Bipolar Disorder & Depression

Bipolar Disorder &
Depression
Dr. Sehrish Khan

Medical Affairs, PharmEvo Pvt Ltd
Bipolar Disorder
It is a mood disorder that can cause intense mood swings:
• Manic episode - feeling extremely up, elated, irritable,
or energized.
• Depressive episode – Feeling down, sad, indifferent, or
hopeless.
• Mixed episode – Having both manic and depressive
symptoms together.
A systemic review in 2013 estimated prevalence of

bipolar disorder to be 0.5% - 4.3% in primary care
patients. Cerimele JM, Chwastiak LA, Dodson S, Katon WJ. The prevalence of bipolar disorder in general
primary care samples: a systematic review. General hospital psychiatry. 2014 Jan 1;36(1):19-25.
Types
Bipolar I disorder Bipolar II disorder Cyclothymic disorder
• Involves manic episodes that last • Involves mainly depressive • Involves hypomanic and
at least 7 days or require episodes. depressive symptoms but not as
immediate hospital care. • Characterized by hypomaniac intense as hypomanic or
• Depressive episodes are also episodes instead of full-blown depressive episodes.
common, often lasting at least manic episodes • The symptoms usually last for at
two weeks. • Hypomania is a less severe least two years in adults and for
• Also involves mixed episodes. version of mania. one year in children and
teenagers.
With any of these types, having four or more episodes in a year is called "rapid cycling."
Presentation title
Symptoms
Manic Episode Depressive Episode
• Feeling very up, high, or elated • Feeling very sad, hopeless, or worthless
• Having a very short temper or seeming • Feeling lonely or isolating yourself from others
extremely irritable • Talking very slowly, or forgetting a lot
• Having racing thoughts and talking very fast
• Having little energy
• Needing less sleep
• Sleeping too much
• Feeling like you are unusually important,
• Eating too much or too little
talented, or powerful
• Lack of interest in your usual activities and
• Do risky things showing poor judgement, such
being unable to do even simple things
as eating and drinking too much, spending a lot
of money, etc. • Thinking about death or suicide
Causes and Diagnosis
Causes Risk Factors Diagnosis

Genetics Family history History
Environment Stressful life Physical exam
Trauma Going through Tests to rule out other
trauma causes
Pathophysiology of Bipolar Disorder
The precise mechanisms that cause bipolar
disorder are not well understood.
BD is associated with abnormalities in brain areas

responsible for cognitive tasks and processing of emotions.
The model hypothesizes that BD may occur when the ventral

system is overactivated and the dorsal system is underactivated.
Dopamine has increased transmission during the manic

phase. Its secondary downregulation results in decreased
dopamine transmission characteristic of the depressive phase.
Treatment Medications
• Detailed later
Psychotherapy
• It can give you support, education, skills, and coping
strategies.
Electroconvulsive Therapy (ECT)

• When patient is suicidal or unresponsive to treatment
Lifestyle Modifications
• Exercise to relieve anxiety, depression
• Maintain a diary / chart of symptoms
Medications
Mood Stabilizers Antipsychotic

Antidepressant Antianxiolytic
Carbamazepine Olanzapine
Divalproex sodium • Olanzapine with /Sedatives
Risperidone fluoxetine
Lithium Benzodiazepines
Lamotrigine
Quetiapine • Quetiapine
Valproic acid Lurasidone fumarate
Depression
Depression is a mood disorder characterized by:

• Feeling sad
• Loss of interest or pleasure in activities once enjoyed
• Changes in appetite — weight loss or gain unrelated to dieting
• Trouble sleeping or sleeping too much
• Loss of energy or increased fatigue
• Increase in purposeless physical activity (e.g., inability to sit still,
pacing, handwringing) or slowed movements or speech
• Feeling worthless or guilty
•Thoughts of death or suicide
Symptoms must last at least two weeks and must represent a change
in previous level of functioning for a diagnosis of depression.
Types of Depression
Disruptive Mood Dysregulation Disorder (DMDD)
• Occurs in children and youth ages 6 to 18
• It involves a chronic and severe irritability resulting in
Major Depressive Depression (MDD)
severe and frequent temper outbursts. • Also called Clinical Depression or Unipolar
• These occur three or more times per week. In between Depression.
the outbursts, the child’s mood is persistently irritable • It is a constant sense of hopelessness and
or angry, nearly every day. despair, present everyday for at least two
weeks.
• With major depression, it may be difficult to
work, study, sleep, eat, and enjoy friends and
Persistent Depressive Disorder (PDD) activities.
• Characterized by depressed mood for most of the • Some people have this only once in their life,
day, for more days than not, for at least two years. while others have it several times in a lifetime.
• Other symptoms include poor appetite, insomnia or
hypersomnia, fatigue, low self-esteem
• The symptoms cause significant distress in work and
social activities.
Premenstrual Dysphoric Disorder
• Occurs a week before menstruation and stops at its
onset Postpartum Depression
• Symptoms mood swings, irritability, anger, • Occurs after birth of baby
depression and marked anxiety. • Mothers experience extreme sadness,
• Body ache, breast pain/swelling, bloating anxiety, and fatigue affecting daily tasks.
• The symptoms disrupt regular functioning or social • There may even be delusions, mania,
interactions. confusion, hallucinations, suicidal thoughts.
• Unlike baby blues (less severe form of
symptoms), this requires treatment.
Seasonal Affective Disorder (SAD)

• Feelings of sadness or low at the start of a season,
which end once the season ends.
• More common in winters, less common in summers.
20XX 11
Treatment Resistant Depression (TRD)
•This occurs when at least two pharmacologically different

antidepressants fail to produce a significant clinical
improvement.
•Around 1/3 of all depression patients suffer from TRD.
•A double blind, RCT published in Journal of Clinical Psychiatry
demonstrated marked improvement in symptoms of TRD when
patients were given combination of Olanzapine and Fluoxetine.*
•Another meta-analysis published in Neuropsychiatric Disease
and Treatment in 2017 showed increased efficacy of olanzapine
and fluoxetine for TRD as compared to their monotherapy.**
*Thase ME, Corya SA, Osuntokun O, Case M, Henley DB, Sanger TM, Watson SB, Dubé S. A randomized, double-blind comparison of olanzapine/fluoxetine combination, olanzapine, and fluoxetine in treatment-resistant
major depressive disorder. The Journal of clinical psychiatry. 2007 Feb 15;68(2):16696.
**Luan S, Wan H, Wang S, Li H, Zhang B. Efficacy and safety of olanzapine/fluoxetine combination in the treatment of treatment-resistant depression: a meta-analysis of randomized controlled trials. Neuropsychiatric Disease
and Treatment. 2017;13:609.
Challenges in
Diagnosing
Bipolar Disorder
Current Scenario
Phillips ML, Kupfer DJ. Bipolar disorder diagnosis: challenges and future
directions. Lancet. 2013;381(9878):1663-1671. doi:10.1016/S0140-6736(13)60989-7
•Diagnostic criteria for depressive episodes are identical in bipolar disorder and unipolar
depression.
•Bipolar disorder type II is especially difficult to distinguish from unipolar depression,
because of frequent depressive episodes and the absence of full-blown mania.
•Mixed mood episodes are very common. These episodes might obscure detection of mania
and hypomania.
•Subthreshold symptoms of hypomania are common in unipolar depression. They are
present in 30–55% of people during a depressive episode and are common in unipolar
depression.
Words by Dr. Tom Greenlahgh – Clinical Psychiatrist
Breaking the
news Finding the
Difficult right
diagnosis treatment
plan
Dealing with Managing

patient’s non-
suicide adherent
attempts patients
There is hope, even
when your brain tells
you there isn’t.
John Green
20XX 16
•Dr. Sehrish Khan
•sehrish.khan@pharmevo.biz
Thank you
20XX 17

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Bipolar Disorder &

Dr. Sehrish Khan

A systemic review in 2013 estimated prevalence of

Bipolar I disorder Bipolar II disorder Cyclothymic disorder

Causes Risk Factors Diagnosis

BD is associated with abnormalities in brain areas

The model hypothesizes that BD may occur when the ventral

Dopamine has increased transmission during the manic

Electroconvulsive Therapy (ECT)

Mood Stabilizers Antipsychotic

Depression is a mood disorder characterized by:

Seasonal Affective Disorder (SAD)

•This occurs when at least two pharmacologically different

Dealing with Managing

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