Predominant Polarity: what it is and how it affects Bipolar Disorder
May 25, 2023
Perhaps you have heard about the Bipolar disorder and its subtypes and you may even know the characteristics of this mood-related ailment. Although the current classifications of bipolar disorder into type I and type II have proven useful, they provide insufficient clinical information in some patients.
For this reason, complementary classifications have been proposed, such as the prevailing polarity. Let's see what this alteration of the mental health.
What is the predominant polarity?
On the one hand, bipolar type I disorder It is characterized by having suffered at least one manic episode that may be preceded by either a hypomanic episode or a major depressive episode. The mania in this subtype is so strong that it can cause a disconnection with reality (psychosis).
On the other hand, bipolar type II disorder characterized by the presence of at least one depressive episode, but unlike individuals with bipolar disorder type I, those with type II experience hypomanic episodes instead of manic episodes severe. To understand, hypomania is a mental state similar to mania with the difference that the symptoms are less pronounced. After all, it is characterized by a high mood, disinhibition, and in a large number of cases there is also a greater facility to become irritated.
It is important to clarify that bipolar II disorder is not a milder form of bipolar I disorder, but rather an entirely different diagnosis. As we have well commented, people who suffer from type II bipolar disorder can be depressed for a long time, creating significant deterioration that interferes with their quality of life. Similarly, those individuals diagnosed with type I bipolar disorder need to be treated as their Manic episodes can be extremely dangerous both to themselves and to the people around them. around.
Not everyone diagnosed with bipolar experiences bipolar disorder in the same way, moving from mania to depression or from depression to hypomania. In fact, around 50% of people with bipolar I or II disorder spend a great deal of time at one pole over the other. This is called the predominant polarity and is defined as have twice as many episodes of one pole over the other. In other words, it is the clear tendency for the patient to present relapses of manic or depressive polarity.
Identifying which phase the person spends the most time can make a difference when it comes to helping them. It is known that those individuals in whom depressive episodes predominate have both clinical and as different therapeutics compared to people with a predominance of having manic episodes or hypomanic. How do we discover the predominant polarity of the patient?
The initial episodes are key to finding the dominant pole in terms of the person's state of mind. In fact, if the depressive polarity predominates, it is most likely that your first episode was a major depression and having had several depressive episodes before having manic episodes or hypomanic. It is extremely important to prevent depressive episodes among patients with this condition. trend since there are several studies that support the high risk of suicide attempts in this population.
- Related article: "Emotional instability: what is it and in what signs can it be detected?"
How does predominant polarity affect people with bipolar disorder?
Many times, the person comes to the consultation with a masked depression that is actually an unrecognized bipolarity. In these cases, an antidepressant is administered to alleviate their symptoms. This can be a serious mistake since there is a risk of not progressing properly with the medication. Rather, antidepressants tend to make bipolar disorder worse by triggering rapid cycling or creating mixed episodes where you have horrible churning depression.
The individual may have spent years being treated with antidepressants alone and not getting better since the treatment for bipolar disorder is primarily a mood stabilizer. It should be noted, however, that some people with bipolar disorder may be able to tolerate a small dose of antidepressant as long as they also take the aforementioned mood stabilizer cheer up.
The same goes for the other pole. People with a predominance of manic polarity often present their first episode as manic.. They also have their first episodes at a younger age, near their late teens and early twenties, and often have more psychotic symptoms with mania or depression. The main psychotic symptom is delusions. If it is a manic episode, the delusion tends to be grandiose or religious. In the depressive stage, the delusions are more persecutory, where they feel that someone is after them and wants to hurt them.
In the case of manic predominance, it is clear from the start that it is not unipolar depression. From a treatment standpoint, mania is much easier to treat than depression because the antipsychotics that are used as mood stabilizers are much better at curbing mania than at getting someone out of a depression. Manic episodes are frightening because of how unpredictable and destructive the behavior becomes, but if the person maintains regular contact with their professional and his entourage are committed to monitoring him, the symptoms can be detected before they get out of control and the results of the treatment are much better.
We have previously discussed that some people can improve their depressive episodes with a low dose of antidepressants and, of course, a mood stabilizer. However, it is important to clarify that individuals with a predominance of the manic state should not use antidepressants as treatment. This is because being manic with infrequent depressive episodes makes it more likely that an antidepressant will trigger the manic state. In this case, it is recommended to go to a professional so that they can assess and advise another mood stabilizer or even refer the patient to psychotherapy.
It may also happen that we find people with a recent diagnosis of bipolar disorder and for Therefore, they do not have enough information about their behavior pattern to establish a predominance clear. Experts on the subject recommend using a diary to be able to write down your mood. It is not necessary to write down how the person feels every day, but if, for example, they experience a depressive episode in August 2020, it is important to write it down. Write down when it was, how long it lasted and how you felt. By repeating this every time you have both a depressive and a manic state, you get to have a idea of how many episodes you have per year, how long they last and most importantly, which pole is the most dominant.
- You may be interested in: "The 6 types of mood disorders"
In sum, the predominant polarity is useful as a complement to the current classifications of bipolar disorder. It is a beneficial parameter when making therapeutic decisions. However, more prospective studies and a unified methodology are needed since data are available consistent in various investigations, but there are others where completely contradictory.
However, there seems to be agreement that individuals with predominantly manic polarity benefit from neuroleptics or atypical antipsychotics during the acute phase of treatment. Regarding maintenance therapy in this population, the use of atypical antipsychotics is also the most advantageous. On the other hand, patients with predominantly depressive polarity improve more frequently with antidepressants, as we mentioned at the beginning of the article.
Finally, we return to the importance of the onset of the disease. In various studies, they conclude that individuals prone to developing a depressive polarity are those in whom there is a relationship between a vital event and the onset of the disease. In contrast, the misuse of psychoactive substances is associated with predominantly manic polarity. It is clear that the mode of onset of the disease influences the predominant polarity of each patient, which in turn is useful for predicting the goal of long-term maintenance therapy. term. Going a step further, it is known that the initial episode strongly predicts the characteristics of the following episode and therefore it is necessary to take both aspects into account to determine which will be the appropriate mood stabilizing therapeutic strategy for each patient. With this, comprehensive, optimal and personalized medical assistance is achieved.