Department of Psychiatry
Penn Behavioral Health

Depression Research Unit (DRU)

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Bipolar Disorders

BP IBP crying


Bipolar (BP) disorder, also known as "mood swings," is a mood disorder that is characterized by recurrent periods of depression and interspersed by brief periods of elevated mood consisting of increased energy and drive, rapid or sharper thoughts, increased involvement in professional or social activities, a sense of well being and a "can do" feeling, and a decreased need for sleep. Sometimes individuals may experience extreme talkativeness, irritability, over-enthusiasm, over-spending, or boundless energy during these "high" periods. The more mild form of this disorder is called BP type II disorder, while the more severe form is called BP type I (or manic depressive) disorder. BP type II disorder is often difficult to diagnose and is often thought to be recurrent depression. It is much more common than BP type I disorder.

In addition to the symptoms noted above, individuals with BP type I disorder may also have feelings of extreme energy, creativity, and euphoria - that they can achieve almost anything. Individuals experiencing a BP I "high" episode may talk a mile a minute, need very little sleep, and over-engage in pleasurable activities. They often over-spend or put themselves into debt, feel easily angered, have rapid changes in mood, or feel like they are invincible or destined for greatness. Many individuals with BP I disorder say that they enjoy these "high" feelings, and will turn to stimulants or street drugs to try to maintain or recreate these episodes - without much success. Individuals with BP I disorder often exhibit reckless behavior including excessive gambling, excessive spending, or engaging in risky pleasurable or sexual activity. These individuals often become easily angered or irritable with anyone who criticizes their behavior.

On the other hand, individuals with BP type II disorder never have extreme "high" periods, but instead suffer mainly from depression. BP type II disorder affects nearly 2.5% of the US adult population. Individuals with BP type II disorder generally report depressive symptoms beginning in adolescence or teenage years. These episodes often interfere with schoolwork, professional activities, and social and personal relationships. Most individuals with BP type II disorder spend the majority of time in the depressed phase which is associated with high rates of substance abuse, alcoholism, job loss, marital discord, and divorce.

The treatment of BP type I disorder with mood stabilizer medication is now established. However, the treatment of BP type II disorder remains a challenge for clinicians. In this regard, while mood stabilizer therapy is also currently recommended for individuals with BP type II depression, there is reason to believe that antidepressant medications (which are often avoided in BP type I disorder) could be effective for BP type II disorder. Studies of BP type I and BP type II disorder presently being conducted on the DRU at Penn are advancing the field in its understanding of the best treatment approaches for these disorders.



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