What Is Bipolar Depression And How Is This Disorder Treated?

People living with bipolar disorder (bipolar depression) typically experience periods of intense mania and depression that are severe enough to cause significant impairment of daily function. The emotional highs and lows are likely due to imbalanced brain chemistry, and it is generally considered a lifelong mental health condition. An estimated seven million Americans were living with the disorder in 2020. Read on to learn more about bipolar depression, how it’s treated, and how a combination of medication and therapy (in-person or online) can help you manage symptoms for fewer manic or depressive episodes.

What is bipolar depression?

Bipolar depression subtypes

Medical professionals usually diagnose bipolar depression using the following subtypes based on the frequency and severity of manic, depressive, and hypomanic episodes you’ve experienced. It can be important to note that bipolar II disorder is not necessarily a milder form; it is usually viewed as a separate diagnosis. 

Bipolar I disorder

You’ve experienced at least one manic episode, which may be preceded or followed by either hypomanic or major depressive episodes. Mania can trigger psychosis or a break from reality. People with bipolar I disorder tend to experience a more severe high (manic episode), which can end up being severe and dangerous.

Bipolar II disorder

You have had at least one hypomanic and one major depressive episode, but have never experienced a manic episode. While people with bipolar II disorder experience a less severe high (hypomania), there depressive symptoms tend to be worse, and can be long term.

Cyclothymia

Cyclothymia disorder is sometimes known as Bipolar III, and is a type of affective disorder. For at least two years (one in children and teens), you have experienced multiple episodes of hypomania and depressive symptoms not severe enough to qualify as major depression. The shifts in mood are not as intense as those in people with bipolar disorder.

Conditions frequently occurring alongside bipolar depression disorder

Bipolar disorders often overlap with other mental health conditions, such as psychosis, anxiety disorders, substance or alcohol use disorders, post-traumatic stress disorder (PTSD), eating disorders, and attention-deficit/hyperactivity disorder (ADHD).

What causes bipolar depression and manic episodes?

While the exact cause of bipolar disorders is unknown as of yet, many medical professionals believe several factors may play a role in whether or not a person develops this mental health condition. Biological abnormalities and neurochemical imbalances may play a part, though their significance is not fully understood. Genetics and a family history of mental illness may be another factor, as those who have an immediate relative, such as a sibling or parent, with bipolar depression are approximately ten times more likely to develop the disorder.

Signs and symptoms of bipolar depression 

Early symptoms of bipolar depression can include feelings of sadness or hopelessness, difficulty sleeping, and lack of energy. The primary characteristic of the disorder is usually a recurring cyclical shift between two types of extreme episodes—manic (or hypomanic) high points and depressive low points with no predictable pattern. 

Mania and hypomania

Mania is usually more severe than hypomania and can cause more noticeable disruptions in your daily life with more pronounced symptoms and a lack of emotional and behavioral control. This is unlike agitated depression, which normally involves both depressive and manic symptoms. Mania typically lasts for around a week, while hypomania usually lasts for at least four days. Both manic and hypomanic episodes normally require three or more of the following symptoms:

• An abnormally upbeat mood, in which you may feel jumpy or wired with excess energy
• An elevated period of activity where you may feel full of energy or easily agitated 
• An exaggerated sense of self-confidence or well-being; you may feel euphoric
• A decreased need or ability for sleep 
• You may be unusually talkative and unable to stem the flow of thoughts to speech
• Your thoughts may race, making it difficult to focus
• You may be easily distracted
• You may demonstrate poor judgment and decision-making, such as risky sexual behavior, spending sprees, or hasty, unwise investments

Depressive episodes

Major depressive episodes often include symptoms that are severe enough to cause a noticeable impact on your daily life and tend to last longer than manic episodes. Five or more of the following symptoms are generally required to qualify as a depressive episode.

• Depressed mood, often with feelings of sadness, emptiness, hopelessness, or irritability 
• A noticeable loss of interest or ability to take pleasure from nearly all activities 
• Significant weight loss or gain or a noticeable increase/decrease in appetite 
• Feeling lonely or isolating yourself from social contact
• Sleeping too much or difficulty falling and staying asleep
• Slowed or restless behavior
• Racing thoughts and/or quickly changing topics while speaking 
• Loss of energy or persistent fatigue 
• Feeling worthless or subjecting yourself to excessive or misplaced guilt
• Feeling indecisive or experiencing a decrease in your ability to think clearly and focus
• Thoughts, plans, threats, or attempted suicide

Death or suicide rates are higher for people with bipolar disorder, so it’s important to seek help if manic or depressive symptoms become worse. If you or a loved one are experiencing suicidal thoughts, reach out for help immediately. The National Suicide Prevention Lifeline can be reached at 988 and is available 24/7.

Mixed manic and depressive episodes

During a mixed episode, you may exhibit symptoms from manic and depressive episodes simultaneously. For example, you may feel energized to the extreme while experiencing hopeless emptiness or overwhelming sadness. 

Differences in symptoms by gender

Research shows that women often experience the onset of bipolar depression symptoms later in life than men and tend to demonstrate a more seasonal pattern of mood disturbance. The research states that women are also likely to encounter mixed mania, rapid cycling, and depressive episodes more often than men. Mixed mania is when manic episodes (or hypomanic episodes) and depressive episodes (or mood episodes) occur at the same or within a rapid sequence of each other. Rapid cycling is when four or more depressive, hypomanic, and manic episodes have occurred within a twelve-month period. Women with bipolar disorder are more susceptible to these variations. Substance use disorders tend to be more common in men with bipolar disorders, while women are usually more likely to have other concurrent mental health conditions. 

How is bipolar depression diagnosed?

To diagnose one of the bipolar depression subtypes, your mental healthcare provider will likely use various techniques to evaluate your symptoms using the established criteria, including a comprehensive clinical interview about your medical history and past mental health experiences. You should be prepared for a potentially lengthy process.

Comparing mood characteristics of bipolar depression and borderline personality disorder

Bipolar depression and borderline personality disorder (BPD) often have several overlapping symptoms and can be frequently confused due to their similar mood disruption characteristics. A licensed mental health provider should be able to distinguish between the two conditions. 

Treatments for bipolar depression

Achieving a stable emotional and behavioral state is the general goal of bipolar depression treatment. Many find that the most effective treatment combines therapy, medication, socialization, and a strong support system. Bipolar depression can be a lifelong condition, and it can be essential to continue treatment through discouraging setbacks and low points. 

Medication for bipolar depression disorder

Mood-stabilizing medications are often crucial to a bipolar depression treatment plan, as they can provide neurochemical stability and prevent mood episodes. Mood stablizers can also reduce associated symptoms of bipolar disorder such as delusion, agitation, and problems with sleep. Antipsychotic drugs may be used to treat a patient during severe manic episodes, and antidepressant or antianxiety medications may be used to help alleviate other symptoms. Certain medications can produce side effects, therefore, it’s important to speak with a healthcare professional before starting or stopping medication.

Psychotherapy treatment

Therapeutic health services often offer various types of talk therapy, such as cognitive behavioral, interpersonal, and family therapy. Talk therapy can be a beneficial addition to a comprehensive treatment approach for bipolar depression. Working with a therapist can help you develop coping and communication skills, identify and change harmful thought patterns and behaviors, and assist you in working through many symptoms of your mental health condition. 

• Cognitive behavioral therapy (CBT) has been shown to reduce the severity of mania. CBT usually focuses on recognizing unhealthy behaviors and beliefs and replacing them with healthier, more positive options. CBT may also help identify episode triggers and teach coping strategies to manage symptoms. 
• Interpersonal and social rhythm therapy (IPSRT) typically centers on stabilizing daily rhythms, such as when you eat, sleep, and wake, because a consistent routine often makes mood management easier. 
• Family therapy can help you and your loved ones learn communication skills, methods to support each other, and strategies to help manage your symptoms and triggers. 

Electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) for mood stabilization

Bipolar disorder is a lifelong condition, and finding the right approach to treatment can take time. When symptoms of bipolar disorder are severe or treatment-resistant, you may want to consider electroconvulsive therapy (ECT). This treatment approach can rapidly improve symptoms of bipolar depression. During electroconvulsive therapy, your healthcare provider will transmit electric currents through the brain to improve depressive symptoms. This form of therapy is considered to be safe and effective.

Coping with the manic and depressive episodes of bipolar depression

While your therapist or healthcare provider will likely build a treatment plan for your bipolar depression—which should also include coping skills—there may be lifestyle changes and perspective shifts you can practice on your own to help cope with your symptoms. 

• Build a support network of family, friends, and medical professionals.
• Track your moods and monitor changes in your symptoms and triggers.
• Take all medication as prescribed by your doctor. 
• Avoid alcohol and drug use.
• Practice self-care with adequate sleep, nutritious food, and physical activity. 
• Try to limit your stress and find healthy ways to cope with it. 

Therapy for the management of symptoms and treatment of bipolar depression 

Living with bipolar depression can be challenging, but working with a therapist can teach effective coping strategies that can prevent mood swings and help you develop communication skills to manage your symptoms and live with as little disruption as possible. People with bipolar depression may have trouble attending appointments regularly and have praised the convenient flexibility of multiple formats on virtual therapy platforms.

A 2019 study showed that online psychotherapy treatments to address depression symptoms could be as effective as the in-person clinical setting. Those with no prior experience with therapy in the traditional face-to-face format generally showed increased improvement during the study.