What Is Bipolar Depression?

Most people find ways to balance the highs and lows of life. With bipolar depression—technically, bipolar disorder—the task isn’t so simple.


People with bipolar disorder experience rollercoaster-type mood shifts.

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What is bipolar depression? It’s a phrase used typically to describe bipolar disorder, but in reality, bipolar disorder isn’t actually a type of depression. It’s often included in discussions of depression, however, because a person with bipolar disorder has extreme mood shifts. Those moods are very low or very high, referred to as manic. Bipolar disorder was previously known as manic depression.

Most people experience sadness and happiness in response to life’s surprises, but all in all, their temperament remains steady. Not so for people with bipolar disorder. Bipolar depression symptoms are characterized by radical mood shifts. Life is more like a dramatic rollercoaster than a sailboat on an even keel. Understandably, swinging between extremes in mood and behavior can severely disrupt a person’s life, work, and relationships.

It’s important to correctly distinguish unipolar (one sided) major depressive disorder and bipolar disorder because proper treatment depends upon the right diagnosis.

Manic Extremes

People with bipolar disorder in the manic state tend to be euphorically happy, full of energy and activity, sleep little or not at all for days on end, and engage in reckless behavior They also may have racing, disorganized thoughts and speak almost too quickly to be understood.

As with severe depression, sometimes people in a manic stage of bipolar disorder hallucinate or have delusions. A person who is manic may, for instance, abandon her family because she believes she must immediately contact the government, as it is her job to save the world.

A somewhat less intense form of mania is known as hypomania. Someone in a hypomanic state may feel great but probably lacks common sense. She might, for instance, stay up half the night cleaning the house because she feels full of energy and purpose and then spend the day shopping for shoes she can’t really afford.

Manic and hypomanic episodes typically last from four or five days to a few weeks. Unfortunately, when mania and hypomania subside, the person often plunges into the deepest depths of a depressive episode.

Depressive Extremes

During the depressive state, the symptoms of bipolar disorder are hard to distinguish from the symptoms of major depression. The person will often feel sad, tired, withdrawn, and will have trouble concentrating, sleeping, and eating. He or she may experience thoughts of worthlessness, guilt, death, or suicide.

Although mania is a defining feature of bipolar disorder, most individuals with bipolar disorder experience depression far more frequently and for much longer periods of time than they experience mania. For that reason, people with bipolar disorder are often initially misdiagnosed as having depression. In fact, research is finding that some people with major depression may actually have a “hidden” form of bipolar disorder.

In a 2010 study that involved more than 9,200 people, nearly 40 percent of the people who had a history of major depressive disorder described periods of hypomania that fall just under the radar for an official diagnosis of bipolar disorder, a condition called sub-threshold hypomania. The study’s authors say the criteria for bipolar disorder should be broadened, because some patients with sub-threshold hypomania might benefit more from treatments for bipolar disorder than for depression.

Mixed Extremes

Although manic and depressive episodes usually alternate with each other, doctors now recognize that in some people, bipolar disorder appears as a mixture of the two states: mania and depression. During these mixed episodes, a person can experience the elements of mania (such as high energy, physical restlessness, and impulsivity) at the same time as the symptoms of depression (such as intense sadness, guilt, or suicidal urges).

Not only are mixed states more common than was once thought, they may be particularly dangerous because the person’s energy level is high enough for them to act on their negative thoughts, such as thoughts of self-harm.

Bipolar disorder often develops in a person’s late teens or early adult years and will persist throughout their lives. It can be treated but not cured.

Bipolar disorder does run in families but a family predisposition for it does not mean all children will inherit it. According to the National Institutes of Mental Health, most children with a family history of bipolar disorder will not develop the illness.

Bipolar disorder can worsen if left undiagnosed and untreated. Episodes may become more frequent or more severe over time. Proper diagnosis and treatment help people with bipolar disorder lead healthy and productive lives. In most cases, treatment can help reduce the frequency and severity of episodes.

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JoAnn Milivojevic

JoAnn Milivojevic became the executive editor of UCLA Health’s Healthy Years in 2015 and has written numerous articles featuring some of the most preeminent and passionate scientists, researchers, physicians, and … Read More

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