The first episode of bipolar disorder usually begins before the age of 20 years, and the lifetime prevalence is 15%~6.4%。
In recent years, people's understanding of bipolar disorder has increased greatly, and it is also recognized that many unipolar depression and even psychiatric disorders may be misdiagnosed.
Depressive episodes in bipolar disorder differ from depression (unipolar depression) in many ways in which symptoms manifest and are different, such as in patients with bipolar disorder depressive episodes, it is best not to use antidepressants unless necessary, because manic episodes may occur.
A 19-year-old girl with depression comes to the hospital for follow-up visits. She told the doctor that she had seen her problems in two hospitals in the province, and one hospital diagnosed depression and prescribed antidepressant drugs. A hospital diagnosed bipolar disorder and prescribed antidepressants.
Because the girl had strong suicidal thoughts for a long time before going to the hospital, and even self-harmed when she was emotional, so both hospitals accurately pointed the problem to the depressive episode, and successively gave the first plan of antidepressant drugs, but the girl took the medicine for a period of time, and the depression did not improve, but felt more excited, and after the excitement, she was more desperate, and the night before coming to the hospital, she used a knife to cut more than 20 wounds on her upper arm, and when I showed the wound, I could see obvious redness and swelling.
In an in-depth conversation with the girl, the doctor confirmed that the girl's diagnosis was indeed bipolar disorder, and that the 19-year-old girl had a medical history of no less than 10 years.
The girl's parents both went out to work when she was very young, and the girl grew up without parents since she was a child, and she also encountered very bad things when she was very young, which left a shadow on her young heart that she can never forget.
When she was still a minor, she went out to work, played well with her friends for a while, and drank and played all day long. But after a period of time, I may not want to go out at all, I don't want to contact people, I feel that my life is so miserable, my family doesn't care about me, there is no hope for the future, and 2 years ago, I committed suicide by cutting my wrists because I felt that life was very hard and I didn't have any hope for the future. In her own words, she feels like she is "half angel and half demon", "one foot in heaven and the other in hell".
The girl's diagnosis was indeed a depressive episode of bipolar disorder, due to obvious family factors and psychosocial factors, without effective emotional support, she thought more than once of suicide, or released her depression and despair by hurting herself.
So why do girls who are so depressed that they self-harm and suicide have no relief after taking ** depression medicine, and even have a more excited and painful experience?
Risk of taking antidepressants for depressive episodes in bipolar disorder
First, there is no doubt that patients with bipolar disorder depressive episodes may indeed be at risk of agitation while taking antidepressants.
A study by Chinese scholars showed that the chance of a first depressive episode and recurrent depression under the action of antidepressant drugs is also 58%。
There are significant manifestations of agitation in the girl's medical history. From the perspective of clinical psychopathology, the presence of agitated depressive episodes is more likely to be irritable.
One study found that agitated depression was about 20Mood fluctuations and alternations occur in 3% of patients, while in almost 7% of non-agitated depressions, the risk of mood fluctuations in agitated depression is nearly three times higher than that of non-agitated depression.
Therefore, there is also a theory among experts that agitated depression is likely to be a mixed episode of bipolar disorder to some extent.
Can't I use antidepressants for bipolar depressive episodes?
In fact, it is not that people with bipolar disorder depressive episodes cannot use antidepressants, but they should not use them unless necessary.
In the "Standards for the Diagnosis and Treatment of Mental Disorders", it is mentioned that for depressive episodes of bipolar disorder, "the use of antidepressants must detect the risk of manic reversal and rapid cycling", "the history of manic hypomanic episodes induced by antidepressants in the past, mixed episodes or mixed states as the main manifestations, and the recent occurrence of rapid cycling characteristics should avoid or use antidepressants with caution", "It is important to emphasize that patients with bipolar disorder should not use antidepressants as a single drug**" "The understanding of doctors is that unless there is severe depression, or strong suicidal thoughts, which must be intervened with antidepressants as soon as possible, and generally should not be the first choice for bipolar depression.
In fact, most of the current mainstream guidelines for bipolar disorder** are atypical antipsychotics such as quetiapine fumarate, or mood stabilizers such as sodium valproate, or a combination of the two, as first-line recommendations for bipolar depression**.
In clinical work, I have also encountered some patients whose first diagnosis is depression, who have obvious manifestations of irritability during the use of antidepressants, and even these patients and their families think that their depression has been relieved like an "epiphany" when they have a frenching phenomenon.
In fact, this kind of manic manifestation that transitions from the depressive phase to the manic phase can be said to be a "pathological" manifestation, at least it will not be "better". The transition from a manic state of high emotion and high energy to a depressed state of low mood and lack of energy, even because of taking depressants, is enough to show that the patient's emotions are not in a stable state for ordinary people, and this fluctuation is precisely the main characteristic of bipolar disorder.
Therefore, if a depressed patient is "agitated" on a depressive medication, then his diagnosis needs to be revised to bipolar disorder.
Half angels, the other half demons". This sentence of the girl can be said to be a portrayal of the heart of a person with bipolar disorder, and it is a very apt description of emotional fluctuations. But the girl's "paradise" does not represent salvation, but heralds "madness", and the coming "cold winter".
In fact, patients with significant emotional instability such as girls, even in the middle of a depressive episode, are not candidates for depressive medication because they can worsen mood swings. Clinically, antipsychotic drugs combined with mood stabilizers are usually used to treat emotional instability in patients. Therefore, with full communication, the doctor helped her choose quetiapine fumarate combined with sodium valproate sustained-release tablets to **. I hope that the girl's emotions can really stabilize, and I also hope that the girl can return to her original life.