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 I considered suicide. This frightened me into getting help. Eventually my psychiatrist uncovered the missing pieces of the puzzle: We realized that it wasn’t depression and anxiety that I had. My chronic and severe symptoms were due to Bipolar Disorder.

What is Bipolar depression?

Bipolar depression is defined as the “depressive” half of what we used to call “manic-depressive illness.”

It is different from “ordinary” or unipolar depression. The treatment is also different. Bipolar depression symptoms require very specific, targeted Bipolar depression treatments.1

The Depression and Bipolar Support Alliance (DBSA) states that

“The symptoms of unipolar depression and Bipolar depression are very similar. The main difference is that someone with unipolar depression doesn’t experience the highs, periods of Bipolar mania (if severe) or hypomania (if mild) and this is extremely important, because the preferred treatments of the two can be quite different.”

Another fascinating and related question – Is depression in Bipolar I Disorder the same as depression in Bipolar II Disorder?

Do Bipolar depression symptoms look just like “ordinary” depression? The answer is a definite, emphatic NO!

We now have a greater understanding of the subtle, profuse, and complex symptoms of Bipolar Disorder compared to decades ago when the disorder often went undiagnosed in many cases. With increased research has come greater insights, including more choices 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.


Bipolar vs Depression

The wrong diagnosis may lead to an eventual disaster and can be dangerous for the affected person and loved ones. So, is it depression or Bipolar?

In short, the difference between the two lies in the presence or absence of mania. The person that is suffering from either of these mood disorders will experience many of the same symptoms, and it will suck!

People suffering from Bipolar depression can experience some of the same feelings as a person struggling with “Regular” depression and these symptoms include,

  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. A 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.

It’s important to consider when examining your symptoms if mania present or not? With mania = Bipolar! Without mania = depression!

Bipolar Disorder is characterized by the presence of one or more depressive episodes (that last at least 2 weeks), 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 (i.e., just a few hours) 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 affect the person’s life such as their ability to work, socialize, and/or carry on with typical, every day activities.

However, some manic episodes go undiagnosed because the signs overlap with certain symptoms of depression or other conditions, and do not fit into the well-known stereotype of the manic-depressive Bipolar Disorder.

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.


Signs of Bipolar Depression

Signs of Bipolar depression are more varied than you may expect.2

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 mood (or both).
  3. Psychosis of any kind (although this can occur with unipolar depression).
  4. More frequent changes in mood.
  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. Changes in appetite (eating too much or too little) and/or extreme weight loss or weight gain within a short period of time.
  3. Anxiety and agitation.
  4. Insomnia
  5. Less variability in symptoms. Tends more towards the stereotypical cliché 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:

  1. Concentration.
  2. Judgment.
  3. Memory.
  4. Comprehension, and
  5. Capacity for abstract thinking.

In recent years, cognitive difficulties are being increasingly recognized and researched as Bipolar depression symptoms. There is some overlap here because people with “classic” or unipolar depression can experience difficulty with concentration or memory, but with Bipolar Depression, these cognitive are much more evident and severe

If the topic of cognitive problems in Bipolar depression interests you, see our page on “Bipolar Memory Loss”.

Bipolar Depression in Teens

Teens also experience Bipolar depression, and correctly diagnosing it is often more difficult than with adults. Even though many of the symptoms are the same, they are often mistaken for normal teenage “growing pains” caused by their rapidly changing hormone levels.

Some of the common signs of Bipolar depression Disorder in teens are,

  • Loss of interest in daily activities.
  • Prolonged sad or irritable mood.
  • Mood swings or having frequent emotional “meltdowns”.
  • Inability to cope with stress (in excess of what is expected of the teens age and developmental level).
  • Loss of energy or fatigue.
  • Feelings of guilt or worthlessness.
  • Sleeping too much, inability to sleep, or difficulty falling asleep.
  • Drop in grades and inability to concentrate.
  • Inability to experience pleasure.
  • Hyperactivity.
  • Impulsivity.
  • Behavioral problems (e.g., getting in trouble in school, defiance towards authority figures, lying, stealing).
  • Attention difficulties.

Remember, for it to be Bipolar depression teens also must have episodes of mania.


Bipolar Depression vs Unipolar Depression

We are often told that the way to distinguish depression (as in unipolar depression) from Bipolar depression is to look for other symptoms, 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 or anxiety symptoms 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 cliché of a depressed person.

Research has also revealed some clinical differences between Bipolar I and Bipolar II depression.


Bipolar 2 Depression

Is there a difference between Bipolar II depression versus “classic” Bipolar I depression?

Traditionally we distinguish Bipolar Type I from Bipolar Type II according to the presence or absence of mania OR the intensity of any manic episodes.

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 II:

  1. Sufferers are more likely to be women.
  2. Episodes of depression are less severe but are more frequent and last longer.

In Bipolar II depression, the accompanying conditions are more likely to be substance abuse and/or anxiety, but Bipolar I is more likely to be co-morbid with psychosis and hospitalizations.


Bipolar Depression Treatment

There is not just one way to treat bipolar depression, regardless of the type.

Instead, you will need a complete treatment plan and it will vary from patient to patient. This means what works at controlling bipolar mania and depression for someone else, might do little at helping you control your symptoms.

Bipolar medications, like antidepressants and mood stabilizers, are commonly prescribed but this needs to be combined with other therapies.

Some types of treatment that have shown to be effective at controlling Bipolar moods include support groups and psychotherapy. Meeting one-on-one with your counselor can help you establish a daily routine, and provide you with tools to help manage and even control Bipolar depression episodes.

A long-term study (STEP-BD) conducted by the National Institute of Mental Health is finding that a combination of the right medications and therapies that include, cognitive behavioral, interpersonal and social, along with ones that are family focused can improve treatment response in patients with Bipolar Disorder depression.

For any of these or other therapies to work effectively, it is critical that you find the right combination of medications to treat your symptoms of Bipolar depression.


Bipolar Depression Medication

Many people do not understand that medications for treating Bipolar depression are not necessarily effective at treating mania. One of the best medications for treating Bipolar depression is Lamictal, but it is not useful as an anti-mania agent.

It is also important to understand that medications that are very effective for treating “ordinary” or unipolar depression, such as SSRI drugs (e.g. Prozac) are not as effective for Bipolar depression AND can even be dangerous for people with Bipolar depression as they may trigger mania.

Finding a single or combination of medications that work for you will take time, but it is important that you keep trying.

Some of the medications commonly prescribed to treat depression in Bipolar Disorder include:

  • Antidepressants (SSRIs): Unfortunately, these can also trigger mania so you might also need to take a mood stabilizer like Depakene, Depakote, Lamictal or Lithium. However, they can be effective at treating unipolar depression.
  • Antidepressant-antipsychotics: Symbyax is an example of a medication that can work as a treatment for Bipolar depression and as a mood stabilizer.
  • Antipsychotics: When depression symptoms or mania persist despite treatment, an antipsychotic medication may need to be added. Risperdal, Seroquel, Abilify and Latuda are examples of some antipsychotic medications.
  • Anti-anxiety (Benzodiazepines): While taking an anti-anxiety medication can help improve your ability to sleep during Bipolar mania or depression, it should only be prescribed for a brief period.

Learn about medications for symptoms of Bipolar depression.

In summary, specific Bipolar depression treatments are needed 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 that 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 Disorder and depression and the main source of the information reported here.