Depression is a much more common illness than mania, and there are indeed many sufferers from depression who have never experienced mania.
In 1949, John Cade published an article in the Medical Journal of Australia describing his discovery that lithium sedated people who experienced mania.
A total of 89 patients who had at least two major depressive episodes, but never experienced mania or hypomania, were randomly assigned to treatment with immediate-release CBZ 300 800 mg/daily (n = 51) or placebo (n = 38) for 12 weeks.
Diagnosed with bipolar disorder, he experienced mania accompanied by hallucinations that made him certain that he had to die.
In the short dark days of winter, many people, especially bipolars (people who have experienced mania or hypomania), experience a tendency towards low mood, usually mild.
In another study, patients experiencing mania showed hyperactivation of ventral prefrontal cortex given the prospect of increasing reward, but relatively reduced activation when faced with increasing loss (Bermpohl et al., 2010).
Some international guidelines [ 1, 2] have been updated with regard to the drug treatment of patients experiencing mania, but there has been no assessment as yet of their application in medical practice.
Finally, regarding the statistical difference on item 17 (Insight), it is known that people with bipolar disorder are more likely to seek help when they are depressed than when they are experiencing mania or hypomania [ 5], so this is an expected result.
One study of patients experiencing mania reported an elevated ventral striatal response to omission of reward outcomes, but no difference in response to expected reward outcomes (Abler et al., 2007 a ), although unexpected rewards, which may be more valued, were not available in their design.
"Whereas those with bipolar I tend to experience severe mania as well as severe depression, bipolar II presents more as depression, feelings of sadness, hopelessness and guilt".
