DYSPHORIC MANIA AND MIXED STATES –
It is possible to have the symptoms of major depression and mania at the same time. This is called a mixed, or dysphoric state. It is estimated that 31% of patients presenting with mania have a mixed state. It is characterized by distinct periods of abnormally and persistently elevated, expansive, and/or irritable mood with depression (neither is due to just drug abuse.)
While the absolute changes in the brain chemistry are not fully known, mixed mania may be associated with brain transmitters that are too high (dopamine and norepinephrine), and/or too low, (serotonin). Mixed states sometimes occur during transitions from one phase of mood to the other.
In mixed mood states it is essential to treat the mania before treating the depression. Starting treatment with an antidepressant is like throwing kerosene on a fire because it can trigger a manic state.
RAPID CYCLING –
Persons with rapid cycling have at least 4 episodes per year of mania/hypomania, and/or major depression. It is estimated that 13-20% of bipolar patients are rapid cyclers. It is more common in women, probably because women have more hypothyroidism.
Rapid cycling is frequently caused by low thyroid. Some experts recommend keeping thyroid levels within the top 25% of normal range of free T4. This can be measured by a standard blood test. Note: Many doctors only test the TSH for thyroid disorders. Testing only TSH is not adequate for secondary thyroid disorders.
Rapid cycling is difficult to treat and may respond better to a mood stabilizer than Lithium. Lamictal has the best controlled studies for treatment of rapid cycling.
