Bipolar Depression Symptoms, Causes, and Treatment

Bipolar depression is a period of low mood, fatigue, and lack of motivation that someone with bipolar disorder may experience.

Bipolar disorder is a chronic mood disorder that affects close to 3% of people in the United States. This condition can cause people to experience severe fluctuations in mood, energy levels, concentration, thought patterns, and behavior.

People with bipolar disorder have different types of mood episodes, says Aimee Daramus, PsyD, a licensed clinical psychologist and author of “Understanding Bipolar Disorder.” The different types of mood states include:

• Depression: Depressive episodes involve periods of low mood where the person experiences symptoms of depression. This state is referred to as bipolar depression.
• Mania: Manic episodes are characterized by elevated energy and activity, where the person barely sleeps, has racing thoughts, talks very fast, and tries to do several things at once.
• Hypomania: Hypomania is a less severe form of mania.
• Mixed: Mixed episodes involve both depressive and manic symptoms.
• Euthymia: These are periods of normal mood where the person is calm and happy.

Symptoms of Bipolar Depression

According to Dr. Daramus, someone who is experiencing an episode of bipolar depression may have all the symptoms of major depressive disorder (commonly referred to as depression or clinical depression). 

The symptoms of bipolar depression may include:

• Feelings of sadness
• Emotional numbness or emptiness
• Feelings of hopelessness or worthlessness
• Feelings of guilt or shame
• Preoccupation with personal failures or losses
• Worry or anxiety
• Indifference or lack of interest in activities
• Withdrawal and isolation
• Restlessness or a feeling of moving in slow motion
• Difficulty concentrating and making decisions
• A tendency to speak slowly, forget what they were saying, or feeling like there’s nothing to say
• Difficulty going about their day or doing simple things
• Low motivation
• Fatigue and tiredness
• Changes in appetite and weight
• Insomnia or hypersomnia 
• Thoughts of self-harm or suicide

A depressive episode can last for several days or weeks and the person may experience symptoms every day, for most of the day.

Causes of Bipolar Depression

These are some of the factors that can contribute to the risk of developing bipolar disorder:

• Biological factors: People who have bipolar disorder may have differences in the structure and functioning of their brain.
• Genetic factors: Bipolar disorder usually has a strong genetic influence, so someone who has a biological relative with bipolar disorder may be more likely to have it too, says Dr. Daramus. In fact, Dr. Daramus notes that the genetic influence may cross over with certain other disorders such as schizophrenia as well. So, for instance, she says someone may be more likely to develop bipolar disorder if they have a family history of schizophrenia.
• Seasonal factors: Some people may find that their bipolar disorder is seasonal, says Dr. Daramus. According to a 2013 study, depressive episodes are more common in winter; whereas, manic episodes are more common in summer.
• Emotional factors: Having relationship problems or emotional issues can increase the likelihood of experiencing a depressive episode, according to Dr. Daramus.

Diagnosing Bipolar Depression

According to Dr. Daramus, the diagnosis process may involve:

• A detailed family and personal medical history
• A clinical interview
• Observations by your healthcare provider

Bipolar Depression Misdiagnosed as Major Depressive Disorder

While diagnosing bipolar depression, Dr. Daramus says it’s important for mental healthcare providers to check for symptoms of mania or hypomania as well, otherwise bipolar depression can be mistaken for major depressive disorder.

According to Dr. Daramus, bipolar depression is often misdiagnosed as major depressive disorder at first and treated with therapy and antidepressants. However, she explains that antidepressants can cause people with bipolar disorder to experience manic episodes. Healthcare providers realize the patient has bipolar disorder when the patient doesn't respond well to therapy and starts to experience mania.

Unfortunately, that’s how the diagnosis of bipolar disorder is arrived at in many cases, says Dr. Daramus. According to a 2020 study, up to 40% of people with bipolar depression are first diagnosed with major depression.

Treating Bipolar Depression

Bipolar depression can be treated with medication and therapy. 

Medication

These are some of the types of medication that can help treat bipolar depression, according to Dr. Daramus:

• Mood stabilizers, which can help reduce mood swings and prevent depressive and manic episodes.
• Anticonvulsant medications, which help prevent seizures in people who have epilepsy, but may also help stabilize mood in people with bipolar disorder.
• Antidepressants, which can help treat depressive episodes but must be paired with mood stabilizing medications so that they don’t cause mania. 

Therapy

Therapy can help you recognize the first signs of a new depressive episode and put safety plans in place, says Dr. Daramus.

However, Dr. Daramus says it’s important to note that therapy can provide support and teach coping skills, but doesn't usually help as much as it would with non-bipolar depression.

Coping With Bipolar Depression

Dr. Daramus suggests some strategies that can help you cope with bipolar depression:

• Monitor your symptoms: Track your symptoms on a chart. It can help you identify the first signs of a new depressive episode, whether your medication is working, and what coping skills are helping you the most. 
• Create a safety plan: Bipolar depression is dangerous and has to be taken seriously. Rates of suicide and self-harm are very high, so you absolutely do need a plan for what to do if those urges ever happen. Have a safety plan and share it with your therapist, prescriber, and some supportive friends and family members. 
• Stay in touch with your healthcare provider: Make sure you report any symptoms or side effects you’re experiencing to your healthcare provider. Don’t stop taking your medications without discussing it with them first.
• Seek support: During a depressive episode, you may find yourself withdrawing from people and isolating yourself. However, it’s important to surround yourself with loved ones and seek their help when you need it.
• Stay active: Try to stay active and get some exercise every day. Go for a walk, jog, swim, or bike ride, or do any other activity you prefer.