What Is Bipolar Depression?
By Sarah Fader
Updated February 25, 2020
Reviewer Patricia Corlew , LMFT, LPC,
In its simplest form, bipolar depression is defined as an imbalance in brain chemistry causing extreme emotional highs and lows in a person. This disorder is a chronic, life long illness and untreated makes it difficult for the patient to lead a 'normal' life. Everyday tasks such as going to work, to school and sustaining relationships (personal and professional) can become challenging. While there is no known cure for this illness, proper medication along with psychotherapy can effectively manage the symptoms.
Thought to be a rare disorder, bipolar depression is, in fact, a mental illness which affects close to 6 million Americans over the age of 18 every year and is becoming a growing concern globally due to an increase in disability and mortality rates. Because a proper diagnosis of bipolar depression can take anywhere from five to ten years after the first onset of symptoms and because it is usually diagnosed in the patient's early twenties, it's more difficult to gauge the number of affected children. But it is estimated that approximately 750,000 children in the US suffer from the disorder yearly; some researchers believe this number is much higher.
Within the spectrum of Bipolar Depression, there are four sub-types:
- a) Bipolar I Disorder - where the individual has experienced a minimum of one manic episode (lasting at least 7 days), it's not necessary to experience a depressive episode to diagnose Bipolar I;
- b) Bipolar II Disorder - where the individual has experienced at least one major depressive episode (lasting two weeks) as well as a hypomanic episode (lasting at least 4 days);
- c) Cyclothymia - where the individual has experienced a combination of depressive and hypomanic episodes, the episodes are short but shift frequently;
- d) Other - when bipolar depression is present but does not fall under the categories listed above.
A person is diagnosed within one of these sub-types based on the number and severity of manic, depressive and hypomanic episodes.
WHAT CAUSES BIPOLAR DEPRESSION?
Unfortunately, bipolar depression is an illness that has no one known cause or cure and it can affect anyone. There is no exact science to break down the what's and why's of the disorder. Research and studies have shown that a combination of genetics, family history, environment, physical health, brain chemistry, and personality can all play a role in why someone may be bipolar.
Of these causes, genetic and hereditary influences are shown to be the biggest ones. Like many mental health disorders, bipolar depression runs in the family.
It's not easily diagnosable as the symptoms often mimic those of other mental health issues.
SYMPTOMS OF BIPOLAR DEPRESSION:
Early symptoms of bipolar depression such as feelings of sadness, hopelessness, lack of sleep, and energy, can often be confused with depression or other mental illnesses such as schizophrenia, ADHD or personality disorders, making it difficult (often taking years) to reach a conclusive diagnosis.
Bipolar depression is characterized by a shift between two extreme episodes; Manic (high point) and Depressive (low point) lasting anywhere from seven days to several months, and in some cases years. It's important to note there is no predictable pattern to the shift between these moods.
Some of the symptoms to watch out during for a Manic Episode are the following:
- a) Displaying overly exuberant or reckless behavior (i.e. spending a lot of money, behaving in a promiscuous manner);
- b) Talking too fast and too much about different, unrelated things;
- c) Heightened sense of touch or smell;
- d) A sudden extreme spike in energy and activity level
- e) Problems with sleeping (sleeping less than normal yet still feel energized).
A milder form of Mania is known as Hypomania (present only in Bipolar II and Cyclothymia). Someone in a hypomanic state will exhibit similar symptoms as a Manic Episode but to a lesser degree. For instance, the person may experience a boost in energy and be in a very good mood, but they won't be out of control. Sometimes hypomania occurs as a side effect of medication for bipolar depression. Even though a hypomanic state can leave someone feeling great, it's important to take the condition seriously since it can evolve into Mania or turn into a severe depression.
During a Depressive Episode, the following symptoms may be present:
- a) Feeling guilty, worthless, weepy or anxious;
- b) Becoming forgetful or easily tired with very little energy;
- c) Loss of appetite and interest in people, activities or daily life;
- d) Deep depression and suicidal thoughts;
- e) Problems with sleeping (an increased need for sleep or not being able to sleep at all).
When depressive episodes go untreated, they can happen in rapid succession becoming harder to treat.
Sometimes some people also experience a 'Mixed Feature' Episode; this means the person is going through a combination of symptoms from both Manic and Depressive Episodes. For example, someone going through a Mixed Feature Episode may be feeling hopeless and depressed, but at the same time they are behaving recklessly i.e. having lots of sex or spending lots of money and are full of energy. It is not uncommon for someone who experiences severe manic or depressive episodes to experience psychotic symptoms like delusions or hallucinations such as hearing voices.
In addition to bipolar depression, people can also suffer from other disorders such as a substance abuse problem or an anxiety disorder making it harder to treat the bipolar depression.
Often, it is the loved ones of an affected person who will notice the extreme mood swings and erratic behavior first since the affected person views their behavior as normal. It is, therefore, important for family or friends to address the issue because when bipolar depression is left untreated, it can lead to severe depression or even suicide.
HOW IS BIPOLAR DEPRESSION DIAGNOSED?
A doctor will typically conduct a physical exam to make sure there is nothing physically wrong before referring the patient to a psychiatrist for proper diagnosis and treatment.
The diagnosis is done clinically using criteria (the patient must meet five of them) outlined by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders and International Statistical Classification of Diseases and Related Health Problems by the World Health Organization.
A few bipolar depression test and quizzes such as the Mood Disorder Questionnaire and General Behavior Inventory are readily available online as a way of self-testing when people exhibit bipolar depression symptoms. However, these tests are not medically valid, and it is strongly recommended that the patient seeks professional, medical help for a proper diagnosis.
Bipolar Depression is not something that will ever go away with time, in fact, the longer it's left untreated, the worse it gets, the change in episodes come faster and closer together and become more severe, so treatment should be sought early on; especially since diagnosing the illness is a lengthy process.
A Bipolar Depression diagnosis can be difficult to come to terms with for the individual and their loved ones. But it is important to remember that people suffering from bipolar depression can go on to lead very healthy and productive lives with timely intervention and proper diagnosis and treatment.
The challenge is often the illness itself or admitting to oneself that there is a problem. Like anything, the first step is the hardest, but once the person acknowledges the disorder and decides to get the help they need, they will recover.
The most common medications used to treat Bipolar Depression are mood stabilizers and antipsychotics. It is important to note that most anti-depressants only make Bipolar Depression worse.
Because there are different types of medications, finding the right dosage for the patient can take trial and error until the right one is found. Like with any other drug, there are risks and side effects with these medications; thus, they should be monitored on an ongoing basis by the prescribing psychiatrist.
In addition to receiving drug treatments, individuals suffering from Bipolar Depression are strongly encouraged to seek therapy and counseling. It allows them to get support, better understand their illness, and learn how to cope with the disorder.
A more extreme treatment is available in the form of Electroconvulsive Therapy (ECT). It is reserved as a last resort for people who cannot take medication due to other health concerns or when traditional treatments and medications are ineffective in treating extreme episodes.
Bipolar Depression can be a challenging illness affecting the lives of the individual and their loved ones; but the good news is, with the right course of treatment and medical attention, this mental health disorder can be managed successfully and allow the person to lead a happy, successful life. There is also a lot of help and support out there in the form of community groups, therapy, online counseling, etc. It can all feel very overwhelming and confusing so don't feel scared to reach out to people around you.
If you or a loved one are currently experiencing any of the symptoms discussed in this article or feel as though you may be unwell, please contact a medical professional right away and get the help you need.