What Is Bipolar Depression, And How Can It Affect You?

Most people have heard of depression, but not everyone understands what it entails. Rather than simply being sad, a person with depression may feel hopeless, lack energy, struggle to focus, and have changes in sleeping and eating habits. These symptoms interfere with daily living and are usually considered a depressive episode when they last for at least two weeks.

A person with bipolar disorder experiences depressive episodes some of the time and manic episodes at other times. Manic episodes involve highly elevated moods, during which a person might feel unusually happy, wired, active, and like they need much less sleep—sometimes only a couple hours. In this article, we describe both types of episodes and specifically delve into the depression experienced by people with bipolar disorder.

What is depression?

Everyone feels sad or down sometimes, but depression is more serious.

Depression is a primary characteristic of several different mental disorders, including major depressive disorder, persistent depressive disorder, and bipolar disorder, also called bipolar depression. It can also occur alongside other forms of mental illness, such as anxiety disorders, post-traumatic stress disorder, and substance use disorder. 

People with depression experience some of these symptoms nearly every day, for a majority of the day, for two or more weeks:

• Feelings of sadness, anxiety, or emptiness

• Feelings of negativity or hopelessness

• A lack of energy or feelings of fatigue

• Feelings of guilt or worthlessness

• Difficulty making decisions or concentrating

• Difficulty sleeping or, conversely, difficulty staying awake

• Little to no interest in activities once enjoyed

• Feelings of restlessness or irritability

• Aches and pains that do not go away with treatment

• Unexpected changes in appetite or weight

• Thoughts of suicide or death

In the case of bipolar I disorder—what a lot of us imagine when we think of bipolar disorder— these depressive episodes alternate with manic or mixed episodes.

Symptoms of bipolar disorder

A person with bipolar disorder, previously called manic depression or manic-depressive illness, experiences different symptoms at different times, depending on what type of episode they are currently having. They may cycle through mania, hypomania, depression, or mixed states, depending on which type of bipolar disorder they have.

An individual experiencing a severe manic or depressive episode may develop psychotic symptoms, including delusions, hallucinations, and disorganized speech. 

The following behaviors, activities, and energy levels are potential symptoms of mania, characterized by a period of abnormally elevated, extreme changes in mood.

• Extreme energy, creativity, and euphoria

• Disinterest in sleep

• Racing thoughts and ideas

• Extreme distractibility and lack of concentration

• Feelings of invincibility or greatness

• Reckless behavior

• Irritability, aggressiveness, and anger

• Extremely impulsive behavior

• Talking so fast others can't keep up

• Increased appetite for food, alcohol, sex, or exciting activities

• Hearing voices or experiencing delusions

The person could also be showing signs of hypomania, which is a less severe form of a manic episode, though still characterized by a "revved up" energy level and euphoric mood.

• Better mood than normal

• Increased productivity

• Increased energy

• Impulsive behavior

• Poor decision-making

In other cases, a person may show signs of depression. Unlike symptoms of mania, depressive symptoms are characterized by lower affect and energy levels and reduced activity.

• Feelings of hopelessness and emptiness

• Irritability

• Loss of energy and tiredness

• Changes in appetite or weight

• Difficulty sleeping despite being tired or sleeping too much

• Difficulty concentrating and remembering things

• Feeling sluggish physically or mentally

• Thoughts of suicide

While the exact cause of the condition is unknown, genetics and abnormalities in brain structure and function can increase one’s risk of developing bipolar disorder. Stressful or traumatic events, the use of recreational drugs, and sleep disruptions can also contribute to the likelihood that an individual will develop bipolar disorder. 

Bipolar mood episodes can occur alongside other mental health conditions, including anxiety disorders, attention deficit hyperactivity disorder (ADHD), other affective disorders, and oppositional defiant disorder. Additionally, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), substance use disorder affects 30-50% of people with bipolar disorder. 

Treated properly, bipolar symptoms can be effectively managed. If you believe you’re experiencing depressive and hypomanic or manic symptoms, consider consulting with a mental health provider who can diagnose bipolar disorder. A health care professional can provide you with mental health information and an evaluation to determine whether further testing, diagnosis, and a treatment plan are necessary.  

What is happening in a bipolar episode?

Bipolar episodes involve significant changes in cognition, behavior, and mood. When you experience an extreme high associated with a bipolar manic episode, everything feels like it’s going great. It feels like nothing can stand in your way, and you can do anything. Unfortunately, manic symptoms can lead to dangerous or harmful decisions.

On the other hand, when you experience the low associated with a bipolar depressive episode, you may feel sad or empty and like you can't get out of it. Depressive symptoms can make an individual feel like they are hopeless, alone, and lost. The low feelings of major depression may be particularly challenging following the highs of manic or hypomanic episodes. 

During a mixed episode, a person experiences symptoms of both depression and mania at once. A mixed episode carries the highest risk of suicide because it carries feelings of extreme energy and, at the same time, extreme sadness. Psychotic symptoms can present as well, but the content typically varies based on whether they occur during mania or depression. Psychosis during mania, for instance, may bring delusions of grandeur or auditory hallucinations of encouraging voices, while psychosis during depression might bring hallucinations of demeaning voices and negative delusions.

Depressive symptoms in people with bipolar disorder

There are three types of bipolar depression, characterized by different combinations of mania, hypomania, depression, and mixed episodes.

Bipolar I disorder

With bipolar I, a person typically experiences both manic and depressive episodes. They may also experience mixed episodes. This is the most common form of bipolar disorder. Sometimes mania can be extreme, causing a person to require hospitalization or experience psychosis. If a person has four or more manic or depressive episodes in one year,  it's called rapid cycling—though rapid cycling can occur in other iterations of the disorder as well.

Bipolar II disorder

With bipolar II, a person typically experiences hypomanic and depressive episodes. To meet the criteria for a major depressive episode, symptoms must persist most of the day, every day, for two weeks or more. Hypomanic episodes are less severe episodes of mania. Typically, a hypomanic episode will not cause significant impairment in everyday functioning. Still, the hypomanic and depressive symptoms of bipolar II can lead to complications in several facets of life.  

Cyclothymia

Cyclothymia, also called cyclothymic disorder, is one of the mildest forms of bipolar disorder, though it is still extremely important to treat. This form of bipolar disorder is characterized by periods of mood symptoms that do not meet the diagnostic criteria for a depressive or hypomanic episode, but that still negatively impact daily functioning.

Treatment options for bipolar depression

All forms of bipolar depression require professional treatment. Trying to go through bipolar depressive episodes alone may lead to experiencing associated feelings, symptoms, and emotions for longer than necessary. Although there isn't an official cure for bipolar, you can get better if you find the proper treatment.

Medication

Medication can help mitigate the severity of depressive and manic episodes, especially while you are working on making other changes necessary in your life to manage bipolar depression. You may need different medications as your treatment progresses and you learn how to cope. Many people with bipolar disorder stay on medication for life.

Commonly prescribed medications for bipolar disorder include mood stabilizers, antipsychotics, and antidepressants. Multiple medications may be utilized to manage bipolar disorder symptoms effectively, such as a mood stabilizer and antipsychotic. Always consult with a healthcare professional prior to starting or stopping any medication.  

Counseling

In addition to medication, talk therapy sessions are an essential aspect of treatment for bipolar depression. Talking with someone and working through your feelings and thoughts can help you learn healthy thought patterns and more. Bipolar is a complex disorder, so it's ideal if you can receive counseling from a professional who has experience treating it.

Lifestyle changes

Sometimes, different events in your life can contribute to manic or depressive episodes. By making lifestyle changes related to your job, your relationships, your diet, your sleep schedule, and more, you can start to alleviate some of the symptoms you experience. However, it's important to note that lifestyle factors alone do not cause bipolar disorder, and lifestyle changes without medication or therapy are often insufficient treatment.

What your diagnosis means

Bipolar disorder is a serious mental illness, and receiving treatment for it is very important. Do not attempt to fight through it alone. Bipolar disorder is intense, but with the aid of therapy, a support system of family members and other loved ones, and medication, you can live a healthy and happy life.

If you’re ready to start treatment, there are many benefits to choosing online therapy. When you have bipolar disorder, your mood swings can be unpredictable. During times you feel down or like you don’t have the energy to get through the day, online therapy makes it easy to continue treatment. You can attend sessions from the comfort of your home, and you can reach out to your therapist any time, and they will get back to you as soon as they can. 

Research shows that online therapy is effective for treating bipolar disorder, too. One study concluded that online cognitive behavioral therapy was effective at treating both bipolar disorder and depression, and it was also more cost-effective for both patients and therapists. If you want to learn more, you can reach out to a mental health care provider or browse resources like the National Institute of Mental Health.

Takeaway

Bipolar depressive episodes—and bipolar mood disorders in general can be challenging to manage on your own. Up to half of people with the condition also struggle with substance misuse, and many will experience a comorbid condition like anxiety. Along with medication, therapy can give you the support you need to change your life.