Discussing Bipolar Disorder

on ET Canada

Major Depressive Disorder (MDD) has 9 symptoms. 5 symptoms must be present most of the day and everyday for at least 2 weeks and function must be impaired. The 9 symptoms are remembered using the mnemonic FACE IS SAD  with each letter representing a symptom. One of the 5 symptoms must be depressed mood or loss of interest.


                                         F: fatigue (or lack of energy)

                                         A: anxiety (or agitation)

                                         C: concentration impairment

                                         E: esteem loss (or feelings of worthlessness or guilt)

                                         I: interest loss
                                         S: sleep disturbance (too little or too much)

                                         S: suicidal thoughts or behaviors

                                         A: appetite change (decreased or increased)

                                         D: depressed mood


Treatment of MDD includes psychotherapy (talk therapy) and pharmacotherapy. Mild cases often do not require medication but if symptoms persists and function remains impaired, medication is considered.


Medication, at the correct dose, usually takes 3 to 4 weeks before significant improvement occurs. Antidepressants must be taken daily and an initial "course" of medication lasts at least 9 months. At the end of treatment, medication is reduced gradually to avoid withdrawal symptoms. Early side-effects include agitation and nausea. Later side-effects include sexual disturbances.


Antidepressant Withdrawal symptoms often occur when antidepressants are discontinued suddenly rather than tapered gradually. The withdrawal symptoms are remembered by the mnemonic FINISH:F:flu-like symptoms,I:imbalance or dizziness, N:nausea, I:insomnia, S:sensory feelings (pins & needles, feeling your brain is like "jelly"),H:hyper-agitation & headache.


Bipolar Affective Disorder(also called manic depression) features episodes of depression alternating with periods of elevated, expansive or very irritable mood (the manic or hypomanic phase).MANIC phases last at least 7 days and HYPOMANIC phases (the milder form) last 4 days. In MANIA there is marked impairment of functioning while in HYPOMANIA function is less impaired.


The elevated mood is characterized by  3 or more of 7 symptoms, from the mnemonic IMPAIRED:


                                  IMpulsivity (sexual indiscretions, driving and spending recklessly)

                                   Pressured Speech (speaking very quickly)

                                   Activity Increase

                                   Insomnia (decreased need for sleep)

                                   Racing Thoughts

                                   Esteem elevation

                                   Distractibility