Bipolar Depression: Signs, Symptoms, and Treatment
Bipolar disorder is a mental health condition marked by dramatic fluctuations in mood, energy, and behavior. While mania often comes to mind, depression is a significant aspect as well. Bipolar depression refers to the depressive episodes specific to bipolar disorder, which are distinct from other forms of depression. These episodes can be severe, often lasting from two weeks to several months, and impact daily function considerably. During these periods, individuals may experience persistent feelings of sadness, worthlessness, or hopelessness, disrupted sleep, diminished interest in activities, changes in weight or appetite, and even suicidal thoughts, making managing the condition challenging.
Differences Between Bipolar Depression and Major Depressive Disorder
Both Bipolar Depression and Major Depressive Disorder (MDD) exhibit similar depressive symptoms, which include: persistent sad or hopeless mood, noticeable irritability in youth, and significant weight or appetite changes. Other shared symptoms involve psychomotor agitation or restlessness, overwhelming fatigue, and a pervasive sense of worthlessness. Sleep disturbances — insomnia or hypersomnia — impair daily functioning, while cognitive difficulties manifest as poor concentration or indecisiveness. Recurrent thoughts of death or suicidal ideation further characterize these episodes.
Diagnostic Variations
While depressive episodes are a hallmark of Bipolar II, they are not mandatory for diagnosing Bipolar I. In contrast, they are essential for an MDD diagnosis. Unique to Bipolar Disorder, however, are mixed features — concurrent manic and depressive symptoms. This can feel like a low mood accompanied by high energy, complicating diagnosis and treatment. Understanding these distinctions aids in crafting effective, individualized care plans.
Can One Have Bipolar Disorder and Be Mostly Depressed?
In bipolar disorder, the presence of depressive episodes can dominate one's experience. This is particularly true for those diagnosed with bipolar II disorder, where depressive episodes are more prevalent and intense. Unlike bipolar I, which necessitates a manic episode for diagnosis, bipolar II requires both hypomanic and depressive episodes.
Bipolar I vs. Bipolar II
While a diagnosis of bipolar I disorder includes manic phases, depressive episodes are not mandatory. However, individuals with bipolar II often endure more severe depressive periods. These episodes are not just clinically significant; they profoundly affect daily life, relationships, and overall well-being.
How is Bipolar Depression Diagnosed
Bipolar depression is diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria. For bipolar I, the presence of a manic episode lasting at least one week, evident most of the day, nearly every day, is critical. In contrast, bipolar II requires hypomanic episodes persisting for a minimum of four consecutive days.
Symptoms of Mania and Hypomania
To diagnose either condition, individuals must exhibit at least three of the following symptoms (or four if only irritable mood is present):
Inflated self-esteem or grandiosity
Decreased need for sleep, feeling rested with minimal rest
Excessive talking or a compulsion to continue talking
Racing thoughts or wild ideas
Engagement in activities with high-risk consequences, such as uncontrolled spending, reckless business ventures, or sexual irresponsibility
Easy distractibility
Intense focus on goal-directed activities in various domains, including social, occupational, or sexual realms
Treatment Options for Bipolar Depression
Even during periods without noticeable symptoms, maintaining a consistent regimen is crucial to prevent relapses and manage future episodes.
Medication and Mood Stabilization
Medications stabilise moods, enabling individuals to navigate daily tasks with minimal disruption. Mood stabilizers, such as lithium, and antipsychotics are commonly prescribed. These pharmaceuticals aim to balance mood swings, reducing the intensity and frequency of manic and depressive episodes.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) offers significant benefits for individuals with bipolar disorder. As a goal-oriented form of psychotherapy, CBT helps you identify and transform negative thinking patterns. Research indicates that CBT can effectively decrease the severity of mania, alleviate depressive symptoms, lower relapse rates, and enhance psychosocial functioning.
If you or someone you love is struggling with bipolar depression, you aren't alone, and help is available. Contact my office today to schedule a mood disorder session.