Mania With Depressive Symptoms: A Pathophysio-Logical Review

Volume 1 Issue 1
Article Information


Key messages
● Bipolar disorder (BD) is a common, complex, and costly psychiatric illness that can be devastating for the
affected individual and their families. Suicide is an important risk across the life span of bipolar patients.
● Accurate diagnosis is not easy, particularly in mixed states. Psychotic symptoms may suggest schizophrenia,
and a major depressive episode may appear to be unipolar depression. Comorbid anxiety and substance/
alcohol abuse often confuse the diagnostic picture. These factors contribute to under-diagnosis of BD.
● Incorrect diagnosis may worsen prognosis and increase hospital stay and the overall costs of treatment and
patient management.
● There is a significant clinical need for more effective and better-tolerated drug treatments for BD. Although
the pathophysiology and neurobiological processes responsible for BD are not fully understood, a greater
understanding of the causative underlying mechanisms is emerging.
● Identification of new drug targets driven by recent research should help define a more tailored and potentially
more successful approach to the treatment of BD. Future advances are expected based on the ability to
manipulate and redress the fundamental disease processes and neurobiological dysfunction that underlie BD.
● To describe BD as alternating periods of mania and depression is an oversimplification. Mania can present with
associated depressive symptoms and features leading to complicated, problematic, and difficult-to-treat mixed states.

Key words: mania, manic, depressive symptoms, depression, anxiety, bipolar disorder, psychiatric, psychotic, schizophrenia

Acknowledgments: The publication of this article was supported by H Lundbeck A/S. The views and opinions expressed are those of the authors and not necessarily those of H Lundbeck A/S.