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,
- Feelings of hopelessness or worthlessness.
- Lethargy or outright exhaustion.
- No interest in the people, activities and things that once mattered most.
- Changes in appetite, sleep and concentration.
- Zero interest in sex and/or no confidence in one’s own sexual appeal.
- Social withdrawal.
- Sometimes feeling weepy or outright crying jags.
- A decline in personal grooming or hygiene.
- 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:
- Need little (i.e., just a few hours) or no sleep.
- Become very talkative.
- Become very uninhibited.
- Have racing thoughts.
- 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:
- Substance abuse also present.
- Abnormally irritable or hostile mood (or both).
- Psychosis of any kind (although this can occur with unipolar depression).
- More frequent changes in mood.
- 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:
- Physical symptoms such as unexplained pains or heightened sensitivity to pain.
- Changes in appetite (eating too much or too little) and/or extreme weight loss or weight gain within a short period of time.
- Anxiety and agitation.
- 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:
- Comprehension, and
- 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.
- 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:
- Co-morbid substance abuse.
- Irritability and/or hostility.
- Psychotic features.
- Unstable, fluctuating moods.
- 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:
- Physical symptoms with a range of physical complaints such as pain sensitivity or unexplained pains.
- Anorexia and/or appetite loss and/or weight loss.
- Anxiety and agitation.
- 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:
- Sufferers are more likely to be women.
- 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.
DO NOT MAKE THE MISTAKE OF THINKING THAT DEPRESSION IN BIPOLAR II IS LESS IMPORTANT OR DANGEROUS. RESEARCH SHOWS THAT THERE ARE MORE SUICIDE ATTEMPTS AMONG THOSE WITH BIPOLAR II DEPRESSION.
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.
Great explanation of bipolar depression!
My psych doc apparently suspects I’m bipolar, as she asked if it ran in my family & then proceeded to Rx Latuda. However, I’ve never had a manic (or hypomanic) episode & have never been psychotic at all. (Believe me, I know what that looks like because my grandma dealt with those symptoms). No paranoia, delusions or reckless behavior. Nothing but lethargic depression.
But my depression does fit more with the bipolar type according to this page. I have circadian rhythm issues–sleep all day & up all night–and my mood gets much worse in the Spring. I dislike sunny days & generally feel out of step with the living world. To me that sounds more bipolar than unipolar, BUT:
Is it possible to have bipolar depression WITHOUT any episodes of mania or psychosis? Or am I likely suffering from some other atypical, treatment-resistant depression? I’m tired literally all the time & kinda envy those with hypomania because at least they have energy. I take Prozac & it barely does anything–ditto for all other SSRI’s and SNRI’s. No medical cause for the fatigue has been found.
I really don’t feel comfortable taking an anti-psychotic if I’m not truly psychotic due to the toxicity & side effect profile. I gained 55 lbs in 3 months on Risperdal as a teen & don’t ever want to feel that way again.
I was diagnosed with bipolar about 30 years ago. I’m going through menopause and meds are not working for my depression.
I need more understanding. my depression seems worse
I think that people should look to nature and more natural ways of dealing with depression and other mental health issues. From what I am learning, there are alot of side effects associated with taking drugs and other prescription medications. Maybe a more natural, holistic way of looking at our health is needed.
I was told I had a diagnosis of clinical depression with anxiety most of my adult life however as things have got worse these past few years I’m now looking at a diagnosis of Bi Polar 2
My manic periods, or at least the symptoms I display, are not extreme and would never attract outside attention nor hospitalisation, however, they are there and can have some very detrimental outcomes. I spend way more than I have, so credit card limits and loans get hammered. I take on more than I can handle at work and at home. I’m extrovert socially which, at times offends and upsets people. I need much less sleep much of the time and then find myself eventually crashing out for the day/ weekend to catch up. I act more on a whim and therefore am not the most reliable person where making arrangements are concerned. I believe that I can do anything I set my mind to with no thought as to whether it is sustainable, which then end up with me ‘failing’ or leaving a trail of half- finished projects behind me.
All of the above is in sharp contrast to my periods of depression – and I have to say here that there is very little ground for me between being in a state of mania and one of depression.
During my worst episodes of depression I have attempted suicide and in fact last autumn I voluntarily admitted myself to a secure Mental Health Unit when I felt I could no longer keep myself safe.
I feel that the yo-yoing between my mania and depression is way worse than just experiencing unipolar depression as the extremes are so much harder to deal with. I’m on antidepressants (venlafaxine) and a mood stabiliser (lamotrogine) but this doesn’t seem to prevent the symptoms from reappearing?
I am just grateful that further study and research is being done into the differences between unipolar depression, Bi-polar I and Bi-polar II. Perhaps we may eventually find more effective solution to these awful, disabilitating conditions.
I have bipolar 2 so I’m told and find it hard to cope with thoughts of taking my own life on a daily basis
I plan and feel most t of the time everyone would be better if without me .but then I think of my son and how would he cope with me doing that so I don’t
I feel stupid most of the time .I speak with no one at the moment about things
They say we live in a world where we understand mental heath now …I disagree
Kids and young adults who are on medication may be taking medicine for depression, when really, it could be bipolar disorder or another mental health disorder that they were not properly diagnosed with. Kids who are on medicine for one thing, when really it’s something different, will have lots of side effects once they get older. Improperly diagnosing someone, then putting them on medication, can have lifelong risks. Sometimes the best thing you can do is to look at natural ways to healing the body that will not give you the adverse side effects too. There are natural ways to beat depression that don’t require medicine or the whole host of side effects that come along with them. Maybe try walking, swimming, dancing, keeping a journal, or even meditating or talking with friends about why you are sad. There are herbs as well and natural remedies that may help with your mental health and mine too that should be looked into.
When I swim like a week before I get my monthly cycle, I suffer less with my PMDD symptoms. I told the doctor about this, and he became quiet. Meanwhile, he was very quick to put me on a variety of PMDD medications, to which I declined.
I think that this is worth it. If you are suffering from a mental health disorder, it’s good to look at not just the medicine and all of the side effects, but to also look to herbal and more natural remedies as well. These should be considered, along with eating the right foods for your body and mind. May you be blessed with better health and happiness in your life! Much love, From Stephanie