My knowledge of bipolar depression symptoms has been gained the hard way.
For many years I suffered from depression but had no idea that what I really had was bipolar disorder. Then, after my most serious manic meltdown, I fell into a depression so bleak that I considered suicide. This frightened me into getting help. Eventually my psychiatrist uncovered the missing pieces of the puzzle we realized that instead of depression and anxiety, I had bipolar disorder.
Bipolar depression is the “depressive” half of what we used to call “manic-depressive illness”.
Bipolar depression is different from “ordinary” or unipolar depression and the treatment is also different. Bipolar depression symptoms require very specific, targeted bipolar depression treatments.
Another fascinating and related question is – Is depression in Bipolar Type I the same as depression in Bipolar Type II?
And how about the less known symptoms of bipolar depression such as problems with cognitive functions?
Do bipolar depression symptoms look just like “ordinary” depression? The answer is a definite, emphatic NO!
Bipolar symptoms are turning out to be more subtle, profuse, and complex than we ever thought.
With increased research has come increased insights, including more choice in medications and “talk” therapies.
These insights are coming just in time – and for many of us just a bit too slowly – as a more complete picture of bipolar depression emerges.
For example, many people do not understand that medications for treating bipolar depression are not necessarily very effective for treating mania. For example, one of the best drugs for treating bipolar depression is Lamictal, but Lamictal is not useful as an anti-manic.
Itis also important to understand that medications that are very effective for treating “ordinary” or unipolar depression, such as SSRI drugs – Prozac etc – are not as effective for bipolar depression AND can even be dangerous for people with bipolar disorder depression as they may trigger mania
The short answer is that the difference between the two lies in the presence or absence of mania.
For the person who is suffering, their subjective experience will feel a lot the same. And it will suck!
A “regular” depression and a bipolar depression may feel the same on the inside:
1. Feelings of hopelessness or worthlessness.
2. Lethargy or outright exhaustion.
3. No interest in the people, activities and things that once mattered most.
4. Changes in appetite, sleep and concentration.
5. Zero interest in sex and/or no confidence in one’s own sexual appeal.
6. Social withdrawal.
7. Sometimes feeling weepy or outright crying jags.
8. Sometimes decline in personal grooming or hygiene.
9. In extreme cases, an inability to keep getting up and going to work or school, or even get out of bed.
Is mania present or not? With mania = bipolar! Without mania = depression!
Bipolar disorder is characterized by the presence of major depression, AS WELL AS episodes of mania that last for at least one week.
So what is mania anyway? The tricky part is that mania can take different forms.
Sometimes it can be feeling euphoric or expansive. A manic episode may lead a person to feel highly energized, on top of the world, or like they can do anything (feelings of grandiosity).
A manic person may: 1. Need little or no sleep.
2. Become very talkative.
3. Become very uninhibited.
4. Have racing thoughts.
5. Engage in reckless or impulsive behavior like excessive spending where they waste cash or run up credit cards, or be very sexually active (in contrast with usual attitudes and behaviors about sex).
To satisfy the clinical criteria, the manic episode must negatively effect the person’s life.
However, some manic episodes go undiagnosed because the signs overlap with certain symptoms of depression or other conditions, and do not fit into the old time stereotype of the manic-depressive.
For example, instead of seeming euphoric or energized, the manic person may be extremely irritable, disorganized or anxious.
Differentiating depression from bipolar depression symptoms matters a lot because of the difference in treatment options.
Some of the most effective treatments for depression are medications such as SSRIs like Lexapro, Prozac and Zoloft.
The issues are complex and still being debated, but it seems that at least sometimes, these medications can trigger mania in a person with bipolar depression symptoms and make their condition much worse.
The most effective treatments for bipolar are different to the more commonly prescribed SSRIs and include mood stabilizers such as lithium.
Signs of bipolar depression
Signs of bipolar depression are more varied than you may expect.
Actually one of the critical ways bipolar depression can be distinguished from unipolar depression is this variability in the symptoms of depression – bipolar depression symptoms are varied, whereas unipolar depression is more predictable.
A summary of the existing research indicates you could be looking at bipolar depression if there is:
1. Substance abuse also present.
2. Abnormally irritable or hostile (or both).
3. Psychosis of any kind.
4. More changes in mood so that the person appears more emotionally unstable.
5. Symptoms are different from episode to episode for any one particular individual, and symptoms are more varied on the whole.
On the other hand, you are more likely dealing with unipolar (“Ordinary” or “Classic”) depression if there are:
1. Physical symptoms such as unexplained pains or heightened sensitivity to pain.
2. Anorexia and/or appetite loss and/or weight loss.
3. Anxiety and agitation.
5. Less variability in symptoms. Tends more towards the stereotypical cliche of a depressed person.
Also, there are COGNITIVE symptoms of bipolar depression that many people (including clinicians) are NOT well informed about.
By “cognitive symptoms” I mean those things that show some problems with what we usually consider normal day to day thought processes. Examples would be functions such as:
4. Comprehension, and
5. Capacity for abstract thinking.
Cognitive difficulties are increasingly recognized and researched as bipolar depression symptoms.
If the topic of cognitive problems in bipolar depression interests you, see our page on “Bipolar Memory Loss”.
Commonly overlooked clues
We are often told that the way to distinguish depression (as in unipolar depression) from bipolar depression is to look for other symptoms in the patient, in particular to search for clues about the presence or absence of mania.
By now it is well known that bipolar disorder is often misdiagnosed – or just plain missed. One of the most common misdiagnoses is to make the mistake of seeing only “regular” depression rather than bipolar depression symptoms. Further, we are also told that the way to tell the difference between the two is the presence or absence of mania.
However, there are other important diagnostic clues that are well researched but not well known. As a result they are all too often overlooked.
As it turns out, bipolar depression differs from unipolar depression in some important ways. Understanding these differences can aid accurate diagnosis, even before we embark on the “hunt for mania”.
One key feature – which really comes as no surprise – is that bipolar depression is characterized by more variability in symptoms, as opposed to the more predictable unipolar depression.
Here is a summary of differences from some of the studies to date:
BIPOLAR DEPRESSION is more likely to feature:
1. Co-morbid substance abuse. 2. Irritability and/or hostility. 3. Psychotic features. 4. Unstable, fluctuating moods. 5. Symptoms vary from episode to episode for a single individual, with a greater variety of symptoms overall.
UNIPOLAR (“Ordinary”, “Simple” or Classic”) DEPRESSION is more likely to feature: 1. Physical symptoms with a range of physical complaints such as pain sensitivity or unexplained pains. 2. Anorexia and/or appetite loss and/or weight loss. 3. Anxiety and agitation. 4. Insomnia. 5. Less variability in symptoms. Tends more towards the stereotypical cliche of a depressed person.
Research has also revealed some clinical differences between Bipolar I and Bipolar II depression.
However, all this focus on mania may not give us the full picture of bipolar symptoms.
It seems there are differences in how depression is experienced in Bipolar Type I versus Bipolar Type II.
In Bipolar Type II:
1. Sufferers are more likely to be women.
2. Episodes of depression are less severe but are more frequent and last longer.
3. In Bipolar Type II depression, the accompanying conditions are more likely to be substance abuse and/or anxiety, but Bipolar Type I is more likely to be co-morbid with psychosis and hospitalizations.
DO NOT MAKE THE MISTAKE OF THINKING THAT DEPRESSION IN BIPOLAR TYPE II IS LESS IMPORTANT OR DANGEROUS. RESEARCH SHOWS MORE SUICIDE ATTEMPTS AMONGST THOSE WITH BIPOLAR TYPE II DEPRESSION.
In summary, specific bipolar depression treatments are needed in order to successfully overcome bipolar depression symptoms. Bipolar depression differs from other causes of depression such as postnatal depression or “regular”, “unipolar”, or “classic” depression. In particular bipolar depression does not exist in isolation from other bipolar symptoms such as switches into bipolar mania.
(Anyone who wants to learn more about bipolar depression symptoms should read Manic-Depressive Illness: Bipolar Disorder and Recurrent Depression, 2nd edition, by Goodwin and Jamison – the most authoritative text book on bipolar and depression and the main source of the information reported here.)