Bipolar depression disrupts and devastates lives, and tends to dominate the course of a person’s illness. Yet, it’s still difficult to diagnose and treat.
Leading Hollywood actress Catherine Zeta-Jones is fighting stigma by being open about receiving treatment for bipolar II, which has a 40:1 ratio of time spent in depression versus mania.
It is the manic phase of bipolar disorder that attracts—no, demands—attention. But those who have the illness, or love someone who does, know it is depression that most disrupts and devastates lives—and dominates the course of the illness.
“Few people understand [that] depression sucks the life out of you,” says C.A., 52, of Oregon. “Desires, self-esteem, motivation, self-worth—any of those qualities that keep you going in life—disappear.” Since her 2002 bipolar diagnosis, she has gone only 18 consecutive months without depression.
Frequency of Mania vs. Depression
When P.S. of Halifax, Nova Scotia, is sad, she sometimes avoids bike riding with her seven-year-old daughter. The guilt she feels at withdrawing from her child only intensifies her depression.
One reason depression is more debilitating than mania is that it lasts longer; another is that it occurs more frequently: According to a 2002 study by Lewis L. Judd and colleagues at the University of California at San Diego published in the Archives of General Psychiatry, people with bipolar I experience depression three times as often as mania. For bipolar II, the ratio of time spent in depression versus mania is a whopping 40:1.
The Difficulties of Bipolar Depression Diagnosis
Bipolar depression is also difficult to diagnose, and therefore to treat. Some studies suggest that as many as 50 percent of those with bipolar disorder are misdiagnosed with unipolar depression, according to Michael E. Thase, MD, professor of psychiatry at the University of Pennsylvania School of Medicine and author of several books on bipolar, depression and related topics.
“Bipolar depression looks very similar to major depression, with no distinct features,” says McIntyre. “That being said, people with bipolar depression more often complain of symptoms that are atypical for unipolar depression, including increased eating, sleeping, and profound reduction in energy. Moreover, people with bipolar depression also frequently complain of seasonal worsening and ‘therapeutic misadventures’ with antidepressants—that is, the depression gets worse with antidepressant therapy.”
Because bipolar and unipolar depression can “look” so similar, psychiatrists must take care to get detailed family histories—and to ask patients if they have ever experienced symptoms of mania or hypomania, says Eric D. Caine, MD, chairman of psychiatry at the University of Rochester Medical Center. Otherwise, “the tendency is to treat it as if it’s unipolar depression, with antidepressants alone, which may serve as rocket fuel for a manic episode,” he adds.
How Does Bipolar Depression Feel?
How does one experience bipolar depression? That depends upon whom you ask. Many people undergo distinct periods of stability, mania, and depression. Yet other individuals can feel both depressed and manic at the same time—simultaneously feeling very sad and energized.
Holly A. Swartz, MD, associate professor of psychiatry at the University of Pittsburgh School of Medicine, says it is relatively rare for people to meet the DSM-IV criteria for a mixed state, which requires a major depressive episode and a manic episode nearly every day for at least one week. “However, individuals meeting diagnostic criteria for either a depressive episode or a manic episode often have a few subsyndromal symptoms of the opposite pole of the disorder that co-occur with their predominant mood episode,” Swartz says. “For example, someone will meet full criteria for a depressive episode but will also have racing thoughts.”
Rapid-cycling—as defined by the DSM-IV diagnostic criteria—is having at least four distinct episodes of major depression, mania or hypomania, or mixed symptoms within a 12-month period. But it is possible to experience more than one rapid-cycling episode a week, or “even within one day,” according to the National Institute of Mental Health.
Rapid Cycling vs. Mood Instability
Just because you are feeling down when you wake up and hypomanic later in the day, however, doesn’t mean you are rapid-cycling, emphasizes Joseph R. Calabrese, MD, director of the Mood Disorders Program at Case Western Reserve University in Cleveland. He says consumers often confuse mood lability [instability] with rapid-cycling. Only about 15 to 20 percent of people with bipolar experience rapid-cycling, he adds.
Jennell A., 53, of The Villages, Florida, says her moods shift quickly—sometimes from one hour to the next.
“Yesterday morning, I woke up at 5:30 a.m. and by 8:00, I knew I was in a hyper-manic cycle,” she says. I was running around nonstop, never stopped talking, and felt like I was running a marathon all day.” But the next morning, Jennell, who awoke early for a golf date, felt like she was “in a fog.” “I knew I could either get up and get going, or spiral into the depressed side of me. I went golfing!”
“After a couple days, he becomes extremely irritable and annoying,” says T.L., who lives in Wayne, New Jersey. “He can’t relax, which is no vacation for either of us! It seems to have to do with breaking out of his work routine and structure. Even on weekends, he tends to be more symptomatic.”
Then there are the stress factors beyond one’s control—such as ill health or the death of a loved one. “The economy has greatly affected our finances and our work situations,” says Therese J. Borchard, a mother of two, popular blogger (Beyond Blue on beliefnet.com), and author of several books, including the memoir, Beyond Blue: Surviving Depression & Anxiety and Making the Most of Bad Genes (Hachette Book Group, 2009). “It has taken about nine months to navigate through that stress, but now that we have found a way to produce enough income, I think I will be less prone to fall into depression.”
Managing Bipolar Depression
The severity of the illness, one’s support system, the luck—or failure—of finding effective medication, a competent doctor, and a supportive partner—all affect how successfullybipolar depression can be stabilized. Muriel H. of Easley, South Carolina, managed to teach for 32 years, in part because of her husband’s steady encouragement, but some days it took all her inner resources to make it through the day.
“Had it not been for my work ethic, I would have been home in bed,” Muriel says. “On many weekends, I would hole up in my apartment, not coming out again until Monday morning.”
Managing Severe Bipolar Depression
Severe bipolar depression not only robs one of the ability to enjoy life, but also may even interfere with basic acts of self-care. C.A. lives directly across the street from a grocery store, but recalls one morning when even that short distance was too far to walk. She showered, applied some makeup, but found she couldn’t leave the house. “I stood at my bedroom window, looking across the way at the store and crying. I felt helpless and stupid.”
T.L. knows her husband’s depressed when he grows quiet, turns from sweet to “snappy,” has trouble sleeping, becomes overly critical, and begins obsessing over trivial things, like irritating TV commercials. As soon as she observes such symptoms, T.L. asks her husband how he’s feeling and whether anything is stressing him out.
“One time, I was on the computer and he came down to the office to say good night. I was in the middle of writing an email. He gave a big sigh, stomped up the stairs, and slammed the bedroom door. I went up and calmly asked what his problem was, and he snapped something about not kissing him goodnight … as if I could read his mind. I quickly realized this was an [irrational] conversation, told him so and to get some sleep, and we could have a rational conversation the next day, which we did.”
What if your manic 80% of the time? Run run run…no time to sleep or eat sometimes. Depression hits but I keep going. My mind doesn’t stop and neither does my body. Medication doesn’t help. I’ve had to try ECT and sometimes that doesn’t work.
The comments make me really nervous to relocate to the US. I have such a brilliant psychiatrist who believes I can come off medication one day. In order to have a family.
I was diagnosed at 17 after a period of insomnia and mania following glandula fever and my parents divorce. I was hospitalised and put on lithium at a very young age.
After a couple of years of different Drs thinking different things, me rebelling and not wanting to listen ( who wants to in their early 20s) I finally got my head down in 2012 went back on lithium. It took me longer than most to graduate from nursing school. My psychiatrist put me through a pilot study of a pschoeducation Bipolar course.
This was the first time I had met other sufferers and motivated to learn how to look after myself.
Fast forward to now I have been in a 8 year relationship. Worked in intensive care for 4 years. This would not have been possible without so much support and learning to ask for help, calling in sick to work opening up to my managers, friends, family.
The stigma is still hard to not get anxious about even here In the UK where mental wellbeing seems to be all anyone wants to talk about after COViD.
I am really worried about the US and what kind of stigma mental health has there? Also how much it will cost?
Any help would be appreciated.
I was diagnosed with Bipolar Disorde, Hypomania and was given mood stailizers that simply didn’t work so I went off all medication and now meditate often throughout the day and avoid spending time with people who are negative.
I recently diagnosed myself with bipolar disorder. I have been in turmoil for 2 years- nothing like I’ve ever experienced. I have been taking SSRIs with no effect. So I did some research and bp fit me. I presented my finding to my therapist who in turn consulted with my doctor. I started a mood stabilizer, stopped antidepressants and my symptoms improved very fast. I am so grateful I figured it out. Life isn’t perfect, exercise and healthy diet helps me a lot with moods, but it’s a lot better. I realize in hindsight the antidepressants were making my symptoms worse. It all fits together.
While bipolar depression can make employment incredibly difficult, some simple tips can help you make it through every work day with success. If video is not showing, click here I’m going to share something personal with you. About a year ago, I got a new job, and I love it! It is everything I have...
If you are struggling with a depressive episode and you feel you should talk to your employer about it, there are a few important things to consider. If video is not showing, click here Hi friends! This is Linea Johnson with bp Magazine’s bphope Vlog, here to talk to you about talking to your employer about...
If the onset of depression always seems to surprise you, here are seven signs that your mood is headed south. #1 Impaired Memory One of the hallmark symptoms of bipolar depression is the presence of cognitive-based symptoms. As such, small impairments in memory—misplacing things, struggling to remember your daily to-do list—may be indicative of a...
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Celiac disease increases likelihood of bipolar disorder February 8, 2021, CLEVELAND, OH—People with celiac disease are at increased risk of developing bipolar disorder, a new study suggests. American researchers looked at health record data from 360 U.S. hospitals to find information on people with celiac disease, a chronic disorder resulting from an immune reaction to...
Thank you all for your courage and honesty. I have a young adult daughter struggling right now. You all give me hope. Thank you again
What if your manic 80% of the time? Run run run…no time to sleep or eat sometimes. Depression hits but I keep going. My mind doesn’t stop and neither does my body. Medication doesn’t help. I’ve had to try ECT and sometimes that doesn’t work.
The comments make me really nervous to relocate to the US. I have such a brilliant psychiatrist who believes I can come off medication one day. In order to have a family.
I was diagnosed at 17 after a period of insomnia and mania following glandula fever and my parents divorce. I was hospitalised and put on lithium at a very young age.
After a couple of years of different Drs thinking different things, me rebelling and not wanting to listen ( who wants to in their early 20s) I finally got my head down in 2012 went back on lithium. It took me longer than most to graduate from nursing school. My psychiatrist put me through a pilot study of a pschoeducation Bipolar course.
This was the first time I had met other sufferers and motivated to learn how to look after myself.
Fast forward to now I have been in a 8 year relationship. Worked in intensive care for 4 years. This would not have been possible without so much support and learning to ask for help, calling in sick to work opening up to my managers, friends, family.
The stigma is still hard to not get anxious about even here In the UK where mental wellbeing seems to be all anyone wants to talk about after COViD.
I am really worried about the US and what kind of stigma mental health has there? Also how much it will cost?
Any help would be appreciated.
I was diagnosed with Bipolar Disorde, Hypomania and was given mood stailizers that simply didn’t work so I went off all medication and now meditate often throughout the day and avoid spending time with people who are negative.
I recently diagnosed myself with bipolar disorder. I have been in turmoil for 2 years- nothing like I’ve ever experienced. I have been taking SSRIs with no effect. So I did some research and bp fit me. I presented my finding to my therapist who in turn consulted with my doctor. I started a mood stabilizer, stopped antidepressants and my symptoms improved very fast. I am so grateful I figured it out. Life isn’t perfect, exercise and healthy diet helps me a lot with moods, but it’s a lot better. I realize in hindsight the antidepressants were making my symptoms worse. It all fits together.