What is bipolar depression? Signs, symptoms, & treatments

By

Walter Alejos

|

April 20, 2021

young woman with short hair learning to live with bipolar disorder symptoms
Even if you experience significant symptoms from bipolar disorder, the right treatment can be very effective.

Bipolar disorder is a chronic mental health condition that may include periods of depression, as well as periods of increased energy called mania and hypomania. Though these episodes can cause serious interruptions to your life, the symptoms of bipolar depression can be treated with medication and therapy.

For people with anxiety and depression, purposefully engaging in pleasurable activities can improve mental health.
Even if you experience significant symptoms from bipolar disorder, the right treatment can be very effective.

Bipolar disorder is a chronic mental health condition that may include periods of depression, as well as periods of increased energy called mania and hypomania. Though these episodes can cause serious interruptions to your life, the symptoms of bipolar depression can be treated with medication and therapy.

What is bipolar disorder?

Bipolar disorder, formerly called manic depression, is a mental health condition that includes both depressive episodes and periods of mania or hypomania. If you have this disorder, your symptoms may continue to worsen until you seek medical treatment.

Bipolar depression can cause you to feel sad, tired, or worthless. During a bipolar manic or hypomanic episode, you’re likely to feel energized and behave more recklessly than you usually would.

The mood swings caused by bipolar disorder can make it difficult to function in day-to-day life. You may find that you have trouble fulfilling your obligations at home, work, school, and in your social life.

Bipolar disorder is a chronic condition, meaning that you’ll need ongoing care and treatment to find relief from symptoms.

That being said, you can treat both manic and depressive symptoms with medication and therapy. It’s also helpful to care for your mental health by reducing stress, exercising regularly, prioritizing rest, and eating healthily.

Manic depression vs. bipolar disorder

When first introduced as a diagnosis, clinicians referred to this disorder as “manic depression” or “manic-depressive disorder.” Because of the harm and stigma associated with this label, the American Psychiatric Association changed the name for this disorder to “bipolar disorder” in 1980.

Without treatment, bipolar disorder can become life-threatening. It’s associated with a greater risk for suicide, self-harm, and fatal accidents.

In a psychiatric emergency, call 911 or go to an emergency room near you. If you’re having suicidal thoughts, dial the National Suicide Prevention Hotline at 1-800-273-8255 or text 741-741 with the word “home.”

Causes

Although researchers still don’t understand what causes bipolar disorder, they believe that specific genetic signatures and biological differences may contribute to the development of this disorder.

With several different genes at play, the genetic heritability of bipolar disorder is estimated between 60 – 80%. Heritability is the statistical probability that a condition or trait results from your genes rather than your environment and upbringing.

There’s no single gene associated with all cases of bipolar disorder. Instead, the combination of genes and genetic mutations may make some people more susceptible to this condition than others.

In addition, brain imaging research indicates that there may be a connection between bipolar disorder and smaller-sized regions in the hippocampus. This is the part of the brain responsible for memory, spatial awareness, and navigation.

In people with bipolar disorder, specific areas of the hippocampus became smaller the longer their condition lasted. This was especially notable in those who had more manic episodes.

Finally, the symptoms of this disorder can occur during pregnancy or be triggered by the changing seasons.

Risk factors

Other risk factors for bipolar disorder include:

Having a family member with the disorder

If you have a first-degree relative with bipolar disorder, you may be at higher risk.

Stressful life events

Periods of high stress, such as the loss of a loved one, trauma, or abuse, may trigger the onset of symptoms. Research suggests that childhood trauma is present in up to 50% of individuals with bipolar disorder.

Substance abuse

Certain substances and medications can exacerbate the symptoms of bipolar disorder. This condition is associated with an elevated risk of developing a substance use disorder.

Signs

The signs of bipolar depression, including episodes of mania, hypomania, and depression, can vary from person to person. The onset of symptoms usually begins around age 25, but some patients are diagnosed much earlier.

For children and adolescents, the duration of each mood episode may be shorter than it would be in an adult. As a result, bipolar disorder can sometimes be challenging to diagnose in young people.

Some people have mood episodes that involve mixed features, meaning they experience a combination of manic and depressive symptoms. In almost all cases, people with bipolar disorder have intense emotions, sleep disturbances like insomnia, extreme variation in energy levels, and display uncharacteristic behavior, especially during manic episodes.

Finally, some people with severe bipolar disorder can enter into a psychotic state, marked by hallucinations or delusions. That’s why this disorder can sometimes be misdiagnosed as schizophrenia.

Bipolar disorder can co-occur with other conditions, including:

Symptoms

There are 4 distinct types of bipolar disorder, each with a unique set of symptoms. Before we look at specific types, it can help to understand bipolar depression symptoms in general, especially those usually associated with manic and depressive episodes.

If you’re having a depressive episode, you may experience the following symptoms:

  • Depressed mood with feelings like sadness, hopelessness, and worthlessness
  • Frequent crying, emotional numbness, or both
  • Losing interest in activities
  • Slowed speaking and movement
  • Changes in sleep, either sleeping too much or not enough
  • Changes in weight, either gaining or losing a significant amount
  • Feelings of guilt and shame
  • Inability to think clearly or make decisions
  • Thoughts of self-harm or suicide

During a manic or hypomanic episode, you may experience:

  • Having too much energy
  • Feeling amped up, jittery, or like you can’t sit still
  • Inflated sense of self-esteem and well-being
  • Not needing to sleep
  • Ruminative thinking
  • Speaking quickly and being more talkative than usual
  • Being easily distracted
  • Feeling uninhibited
  • Involuntary body movements
  • More willingness to participate in high-risk behaviors

Types of bipolar disorder

There are 4 main types of bipolar disorder: bipolar I, bipolar II, cyclothymia, and “other bipolar disorders.” We’ll explain each type below, including symptoms and criteria for diagnosis. While there’s no bipolar depression test, a clinician will be able to diagnose your condition based on its diagnostic criteria.

Bipolar I disorder

Bipolar I includes at least one episode of mania that lasts for at least one week. To be diagnosed with bipolar I disorder, you don’t need to exhibit the symptoms of depression.

Some people with bipolar I display a period of depression preceding or following a manic episode, but that’s not necessary for a diagnosis. A diagnosis of bipolar I means your symptoms cause you clinically significant distress or impairment.

Diagnosis

In order to be diagnosed with bipolar I disorder, you must have had at least one manic episode, defined by:

  • An unusually elevated mood and goal-directed behavior lasting at least 1 week and is present most of the day, nearly every day
  • 3 or more of the following symptoms, not caused by medication, a medical condition, or another mental health condition:
    • Increased self-esteem or grandiosity
    • Less need for sleep
    • Being very talkative
    • Racing thoughts
    • Being easily distracted
    • Activity directed at a goal or anxiety that causes involuntary movements
    • Engaging in activities that are likely to have harmful consequences

Bipolar II disorder

Bipolar II is distinguished from bipolar I in that the episodes of heightened energy are less intense and shorter in duration. For this reason, they are called hypomanic episodes rather than manic episodes.

Also, you must display depressive symptoms to be diagnosed with bipolar II disorder. If you have bipolar II disorder, your symptoms of depression or the unpredictability of your mood swings must cause you clinically significant distress or impairment.

Diagnosis

In order to be diagnosed with bipolar II disorder, you must have had at least one hypomanic and one depressive episode. The hypomanic episode is defined by:

  • Abnormally elevated mood and abnormally goal-directed behavior that lasts at least 4 consecutive days and is present most of the day, nearly every day
  • Change in functioning that is uncharacteristic for you and is observable by others
  • Symptoms of hypomania alone are not severe enough to cause marked impairment in social or occupational functioning
  • 3 or more of the following symptoms of mania that aren’t caused by medication, a medical condition, or another mental health condition:
    • Inflated self-esteem or grandiosity
    • Decreased need for sleep
    • Talkativeness
    • Racing thoughts
    • Distractibility
    • Goal-directed activity or psychomotor agitation
    • Excessive involvement in activities that have a high potential for painful consequences

The depressive episode must meet at least 5 of the following criteria:

  • Depressed mood, or an irritable mood if you’re a child or adolescent
  • Loss of interest in almost all activities
  • Significant weight gain or loss or a discernible change in appetite
  • Abnormal sleep—either too much or too little
  • Moving faster or slower than usual in a way that’s noticeable to others
  • Tiredness, fatigue, low energy, or a decrease in productivity
  • A sense of worthlessness
  • Inability to think clearly, concentrate, or make decisions
  • Recurrent thoughts of death and suicide, or suicide attempts

Finally, you’ll only receive this diagnosis if you’ve never met the criteria for a full manic episode.

Cyclothymic disorder

Cyclothymia describes bipolar disorder, where the symptoms of mania and depression cycle with less intensity and longer duration.

Diagnosis

In order to be diagnosed with cyclothymic disorder, you must

  • Have had hypomania and depression at least half the time over a 2-year period and haven’t gone without symptoms for more than 2 months at a time.
  • Not meet the clinical criteria for major depressive, manic, or hypomanic episodes.
  • Have symptoms that cause clinically significant distress or impairment.

Other bipolar disorders

Other bipolar disorders refer to manic and depression symptoms that don’t meet the diagnostic criteria for bipolar I, II, or cyclothymia.

For example, bipolar symptoms induced by substance abuse or a medical condition, such as Cushing’s disease, multiple sclerosis, or stroke, would qualify as other types of bipolar disorder.

Testing & diagnosis

You’ll need to be evaluated by a mental health or healthcare professional to be diagnosed with any type of bipolar disorder. Your provider will usually evaluate you to determine your condition.

You’ll probably need to fill out a questionnaire about your medical history, symptoms, and any medications, substances, or supplements you take. It’s also likely that your clinician will ask you to describe the way you’ve been feeling. Your provider may also ask about the medical history of your family members.

Your provider will seek to understand your family and personal histories to uncover any other mental health conditions, including depressive disorders or anxiety disorders, that may contribute to your mood changes.

You may also be asked to complete a mood chart or journaling exercise in order to track your symptoms over time.

Treatments

With the help of a clinician, you can develop a treatment plan designed to address your unique symptoms. Treatment plans for bipolar disorder often include one or more of the following tools:

Medication

Your doctor may prescribe a mood stabilizer, such as lithium, to help eliminate your mood swings. People who experience psychotic symptoms may be prescribed antipsychotic medications, also called atypical antipsychotics.

In some cases, your provider may prescribe antidepressants, antidepressant-antipsychotics, and anti-anxiety medications. You may need to take more than one drug to manage the symptoms of bipolar disorder.

Psychotherapy

Talk therapy can be an effective way to reduce your depressive and manic (or hypomanic) episodes. Some of the therapeutic models that work well for bipolar disorder include cognitive behavioral therapy (CBT), psychoeducation, interpersonal and social rhythm therapy (IPSRT), and family-focused therapy.

Treatment approaches

Your doctor may recommend a treatment approach that offers individual, group, and support services. Inpatient and outpatient programs, including short-term hospitalization, may be necessary if there’s a high risk of harming yourself or others.

Substance abuse treatment

If you have a substance use disorder, you may need to seek addiction treatment. Because of the prevalence of bipolar disorder co-occurring with substance use disorder, some support groups, such as integrated group therapy (IGT) and dual recovery anonymous (DRA), aim to address both disorders.

Maintenance

Bipolar disorder is a life-long diagnosis, and most people who have the disorder need to maintain their treatment protocol even after their symptoms have been reduced or eliminated. You should stay on prescribed medications. Try keeping a journal or track your moods and promote healthy behaviors.

Electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS)

Brain stimulation involving electrical currents or magnetic waves may be recommended for people at high risk of suicide. These treatments are primarily used when medication is not an option due to pregnancy or other health concerns.

Lifestyle changes

Developing a daily routine to add structure to your life can help you avoid the highs and lows of bipolar disorder. In particular, scheduling time for hobbies that reduce stress, such as yoga and tai chi, may be beneficial.

Outlook

Bipolar disorder is a chronic mental health condition that may cause periods of mania, hypomania, or depression. The mood swings you experience as part of bipolar disorder can interrupt your daily activities and stop you from functioning normally.

For some people, bipolar disorder leads to risk-taking behavior, hallucinations, and a higher risk of accidents. In extreme cases, symptoms include an increased risk of self harm or suicide.

If you think you may have bipolar disorder, seek treatment immediately. An appropriate treatment plan, which usually involves medication and talk therapy, can help reduce your symptoms.

Many people experience bipolar disorder along with a substance use disorder. It’s essential to seek treatment for both bipolar disorder and any other co-occurring mental health disorders, including addiction.

Although there is no current cure for bipolar disorder, you can successfully treat its symptoms. Using long-term treatment and consistent maintenance, you can successfully manage episodes of mania, hypomania, or depression.

The sooner you treat your symptoms, the better your outcome. Seeking and maintaining treatment can help minimize the impact of this condition on your relationships, career, health, and finances.

Takeaway

  • There are 4 main types of bipolar disorder: bipolar I, bipolar II, cyclothymia, and “other bipolar disorders.”
  • Genetics and differences in the brain can increase your likelihood of developing the disorder.
  • Bipolar disorder can’t be cured, but the symptoms can be managed with treatment.
  • The most effective treatments include a combination of medication, therapy, behavioral tools, and lifestyle changes.
  1. Cao et al. (2017). Hippocampal subfield volumes in mood disorders. https://doi.org/10.2147/TACG.S39297
  2. Mayo Clinic. (2021). Bipolar Disorder. https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955
  3. The National Alliance on Mental Illness. (2017). Bipolar Disorder. https://nami.org/About-Mental-Illness/Mental-Health-Conditions/Bipolar-Disorder
  4. The National Institute of Mental Health. (2020). Bipolar Disorder. https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
  5. The Substance Abuse and Mental Health Services Administration. (2016). Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health. https://www.ncbi.nlm.nih.gov/books/NBK519697/pdf/Bookshelf_NBK519697.pdf
  6. The Substance Abuse and Mental Health Services Administration. (2016). An Introduction to Bipolar Disorder and Co-Occurring Substance Use Disorders. https://store.samhsa.gov/sites/default/files/d7/priv/sma16-4960.pdf

By

Walter Alejos

|

April 20, 2021