Bipolar Depression (A comprehensive guide)

Bipolar Depression

In this guide bipolar depression will be discussed, the depression experienced in bipolar disorder, the difference between bipolar I and bipolar II disorder, their diagnostic features, risk factors, and therapeutic plans.

What is Bipolar Depression

Bipolar depression presents in the same way as unipolar depressive episodes.

The only way to establish whether a depressive episode is part of a unipolar or bipolar disorder is to check for a history of manic episodes.

There are, however, features of depressive episodes that can suggest the possibility of bipolar disorder – psychotic symptoms, severe agitation suggestive of a mixed affective state, atypical symptoms such as increased sleep and appetite, and poor response to antidepressant drugs are all suggestive of bipolar depression and should prompt a review of the case, to check whether a history of manic episodes has been missed.

The way Bipolar and depression are linked to each other, bipolar and anxiety too, are related to each other.

However, unlike depression, anxiety is not one of the symptoms of bipolar.

Bipolar Disorder

Bipolar disorder is described as a condition that causes extreme changes in energy and activity level and mood fluctuations which hinders a person’s daily life.

This disorder is named Bipolar and other related disorders which include bipolar I and II disorders along with cyclothymia.

Bipolar Depression (A comprehensive guide)

Before DSM-5, this condition has been as manic depression which is a serious mental condition that has been put in between the depression disorders and psychotic disorders in the Diagnostic Statistical Manual of Mental Disorders.

If it is not treated, it can create a lot of hindrances in relationships, in career and education.

In extreme cases, it can lead to suicide.

Prevalence of Bipolar Disorder

Bipolar disorder has been found in males and females equally. It is commonly diagnosed between the ages of 15 and 25 years but the symptoms can occur any time, at any age.

Alternating episodes of mania or extreme euphoria and depression are the main symptoms of Bipolar disorder.

These episodes can be extreme but in between the highs and lows, the mood may stay normal. Fluctuations in mood are severe, incapacitating and devastating than normal mood swings.

Some people with bipolar disorder might experience having hallucinations as well.

Many people refuse to take medication or some stop taking them and their condition gets worse, however, if the patients follow proper treatment, the condition can be controlled and managed, they can work, study and have a productive life.

Studies revealed that people with bipolar disorder are extremely creative but because of their abrupt mood swings make it hard for them to concentrate and stay on a project or plan which results in them having started a lot of projects but nothing finished.

Bipolar Disorder Symptoms

Symptoms of bipolar disorder may be different for each individual according to their mood.

Some people may experience clear mood shifts with manic symptoms and then depressive symptoms, each with months of stability in between shifts and lasting for a few months.

Others might suffer in a high or low mood for months or years. 

When depressive and a manic episode happen simultaneously, it is called a mixed state.

A person may feel restless or weird but also experience negative feelings.

Symptoms of Bipolar disorder can broadly be categorized in:

1.  Mania or Hypomania

2.  Major Depressive Disorder

Mania or Hypomania

Mania and hypomania are terms that refer to a high mood where mania is a severe form than hypomania.

Following are the symptoms of mania/hypomania:

●       A sense of euphoria, being on top of the world, unstoppable

●       Faulty judgment

●       Easily distracted or get bored and shift from one task to another

●       Underperformance, missing school or work

●       Engaging in risky behaviour

●       Inflated self-confidence, self-importance, and self-esteem

●       Belief that nothing is wrong

●       Rapid and excessive talking, jumping from one topic to another

●       Aggressively forthcoming

●       Bizarre ideas on which they might act upon

Examples include spending a lot of money on useless things, taking part in dangerous activities, abusing drugs or alcohol and higher libido.

Paranoia can also be a symptom of bipolar.

 Depressive symptoms

Bipolar Depression (A comprehensive guide)

Symptoms experienced during a depressive episode include:

●       Loss of interest in activities and loss of pleasure

●       Extreme sadness

●       Feelings of hopelessness and despair

●       Sleep disturbances (insomnia or hypersomnia)

●       Anxiety about small meaningless things

●       Physiological symptoms not responding to treatment

●       Eating problems

●       Weight gain or loss

●       Feelings of extreme guilt about everything that appears to be going wrong

●       Concentration and memory problems

●       Irritability triggered by smells, noises, tight clothing, and other trivial things

●       Inability to get up and move about doing normal life chores

●       Extreme fatigue, tiredness and/or restlessness

●       In many cases where the symptoms are severe, the individual suffers from suicidal ideation and some might think about acting on them.

In both manic and depressive episodes, psychosis can occur and the person might not be able to tell the difference between reality and fantasy.

During a person’s high state of manic/hypomanic phase, he might believe that he is famous and has connections with high ranking people.

While in the depressive phase, he might think that he has committed a crime.

Teenagers and children with bipolar disorder are likely to have rapid mood changes, explosive anger, temper tantrums, reckless behaviour and outbursts of aggression.

All the symptoms mentioned above should not be chronic but episodic to make a diagnosis of bipolar disorder and these are manageable with proper treatment.

Types of Bipolar Disorder

There are three broad types of bipolar disorder according to DSM-5.

1.  Bipolar I disorder

2.  Bipolar II disorder

3.  Cyclothymia

Bipolar I disorder

In order to diagnosis a person with bipolar I:

●       One manic episode is must

●       The person previously should have had a depressive episode

●       Other disorders must be ruled out that are not associated with bipolar disorder, for instance, delusional disorder, schizophrenia, and other psychotic disorders

Bipolar II Disorder

Bipolar II diagnosis is given when

●       At least one hypomanic episode and,

●       One or more episodes of depression has been experienced

Hypomanic symptoms include being competitive, sleeping less than normal and extremely energetic.

This state is not as severe as manic state and hence, it does not affect the functioning of a person fully.

Bipolar II can have

●       Mixed episodes of mania and depression

●       Symptoms of mood incongruent or mood-congruent psychotic features

Cyclothymia

In cyclothymia, there are symptoms of hypomania but that does not meet the full criteria of hypomania and there are symptoms of depression that do not fully meet the criteria of major depressive disorder.

The mood changes are less dramatic than that of mania/hypomania or depression.

Conditions of Diagnosis

Bipolar Depression (A comprehensive guide)

The diagnosis should be made by the psychologist or a psychiatrist on the bases of the criteria mentioned in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5).

The criteria must be met for mania and depression for at least 7 days, including the symptoms of irritable or elevated mood and repetitive increased energy or activity levels.

For hypomania, symptoms must be met for at least 4 consecutive days. Family members, teachers, colleagues and friends of the individual should report their observation of the symptoms.

Secondary signs of the conditions should easily be evident to other healthcare professionals.

Diagnosis should only be made after getting verbal reports from family and friends, clinicians’ observation and interview with the individual, physical examination, urine tests, and diagnostic tests.

Once received the diagnosis of Bipolar disorder, it will stay lifelong.

There might be periods of stability but the condition is not recoverable and a person can experience episode any time in his life again.

Comorbidities

Other conditions that might occur with bipolar disorder are:

●       Attention deficit hyperactivity disorder

●       Anxiety disorder

●       Post-traumatic stress disorder

●       Substance abuse disorders

It is important to understand that these comorbidities might actually be masking bipolar disorder.

As a person is more likely to seek help when he is in a down or low phase than during a high, hence, to prevent misdiagnosis, it is important for the mental health professional to go through a person’s history thoroughly and look for the signs of mania.

Treatment

Bipolar disorder can be managed with proper treatment.

The treatment aims to reduce the symptom severity and the frequency of depressive and manic/hypomanic episodes to help the person live a relatively productive and normal life.

If the condition goes untreated, mania or depression can persist for a long time and treatment will need three to four months to make improvements in the patient.

Treatment involves:

●       Combination of therapies

●       Medication

●       Physical and psychological interventions

Even though a person might continue to experience mood shifts but working with a doctor on a regular basis will help reduce the severity of symptoms and make them more manageable.

Medication

To treat long-term episodes of mania/hypomania and depression, the most common long term drug treatment which psychiatrists prescribe is Lithium carbonate.

This medication must be taken for 6 months at least.

The patient should refrain from self-medication, it is important to follow the instructions of a doctor about how and when to take the medication for them to work.

Other medications for bipolar include:

●       Antipsychotics like olanzapine, aripiprazole and risperidone and these are prescribed when the symptoms are severe resulting in disturbing behaviour

●       Anticonvulsants are prescribed as a treatment for mania episodes

Drugs have side effects and need to be adjusted with mood shifts. If the patient is misdiagnosed and given antidepressants, it may trigger an episode of mania.

Therapeutic Interventions

To alleviate the symptoms and help patients manage them, psychotherapy is used.

It helps in making the patient identify and recognize the triggers to episodes which makes them able to decrease the secondary effects beforehand.

Bipolar Depression (A comprehensive guide)

When the patient is taught to recognize the early symptoms of an episode, he can work on aspects that will help in maintaining the normal phase for as long as possible.

This is important in maintaining healthy relationships at work and home.

Following are the therapies used by therapists or psychologists to manage bipolar disorder:

●       Cognitive Behavioral Therapy (CBT)

●       Family therapy

●       Interpersonal therapy combined with CBT for depressive symptoms

●       Electroconvulsive therapy (ECT) when no other treatment is effective

In bipolar patients, hospitalization has become less common than it was in the past.

Nevertheless, it is advisable for the patient to be temporarily hospitalized if he is harmful to themselves or others.

They should have a routine with enough sleep, a healthy diet, and regular exercise to keep them stable.

Causes of Bipolar Disorder

There is no single cause for Bipolar disorders but multiple factors interact to cause the condition.

These factors include:

●       Genetic factors: if any family member of a person suffers from this condition, he is more likely to have a bipolar emerge

●       Biological traits: physical changes in brains but the link with bipolar disorders is unclear

●       Imbalances of Brain-chemical: In many mood disorder, including bipolar disorders imbalance in neurotransmitters play a key role

●       Hormonal problems can trigger bipolar disorder

●       Environmental factors include significant loss, extreme mental stress or other traumatic event

Sometimes, there is a genetic predisposition in a person for bipolar disorder but only the environmental factors play a role in triggering the symptoms and mood shifts.

Bipolar disorder is a mood disorder that has two episodic phases; mania/hypomania and depression.

The person might feel extremely euphoric for months and then extremely sad for other months. There can be a mixed state where mood shifts are rapid.

There are three types of bipolar disorder, bipolar I, bipolar II and cyclothymia.

Even though it is a lifelong diagnosis and interferes with a person’s daily life but it is easily treatable with medication and psychotherapeutic help.

Causes of bipolar disorder include a number of factors working together.

Frequently Asked Questions for Bipolar Depression

What is the difference between bipolar disorder and bipolar depression?

The difference between bipolar disorder and bipolar depression is that bipolar disorder has two sides, but depression is unipolar and has no ‘up’ and mania.

What causes bipolar depression?

Bipolar disorder is caused by hormonal imbalance and environmental factors.

What is good for bipolar depression?

Medication is good for bipolar depression.

Quetiapine for short-term, olanzapine and atypical antipsychotics are good for bipolar depression.

What are the signs of bipolar in a woman?

The signs of bipolar in woman can be irritability, more energy, heightened self-esteem, grandiosity, sleep disturbance, excessive talking, flight of ideas and easily distracted.

Please feel free to ask any questions that you might have in the comment section below.

References

WebMD

NIMH

MayoClinic

Medical News Today

Recommended Readings

An Unquiet Mind: A Memoir of Moods and Madness

 The Bipolar Disorder Survival Guide, Second Edition: What You and Your Family Need to Know

Bipolar Disorder: A Guide for Patients and Families (2nd Edition)

The Bipolar Workbook, Second Edition: Tools for Controlling Your Mood Swings

Take Charge of Bipolar Disorder: A 4-Step Plan for You and Your Loved Ones to Manage the Illness and Create Lasting Stability

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Bipolar Depression (A comprehensive guide)


Daniela Paez

Daniela Paez is a Clinical Psychologist with an MSc. In Clinical Neuropsychology from Bangor University. She has vast experience in working with children with disabilities, adolescents and their families, in extreme conditions of poverty and vulnerability. Additionally, she owns a private practice where she provides neuropsychological evaluation for children and adults, and treatment for mood disorders, anxiety, couple therapy, among other conditions.