Bipolar disorder is a mood disorder characterized by episodes of mania or hypomania alternating with depressive episodes. This article covers the bipolar spectrum, diagnosis, and management strategies.
BIPOLAR SPECTRUM
Bipolar I Disorder
- At least one manic episode (≥7 days or requiring hospitalization)
- Depressive episodes usually occur but not required for diagnosis
Bipolar II Disorder
- At least one hypomanic episode (≥4 days)
- At least one major depressive episode
- No history of full manic episodes
Cyclothymic Disorder
- Chronic fluctuating mood with hypomanic and depressive symptoms
- Symptoms present for ≥2 years
- Never meets full criteria for hypomanic or depressive episodes
MANIC EPISODE CRITERIA (DSM5)
A distinct period of abnormally elevated, expansive, or irritable mood AND increased activity/energy, lasting ≥7 days, with ≥3 of:
- Decreased need for sleep
- Pressured speech
- Racing thoughts
- Distractibility
- Increased goal-directed activity or psychomotor agitation
- Excessive involvement in risky activities
PHARMACOTHERAPY
Mood Stabilizers
1. Lithium - Gold standard, best evidence for suicide prevention
- Therapeutic level: 0.6-1.2 mEq/L
- Monitor: renal, thyroid function
2. Valproate - Effective for mania, mixed episodes
- Therapeutic level: 50-125 mcg/mL
- Teratogenic risk
3. Carbamazepine - Second-line option
- Drug interactions (CYP450 inducer)
4. Lamotrigine - Best for bipolar depression
- Slow titration to prevent Stevens-Johnson syndrome
Atypical Antipsychotics
- Quetiapine, olanzapine, aripiprazole, lurasidone
- Effective for acute mania and bipolar depression
MAINTENANCE TREATMENT
- Long-term mood stabilization is essential
- Lithium reduces suicide risk
- Psychoeducation improves adherence
- Regular monitoring for side effects
AVOID: Antidepressant monotherapy (risk of manic switch)