Frequency of depressive symptoms during mania under-recognised

The global need to understand that episodes of mania in people with bipolar I disorder can often be coupled with depressive symptoms is of the utmost importance. Mania with depressive symptoms is a severe illness which is attributed to an increased rate of suicidality and hospitalisations, compared with episodes of “pure mania”.^1,2 Mental Health Awareness week took place at the beginning of May, helping to raise awareness of mental illness and drive conversation around the topic. I hope that the momentum continues, prompting greater recognition of mania with depressive symptoms and initiating conversation around the often devastating consequences.

Published research has shown that 64 per cent of bipolar I disorder patients will suffer from at least one concurrent depressive symptom during an episode of mania,³ however, results from a new survey amongst 370 global psychiatrists show that 72 per cent are not aware of the frequency of mania with depressive symptoms.⁴ This can have devastating consequences: half (44–54%) of people experiencing mania with three or more depressive symptoms have considered or attempted suicide,¹ compared with 12–26 per cent of people with ‘pure mania’.

The increased risk of suicide amongst bipolar I disorder patients stems from the combination of volatile and erratic moods associated with dysphoria and a depressed mood.⁵ It is understood that 26 per cent of patients with 0-2 depressive symptoms have attempted suicide in their lifetime - a figure increasing to 54 per cent in patients with ≥3 depressive symptoms.¹

Sadly, in the UK, the numbers of suicides are increasing. In 2013 alone there were 6,233 suicides in the UK, an increase of 4% from the previous year.⁶ Whilst these cannot all be attributed to bipolar I disorder, the increase is a worrying trend. Despite the known increase in suicides, mental health trusts in England are forecasting significant cuts to their funding over the next four years. This reinforces the urgent need for psychiatrists to recognise and acknowledge vulnerable patients suffering from disorders such as mania with depressive symptoms quickly, in order to treat them effectively.

The good news is that there are ‘tell-tale’ signs of a potential episode of mania with depressive symptoms: anxiety, irritability and agitation (AIA);³ it is important that these are recognised by healthcare professionals in order to ensure a better diagnosis of this dangerous form of bipolar I disorder. Almost three quarters (72 per cent) of patients experiencing mania with depressive symptoms report symptoms of AIA, compared to just 27 per cent of patients without depressive symptoms.³

Increased awareness of mania with depressive symptoms, along with recognition of the known warning signs, can help to ensure that those in need receive potentially lifesaving treatment and care.