What Is Bipolar Depression And How Is It Treated?

Updated March 22, 2023by BetterHelp Editorial Team

People living with bipolar depression typically experience periods of intense mania and depression severe enough to cause significant impairment of daily function. The emotional highs and lows are likely due to imbalanced brain chemistry, and it is 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 can help you manage symptoms for fewer manic or depressive episodes.

Do You Struggle To Manage Bipolar Depression Symptoms?

What Is Bipolar Depression?

Bipolar depression is a mental health condition (formerly known as manic depression) that can cause intense mood swings and often involve emotional extremes—either highs (mania or hypomania) or lows (depression), according to the Mayo Clinic. Depression may make you feel hopeless or find that you can’t maintain interest in or take pleasure from activities, a symptom called anhedonia. As your mood shifts to mania or the less-extreme hypomania, you may experience euphoria, an energy boost, or be overly irritable. Mood swings can influence your judgment, sleep, behavior, energy, and ability to focus or think clearly. 

Bipolar Depression Subtypes

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

  • Bipolar II Disorder

You have had at least one hypomanic and one major depressive episode but have never experienced a manic episode. 

  • Cyclothymia

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.

  • Other Specified And Unspecified Bipolar And Related Disorders

Bipolar-like symptoms and disorders that don’t fully meet the qualifications for the other subtypes.

Conditions Frequently Occurring Alongside Bipolar Depression

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?

While the exact cause of bipolar disorders is unknown, many medical professionals believe several factors may play a role in whether or not a person develops the mental health condition. Biological abnormalities and neurochemical imbalances may have a part, though their significance is not fully understood. Genetics is another factor, as those who have an immediate relative, such as a sibling or parents, 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 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 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. Mania typically lasts for around a week, while hypomania lasts for at least four days. Both manic and hypomanic episodes require three or more of the following symptoms:

  • Displaying abnormally upbeat mood. You may feel jumpy or wired with excess energy. 

  • An elevated period of activity where you may feel full of energy or easily agitated 

  • Feeling 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. 

  • Demonstrating 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 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. 

  • Your behavior is either slowed or restless. 

  • 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 

 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 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. Substance use disorders are more common in men with bipolar disorders, while women are more like to have other concurrent medical conditions. 

How Is Bipolar Depression Diagnosed?

To diagnose one of the bipolar depression subtypes, your mental healthcare provider will 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 Bipolar Depression And Borderline Personality Disorder

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

Do You Struggle To Manage Bipolar Depression Symptoms?

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 is a lifelong condition, and it can be essential to continue treatment through discouraging setbacks and low points. 


Mood-stabilizing medications are often crucial to a bipolar depression treatment plan, as they help provide neurochemical stability and prevent mood episodes. Antipsychotic drugs may be used to treat a patient during severe manic episodes, and antidepressant or antianxiety medications to help alleviate other symptoms.  


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 help you work through many symptoms of your mental health condition. 

  • Cognitive behavioral therapy (CBT) has been shown to help reduce the severity of mania. CBT 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) centers on stabilizing daily rhythms, such as when you eat, sleep, and wake, because a consistent routine 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. 

Alternative Bipolar Depression Treatments

  • Hospitalization

  • Electroconvulsive Therapy (ECT)

  • Transcranial Magnetic Stimulation (TMS)

Coping With 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 are 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 deal with it. 

How Therapy Can Help Manage 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 like BetterHelp, along with several other useful bipolar disorder statistics that give insight into how it develops and what it entails. 

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 showed increased improvement during the study.


Learning to manage symptoms and live with bipolar depression can be challenging, but resources are available to help. The information outlined in this article may make it easier to understand bipolar depression, how it can affect a person’s life, and what treatments are available. 

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