Could Mood Changes Indicate Something More?

Shutterstock

It is natural to feel highs or lows from time to time. Our moods change and fluctuate often. For the roughly 40 million people living with bipolar disorder across the globe,¹ these differences are often more intense and can include a combination of extreme lows, like depression, and highs, called mania or hypomania, which can include abnormal and suddenly elevated moods or energy levels.^2–4

Bipolar depression is part of the larger condition of bipolar I disorder. On average, those living with bipolar I disorder experience three times as many depressive episodes as manic ones, and depressive episodes often last 50% longer.^5–7 Depressive episodes can have significant impact on daily life, as well as quality of life, and are often the catalyst for people to seek treatment for their condition.^8–10

Bipolar depression can be difficult to diagnose in part because people living with it are likely to experience other conditions with similar symptoms like anxiety disorder or Attention Deficit Hyperactivity Disorder (ADHD).¹⁰ In fact, only 20% of people with bipolar disorder who are experiencing bipolar depression are correctly diagnosed within a year of seeking treatment.⁸

In addition, up to 60% of those experiencing bipolar depression are misdiagnosed as having major depressive disorder (MDD), also known as unipolar depression, which is not associated with mania or hypomania.⁸ Bipolar disorder, however, has an earlier age of onset, more frequent episodes, and a greater proportion of time spent with symptoms than MDD.¹⁰

Unfortunately, delays in the proper diagnosis and failure to manage the condition with the right treatments are associated with worse outcomes and potentially more severe symptoms.¹⁰

Shutterstock

“Recognizing the symptoms and having open and honest conversations with healthcare providers, friends, and family can help determine whether what you are experiencing is an aspect of daily life or a sign of something more serious,” said Dr. Roger S. McIntyre, M.D., FRCPC, Professor of Psychiatry and Pharmacology, University of Toronto, Canada. “When patients hear that there is an explanation for how they are feeling, and treatments are available that can help address and manage their symptoms, it is a huge sense of relief. It helps people to know that they are not alone and that there is no stigma associated with getting needed help.”

Bipolar disorder can present in different ways. Monitoring symptoms and identifying trends can help foster informed conversations with a healthcare provider. Experiencing the following symptoms often could be signs of bipolar disorder: ¹⁰

• One or more distinct periods of abnormally and persistently elevated or irritable mood
• Sadness or lack of interest in normal activities
• Negative feelings towards yourself, or feelings of guilt
• Withdrawal from relationships or difficulty adjusting to social situations
• Anxiety, panic, or frustration
• Difficulty concentrating, remembering, or making decisions
• Racing thoughts
• Increased daytime napping
• Increased appetite or weight gain

Having one or several of these symptoms does not mean someone has bipolar disorder. A healthcare provider can help screen an individual and provide the correct diagnosis.

Shutterstock

Managing bipolar depression can include a combination of psychotherapy, counseling, and medication. While bipolar depression looks a lot like MDD, antidepressants used alone may not adequately address bipolar depression and can, in fact, make manic symptoms worse or increase the chance of relapsing.^11,12 In this case, a healthcare provider might prescribe a medicine, like Latuda^® (lurasidone HCl), a once-a-day prescription medicine FDA-approved to be used alone or in combination with other medications to treat bipolar depression in adults and adolescents (10 to 17 years) diagnosed with bipolar I disorder.¹² In clinical studies, LATUDA helped significantly reduce depressive symptoms in people with bipolar depression, with minimal side effects on weight and other metabolic parameters.

The right healthcare team, supportive environment, and treatment can make all the difference for those living with bipolar depression. Sometimes challenges can get in the way, but, with support, people living with bipolar depression can live healthy, fulfilling lives.

To learn more about bipolar depression and LATUDA, please visit: www.LATUDA.com. Please see below for Important Safety Information.

---

IMPORTANT SAFETY INFORMATION AND INDICATIONS FOR LATUDA

INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS; and SUICIDAL THOUGHTS AND BEHAVIORS

Increased risk of death in elderly people with dementia-related psychosis. Medicines like LATUDA can raise the risk of death in elderly people who have lost touch with reality (psychosis) due to confusion and memory loss (dementia). LATUDA is not approved for the treatment of people with dementia-related psychosis.

Antidepressant medicines may increase suicidal thoughts or behaviors in some children, teenagers, and young adults within the first few months of treatment and when the dose is changed. Depression and other serious mental illnesses are the most important causes of suicidal thoughts and actions. Patients on antidepressants and their families or caregivers should watch for new or worsening depression symptoms, especially sudden changes in mood, behaviors, thoughts, or feelings. This is very important when an antidepressant medicine is started or when the dose is changed. Report any change in these symptoms immediately to the doctor.

LATUDA may cause serious side effects, including:

• Stroke (cerebrovascular problems) in elderly people with dementia-related psychosis that can lead to death
• Neuroleptic malignant syndrome (NMS) is a serious condition that can lead to death. Call your health care provider or go to the nearest hospital emergency room right away if you have some or all of the following signs and symptoms of NMS: high fever, increased sweating, stiff muscles, confusion, or changes in your breathing, heart rate, and blood pressure
• Uncontrolled body movements (tardive dyskinesia). LATUDA may cause movements that you cannot control in your face, tongue, or other body parts. Tardive dyskinesia may not go away, even if you stop taking LATUDA. Tardive dyskinesia may also start after you stop taking LATUDA
• Problems with your metabolism such as:
  • High blood sugar (hyperglycemia) and diabetes: Increases in blood sugar can happen in some people who take LATUDA. Extremely high blood sugar can lead to coma or death. If you have diabetes or risk factors for diabetes (such as being overweight or a family history of diabetes), your health care provider should check your blood sugar before you start and during treatment with LATUDA
    • - Call your health care provider if you have any of these symptoms of high blood sugar (hyperglycemia) while taking LATUDA: feel very thirsty, need to urinate more than usual, feel very hungry, feel weak or tired, feel sick to your stomach, feel confused, or your breath smells fruity
  • Increased fat levels (cholesterol and triglycerides) in your blood
  • Weight gain. You and your health care provider should check your weight regularly during treatment with LATUDA
• Increased prolactin levels in your blood (hyperprolactinemia). Your health care provider may do blood tests to check your prolactin levels during treatment with LATUDA. Tell your health care provider if you have any of the following signs and symptoms of hyperprolactinemia:
  • Females: absence of your menstrual cycle or secretion of breast milk when you are not breastfeeding
  • Males: problems getting or maintaining an erection (erectile dysfunction) or enlargement of breasts (gynecomastia)
• Low white blood cell count. Your health care provider may do blood tests during the first few months of treatment with LATUDA
• Decreased blood pressure (orthostatic hypotension). You may feel lightheaded or faint when you rise too quickly from a sitting or lying position
• Falls. LATUDA may make you sleepy or dizzy, may cause a decrease in your blood pressure when changing position (orthostatic hypotension), and can slow your thinking and motor skills, which may lead to falls that can cause fractures or other injuries
• Seizures (convulsions)
• Problems controlling your body temperature so that you feel too warm. Do not become too hot or dehydrated during treatment with LATUDA. Do not exercise too much. In hot weather, stay inside in a cool place if possible. Stay out of the sun. Do not wear too much clothing or heavy clothing. Drink plenty of water
• Mania or hypomania (manic episodes) in people with a history of bipolar disorder. Symptoms may include: greatly increased energy, severe problems sleeping, racing thoughts, reckless behavior, unusually grand ideas, excessive happiness or irritability, or talking more or faster than usual
• Difficulty swallowing

Do not drive, operate heavy machinery, or do other dangerous activities until you know how LATUDA affects you. LATUDA may make you drowsy.

Avoid eating grapefruit or drinking grapefruit juice while you take LATUDA since these can affect the amount of LATUDA in the blood.

Do not take LATUDA if you are allergic to any of the ingredients in LATUDA or take certain medications called CYP3A4 inhibitors or inducers. Ask your health care provider if you are not sure if you are taking any of these medications.

Tell your health care provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. LATUDA and other medicines may affect each other, causing possible serious side effects. LATUDA may affect the way other medicines work, and other medicines may affect how LATUDA works. Your health care provider can tell you if it is safe to take LATUDA with your other medicines. Do not start or stop any other medicines during treatment with LATUDA without talking to your health care provider first.

Before taking LATUDA, tell your health care provider about all of your medical conditions, including if you:

• have or have had heart problems or stroke
• have or have had low or high blood pressure
• have or have had diabetes or high blood sugar, or have a family history of diabetes or high blood sugar
• have or have had high levels of total cholesterol or triglycerides
• have or have had high prolactin levels
• have or have had low white blood cell count
• have or have had seizures
• have or have had kidney or liver problems
• are pregnant or plan to become pregnant. It is not known if LATUDA will harm your unborn baby. Talk to your health care provider about the risk to your unborn baby if you take LATUDA during pregnancy
  • Tell your health care provider if you become pregnant or think you are pregnant during treatment with LATUDA
  • If you become pregnant during treatment with LATUDA, talk to your health care provider about registering with the National Pregnancy Registry for Atypical Antipsychotics. You can register by calling 1-866-961-2388 or going to http://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/
• are breastfeeding or plan to breastfeed. It is not known if LATUDA passes into your breast milk. Talk to your health care provider about the best way to feed your baby during treatment with LATUDA

The most common side effects of LATUDA include:

• Adults with schizophrenia: sleepiness or drowsiness; restlessness or feeling like you need to move around (akathisia); difficulty moving, slow movements, or muscle stiffness; and nausea
• Adolescents (13 to 17 years) with schizophrenia: sleepiness or drowsiness; nausea; restlessness or feeling like you need to move around (akathisia); difficulty moving, slow movements, muscle stiffness, or tremor; runny nose/nasal inflammation; and vomiting
• Adults with bipolar depression: restlessness or feeling like you need to move around (akathisia); difficulty moving or slow movements; and sleepiness or drowsiness
• Children (10 to 17 years) with bipolar depression: nausea; weight gain; and problems sleeping (insomnia)

These are not all the possible side effects of LATUDA. For more information, ask your health care provider or pharmacist.

You are encouraged to report negative side effects of prescription drugs to the FDA.  Visit www.fda.gov/medwatch or call 1800FDA1088.

INDICATIONS

LATUDA is a prescription medicine used:

• To treat adults and adolescents (13 to 17 years) with schizophrenia
• Alone to treat adults, children and teens (10 to 17 years) with depressive episodes that happen with bipolar I disorder (bipolar depression)
• With the medicine lithium or valproate to treat adults with depressive episodes that happen with bipolar I disorder (bipolar depression)

References

1. GBD 2019 Mental Disorders Collaborators. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet Psychiatry. 2022;9(2):137-150. doi:10.1016/S2215-0366(21)00395-3

2. National Institute of Mental Health. Bipolar disorder. National Institute of Mental Health (NIMH). Published January 2020. Accessed June 6, 2022. https://www.nimh.nih.gov/health/topics/bipolar-disorder

3. Bipolar disorder – Symptoms and causes. Mayo Clinic. Accessed June 6, 2022. https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955

4. Carvalho AF, Firth J, Vieta E. Bipolar disorder. Ropper AH, ed. N Engl J Med. 2020;383(1):58-66. doi:10.1056/NEJMra1906193

5. Baldessarini RJ, Vieta E, Calabrese JR, Tohen M, Bowden CL. Bipolar depression: overview and commentary. Harv Rev Psychiatry. 2010;18(3):143-157. doi:10.3109/10673221003747955

6. Sylvia LG, Montana RE, Deckersbach T, et al. Poor quality of life and functioning in bipolar disorder. International Journal of Bipolar Disorders. 2017;5(1):10. doi:10.1186/s40345-017-0078-4

7. Miller S, Dell’Osso B, Ketter TA. The prevalence and burden of bipolar depression. J Affect Disord. 2014;169 Suppl 1:S3-11. doi:10.1016/S0165-0327(14)70003-5

8. Rolin D, Whelan J, Montano CB. Is it depression or is it bipolar depression? J Am Assoc Nurse Pract. 2020;32(10):703-713. doi:10.1097/JXX.0000000000000499

9. Post RM. The impact of bipolar depression. J Clin Psychiatry. 2005;66 Suppl 5:5-10.

10. Angst J, Azorin JM, Bowden CL, et al. Prevalence and characteristics of undiagnosed bipolar disorders in patients with a major depressive episode: the BRIDGE study. Arch Gen Psychiatry. 2011;68(8):791-798. doi:10.1001/archgenpsychiatry.2011.87

11. Angst J, Cui L, Swendsen J, et al. Major depressive disorder with subthreshold bipolarity in the National Comorbidity Survey Replication. Am J Psychiatry. 2010;167(10):1194-1201. doi:10.1176/appi.ajp.2010.09071011

12. Loebel A, Cucchiaro J, Silva R, et al. Lurasidone monotherapy in the treatment of bipolar I depression: a randomized, double-blind, placebo-controlled study. AJP. 2014;171(2):160-168. doi:10.1176/appi.ajp.2013.13070984