Bipolar and Depressive Disorders: Symptoms, Risk Factors, and Recovery

Bipolar and Depressive Disorders (Bipolar I, Bipolar II, Cyclothymia)

Risk Factors (DSM-5 Criteria)

Bipolar Disorder Risk Factors

• Environmental Factors: Bipolar disorder (BP) is more common in high-income countries than in low-income countries. BP is also common among individuals who are separated, divorced, or widowed.
• Genetic Factors: Family history is one of the strongest and most consistent risk factors.
• Gender: Females are more likely to experience BP symptoms compared to males.

Depression Risk Factors

• Temperamental: Neuroticism (negative affectivity) means individuals are more likely to develop depressive episodes in response to stressful life events.
• Environmental Factors: Stressful life events and adverse childhood experiences.
• Genetics: Inherited characteristics.

Clinical Characteristics and Symptoms

Depressive Symptoms

Symptoms of a depressive episode include:

• Depressed mood
• Inability to enjoy usual activities (anhedonia)
• Fatigue and lethargy
• Psychomotor retardation or agitation
• Loss of appetite
• Sleep disturbance
• Bodily complaints
• Reduced sexual interest and loss of interest generally
• Guilt and self-reproach
• Difficulty in concentration
• Anxiety
• Low self-esteem, feelings of helplessness, and pessimism
• Suicidal ideation

Manic Symptoms (Elations)

Manic episodes are characterized by elevated mood or irritability, alongside symptoms such as:

• Increased self-esteem and grandiosity
• Poor judgment
• Overactivity
• Flight of ideas
• Decreased need for sleep
• Distractibility
• Involvement in risky behaviors (e.g., buying sprees, social intrusiveness, inappropriate collection)

Prognosis and Recurrence

Acute Depressive Episodes

The prognosis is generally good, with complete symptom relief occurring within about six months for approximately half of those affected, who may only experience one episode. The other half has a chronic or recurring pattern of depression. The suicide rate among persons with chronic or recurrent depression is about 30–35%.

Manic Episodes

The first manic episode tends to occur in adulthood with a higher tendency to recur. The risk of recurrence can be reduced with appropriate medication. Individuals may appear headstrong, manipulative, insensitive, and hostile to others, often resulting in a higher divorce rate.

Functional Limitations and Cognitive Impairment

Individuals often face limitations in:

• Interpersonal skills
• Dependability and follow-through
• Decision-making and judgment
• Dealing with frequent change
• Stamina, strength, motivation, or initiative
• Self-confidence and self-image
• Drowsiness (due to sleep disturbance)
• Concentration and memory
• Stability and consistency of behavior

Bipolar I (BPI) and Bipolar II (BPII) Impairment

• Bipolar I (BPI): Most individuals with BPI are able to return to a fully functional level between episodes. Approximately 30% of individuals show persistent impairment. Cognitive impairment is significant in individuals with BPI.
• Bipolar II (BPII): Most individuals with BPII are able to return to work between episodes, though about 15% have inter-episode dysfunction. Cognitive impairment can contribute to vocational difficulties and unemployment.

Strategies for Recovery and Management

Successful recovery relies on:

• Compliance with prescribed medications.
• A good support system with family or caregivers.
• Participation in support groups.
• Cognitive Behavioral Therapy (CBT).
• Interviewing practice and selective job placement (vocational support).