happiness. nine0005 This is what mania looks like in BAD. Source: Twitter

After hypomania comes depression. And immediately there is not enough strength not only for what was started during the previous phase, but also for ordinary things. The most understandable image of depression for me is “pressed down by a concrete slab. ” It becomes hard to do the simplest things: wash the dishes, change clothes, go to the store.

Unfortunately, the brighter the hypomania goes, the worse the depression gets later — that's why, with experience, I stopped enjoying the active phase. nine0434 Now it is even more difficult for me: I understand what is happening with my brain, but I cannot control it.

As I remember now, my first hypomania happened at the age of 12. Then there were periods of exacerbations clearly in a year and a half: hypomania lasts 2-3 months, usually May - July, depression - 5-6 months, usually in October - March, in between remission occurs when I feel normal. If I am in a long-term remission, then I hardly notice phase changes: mood swings are smoothed out with the help of medications or psychotherapy. nine0005

10 podcasts about health and medicine

The usual course of bipolar affective disorder

Viktor Lebedev

psychiatrist, science journalist

During an exacerbation of bipolar disorder, episodes of mania or hypomania and depression may alternate. There is a clear separation of phases: first a hypomanic or manic episode, then a depressive episode, it happens that there are recurring episodes of depression, then hypomania. In the latter case, hypomanic phases are sometimes not noticed, a person may be diagnosed with recurrent, that is, recurring depression, and may be prescribed the wrong treatment. nine0005

In fact, in BAD, the phases can alternate in any order, the diagnosis is made if there is any combination of manic and depressive episodes. The first time the disease usually begins with an episode of mania or hypomania, which develops into depression. Less commonly, it starts with depression, then mania or hypomania occurs. But in any case, there must be affective disturbances, that is, mood disturbances.

The exacerbation of the disease lasts from several weeks to several months. This also depends on whether the person is receiving medical treatment. If you respond quickly to an exacerbation, you can sometimes return to normal health in a week. If not treated, the exacerbation can last for several months - especially the depressive phases, episodes of hypomania and mania usually pass faster. nine0005

Seasonality of phases, when there is a connection between the manifestations of the disease and the change of seasons, occurs, but not all patients with bipolar disorder notice it.

How I suspected I had BAD

The first time I thought I was going crazy was when I was 18 years old. Painful relationships ended, obsessive thoughts and images swirled in my head, I listened to the same song in the player, walked for hours and could not stop. This went on for so long and was so unbearable that I almost decided to go to a psychiatrist. However, they didn’t talk about mental disorders then, so I didn’t even know where to turn. Then this state passed by itself. nine0005

I did not see a psychiatrist until seven years later, when I again had a similar severe condition: obsessive thoughts, inability to control emotions, self-harm, sleep and appetite disturbances. Before that, I had three episodes of hypomania every two years, but after them there was no severe depression, and therefore no reason to seek help.

Then I just went to the district clinic - it turned out that a psychotherapist was there. She checked my symptoms on the Beck scale, diagnosed me with an anxiety-depressive disorder, and prescribed a common antidepressant that is often prescribed for depression. nine0005

Beck Depression Scale - online test

It seemed to me that antidepressants helped me immediately: my mood improved, I got energy, I talked a lot with friends, hung out, worked. Now I know this is a bad sign. Antidepressants usually take a long time to work: it takes about three weeks for the effect to appear, and I got better after a few days. In addition, in bipolar affective disorder, antidepressants can cause hypomania if not mitigated by other drugs. nine0005 This meme is well understood by those who were not immediately given the correct diagnosis. If you add Mentos to Coca-Cola, you get a foamy fountain that will splash out of the bottle. Antidepressants, in particular SSRIs - selective serotonin reuptake inhibitors - have the same effect on the mood of people with BAD

I went to this psychotherapist several more times, but she did not track my sharp mood swings, and I had one of the most severe hypomanias . I drank and smoked a lot, I had incredible emotional swings, I ruined my relationship with my best friend, I stopped eating and sleeping. nine0005

After a couple of months, my condition stabilized a little, but I continued to take antidepressants: I knew that they should not be stopped abruptly. Before canceling, I went for a consultation with another doctor, already at a paid clinic. She turned out to be a good specialist: she asked questions about mood swings, found out if I had previously had mood swings, ups and downs, depressions. Then everything was fine because of taking antidepressants, so I denied everything.

A year later, as the doctor ordered, I smoothly stopped taking antidepressants, and a few months later I was overcome by one of the most severe depressions. If last time I could attribute depression to circumstances - burnout, relationship difficulties, fatigue - now there was no reason for it. I had a job I loved, a great relationship with my husband, financial stability, a new city. And I wanted to die. nine0005

/psychotherapy-search/

How to choose a psychotherapist

This moment became a turning point in the diagnosis. I already knew that there is such a disease as bipolar affective disorder, what are its symptoms and features. Information about BAR appeared in the media field: I read articles and blog posts, watched videos on YouTube.

I was able to describe the last 10 years of my life in phases: there was a strong rise, followed by a decline. For example, in the hypomania of 2012, I worked two jobs, passed the state exams, wrote a diploma, hung out with friends until the middle of the night and completely took care of the life of the family. In hypomania in 2014, she entered the magistracy, graduated from a driving school, traveled, and also ran a marathon. nine0005

Every upswing was followed by a downturn: I stopped running, didn't pass the exam in the traffic police, and dropped out of the master's program. Each such exacerbation generally lasts a year and a half, and then repeats.

How I searched for a suitable psychiatrist

After collecting information about BAD, I decided to find a psychiatrist to confirm or deny my diagnosis. It didn't happen right away.

First I went to a psychiatrist on the advice of a friend, he helped her with depression. The doctor saw me in a paid clinic, the appointment cost about 3000 R. The consultation was unsuccessful: the doctor was clearly not interested in my condition, he indifferently asked questions about depression and prescribed antidepressants. And not the ones that were assigned to me last time, but others. I was too depressed to stand my ground, so I just started looking for another doctor. nine0005

6 useful services for finding a psychotherapist

The second doctor was in a state clinic, she was recommended to me on Facebook. At first, I waited a long time for an appointment - the doctor was half an hour late, then I started asking about birth injuries and vascular dystonia. This consultation didn't work for me either. I paid 2,000 rubles for her.

The third appointment was successful: I found a psychiatrist, whom I still go to. She works at the State Institute of Psychiatry, but I see her for a fee. One consultation costs 2500 R.

2500 Р

I pay a psychiatrist for one appointment

The institute where the doctor sees, I was advised somewhere in the comments on the Internet. I called the reception and asked to sign me up for a doctor specializing in affective disorders as soon as possible.

The search for a suitable psychiatrist took about a month, so I went to see a doctor in a completely crushed state, in tears and hysteria. The psychiatrist asked me about the illness, listened to me and offered free hospitalization. However, I refused: I felt that I was controlling myself so as not to commit suicide, and my husband was also nearby, who understood the seriousness of the situation. As a result, I continued the treatment at home. nine0005

When hospitalization is needed for bipolar disorder

Viktor Lebedev

psychiatrist, science journalist

Hospitalization for bipolar affective disorder may be necessary if during a manic episode the patient develops strong arousal, he completely loses a critical attitude to his condition, and hallucinations appear rave. Such a condition can end badly for the patient himself or his relatives. In a depressive episode, indications for hospitalization will be suicidal thoughts or suicide attempts. nine0005

Inpatient treatment may also be needed in case of a severe decrease in working capacity.

If you suspect you have bipolar disorder, but are not in the acute phase of the disease, help is not urgent, it is better to spend time looking for a psychiatrist who specializes in bipolar disorder or affective disorders in general. Such a doctor is likely to quickly make the correct diagnosis and select the best treatment.

Before taking, write down all the symptoms that bother you, and also, if possible, draw up a retrospective graph of the expected phases - mania and depression, write down when they occurred and how long they lasted. This will help the doctor understand if this is BAD or something else. nine0005 This is how the BAR phase sequence looks like in my case

BAD treatment

The psychiatrist first wrote me a prescription for several drugs: antidepressants and mood stabilizers. They are usually prescribed to people with affective disorders.

As they explained to me, treatment is, among other things, checking for the correctness of the diagnosis, a way to distinguish depression from bipolar disorder. If the prescribed drugs help, the diagnosis is correct. nine0434 About two months later, my diagnosis was officially confirmed: bipolar affective disorder type 2.

How bipolar disorder is diagnosed

Viktor Lebedev

psychiatrist, science journalist

Bipolar affective disorder is diagnosed by what problems a person is worried about. His story should contain a description of typical mood and behavioral disorders, usually there is an alternation of phases of the disease.

Complaints and a history of the disease are enough for diagnosis, sometimes the testimonies of relatives are also taken into account, which can tell about a person's behavior. It happens that a doctor can send you to a clinical psychologist for a psychological examination, but usually an ordinary psychodiagnostic conversation is enough. nine0005

You can suspect the disease on your own, although with hypomania or mania, criticality to one's condition often decreases, that is, a person does not understand that something is wrong with him. Sometimes relatives of the patient come for help, and not he himself. It is better to apply for a diagnosis to a specialist who has worked with BAD, knows what the manifestations of the disease look like.

In general, drug therapy for bipolar disorder consists of several types of drugs that relieve different manifestations of the disease. These are normotimics that stabilize mood, antidepressants that help to cope with depression, antipsychotics that relieve excessive arousal. nine0005

Medication for Bipolar Disorders - MSD Handbook

Bipolar Disorder in Adults: Choice of Therapy - Article for Physicians Uptodate

The doctor selects the type of medication and dosage based on the phase the patient is in. Antidepressants are usually used in depressive phases and in combination with mood stabilizers. Antipsychotics - only in manic episodes and also together with normotimics.

In severe cases, a person with bipolar disorder may take up to six different drugs. But you need to strive to get by with one or two. nine0005

I started taking prescribed antidepressants and mood stabilizers immediately after seeing a psychiatrist. This time, the process of getting out of depression was long and smooth.

How therapy is selected for bipolar affective disorder

Viktor Lebedev

psychiatrist, scientific journalist

The psychiatrist selects treatment individually, taking into account the clinical picture: in the depressive phase - some drugs, in the hypomanic phase - others, in mania - still others.

It is important to combine drugs correctly. So, if a patient with bipolar disorder is prescribed only antidepressants, this can worsen the situation, even if he is depressed. Antidepressants can "disperse" his condition to hypomania or even mania. It is necessary to normalize a person’s well-being, and not throw him into a state with the opposite sign, so therapy includes normotimics. nine0005

The fact is that depression in BAD is not the usual depression, they are not always similar even in external manifestations, there are differences from a biological point of view, that is, in how processes in the brain change.

I visit my psychiatrist regularly: she adjusts the doses of drugs and monitors my condition. In the first year, I visited her six times - it cost me 15,000 R. Now I go to the doctor only during an exacerbation or a presumptive phase change - about four times a year, once every three to four months. It costs 10,000 R per year. In total, I have been seeing a doctor for three years now. nine0005

For two years, until recently, I took antidepressants and mood stabilizers in the minimum dosage. A pack of antidepressants for a month cost about 400 R, mood stabilizers - 600 R. That is, during the period of remission, the pills took 1000 R per month.

1000 R

I spend on pills a month in remission

However, a few months ago I had an exacerbation, I went into hypomania, so the regimen and dose of drugs had to be changed on the go. Within two weeks, my psychiatrist and I canceled antidepressants, significantly increased the dose of mood stabilizers - 2.5 times, and added antipsychotics. During the exacerbation, which lasted two months, 4000 R per month was spent on tablets. Now 2000 R will go away - the dose of mood stabilizers has been reduced by one and a half times and neuroleptics by half, antidepressants have been removed. nine0005

It is interesting to observe how quickly drug therapy changes the state of the body and how it then returns to normal. Often, drugs do not fit the first time, so you need to regularly visit a psychiatrist and monitor your well-being. But after choosing the right therapy, you can live almost as before, except that you need to be more attentive to yourself.

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BAD treatment cannot be found once and for all

Each patient who is responsible for the treatment of bipolar disorder and is in contact with the doctor has his own scheme for changing the dosage or types of medications, taking into account well-being. For example, if you cannot sleep for more than a few days and stop eating, you add an antipsychotic. If you fall into an abyss of self-hatred and don’t swim for more than a week, an antidepressant will help.

Of course, this does not cancel regular meetings with a psychiatrist, because the process of choosing drugs and dosages is very complicated. Now I can regulate a lot myself, depending on how I feel, but I still see a specialist. nine0005

At the same time, bipolar affective disorder cannot be cured once and for all - you can only go into a long remission. As my doctor told me, this is five years without pronounced phases. In my case, I lasted two years without episodes, and now I need to start the countdown again.

Also, as far as I know from my experience and the experience of people with the same diagnosis, at some point there is an illusion that everything is cool, there is no illness, it seemed to you that you are doing great. At this point, people stop taking pills - this is a bad decision, never do this. If you feel good, first of all, you should check if this is the beginning of hypomania. And secondly, be glad that you have entered remission. nine0005

During these three years, I once stopped drinking pills - depression occurred, once I did not pay attention to the symptoms - I got severe hypomania, now I am trying to go into remission again.

BAD treatment

The effectiveness of the treatment of bipolar affective disorder can be increased by combining drug therapy with psychotherapy. Cognitive behavioral therapy is often used for bipolar disorder. It teaches you how to cope with stress factors, monitor your condition, manage the symptoms of the disease. Even during the sessions, together with the doctor, they work out trigger situations, that is, what can provoke an exacerbation of the disease. nine0005

Bipolar affective disorder and supportive psychotherapies - an article on the Uptodate physician website

For example, I have trouble admitting my own mistakes. Every mistake for me is a tragedy, and it seems to me that those around her will never forget. It is difficult for me to admit my own mistakes, oversights cause great anxiety. I also have an ideal image of what I should be: read a lot, earn money, keep my house perfectly clean, have six-packs, study, know two foreign languages, go to exhibitions. Obviously, this is impossible, but a persistent desire to reach an unattainable height is also stressful. I work through all this with a psychotherapist. nine0005

I started therapy only six months ago, on the advice of a doctor, before that I thought that I could cope on my own. At first she was in therapy with a psychotherapist, whom she found through the Inhale project, which helps burnt out employees from the charitable field. I worked with her on this project, then continued after completion.

We looked at situations that increase my anxiety, including fear of making mistakes and being judged, as well as difficulties in life in general. The cost within the project was 400 R per meeting, there were about ten of them in total, then, already outside the project, the price increased to 2400 R.

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Now I went to another psychotherapist - she has a more applied approach, we look for my cognitive distortions and try to remove them. For example, we work with my excessive anxiety about the impression I make on other people, and the fear that I cannot control it.

The cost of sessions with this specialist is 2500 R per visit. Now I go to her every 10-14 days, that is, 2-3 times a month. In general, I have been working with my condition on my own for quite a long time, so the therapist only directs me in the right direction. nine0005

Is psychotherapy mandatory for bipolar disorder

Viktor Lebedev

psychiatrist, science journalist

Cognitive behavioral therapy is most often prescribed for bipolar disorder. This is an optional therapy, that is, an auxiliary method of treatment, you only need to take medication. However, psychotherapy can greatly improve the quality of life: it complements the action of drugs well, helps to control and change those things that pills do not work on. First of all, cognitive-behavioral therapy helps to control emotions, better cope with your illness. nine0005

Many also benefit from support groups for people with bipolar disorder. I tried to go to such a meeting, but it didn’t work for me: I don’t want to define myself through illness, this is part of my life - but not me.

The largest project holding such meetings is Sunday BAR. They support not only people with bipolar disorder, but also their loved ones. Meetings are held online and offline.

List of support groups in different cities for people with BAD and other disordersPDF, 275 KB

BAD treatment

Universal advice given for bipolar disorder and beyond includes the following recommendations: maintain sleep and work-life balance, eat right, do not drink alcohol, play sports.

All this really helps, but in fact, organizing your life is difficult: meetings with friends, vacations, unexpected work do not fit into the routine, you want to work more, and alcohol looks like a great way to cope with anxiety, although in fact it can lead to depression. nine0005

I try to keep the correct regimen to the best of my ability. True, according to my feelings, depression comes by itself, without any triggers from the outside, and I cannot influence it. But hypomania is fueled by new projects, loves, and other emotions. For example, even a small amount of falling in love causes hypomania, which, in turn, increases falling in love. It doesn't end well.

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I lived in St. Petersburg for quite a long time, there during the white nights you don’t feel like sleeping at all - and this provokes hypomania. One of the psychiatrists even forbade me to go to St. Petersburg for some time.

Now I have an established sleep and eating regime, I quickly notice its violation - this is a signal that an exacerbation has begun. Unfortunately, sometimes the regime is knocked down by external circumstances, then it is more difficult to notice the exacerbation of BAD.

Sleep is very important to me - it's my priority. I try not to hang out until the middle of the night, and if I didn’t manage to get enough sleep, then I try to sleep in the afternoon. I usually go to bed around midnight, get up at 8-9hours of the morning is a comfortable mode for me and my work. I very rarely stay awake at night or wake up later than 10 am.

I have a fitness bracelet that tracks the phases and amount of sleep - it helps to see the dynamics and notice deviations. When I see a sleep disorder, I start drinking light tranquilizers and antipsychotics to return to a comfortable mode.

Sleeping less than seven hours on pills indicates an episode of hypomania, without drugs in this phase I would sleep less than four hours

And sleep for more than seven hours is already the normalization of the state after the addition of other tablets

It’s getting more difficult with food: I have a difficult relationship with my own body, so I perceive a decrease in appetite with enthusiasm. I am working on the problem with a psychotherapist, how to solve it, until I figured it out. My psychiatrist believes that first sleep, and then everything else, and my experience confirms this: sleep disturbances have a stronger effect on well-being. I also keep a record of alcohol consumption in the Alcogram application - abuse negatively affects my condition. When I see how many sober days there were, it motivates me to control myself. nine0005

I am lucky that I take my job seriously: it is responsible and resource-intensive, it is important for me to be productive, it disciplines and helps me to keep the regime.

What to do to reduce the frequency of exacerbations

Viktor Lebedev

psychiatrist, science journalist

In BAD, it is important to have a daily routine that allows you to maintain normal behavior. This reduces the frequency of exacerbations, sometimes helps to completely avoid the recurrence of episodes of the disease. In addition to quality sleep and proper nutrition, you need to avoid overwork, work in an exhausted state, give yourself a rest. Doctors usually insist on the exclusion of alcohol, drugs are also dangerous, especially stimulants, which can cause psychosis in a healthy person. nine0005

Exacerbations of the disease can occur on their own, without the influence of external factors, or they can be caused by external events, both tragic, such as the death of a loved one or a break in relationships, and joyful. Therefore, it is important to learn to recognize your emotions, to identify in time what provokes a new episode, both independently and with the help of psychotherapy.

How I live with BAD now

Accepting the diagnosis was not easy: on the one hand, it finally became clear what was happening to me and that it could be regulated. On the other hand, this is a diagnosis for life. You need to constantly monitor your condition, take pills, consult with doctors. nine0005

The most difficult thing for me was the inability to separate myself as a person from the disease. What of what I did in life was the result of my choice, and what was a symptom of the disease? Moving from city to city, changing jobs, partners, hobbies - what if all this is just a disease, and I'm not behind it? Three years have passed - and I still cannot separate myself from BAD, it seems impossible.

Now life has become easier: now I know what to expect in the near future, because the phase schedule is still respected. It is clear when to slow down with the pace of life, and when to add antidepressants. nine0005

My work is related to people. Of course, the disease affects my mood and state: in depression I have less strength and the ability to give out emotions, in hypomania, on the contrary, there are a lot of emotions, but there is not enough concentration. It's good that work allows you to vary the load depending on the phase: in depression I can work a little less, and in hypomania - a little more.

At the time of my first diagnosed depression, I had an unloved job, it took the entire resource. I cried in the mornings, afternoons and evenings because it was difficult for me to keep working. Now I really love my job, it gives me more resources than it takes. nine0005

I continue to take medication, see a psychiatrist several times a year and a psychotherapist several times a month. In March, at the most difficult moment of the exacerbation, I spent on medicines, an appointment with a psychiatrist and three meetings with a psychologist 13,000 R.

13,000 R

I go into remission and spend about 8,000-10,000 R per month on medications, a psychologist, and periodic appointments with a psychiatrist. A significant amount, but it allows me to remain in a resourceful and efficient state. nine0005

The unobvious difficulty of living with bipolar disorder is the need to strictly control one's financial situation. In hypomania, money flies away easily, you make decisions instantly - for example, you can decide in a minute to fly to Spain and buy tickets. When you are depressed, you spend less, but it is also difficult to earn money. I try to keep a financial cushion in case of an aggravation, and also take into account all expenses in the application so as not to get into debt. Fortunately, so far my financial anxiety is stronger than bipolar, so there has never been a credit card debt. nine0005

I spent 58,800 rubles on BAD treatment in a year

Treatment	Price
Psychiatric appointment	10 000 R, total 4 receptions of 2500 R
Psychotherapist appointment	25 000 R, total 10 receptions of 2500 R
Antidepressants	4800 R, 12 packs of 400 R
Antipsychotics	7000 R, 7 packs of 1000 R
Normotimics	12000 R, 15 packs of 800 R

Reception of a psychiatrist

10 000 R, total 4 receptions of 2500 r

Reception of a psychotherapist

25 000 R, total 10 doses of 2500 p

antidepressants

4800 r, 12 packages of 400 p 9000,000

neuroleptic neuroleptic

7000 R, 7 packs of 1000 R

Normotimics

12000 R, 15 packs of 800 R

Books I recommend reading about bipolar affective disorder

The most famous book about living with bipolar disorder is The Restless Mind.