The basics of depression and bipolar disorder


Depression is a mood disorder. It can:

  • cause feelings of extreme sadness and despair
  • interfere with your sleep and appetite
  • lead to overwhelming fatigue
  • make it difficult to fulfill your daily responsibilities

Effective treatments for depression are available.

Bipolar disorder

Sometimes, we feel energetic. At other times, we feel unmotivated and sad. Experiencing a range of emotional highs and lows is normal.

If you have bipolar disorder, these ups and downs can be extreme and not necessarily related to anything going on in your life. They’re severe enough to interfere with daily life and can lead to hospitalization.

Bipolar disorder is sometimes called manic depression. Most people with bipolar disorder can function well if they get treatment.

Types of depression

The following are some types of depression:

  • When depression lasts more than two years, it’s called persistent depressive disorder.
  • Postpartum depression is a form of depression that occurs after giving birth.
  • If you have depression during a specific season of the year and then ends in another season, it’s called “major depressive disorder with seasonal pattern.” This used to be called seasonal affective disorder.

Types of bipolar disorder

If you have bipolar 1 disorder, you’ve had bouts of major depression and at least one manic episode. Bipolar 1 disorder can cause you to alternate between depressive and manic episodes.

If you have bipolar 2 disorder, it means you’ve had at least one bout of major depression and one episode of hypomania, which is a milder form of mania.

Bipolar Disorder 1Bipolar Disorder 2
major bouts of depressionat least one bout of major depression
at least one manic episodeat least one episode of hypomania
can alternate between episodes of depression and mania

Symptoms of depression

A depressive episode involves five or more symptoms. They last most or all of the day for two weeks or more. The symptoms include:

  • sadness, hopelessness, worthlessness, or an empty feeling
  • pessimism
  • guilt
  • a lack of interest in things you used to enjoy
  • insomnia or sleeping too much
  • restlessness or a lack of concentration
  • irritability
  • eating too much or too little
  • headaches, or various other aches and pains
  • thoughts of death or suicide, or suicide attempts

Symptoms of bipolar disorder

If you have bipolar disorder, you may alternate between depression and hypomania or mania. You may also have periods in between when you have no symptoms. It’s also possible to have the symptoms of mania and depression at the same time. This is called a mixed bipolar state.

Some of the symptoms of hypomania and mania are:

  • restlessness, high energy, or increased activity
  • racing thoughts or being easily distracted
  • grandiose ideas or unrealistic beliefs
  • euphoria
  • irritability, aggressiveness, or being quick to anger
  • needing little sleep
  • a high sex drive

Severe mania can cause delusions and hallucinations. Poor judgment during a manic episode can lead to alcohol and drug abuse. You’re not likely to recognize that you have a problem. Mania lasts at least a week and is intense enough to cause major problems. People who have it often need hospitalization.

Hypomania lasts at least four days and is less severe.

Anyone can have depression. You may be at an increased for it if you have another serious illness or if there’s a family history of depression. Environmental and psychological factors may also increase your risk.

The exact cause of bipolar disorder is unknown. However, you’re more likely to have it if someone else in you family does. The symptoms usually become noticeable during adolescence or early adulthood, but it can appear later in life.

If you have bipolar disorder, you’re at increased risk of:

  • substance abuse
  • migraines
  • heart disease
  • other illnesses

People with bipolar disorder may have other conditions as well, such as:

  • post-traumatic stress disorder (PTSD)
  • attention deficit hyperactivity disorder
  • social phobia
  • anxiety disorder

If you have bipolar disorder, getting a diagnosis can be complicated because it’s difficult to recognize hypomania or mania in yourself. If your doctor is unaware you have those symptoms, your illness will appear to be depression, and you won’t get the right treatment.

Accurate analysis of your symptoms is the only way to arrive at the correct diagnosis. Your doctor will need a complete medical history. You should also list all the medications and supplements you take. It’s important to tell your doctor if you’ve had a problem with substance abuse.

No specific diagnostic test is available to help your doctor determine if you have bipolar disorder or depression. But your doctor may want to order tests to rule out other conditions that can mimic depression. These tests might include physical and neurological exams, lab tests, or brain imaging.

Treatment will be more effective if you start early and stick to it.

Treatment for depression

Antidepressants are the main treatment for depression. Going to talk therapy is also a good idea. You can get brain stimulation for severe depression that doesn’t respond to medication and therapy. Electroconvulsive therapy sends electrical impulses to the brain, resulting in seizure activity. It’s a relatively safe procedure, and you can have it during pregnancy. The side effects include confusion and some memory loss.

Both conditions usually require a combination of medications plus some form of psychotherapy. Doctors often recommend cognitive behavioral therapy. In some cases, family therapy may prove helpful. You may also benefit from breathing exercises and other relaxation techniques. It may take awhile to find what works best for you, and you may need to make adjustments periodically.

Some medications can take weeks to work. All medications have the potential for serious side effects. If you’re considering stopping your medication, talk to your doctor first so you can do it safely.

Treatment for bipolar disorder

Doctors use mood stabilizers to treat bipolar disorder. Antidepressants can make mania worse. They aren’t a first-line treatment for bipolar disorder. Your doctor may prescribe them to treat other disorders such as anxiety or PTSD. If you also have anxiety, benzodiazepines may be helpful, but you should use caution if you take them due to their risk for abuse. A variety of new antipsychotic drugs are approved and available for the treatment of bipolar disorder and can be effective. If one of these drugs doesn’t work, another one might.

  • Seek treatment. This is the first step in helping yourself.
  • Learn all you can about bipolar disorder or depression, including the warning signs of depression, hypomania, or mania.
  • Have a plan for what to do if you’re experiencing any of the warning signs.
  • Ask someone else to step in if you’re not able to help yourself.
  • Practice open communication with your treatment team and stick to therapy. Improvement is generally gradual, so it may take a little patience.
  • If you aren’t comfortable with your therapist, ask your family doctor to recommend someone else.
  • Maintain a healthy diet.
  • Get regular exercise.
  • Avoid alcohol.
  • Check with your doctor before taking any new medications.
  • Work on reaching out to others rather than isolating yourself.
  • You may also find it helpful to join a support group for people with bipolar disorder or depression.

While neither condition is curable, getting the right treatment can help you live a full, active life.

Bipolar disorder and depression aren’t preventable. You can learn to recognize early warning signs of an episode. By working with your doctor, you may be able to prevent the episode from getting worse.