What is Bipolar Depression? Causes, Symptoms, and Treatment

What is bipolar depression or bipolar disorder? It is a mood disorder characterized by episodic symptoms of depression (low mood) and mania (high mood).

In both cases, these episodes are debilitating, with symptoms ranging from lack of joy and loss of motivation to illusions of grandeur, restlessness, and extreme irritability. Bipolar disorder affects roughly 2.2 million Americans and usually begins during adolescence.

Seeing a loved one live through a bipolar disorder can be frightening and experiencing the symptoms of one is even more frightening.

Yet treatments for bipolar disorder are becoming increasingly available over time, ranging from distinct talk therapy methods to different types of mood stabilizing medication. We have come a long way in understanding this condition and what it looks like, and the ways in which it can present itself.

What is Bipolar Depression?

Bipolar disorder is a mood disorder that exists on a spectrum. There are two distinct types of symptoms in a bipolar disorder, and four different types of bipolar episodes. The main characteristic of a bipolar disorder is that a person will usually experience at least two of these four types of episodes, which exist along a spectrum of depressive and manic thoughts and behaviors.

Bipolar episodes can last weeks and even months. They grow and wane in severity, and there are also periods of a stable or neutral mood between them. These episodes do not occur very frequently, unless a patient is experiencing rapid-cycling bipolar disorder. In most cases, a person experiences about three or four episodes or cycles per year. In rare cases (roughly one in ten), a person’s symptoms can switch rapidly, even to the point of daily changes.

Changes and onset of episodes can coincide with certain factors, including a change in season, lack of sleep, hormonal conditions, relationship or work-related stress, and switching medication.

The key to understanding the difference between a bipolar disorder and other mood disorders is the spectrum between depression and mania.

Depression and Mania

Bipolar disorder has symptoms of major depression, mania, hypomania, and mixed symptoms. These four distinct types of episodes are more than simple mood swings. Recognizing and diagnosing bipolar disorder usually means cataloging and characterizing a patient’s symptoms along the lines of these four episodes, and determining whether their symptoms indicate a bipolar disorder diagnosis.

Each type of episode represents a set of debilitating symptoms characterized by overwhelming changes in one’s thoughts and behavior.

Major depressive symptoms in a person with bipolar disorder are like the symptoms experienced by someone diagnosed with major depressive disorder, or other depressive disorders. They include:

• A depressed mood lasting most of the day.
• Loss of interest in hobbies and activities.
• Sudden weight loss or gain.
• Lack of sleep or constant oversleeping.
• Lack of energy, high fatigue levels without physical cause.
• Feeling worthless, excessive self-guilt, constant self-loathing.
• Frequent inability to focus or concentrate.
• Suicidal ideation and thoughts of death or departing from the world.

Manic symptoms, on the other hand, represent the negative effects of excessive energy. A manic episode can look like inspired or energetic behavior on the surface, but it is much more dangerous than first impressions imply. Signs of a manic episode include:

• Extremely inflated self-esteem.
• Easily distracted, constantly drawn to other things.
• Becoming very talkative, more so than usual.
• Lack of sleep, but still feeling rested.
• Lowered inhibition, much higher risk-seeking behavior.
• Volatile and irritable behavior.
• Changes in personality that negatively affect one’s work, family, and interpersonal relationships.

Not all manic symptoms push a person’s behavior to the extreme. Many people also experience hypomania. Hypomania shares many symptoms with regular mania. The main difference is that these episodes do not impair a person’s ability to function. Instead, they are a marked change in behavior and thought, but without being overwhelmingly negative. This reduced form of mania is characterized by symptoms such as:

• Racing thoughts.
• Engaging in high-risk behavior.
• Feelings of grandiosity.
• Restlessness.
• Other manic symptoms.
• Patients can also experience mixed episodes where symptoms range from depressed to manic. Mixed episodes can include daily mood swings, where a person switches from feeling low one day, to feeling manic the next.

The Risk Factors and Causes of Bipolar Disorder

The primary risk factor for bipolar disorder is genetics. Up to 60-80 percent of patients in twin studies who had bipolar disorder shared it with their twin, with the rates being a little lower for other relatives.

However, genetics don’t explain everything. There are many cases of isolated bipolar disorder, wherein no one else in the immediate family shared the condition. This points to other risk factors also playing a role, ranging from recurrent childhood stress to early exposure to drug use. Childhood trauma plays a particularly strong role in the development of early bipolar symptoms.

Recognizing Bipolar Disorder

It can be difficult to recognize bipolar disorder because it can be masked by co-occurring conditions and the age of onset. Co-occurring anxiety and substance abuse and depression and substance abuse can mask symptoms of bipolar disorder by presenting a compounding set of symptoms, while masking certain symptoms under the effects of drug use.

Alcohol use, for example, can lower inhibition and reduce anxious thoughts. It can also explain erratic behavior, as well as the physical symptoms of depressive or manic episodes, such as rapid weight gain, restlessness, or inflated self-esteem.

A professional’s diagnosis relies on multiple interviews and tests conducted over several weeks. While bipolar disorder is a commonly known condition, it is not commonly known that it exists as a spectrum, and that there are many types of bipolar diagnoses.

Types of Bipolar Disorder

In addition to differentiating between rapid-cycling and non-rapid bipolar disorder, a diagnosis of bipolar disorder falls under either Bipolar I, Bipolar II, or Cyclothymia.

Bipolar I is diagnosed in patients with at least one manic episode. This means an episode wherein a patient’s mania has significantly impaired their day-to-day life.

Bipolar II is diagnosed in patients with at least one major depressive episode and one episode of hypomania. This means the patient has cycled between depression and mania, but with less severe manic symptoms.

Cyclothymia is a form of bipolar disorder wherein both depressive and manic symptoms are noticeable but mild. These emotional ups and downs may occur without reason or trigger but are not severe enough to consistently impair a person’s life.

Treating Bipolar Disorder

Treatment for bipolar disorder, regardless of type, will mostly involve talk therapy and medication. But the approach used by a therapist and the type of medication involved may differ from case to case. Treatment will also depend on whether there are any co-occurring conditions, and what these might be. Treatment methods for bipolar disorder include:

• Medication – Medication for bipolar disorder usually involves atypical antipsychotics, antidepressants, or mood stabilizers. 
• Talk therapy – Talk therapy or psychotherapy for bipolar disorder may involve cognitive behavioral therapy techniques, and dialectical behavior therapy. 
• Residential treatment – In some cases of extreme mania or depression, a residential setting can help patients adjust to their medication without risking their lives. This may be an option after hospitalization due to bipolar symptoms. 
• Substance abuse treatment – Substance use disorder or addiction is a common co-occurring disorder in patients. 
• Other treatment options – There are other types of treatment for bipolar disorder, especially in medication-resistant patients. These include treatments such as transcranial magnetic stimulation. 

In Summary

Bipolar disorder can be a lifelong condition, but with a proper treatment plan, a support system, and medication, it can be managed and overcome in the long term. If you or someone you love is struggling with symptoms of bipolar disorder, do not hesitate to seek help. The sooner it is treated, the sooner you can continue living a fulfilling life.