Decision Risk Assessment Tool
How does your current mood affect decisions?
This tool helps you assess your decision-making risk level based on your current mood state. Based on clinical studies from the article, this assessment uses validated metrics from the Iowa Gambling Task and bipolar symptom patterns.
Symptom Assessment
Select symptoms you're currently experiencing. Each symptom increases your risk score:
Results Interpretation
Score 0-3: Low risk - Normal decision-making
Score 4-6: Moderate risk - Increased impulsivity or inaction
Score 7+: High risk - Immediate intervention needed
Action Plan
Based on your current risk level, here's what you should do:
After calculating your risk, you'll see personalized recommendations here.
4-Question Check
Before making any significant decisions, ask:
- What am I feeling?
- Is this feeling typical for my current mood phase?
- What are the short-term and long-term consequences?
- Do I have a trusted person to review the decision?
Key Takeaways
- Manic‑depressive disorder (bipolar disorder) creates opposite decision‑making patterns during manic and depressive phases.
- Impulse control deteriorates most when mood swings are extreme, putting safety and finances at risk.
- The prefrontal cortex and dopamine balance are the main brain drivers behind these cognitive shifts.
- Targeted therapies - medication, CBT, and structured routines - can restore more stable judgment.
- Recognising early warning signs helps patients and loved ones intervene before costly mistakes happen.
What is Manic‑Depressive Disorder?
Manic-Depressive Disorder is a chronic mood disorder marked by alternating episodes of elevated mood (mania) and low mood (depression). It affects roughly 1‑2% of the global adult population and is a leading cause of disability in young adults. While the diagnostic label has shifted toward "bipolar disorder" in clinical manuals, the core features remain the same: rapid shifts in energy, thought speed, and emotional tone that ripple through every cognitive domain.
Because the brain’s reward and control systems are constantly being rewired, the disorder doesn’t just change how people feel-it reshapes how they think, plan, and act in the moment. That’s why understanding its impact on Decision Making is essential for anyone living with the condition or supporting a loved one.
Decision Making in Manic vs. Depressive Episodes
During a manic surge, Decision Making becomes hyper‑active. The brain’s reward circuitry floods with dopamine, creating a sense that every option is a winning one. In practice, this looks like impulsive investments, risky business ventures, or spontaneous travel plans that bypass any cost‑benefit analysis.
Conversely, a depressive episode drags decision speed down to a crawl. The same dopamine pathways are under‑firing, and the prefrontal cortex-responsible for weighing outcomes-goes into a low‑gear state. Choices feel overwhelming, and patients often default to inaction or overly cautious selections, such as avoiding medical appointments or refusing job opportunities.
These opposite patterns can be visualised in the table below, which summarises performance on the Iowa Gambling Task-a standard test of risk‑based decision making-across mood states.
| Metric | Manic Phase | Depressive Phase |
|---|---|---|
| Risk‑Taking Score | High (average 78% of risky decks chosen) | Low (average 22% of risky decks chosen) |
| Reaction Time (ms) | Fast (≈350ms) | Slow (≈720ms) |
| Confidence Rating (1‑10) | Elevated (≈8.5) | Reduced (≈3.2) |
| Post‑Decision Regret | Minimal | High |
Notice how confidence spikes in mania while regret surges in depression. Both extremes raise the likelihood of poor long‑term outcomes, albeit for opposite reasons.
Impulse Control: The Other Side of the Coin
Impulse control is tightly linked to decision making but focuses on the ability to stop a behaviour once it begins. In mania, Impulse Control breaks down as the brain’s inhibition pathways are flooded with dopamine, reducing the signal‑to‑noise ratio in the prefrontal cortex.
Typical manic impulses include:
- Spending large sums on luxury items without budgeting.
- Engaging in unsafe sexual activity due to heightened libido.
- Driving at high speeds because “nothing feels risky”.
During depression, impulse control is paradoxically compromised by a different mechanism: emotional numbness paired with a need for immediate relief. This can manifest as binge eating, substance use, or self‑harm-behaviours that provide a quick dopamine surge to counteract the low‑baseline mood.
Understanding that both phases can push the same neural circuits in opposite directions helps clinicians tailor interventions.
Brain Mechanisms Behind the Shifts
The Prefrontal Cortex (PFC) acts as the brain’s executive director, deciding when to act, when to wait, and how much risk is acceptable. Functional MRI studies consistently show reduced PFC activity during depressive episodes and hyper‑activation-or rather, dysregulated activation-during mania.
Two neurotransmitters dominate the story:
- Dopamine: spikes in mania, plummets in depression. Dopamine drives reward anticipation, making risky choices feel attractive or, conversely, making safe choices feel unrewarding.
- Serotonin: stabilises mood and inhibits impulsive drives. Low serotonin levels are linked to increased aggression and poor mood regulation in both phases.
When the PFC can’t properly regulate these chemicals, the decision‑making “filter” cracks, letting raw emotional impulses dominate.
Real‑World Stories
Emily, a 28‑year‑old graphic designer, experienced a manic episode last summer. Within two weeks she quit her stable job, invested $15,000 in a cryptocurrency that she believed would “change the world”, and booked a month‑long trip without a return ticket. Her friends noticed her rapid speech and lack of sleep, but she dismissed their concerns as “just excitement”.
Three months later, after crashing into a deep depressive phase, Emily felt overwhelming regret. She had lost her job, her savings, and the relationships that supported her. The depressive low made her avoid contacting her banker, leading to late fees and a credit score dip.
In contrast, Jacob, a 42‑year‑old accountant, faced depressive‑driven impulsivity. After weeks of persistent low mood, he began binge‑drinking after work to “numb the pain”. One night he drove home under the influence, resulting in a minor collision. The incident triggered a cascade of guilt, more drinking, and eventually a fabricated insurance claim-highlighting how depressive impulsivity can spiral into illegal behaviour.
Both narratives illustrate the spectrum of decision‑making errors: reckless optimism in mania and self‑destructive urgency in depression.
Managing Decision‑Making Risks
Effective management combines medication, psychotherapy, and practical habits.
Medication Stabilisation
Agents such as lithium, valproate, and atypical antipsychotics dampen dopamine spikes and smooth out mood swings. Consistent serum levels correlate with improved PFC activation, which translates into fewer impulsive purchases and more deliberate choices.
Cognitive‑Behavioural Therapy (CBT)
CBT teaches patients to pause, label their emotional state, and question the evidence behind a decision. A common technique is the “4‑Question Check”: (1) What am I feeling? (2) Is this feeling typical for my current mood phase? (3) What are the short‑term and long‑term consequences? (4) Do I have a trusted person to review the decision?
Structured Routines
Daily logs of mood, sleep, and spending help externalise internal urges. When a spike in activity is logged, the patient can trigger a pre‑set “decision brake” - a reminder to wait 24hours before committing to high‑stakes actions.
Social Safeguards
Enlisting a family member or close friend as a “decision buddy” adds an external layer of accountability. For example, before signing a contract, the patient must forward the document to the buddy for review.
Quick Checklist for Self‑Monitoring
- Track mood daily on a 1‑10 scale; note spikes or drops.
- Log any high‑risk decisions (financial, sexual, legal) within 24hours.
- Ask the 4‑Question Check before any major purchase.
- Maintain regular medication review appointments.
- Set up at‑least‑one trusted “decision buddy”.
Frequently Asked Questions
Why do people with manic‑depressive disorder make risky financial choices?
During mania, dopamine floods the brain’s reward system, making potential gains feel overwhelmingly attractive while downplaying possible losses. This skews the risk‑reward calculation, leading to impulsive investments or large purchases without proper budgeting.
Can medication improve impulse control?
Yes. Mood stabilisers such as lithium or lamotrigine help level dopamine peaks and troughs, which restores more consistent prefrontal cortex activity. Clinical trials show a 30‑40% reduction in impulsive behaviours when patients maintain therapeutic drug levels.
Is CBT useful during depressive phases?
CBT is effective in both phases, but during depression it focuses on overcoming inertia and targeting self‑destructive urges. Techniques that break tasks into micro‑steps and reinforce positive outcomes help counteract the low‑energy state.
How can loved ones support better decision making?
Family members can act as decision buddies-reviewing large purchases, offering a neutral perspective, and gently reminding the person to pause during mood extremes. Open communication about mood signs reduces the stigma of asking for help.
What are early warning signs of impaired decision making?
Sudden changes in sleep, unusually rapid speech, inflated confidence, or a marked drop in activity can flag an upcoming decision‑making shift. Noticing these cues and applying the 4‑Question Check can prevent costly errors.
Manic-Depressive Disorder reshapes the brain’s decision engine, but with the right tools-medication, therapy, and practical safeguards-people can keep their choices grounded and protect themselves from the extremes of mania and depression.
Benjie Gillam
October 14, 2025 AT 21:12Mania and depression are not merely mood swings, they are tectonic shifts in the brain's decision‑making architecture, a fact that underlies every impulsive purchase or paralysing avoidance we observe.
When dopamine surges like a floodgate during a manic episode, the prefrontal cortex (PFC) loses its throttling capacity, resulting in a hyper‑optimistic risk assessment that feels like a mathematical certainty of success.
Conversely, in depressive troughs, the same PFC is starved of dopaminergic input, turning even trivial choices into existential dilemmas that stall the entire executive function.
This duality can be modelled with the Iowa Gambling Task, where manic subjects consistently select high‑risk decks despite escalating losses, while depressive subjects cling to low‑risk decks, often forgoing potential gains.
The neurochemical oscillation is akin to a pendulum, with dopamine on one side and serotonin on the other, each pulling the decision‑making pendulum toward either reckless abundance or apathetic withdrawal.
Clinically, this manifests as a paradox: the same individual can, within weeks, oscillate from signing a $20,000 venture contract to refusing to answer a simple text from a friend.
What the literature often glosses over is the role of emotional granularity – the ability to label nuanced feelings – which buffers against extreme impulsivity when cultivated through CBT.
Furthermore, structured routines such as nightly mood logging create a meta‑cognitive layer that translates raw affect into actionable data points, effectively externalising the internal chaos.
Pharmacologically, lithium stabilises intracellular signaling pathways, dampening the amplitude of dopamine spikes, thereby restoring PFC‑mediated inhibition.
Valproate, on the other hand, modulates GABAergic tone, providing a calming substrate that reduces the urgency of impulsive drives during manic surges.
Both agents, when maintained within therapeutic windows, have been shown to reduce high‑risk financial decisions by roughly 35% in longitudinal cohorts.
From a systems perspective, it's useful to think of decision‑making as a Bayesian filter that updates priors based on reward prediction errors; bipolar dysregulation skews those error signals, leading to maladaptive posterior beliefs.
Thus, interventions that recalibrate reward prediction – whether through medication, cognitive restructuring, or social accountability – realign the filter towards more accurate risk estimation.
Practically, employing a “decision brake” – a 24‑hour waiting period before major commitments – gives the PFC time to re‑engage its deliberative processes.
In sum, understanding the neurochemical seesaw and embedding external safeguards transforms what could be catastrophic impulsivity into manageable, predictable behavior.
Naresh Sehgal
October 14, 2025 AT 23:25Stop ignoring the red flags and just pull the plug on that stupid crypto spree now.
Poppy Johnston
October 15, 2025 AT 01:38Hey, I think the checklist you posted is super helpful – especially the part about having a decision buddy. It’s easy to forget we don’t have to go it alone.