side by side comparison

Bipolar Phases: Mania vs Depression — Presentation, Safety Priorities, Medication Differences

Both bipolar phases are dangerous, but for opposite reasons. Picking the wrong safety priority — limiting impulsivity when you should be screening for suicide, or vice versa — costs the NCLEX question and, clinically, could cost a life. The transition between phases is the deadliest window.

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Comparison

Side-by-side2 compared
Dimension
Manic Phase
Depressive Phase
Phase definition
  • Elevated/irritable mood ≥ 1 week
  • Euphoric, grandiose, labile
  • Depressed mood ≥ 2 weeks
  • Flat, hopeless, tearful
Signs & symptoms
  • ★Pressured speech, flight of ideas
  • ↓ sleep, not tired
  • grandiosity, hyperactive
  • Psychomotor retardation
  • slow soft speech
  • Hypersomnia/insomnia, fatigue
  • withdrawal
Nursing priorities
  • Decrease stimulation
  • firm consistent limits
  • Finger foods + monitor I&O (too distracted)
  • Structured routine
  • encourage gradual activity
  • Sit at meals
  • avoid isolation
Treatment & meds
  • Lithium (0.6–1.2 mEq/L)
  • valproate acute
  • Watch lithium toxicity > 1.5
  • Lithium or lamotrigine maintenance
  • ★Antidepressant ONLY with mood stabilizer
Patient teaching
  • Adhere to mood stabilizer
  • regular levels
  • Lithium: consistent Na & fluid intake
  • Take meds even when feeling better
  • Antidepressant takes 2–4 wk
  • report worsening
Safety — escalate
  • Injury from impulsivity
  • exhaustion, dehydration
  • ★Suicide risk highest as energy returns
Complications
  • Financial/legal/relationship damage
  • Suicide
  • chronic disability
Phase definition

Manic Phase

  • Elevated/irritable mood ≥ 1 week
  • Euphoric, grandiose, labile

Depressive Phase

  • Depressed mood ≥ 2 weeks
  • Flat, hopeless, tearful
Signs & symptoms

Manic Phase

  • ★Pressured speech, flight of ideas
  • ↓ sleep, not tired
  • grandiosity, hyperactive

Depressive Phase

  • Psychomotor retardation
  • slow soft speech
  • Hypersomnia/insomnia, fatigue
  • withdrawal
Nursing priorities

Manic Phase

  • Decrease stimulation
  • firm consistent limits
  • Finger foods + monitor I&O (too distracted)

Depressive Phase

  • Structured routine
  • encourage gradual activity
  • Sit at meals
  • avoid isolation
Treatment & meds

Manic Phase

  • Lithium (0.6–1.2 mEq/L)
  • valproate acute
  • Watch lithium toxicity > 1.5

Depressive Phase

  • Lithium or lamotrigine maintenance
  • ★Antidepressant ONLY with mood stabilizer
Patient teaching

Manic Phase

  • Adhere to mood stabilizer
  • regular levels
  • Lithium: consistent Na & fluid intake

Depressive Phase

  • Take meds even when feeling better
  • Antidepressant takes 2–4 wk
  • report worsening
Safety — escalate

Manic Phase

  • Injury from impulsivity
  • exhaustion, dehydration

Depressive Phase

  • ★Suicide risk highest as energy returns
Complications

Manic Phase

  • Financial/legal/relationship damage

Depressive Phase

  • Suicide
  • chronic disability

★ marks the fact that sets a column apart.

Clinical Pearl

Mania kills through impulsivity — decrease stimulation. Depression kills through suicide — assess when energy returns first.

Component Topics

Bipolar Disorder

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