Understanding When Depression May be Something More: Identifying and Managing Bipolar Depression

(BPT) - It is common for people to experience both periods of happiness and sadness throughout their lives, but it can be hard to determine whether prolonged versions of these emotional states indicate something more serious than changing feelings. Sharp mood swings between extreme highs and extreme lows can often be a sign of a mood disorder. Bipolar disorder, also known as manic-depressive disorder, is a lifelong serious mental health condition that causes debilitating, severe mood swings and changes in energy and activity levels.[1] An estimated 5.8 million adults in the U.S. experienced bipolar disorder in the past year.[1]

Identifying Depressive and Manic Episodes

When symptomatic, most people living with bipolar disorder spend more time in the depressive phase, called bipolar depression.[2] Major depressive episodes in bipolar depression may cause depressed moods, fatigue, loss of interest in activities, or even suicidality.[2] Alternatively, a person experiencing a manic episode may express increased energy and activity, unusual talkativeness, agitation, risky behavior, distractibility, and poor decision making.[2] People living with bipolar disorder experience a 10-30 times higher rate of suicide, compared with the general population.[3]

During a manic or hypomanic episode, individuals living with bipolar disorder may have an elevated mood and an exaggerated sense of self-confidence, and they are less likely to characterize their behavior as risky or problematic.[2] Most of these individuals are likely to seek treatment during a depressive phase because depressive symptoms may be more troubling, negatively impact their quality of life, and cause functional impairment.[2],[4]

Challenges in Diagnosing Bipolar Depression

Bipolar depression can be difficult to diagnose, in part because people living with the condition are likely to experience other conditions with similar symptoms like anxiety disorder or Attention-Deficit Hyperactivity Disorder (ADHD).[5] Additionally, bipolar depression is commonly misdiagnosed as unipolar depression – or frequent depressive episodes without mania or hypomania.[5] In fact, only 20% of people with bipolar disorder who are experiencing bipolar depression are diagnosed correctly within the first year of seeking treatment.[6]

Dr. Roger S. McIntyre, M.D., FRCPC, Professor of Psychiatry and Pharmacology, University of Toronto, Canada, has been working with people with bipolar depression for 20 years and knows the importance of getting the correct diagnosis. It is imperative for healthcare providers to take the time to fully learn and understand an individual’s lived experiences, and that requires the individual to place significant trust in their care team. Once that trust is established, it allows for more productive conversations with people with bipolar depression and their caregivers about potential treatment plans.”

Getting the Proper Help

Talking to a healthcare provider about episodes of bipolar depression can be difficult, especially since people may feel embarrassed about their condition. “I always remind individuals that there is no shame in a bipolar depression diagnosis. With the right support and treatment, it is a manageable condition that is more common than many think,” says Dr. McIntyre.

Fortunately, there are treatments available to specifically treat bipolar depression that have been shown to reduce depressive symptoms. One such treatment is Latuda® (lurasidone HCl), a once-a-day prescription medicine FDA-approved to treat bipolar depression in adults, children, and teens (10 to 17 years).[7] In clinical studies, Latuda has shown efficacy in significantly reducing depressive symptoms in people with bipolar depression, with minimal side effects on weight, metabolic parameters, or prolactin.[7]

With the right caregiver support, healthcare team, and medication routine, those with bipolar depression can learn how to live a more balanced lifestyle and manage their symptoms. Before starting any treatment, people should talk to their healthcare providers to determine which treatment options may be right for them and to understand the potential benefits and risks.

For more information on bipolar depression and a discussion guide with tips on how to speak with your doctor about symptoms, visit www.latuda.com. Please see below for Important Safety Information.

IMPORTANT SAFETY INFORMATION AND INDICATIONS FOR LATUDA

INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS; and SUICIDAL THOUGHTS AND BEHAVIORS

Increased risk of death in elderly people with dementia-related psychosis. Medicines like LATUDA can raise the risk of death in elderly people who have lost touch with reality (psychosis) due to confusion and memory loss (dementia). LATUDA is not approved for the treatment of people with dementia-related psychosis.

Antidepressant medicines may increase suicidal thoughts or behaviors in some children, teenagers, and young adults within the first few months of treatment and when the dose is changed. Depression and other serious mental illnesses are the most important causes of suicidal thoughts and actions. Patients on antidepressants and their families or caregivers should watch for new or worsening depression symptoms, especially sudden changes in mood, behaviors, thoughts, or feelings. This is very important when an antidepressant medicine is started or when the dose is changed. Report any change in these symptoms immediately to the doctor.

LATUDA may cause serious side effects, including:


  • Stroke (cerebrovascular problems) in elderly people with dementia-related psychosis that can lead to death
  • Neuroleptic malignant syndrome (NMS) is a serious condition that can lead to death. Call your health care provider or go to the nearest hospital emergency room right away if you have some or all of the following signs and symptoms of NMS: high fever, increased sweating, stiff muscles, confusion, or changes in your breathing, heart rate, and blood pressure
  • Uncontrolled body movements (tardive dyskinesia). LATUDA may cause movements that you cannot control in your face, tongue, or other body parts. Tardive dyskinesia may not go away, even if you stop taking LATUDA. Tardive dyskinesia may also start after you stop taking LATUDA
  • Problems with your metabolism such as:
    • High blood sugar (hyperglycemia) and diabetes: Increases in blood sugar can happen in some people who take LATUDA. Extremely high blood sugar can lead to coma or death. If you have diabetes or risk factors for diabetes (such as being overweight or a family history of diabetes), your health care provider should check your blood sugar before you start and during treatment with LATUDA
      • - Call your health care provider if you have any of these symptoms of high blood sugar (hyperglycemia) while taking LATUDA: feel very thirsty, need to urinate more than usual, feel very hungry, feel weak or tired, feel sick to your stomach, feel confused, or your breath smells fruity
    • Increased fat levels (cholesterol and triglycerides) in your blood
    • Weight gain. You and your health care provider should check your weight regularly during treatment with LATUDA
  • Increased prolactin levels in your blood (hyperprolactinemia). Your health care provider may do blood tests to check your prolactin levels during treatment with LATUDA. Tell your health care provider if you have any of the following signs and symptoms of hyperprolactinemia:
    • Females: absence of your menstrual cycle or secretion of breast milk when you are not breastfeeding
    • Males: problems getting or maintaining an erection (erectile dysfunction) or enlargement of breasts (gynecomastia)
  • Low white blood cell count. Your health care provider may do blood tests during the first few months of treatment with LATUDA
  • Decreased blood pressure (orthostatic hypotension). You may feel lightheaded or faint when you rise too quickly from a sitting or lying position
  • Falls. LATUDA may make you sleepy or dizzy, may cause a decrease in your blood pressure when changing position (orthostatic hypotension), and can slow your thinking and motor skills, which may lead to falls that can cause fractures or other injuries
  • Seizures (convulsions)
  • Problems controlling your body temperature so that you feel too warm. Do not become too hot or dehydrated during treatment with LATUDA. Do not exercise too much. In hot weather, stay inside in a cool place if possible. Stay out of the sun. Do not wear too much clothing or heavy clothing. Drink plenty of water
  • Mania or hypomania (manic episodes) in people with a history of bipolar disorder. Symptoms may include: greatly increased energy, severe problems sleeping, racing thoughts, reckless behavior, unusually grand ideas, excessive happiness or irritability, or talking more or faster than usual
  • Difficulty swallowing

Do not drive, operate heavy machinery, or do other dangerous activities until you know how LATUDA affects you. LATUDA may make you drowsy.

Avoid eating grapefruit or drinking grapefruit juice while you take LATUDA since these can affect the amount of LATUDA in the blood.

Do not take LATUDA if you are allergic to any of the ingredients in LATUDA or take certain medications called CYP3A4 inhibitors or inducers. Ask your health care provider if you are not sure if you are taking any of these medications.

Tell your health care provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. LATUDA and other medicines may affect each other, causing possible serious side effects. LATUDA may affect the way other medicines work, and other medicines may affect how LATUDA works. Your health care provider can tell you if it is safe to take LATUDA with your other medicines. Do not start or stop any other medicines during treatment with LATUDA without talking to your health care provider first.

Before taking LATUDA, tell your health care provider about all of your medical conditions, including if you:

  • have or have had heart problems or stroke
  • have or have had low or high blood pressure
  • have or have had diabetes or high blood sugar, or have a family history of diabetes or high blood sugar
  • have or have had high levels of total cholesterol or triglycerides
  • have or have had high prolactin levels
  • have or have had low white blood cell count
  • have or have had seizures
  • have or have had kidney or liver problems
  • are pregnant or plan to become pregnant. It is not known if LATUDA will harm your unborn baby. Talk to your health care provider about the risk to your unborn baby if you take LATUDA during pregnancy
    • Tell your health care provider if you become pregnant or think you are pregnant during treatment with LATUDA
    • If you become pregnant during treatment with LATUDA, talk to your health care provider about registering with the National Pregnancy Registry for Atypical Antipsychotics. You can register by calling 1-866-961-2388 or going to http://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/
  • are breastfeeding or plan to breastfeed. It is not known if LATUDA passes into your breast milk. Talk to your health care provider about the best way to feed your baby during treatment with LATUDA

The most common side effects of LATUDA include:

  • Adults with schizophrenia: sleepiness or drowsiness; restlessness or feeling like you need to move around (akathisia); difficulty moving, slow movements, or muscle stiffness; and nausea
  • Adolescents (13 to 17 years) with schizophrenia: sleepiness or drowsiness; nausea; restlessness or feeling like you need to move around (akathisia); difficulty moving, slow movements, muscle stiffness, or tremor; runny nose/nasal inflammation; and vomiting
  • Adults with bipolar depression: restlessness or feeling like you need to move around (akathisia); difficulty moving or slow movements; and sleepiness or drowsiness
  • Children (10 to 17 years) with bipolar depression: nausea; weight gain; and problems sleeping (insomnia)

These are not all the possible side effects of LATUDA. For more information, ask your health care provider or pharmacist.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

INDICATIONS

LATUDA is a prescription medicine used:

  • To treat adults and adolescents (13 to 17 years) with schizophrenia
  • Alone to treat adults, children and teens (10 to 17 years) with depressive episodes that happen with bipolar I disorder (bipolar depression)
  • With the medicine lithium or valproate to treat adults with depressive episodes that happen with bipolar I disorder (bipolar depression)

References



[1] National Institute of Mental Health. “Bipolar Disorder Statistics.” Available from: https://www.nimh.nih.gov/health/statistics/bipolar-disorder.shtml. Accessed April 2021.

[2] Depression and Bipolar Support Alliance. Bipolar Disorder Diagnosis and Symptoms. [Internet]. Available from: https://www.dbsalliance.org/education/bipolar-disorder/diagnosis/. Accessed April 2021.

[3] Dome, P., Rihmer, Z., & Gonda, X. (2019). Suicide Risk in Bipolar Disorder: A Brief Review. Medicina (Kaunas, Lithuania), 55(8), 403. https://doi.org/10.3390/medicina55080403

[4] Sylvia, L.G., Montana, R.E., Deckersbach, T. et al. (2017). Poor quality of life and functioning in bipolar disorder. International Journal of Bipolar Disorders, 5, 10. https://doi.org/10.1186/s40345-017-0078-4

[5] Singh T, Rajput M. (2006). Misdiagnosis of bipolar disorder. Psychiatry (Edgmont), 3(10):57-63. PMID: 20877548, PMCID: PMC2945875

[6] Phillips ML, Kupfer DJ. (2013). Bipolar disorder diagnosis: challenges and future directions. The Lancet, 381(9878): 1663-1671. https://doi.org/10.1016/s0140-6736(13)60989-7

[7] Loebel, A., Cucchiaro, J., Silva, R., Kroger, H., Hsu, J., Sarma, K., & Sachs, G. (2014). Lurasidone monotherapy in the treatment of Bipolar I Depression: A randomized, double-blind, placebo-controlled study. The American Journal of Psychiatry, 171(2): 160-168. https://doi.org/10.1176/appi.ajp.2013.13070984.

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