- Major Depressive Episodes: Major depressive episodes are one symptom of Bipolar disorder. In Bipolar disorder, these episodes are usually severe and last a long time. Similar to what is called unipolar major depression (depression in a person who has not experienced mania or hypomania), patients with bipolar depression typically experience a depressed mood, slow speech and less speech in general, decreased interest in previously enjoyable activities, low energy, poor concentration and focus, decreased appetite or weight gain, generally slowing down of body movements or feelings that one can’t sit still, sleep issues, feelings of excessive guilt and suicidal thoughts. Other features that may be present include avoidant eye contact, social isolation, lack of self-care such as showering and cooking, feelings of hopelessness, body pain and difficulty taking care of family duties or work. Many individuals with bipolar depression have difficulty getting up to go to work or are arriving late. People with bipolar disorder spend the majority of their time in a depressed phase as opposed to the manic or hypomanic phase. Depressive episodes may develop slowly or quickly. The depressive episodes typically last many months. People with bipolar may experience symptoms of “mixed features” which mean that a person may have symptoms of depression and mania at the same time.
- Manic or Hypomanic episodes: These are the episodes where the person may have inflated self-esteem, lots of energy, lots of goal-directed activity (working on projects or new goals), not sleeping enough, and may pursue activities in excess like shopping or gambling etc.
Bipolar depression is very difficult to diagnose and may take years before it is treated correctly. Besides having an episode of mania or hypomania, other features that make a later diagnosis of bipolar depression more likely include : early and severe depression as a youth, a family history of bipolar disorder, hypomania or mania after taking a serotonin reuptake inhibitor (SSRI) and symptoms such as hallucinations or paranoia.
A clinical interview with the patient and family members as well as rating scales will assist a physician in making an accurate diagnosis. The treatment of bipolar depression is very distinct from unipolar depression.