Depression and bipolar disorder can both cause people to go through periods of extreme sadness and despair, and even mental health experts may find it difficult to distinguish between the two disorders. But new research suggests these conditions may have very different patterns of brain activity.
In a new study, researchers scanned the brains of people with clinical depression and other people with bipolar disorder, and measured these individuals’ reactions to emotional photographs. The researchers found differences in the amount of activity in brain areas involved in regulating emotion in bipolar patients, compared with patients who had “unipolar” depression (a term used to distinguish the condition from bipolar disorder).
“As psychiatrists, we have a big problem: We cannot distinguish unipolar depression from bipolar depression,” said Dr. Eric Ruhe, a psychiatrist at the University of Amsterdam in the Netherlands. This inability to tell which disorder a patient has is a problem because antidepressant medication usually isn’t effective for treating people with bipolar disorder, he said. Such medicines can even increase such a patient’s risk of having a manic episode, he said. During manic episodes, a person with bipolar disorder may become agitated, euphoric and sometimes psychotic. [Top 10 Stigmatized Health Disorders]
The new findings could lead to a better way of diagnosing and treating patients with these disorders, according to the study, published today (May 6) in the journal JAMA Psychiatry.
People with either depression or bipolar disorder may have bouts of severe depression and difficulty regulating their emotions, whether they are happy or sad. But unlike people with depression, those with bipolar disorder also experience manic episodes, during which they can be very destructive. During these episodes, the individuals may have affairs, sell everything they own or buy things they can’t afford. In the new study, Ruhe and his colleagues searched for a better way to distinguish between people with each disorder. They looked at 42 patients with depression, 35 with bipolar disorder and 36 individuals with neither disorder.
The researchers scanned the participants’ brains using functional magnetic resonance imaging while testing the participants’ ability to regulate their emotions. Researchers did this by showing photos of people depicting different emotions (sad, happy, fearful and neutral). For example, a sad photo might show a person overdosing on pills, whereas a happy photo might depict a person skiing. The researchers instructed the participants to either passively experience the images or actively regulate their emotions by distancing themselves from what they were seeing, for example, by reminding themselves, “this is only a picture.” The participants rated how strongly they felt after looking at each image. Researchers measured the individuals’ ability to regulate their emotions by subtracting the rating of the passively viewed photos from the rating reported after the participants had actively distanced themselves from the images.
Unlike previous experiments, this one was conducted both while patients were in a normal state of mind and while they were in a depressed state, and none of the participants were taking psychiatric medication.
The behavioral data revealed that when the participants were feeling normal (not depressed), those with bipolar disorder were much worse at regulating both happy and sad emotions than those with depression. But when they were feeling depressed, the bipolar patients were actually better at regulating happy emotions. Both groups performed about the same when trying to regulate sad emotions while depressed.
The differences in brain activity between the two types of patients were striking, the researchers said in their study. In a nondepressed state, the bipolar patients showed increased brain activity (compared with the depressed patients) in a region called the dorsolateral prefrontal cortex, which is involved in actively regulating emotions. This suggests bipolar patients’ brains had to work harder than those of the depressed patients to achieve the same level of emotional control, Ruhe said.
By contrast, in a depressed state, the bipolar patients showed decreased brain activity (compared with the depressed patients) in the rostral anterior cingulate cortex, which acts as a hub connecting the cognitive and emotional parts of the brain.
So even though both the bipolar and depressed patients showed no behavioral difference in controlling their sadness during bouts of depression, their brain activity revealed a big difference, Ruhe said.
Next, it will be important to study whether the differences in brain activity that the researchers observed in the study can be used to differentiate between patients with these two disorders, the researchers said.
Follow Tanya Lewis on Twitter. Follow us @livescience, Facebook & Google+. Original article on Live Science.
People with bipolar I disorder experience mania in a different way than people with bipolar II disorder. In addition, people with bipolar I disorder may not have major depressive episodes, while all people with bipolar II disorder do.
Most people have emotional ups and downs from time to time. But if you have a condition called bipolar disorder, your moods can reach very high or low levels.
Sometimes you may feel immensely excited or energetic. Other times, you may find yourself sinking into depression. Some of these emotional peaks and valleys can last for weeks or months.
There are four basic types of bipolar disorder:
- bipolar I disorder
- bipolar II disorder
- cyclothymic disorder (cyclothymia)
- other specified and unspecified bipolar and related disorders
Bipolar I and II disorders are more common than the other types of bipolar disorder. Read on to learn how these two types are alike and different.
Bipolar I vs. bipolar II
All types of bipolar disorder are characterized by mood episodes. The highs are known as manic episodes. The lows are known as depressive episodes. Not all bipolar disorder types have episodes of depression.
The main difference between bipolar I and bipolar II disorders lies in the severity of the manic episodes caused by each type.
A person with bipolar I will experience an episode of mania, while a person with bipolar II will experience a hypomanic episode (a period less severe than a full manic episode).
A person with bipolar I may or may not experience a depressive episode, while someone with bipolar II will experience a major depressive episode.
What is bipolar I disorder?
You must have had at least one manic episode lasting 7 or more days to receive a bipolar I disorder diagnosis. A person with bipolar I disorder may or may not have a major depressive episode. The symptoms of a manic episode may require hospital care.
Manic episodes are usually characterized by the following:
- high energy
- restlessness
- trouble concentrating
- feelings of euphoria (extreme happiness)
- behaviors that can lead to harmful consequences
- poor sleep
What is bipolar II disorder?
Bipolar II disorder involves a major depressive episode lasting at least 2 weeks and at least one hypomanic episode. People with bipolar 2 typically don’t experience manic episodes intense enough to require hospitalization.
Bipolar II is sometimes misdiagnosed as depression, as depressive symptoms may be the major symptom when the person seeks medical attention. When there are no manic episodes to suggest bipolar disorder, the depressive symptoms become the focus.
What are the symptoms of bipolar disorder?
As mentioned above, bipolar I disorder involves episodes of mania and may involve depression, while bipolar II disorder includes hypomania and depression. Let’s learn more about what these symptoms mean.
Mania
A manic episode is more than just a feeling of elation, high energy, or distraction. During a manic episode, the mania can interfere with daily activities.
People having an episode of mania may make some irrational decisions, such as spending large amounts of money that they can’t afford to spend. They may also engage in behaviors that may have harmful consequences.
An episode is not considered manic if caused by outside influences such as alcohol, drugs, or another health condition.
Hypomania
A hypomanic episode is a period of mania less severe than a manic episode. However, in a hypomanic episode, behavior still differs from your usual state. The differences will be extreme enough that people around you may notice.
Officially, a hypomanic episode isn’t considered hypomania if it’s influenced by drugs or alcohol.
Depression
Depressive symptoms in someone with bipolar disorder are like those of someone with major depressive disorder. They may include extended periods of sadness and hopelessness. You may also experience a loss of interest in people you once enjoyed spending time with and activities you used to like. Other symptoms include:
- tiredness
- irritability
- trouble concentrating
- changes in sleeping habits
- changes in eating habits
- thoughts of suicide
What causes bipolar disorder?
Scientists don’t know what causes bipolar disorder. Physical characteristics of the brain or an imbalance in certain brain chemicals may be among the main causes.
As with many medical conditions, bipolar disorder tends to run in families. If you have a parent or sibling with bipolar disorder, your risk of developing it is higher. The search continues for the genes responsible for bipolar disorder.
Researchers also believe severe stress, drug or alcohol misuse, or upsetting experiences may trigger bipolar disorder. These experiences can include childhood abuse or the death of a loved one.
How is bipolar disorder diagnosed?
A psychiatrist or other mental health professional typically diagnoses bipolar disorder. The diagnosis will include a review of both your medical history and any symptoms you have that are related to mania and depression. A trained professional will know what questions to ask.
It can be very helpful to bring a partner or close friend with you during the doctor’s visit. They may be able to answer questions about your behavior that you may not answer easily or accurately.
If you have symptoms of bipolar I or bipolar II, you can always start by telling your doctor. Your doctor may refer you to a mental health specialist if your symptoms appear serious.
A blood test may also be part of the diagnostic process. There are no markers for bipolar disorder in the blood, but a blood test and a comprehensive physical exam may help rule out other possible causes for your behavior.
How is bipolar disorder treated?
Doctors usually treat bipolar disorder with a combination of medications and psychotherapy.
Mood stabilizers are often the first drugs used in treatment. These may be used long term.
Lithium has been a widely used mood stabilizer for many years. It does have several potential side effects. These include low thyroid function, joint pain, and indigestion. It also requires blood tests to monitor the therapeutic levels of the medication, as well as kidney function. Antipsychotics can be used to treat manic episodes.
Your doctor may start you on a low dose of whichever medication you both decide to use to see how you respond. You may need a stronger dose than what they initially prescribe. You may also need a combination of medications or different medications to manage symptoms.
All medications have potential side effects and interactions with other drugs. If you’re pregnant or you take other medications, be sure to tell your doctor before taking any new medications.
Writing in a diary can be an especially helpful part of your treatment. Keeping track of your moods, sleeping and eating patterns, and significant life events can help you and your doctor understand if therapy and medications are working.
If your symptoms don’t improve or worsen, your doctor may order a change in your medications or a different type of psychotherapy.
Online therapy options
Read our review of the best online therapy options to find the right fit.
What is the outlook?
With proper treatment and support from family and friends, you can manage bipolar disorder symptoms and maintain your quality of life.
It’s important that you follow your doctor’s instructions regarding medications and other lifestyle choices. This includes:
- alcohol use
- drug use
- exercise
- diet
- sleep
- stress reduction
Including your friends and family members in your care can be especially helpful.
It’s also helpful to learn as much as you can about bipolar disorder. The more you know about the condition, the more in control you may feel as you adjust to life after diagnosis.
You may be able to repair strained relationships. Educating others about bipolar disorder may make them more understanding of hurtful events from the past.
Support options
Support groups, both online and in person, can be helpful for people with bipolar disorder. They can also be beneficial for your friends and relatives. Learning about others’ struggles and triumphs may help you get through any challenges you may have.
The Depression and Bipolar Support Alliance maintains a website that provides:
- personal stories from people with bipolar disorder
- contact information for support groups across the United States
- information about the condition and treatments
- material for caregivers and loved ones of those with bipolar disorder
The National Alliance on Mental Illness can also help you find support groups in your area. Good information about bipolar disorder and other conditions can also be found on its website.
If you have a diagnosis of bipolar I or bipolar II, remember that this is a condition you can manage. You aren’t alone. Talk with your doctor or call a local healthcare center to find out about support groups or other local resources.
