Dr. Angela Hanford
You have likely heard the terms “manic depressive” or “manic depression” thrown around, even though the official name of the diagnosis was changed to bipolar disorder in 1980 when the third edition of the Diagnostic and Statistical Manual of Mental Disorders was published. Bipolar depression is a type of depression that occurs in the context of a bipolar disorder.In one study, researchers estimated that every year 2.8% of adults in the United States experience bipolar disorder (Harvard Medical School, 2007). The American Psychological Association (2013) reported that estimates for bipolar I disorder in a given year for people in the United States are 0.6%, with an estimate of 0.8% for bipolar II disorder. With an estimated population in the United States of over 300 million (United States Census Bureau, 2019), that is a lot of people who experience a bipolar disorder!
What is Bipolar Disorder?
There are three main types of bipolar disorders, as specified by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM 5) (APA, 2013), Bipolar I Disorder, Bipolar II Disorder, and Cyclothymic Disorder.
Bipolar I Disorder
Bipolar I Disorder is characterized by an individual having had at least one manic episode in his or her lifetime (APA, 2013). A manic episode occurs when someone experiences a significant increase in energy and an elevated (even euphoric) or irritable mood. The individual experiences this change in mood and behavior for at least one week.
Sometimes people with Bipolar I Disorder will experience frequent shifts in moods, such as going from feeling euphoric to angry to depressed in a short timespan.
Symptoms of mania may include (APA, 2013):
- Increase in self-esteem – this could be anywhere from a significant increase in self-confidence to a delusional-level of a grandiose sense of self.
- Becoming more talkative, speaking more rapidly or loudly – if mood is in the irritable or angry range, this could look like an unusual angry rant or increased hostility in speech.
- Sleeping less and still feeling rested (e.g., 3 hours of sleep or even staying up all night). According to the DSM-5 authors, this deceased need for sleep is a common symptom for a manic episode and can be the initial signs of a manic episode.
- Racing thoughts
- Increased distraction
- Increase in activities (e.g., starts new activities or projects and working on them all night). A surge in sex drive and fantasies is also common.
- Risk-taking activities (e.g., spending sprees, driving recklessly, sexual promiscuity).
To be classified as a manic episode, the changes in mood and behavior must be severe enough to cause impairment (e.g., relationship problems, financial problems, injuring self due to reckless behavior) or require hospitalization. If the mood and behavior changes are solely related to a substance or medical condition then a bipolar disorder would not be diagnosed.
Someone with bipolar I disorder may or may not experience an episode of major depression at some point during his or her lifetime; however, most people who have had a manic episode also experience a major depressive episode (APA, 2013).
Major Depressive EpisodeBipolar depression is when an episode of major depression occurs and the individual has had a manic or hypomanic episode.
A major depressive episode is diagnosed when a cluster of symptoms are present for most days for at least two weeks (APA, 2013).
Common symptoms of depression include (APA, 2013):
- Depressed mood (e.g., sad, empty, hopeless, tearful; irritability in children or teens)
- Loss of interest in activities that one used to enjoy
- Difficulty with concentration or decision making
- Feelings of worthlessness or of significant or inappropriate guilt
- Suicidal thoughts or recurrent thinking about death
- Change in appetite: Either loss of appetite or increased appetite; may include weight loss or weight gain
- Change in sleep: Either sleeping too little (“insomnia”) or too much
- Decreased psychomotor activity or more agitated psychomotor activity
- Decreased energy or fatigue
If an individual who has had a major depressive disorder (MDD) experiences a manic or hypomanic episode, his or her diagnosis is changed to a bipolar disorder. Symptoms of mania or hypomania can still be present with MDD, but full criteria cannot be met for the diagnosis to remain MDD.
Bipolar II Disorder
Bipolar II disorder is diagnosed when an individual has been at least one hypomanic, but never manic, episode and a major depressive episode. A hypomanic episode is similar to a manic episode but only needs to be present for four days in order to be diagnosed. T
he possible symptoms are the same as symptoms of a manic episode, but the symptoms do not cause the same severity of impairment, include psychotic symptoms (i.e., delusions/hallucinations), or result in hospitalization.
Cyclothymic disorder occurs when someone experiences many periods of hypomanic symptoms (but not full hypomanic criteria) and periods of depressive symptoms (but not a full major depressive episode) over at least a two year period.
The time frame is shorted to one year for children and teenagers. Someone with cyclothymic disorder never meets full criteria for major depression, a manic episode, or a hypomanic episode (APA, 2013).
Bipolar Disorders and Suicide
Having a bipolar disorder diagnosis does increase one’s risk of suicide. For example, the risk of suicide in individuals with bipolar disorder has been estimated to be 15 times greater than that of the general population (APA, 2013).Furthermore, about a third of people diagnosed with bipolar II disorder report attempting suicide at some point during their lifetime (APA, 2013).
According to the DSM 5 authors, the greatest risk for suicide appears to be in individuals with a previous suicide attempt and those who have experienced depression within the past year.
Although suicidal thoughts are not aways evident, there are warning signs that may signal the presence of suicidal thinking.
Examples of warning signs include (SAMHSA, 2019; The American Foundation for Suicide Prevention, 2019):
- Talking about wanting to die/kill self
- Stating that there is no reason to live
- Researching ways to commit suicide
- Reporting “feeling trapped” or in “unbearable pain”
- An increase in alcohol or other substance use
- Talk about how he or she is a burden
- Too much or too little sleep
- Agitation/acting as though anxious
- Isolating from others or feeling isolated
- Rage; stating that they want to seek revenge
- Mood swings that are extreme
- Saying goodbye to people
- Giving away possessions
- Losing interesting in things
This list is not exhaustive and other warning signs may be present. The most important thing to remember is to seek immediate professional help whenever suicidal thinking is present. If an individual is actively suicidal, you should immediately call 9-1-1 or go to a local emergency room.
Coping with Bipolar Depression
Strategies that may be helpful for coping with the depression that can be present in bipolar disorders include:
- Understand your diagnosis and learn to recognize triggers. There is a wealth of information available from reputable sources. Your therapist or medical doctor can help point you in the right direction.
- Make a daily schedule with attainable goals. A common symptom of depression is losing interest and motivation. However, not engaging in activities can actually worsen the depression and lead to isolation. If an activity becomes overwhelming break it into smaller pieces that feel more doable.
- Do not isolate, since loneliness increases feelings of depression. We are relational beings and, therefore, find relief in the support of caring friends and family. If you feel lonely, reach out to a loved one. You could also do volunteer work or join a church activity.
- Monitor your thought patterns and check to see if negative thinking is based on depression. You can even put your thoughts on trial in order to see where the evidence lies: emotion or logic.
- Mindfulness can help you to learn to gain control over your thoughts rather than your thoughts controlling you. There are many websites and apps that can help lead you in mindfulness exercises.
- Relaxation techniques, such as paced breathing, progressive muscle relaxation, and guided meditation.
- Exercise: The health benefits of exercise have been well documented. Check with your doctor to see what type of exercise would be best for you.
- Meditate on Scripture:
Fear not, for I am with you; be not dismayed, for I am your God; I will strengthen you, I will help you, I will uphold you with my righteous right hand. – Isaiah 41:10
Come to me, all who labor and are heavy laden, and I will give you rest. – Matthew 11:28
Answer me quickly, O Lord! My spirit fails! Hide not your face from me, lest I be like those who go down to the pit. Let me hear in the morning of your steadfast love, for in you I trust. Make me know the way I should go, for to you I lift up my soul. – Psalm 143:7-8
Treatment for Bipolar DepressionIf you or someone you love displays symptoms of bipolar disorder, it is important to seek an accurate diagnosis and treatment. If bipolar disorder is left untreated, symptoms tend to worsen rather than fully remit (NAMI, 2019).
Diagnosis will likely involve a medical evaluation in order to rule out other causes for symptoms (e.g., medications or a medical condition). Treatment for bipolar disorder may be a combination of medication management and psychotherapy (individual, group, and/or family).
There are several approaches for psychotherapy that may be helpful for treating bipolar disorders. For example, cognitive behavioral therapy (CBT) is a therapy that teaches individuals how to combat negative thinking styles and behaviors. In CBT you will learn strategies to cope with emotions in a healthy manner.
A therapist can help you to explore triggers for episodes (e.g., stress) and then learn ways to manage these triggers. This may include stress management techniques. Family therapy may also be helpful for teaching family members about bipolar disorders and how to help the patient, along with exploring family dynamics that may lead to increased stress.
Bipolar disorders, including bipolar depression, are serious and can have severe negative consequences. However, treatment is possible and necessary. If you suspect bipolar disorder, do not wait…reach out to a caring counselor today! We are here and excited to help you on your path to growth and healing!
- Crisis Clinic of King County: 1-866-427-4747 or 206-461-3222) – 24 hour, confidential, free
- National Suicide Prevention Lifeline – 1-800-273-8255 – 24 hour, confidential, free
- Veterans Crisis Line – 1-800-273-8255 (press 1) – Confidential, for veterans and family members
American Foundation for Suicide Prevention (2019). Risk Factors and Warning Signs. www.afsp.org/about-suicide/risk-factors-and-warning-signs/. Retrieved on 3/29/19.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Harvard Medical School (2007). National comorbidity survey (NSC). https://www.hcp.med.harvard.edu/ncs/index.php. Data Table 2: 12-month prevalence DSM-IV/WMH-CIDI disorders by sex and cohort. Retrieved on 3/29/19.
National Alliance onMental Health (NAMI) (2019). Bipolar disorder. https://www.nami.org/Learn-More/Mental-Health-Conditions/Bipolar-Disorder/Treatment. Retrieved on 3/29/19.
Substance Abuse and Mental health Services Administration (2019). Suicide Prevention.https://www.samhsa.gov/suicide-prevention. Retrieved on 3/29/19.
Untied States Census Bureau (2019). U.S. and world population clock. https://www.census.gov/popclock/. Retrieved on 3/29/19.
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