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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- Elevated/irritable mood ≥ 1 week
- Euphoric, grandiose, labile
- Depressed mood ≥ 2 weeks
- Flat, hopeless, tearful
- ★Pressured speech, flight of ideas
- ↓ sleep, not tired
- Hyperactive, impulsive
- Psychomotor retardation
- Slow, soft speech
- Hypersomnia/insomnia, fatigue
- Social withdrawal
- Decrease stimulation
- Firm, consistent limits
- High-calorie finger foods, I&O
- Set small, achievable goals
- Encourage gradual activity
- Sit with the patient at meals
- Avoid isolation
- Lithium (0.6–1.2 mEq/L)
- Valproate or antipsychotic (acute)
- Lithium toxicity > 1.5 mEq/L
- Lamotrigine (bipolar depression)
- ★Antidepressant ONLY with mood stabilizer
- Take meds even when feeling better
- Regular lithium levels
- Lithium: consistent Na & fluid intake
- Take meds even when feeling better
- Antidepressant takes 2–4 wk
- Report suicidal thoughts
- Injury from impulsivity
- Exhaustion, dehydration
- ★Suicide risk highest as energy returns
- Financial/legal/relationship damage
- Completed suicide
- Chronic functional disability
Manic Phase
- Elevated/irritable mood ≥ 1 week
- Euphoric, grandiose, labile
Depressive Phase
- Depressed mood ≥ 2 weeks
- Flat, hopeless, tearful
Manic Phase
- ★Pressured speech, flight of ideas
- ↓ sleep, not tired
- Hyperactive, impulsive
Depressive Phase
- Psychomotor retardation
- Slow, soft speech
- Hypersomnia/insomnia, fatigue
- Social withdrawal
Manic Phase
- Decrease stimulation
- Firm, consistent limits
- High-calorie finger foods, I&O
Depressive Phase
- Set small, achievable goals
- Encourage gradual activity
- Sit with the patient at meals
- Avoid isolation
Manic Phase
- Lithium (0.6–1.2 mEq/L)
- Valproate or antipsychotic (acute)
- Lithium toxicity > 1.5 mEq/L
Depressive Phase
- Lamotrigine (bipolar depression)
- ★Antidepressant ONLY with mood stabilizer
Manic Phase
- Take meds even when feeling better
- Regular lithium levels
- Lithium: consistent Na & fluid intake
Depressive Phase
- Take meds even when feeling better
- Antidepressant takes 2–4 wk
- Report suicidal thoughts
Manic Phase
- Injury from impulsivity
- Exhaustion, dehydration
Depressive Phase
- ★Suicide risk highest as energy returns
Manic Phase
- Financial/legal/relationship damage
Depressive Phase
- Completed suicide
- Chronic functional disability
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Mania kills through impulsivity — decrease stimulation. Depression kills through suicide — assess when energy returns first.
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