Depressive episodes are often part of the mood cycling in bipolar disorder.
Bipolar disorder is a mental disorder characterized by significant shifts in mood, energy, and behavior. These mood shifts are often severe and debilitating and can make daily functioning very difficult.
While mania is the primary feature of bipolar disorder, depression can also be a major aspect of the condition.
But does everyone with bipolar disorder experience depression? Are depressive episodes in bipolar similar to other types of depression?
Bipolar depression refers to the depressive episodes that are part of the mood cycling in bipolar disorder.
Evidence shows that bipolar depressive episodes tend to last longer than periods of mania or hypomania. Depressive episodes can last anywhere from 2 weeks to several months.
During a bipolar depressive episode, you may experience the following symptoms:
- persistent feelings of sadness, worthlessness, or hopelessness
- sleeping too little or too much
- loss of interest or pleasure in activities that you once enjoyed
- changes in appetite or weight
- mental or physical fatigue or sluggishness
- poor concentration or decisiveness
- suicidal thoughts
Depressive symptoms in both bipolar disorder and major depressive disorder (MDD) are the same.
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), you must experience five or more of the following symptoms for at least 2 weeks to be diagnosed with a major depressive episode:
- depressed mood (sad, hopeless, empty) most of the day, nearly every day — in kids or teens, this can look like irritability
- loss of interest or pleasure in most activities
- significant changes (more than 5% in a month) in appetite or weight
- psychomotor changes such as restlessness or agitation (severe enough to be noticed by others)
- feeling tired or fatigued or having low energy to complete tasks
- sleep disturbances, such as insomnia or sleeping too much
- a sense of worthlessness or delusional guilt
- poor ability to think or concentrate, indecisiveness
- recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt
While depressive episodes are very common in bipolar I, they’re not actually required for a diagnosis. A depressive episode is, however, required, for a diagnosis of bipolar II.
In bipolar disorder, manic and depressive symptoms can also occur at the same time. This is known as “mixed features.” A mixed episode tends to feel like a low mood aggravated by lots of energy.
Mixed features might look like the following:
- irritability or agitation
- unprovoked rage
- weeping spells
- racing thoughts
Can you have bipolar and be mostly depressed?
It’s possible for most of your mood episodes in bipolar disorder to be depressive. However, this is more common in bipolar II disorder.
While a depressive episode isn’t required for a bipolar I diagnosis (only mania), at least one depressive episode is required for a diagnosis of bipolar II (plus hypomania).
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), a diagnosis of bipolar I or II requires three (or more) of the following symptoms to be present (four if the mood is only irritable):
- inflated self-esteem or feelings of grandiosity
- decreased need for sleep (may feel rested after only a few hours of sleep)
- excessive talking or pressure to continue talking
- racing thoughts or wild ideas
- engages in activities that have a high risk for painful consequences (uncontrolled buying sprees, imprudent business investments, or sexual carelessness)
- easily distracted
- excessive focus on goal-oriented activities (either socially, at school/work, or sexually) or psychomotor agitation
In bipolar I, the manic episode must last at least 1 week and be present most of the day, nearly every day (or less if hospitalization is necessary).
In bipolar II, hypomania (a less severe form of mania) must last at least 4 consecutive days and be present most of the day, nearly every day. Hypomania may feel like a great mood rather than a debilitating disorder. Bipolar II also requires at least one depressive episode.
Bipolar disorder is a chronic disorder, and so it requires a long-term treatment plan, even when you aren’t having noticeable symptoms.
Medications for bipolar disorder can help stabilize your moods so that you can carry out your daily tasks with as few interruptions as possible.
Cognitive behavioral therapy (CBT), a type of psychotherapy, is also effective for people with bipolar disorder. CBT is a goal-oriented therapy that helps you identify and change false or harmful thinking patterns.
- decrease mania severity
- improve depressive symptoms
- decrease relapse rate
- improve psychosocial functioning
Bipolar depression is a depressive episode that occurs as part of the mood cycling in bipolar disorder. Though very common, a depressive episode is not required for a bipolar I diagnosis. It is, however, part of the criteria for bipolar II.
If you think you’re experiencing bipolar depression, you’re not alone. Consider reaching out to a mental health professional to get started on a treatment regimen.