Depression is an affective mental disorder and can be divided into two categories in terms of episode characteristics: one is monophasic, called “depression”. Each episode is characterized by depressed mood. The other category is called “biphasic”, the full name is ‘manic depressive disorder’. There are several episodes of depression, but the other episodes are over-excited and even uncontrollable, showing a manic state. Some patients may also experience hallucinations, hallucinations, delusions, and other symptoms. For example, some patients feel that they have superhuman power or feel that they are God. Some people call manic-depressive disorder affective psychosis. The symptoms are mainly abnormal emotion. Manic-depressive disorder is often accompanied by behavioral and thinking disorders. Its emotional changes are characterized by excessive emotional highs or excessive lows, and its thinking and behavior change accordingly, and are in harmony with the surrounding environment and easily understood by people; therefore, it is often easy to infect others, i.e., people in the vicinity are often moved by the patient’s emotions and behavior. During the onset of the disease, when the patient shows high emotion, it is called mania, and when the patient shows low emotion, it is called depression. These patients can have several episodes repeatedly in their lifetime, and the period between two episodes is called intermittent period. At this time, the patient’s mental state is completely back to normal. The form of repeated episodes can be mania every time, or depression every time, or there can be irregular alternating episodes of both manic and depressive forms. Most of these patients have multiple recurrent episodes, and a few have only one episode in their lifetime. Some patients can have more than 10 episodes from young to old, but although they have many episodes, their mental state rarely changes to decline after the disease. Most patients spend more time in the depressive phase than in the euphoric phase Most patients with bipolar depression spend more time in the depressive phase than in the euphoric phase. Bipolar depression does not follow a certain pattern of mood changes, and mania is not necessarily followed by depression. It is also possible to experience multiple depressions before the onset of manic symptoms. Mood changes may be completed over weeks, months, or even years. Bipolar depression mostly occurs in young adults The disease mostly begins in young adults, and its incidence is lower than that of schizophrenia among common psychiatric disorders, and the duration of the disease is usually 2 to 6 months each time. The duration of the illness not only affects the patient’s workforce but also places a burden on the mental and physical well-being of his or her loved ones, and often the duration of the illness increases with age, and often becomes chronic when the patient becomes old and frail. For example, we met a male ironer who had 19 episodes from the age of 19 when he had his first attack to the age of 60, almost once every two years on average, for about 3 months to 6 months each time, with each episode in the form of mania and only once in the form of atypical mild depression. He worked very well during the intervals and was often awarded as an advanced worker in the factory. He was later tracked after the age of 60 due to old age and frailty, and the onset gradually became chronic and did not remit for many years. The cause of the disease is currently unknown, so emphasis should be placed on timely diagnosis and treatment and prevention. The incidence of women is higher than that of men The first onset is mostly between 16-30 years old, and there are more female patients than male. The typical manifestations of mania are high mood, quick thinking and increased speech and action. In contrast, the typical manifestation of depression is the opposite of mania, which is depressed mood, slow thinking and reduced speech and action. Patients in the manic phase should live in a quiet environment and be appropriately guided to carry out simple activities to avoid positive conflicts with them. Bipolar depression type I: alternating complete mania and severe depression often starts as depression, with at least one manic or euphoric phase in the course of the illness; the depressive phase can be either immediately before or after the manic phase, or several months or years apart from the manic phase. Biphasic type II: alternating depressive and light manic episodes Light manic phase: the patient is bright-eyed, with diminished need for sleep and psychomotor activity above the patient’s usual level; conversion is often influenced by circadian rhythm factors and can recur seasonally. Sleepiness and excessive eating are typical; insomnia and poor appetite may occur during the depressive phase; mild mania is adaptive for some patients, as patients feel energetic, confident, and hyperactive in social functioning. Many patients tend to feel high in mood at the end of a depressive episode. (profligacy, impulsive promiscuity, and stimulant abuse, etc.). A significant number of patients with bipolar disorder are diagnosed with monophasic depression, that is, simple depression, at the time of the depressive episode and are treated only with antidepressants, and sometimes a significant proportion exists even though they are diagnosed with bipolar disorder, but without first using a mood stabilizer. Zhang Yong, Department of Bipolar Disorder, Ting Hospital According to domestic and international treatment guidelines, regardless of whether the patient is bipolar I or II, he or she must first use a mood stabilizer, or at least not first use an antidepressant alone during a depressive episode. This is a basic treatment principle, and clinicians must be aware of it! Medication use and understanding of the concept: mood stabilizers include traditional mood stabilizers such as lithium carbonate, bivalirudinates (sodium valproate, magnesium valproate), lamotrigine, oxcarbazepine, carbamazepine, etc.; second-generation antipsychotics – olanzapine, quetiapine, risperidone, aripiprazole, ziprasidone, etc. can have mood stabilizer Among them, only quetiapine (extended-release tablets) can be used as a mood stabilizer in bipolar mania and bipolar depression. There are some concepts that need to be clarified. Anti-manic drugs include traditional mood stabilizers, but also include all second-generation antipsychotics and some first-generation antipsychotics (haloperidol), and antidepressants include all current cyclic drugs and the most common SSRIs, SNRIs and NaSSAs. How to Rationalize the Use of Mood Stabilizers? Whether biphasic type I or type II, and whether it is currently a manic episode or a depressive episode, one should still use mood stabilizers first, including some of the traditional and non-traditional medications on appeal. Only if a mood stabilizer is used first can a decision be made on what other medications to use in combination based on an assessment of the condition. For example, the patient has a diagnosis of bipolar I and is currently having a depressive episode. First of all, after 2-4 weeks of using mood stabilizers (also combined with quetiapine or olanzapine), if the symptoms are not relieved well, you can consider combining with drugs with low transient mania such as bupropion, etc. Of course, if the symptoms are very severe such as suicidal, sluggish and immobile, refusing food and medication, you should also use MECT (twitch-free electroconvulsive shock) treatment as soon as possible according to your condition, but you need to evaluate the progress of your condition in due time to prevent transient mania! For example, for bipolar II depressive episodes, lamotrigine is the first recommended stabilizer, but also lithium carbonate and dipropionate, and quetiapine extended-release tablets, and of course, oxyfluorfen is also the recommended first-line medication. In conclusion, the symptoms of bipolar disorder are complex and not as easy as one might think, and require careful identification, especially after correct diagnosis, and standardized treatment. What medications are appropriate? When to use antidepressants? As doctors are still so careful, patients and family members should not use medications without authorization, which may lead to unnecessary fluctuations.