There are many types of depression. One type is a phase of bipolar disorder (BPD). BPD is a common mental health condition that results in extreme mood changes between highs (mania or hypomania) and lows (depression). Depression in BPD can be so serious that a person may need to be hospitalized to make sure they are safe.1
It can take years to be correctly diagnosed with BPD. This is partly because the disease is often mistaken for major depressive disorder (MDD). The difference between bipolar disorder and MDD is that MDD does not include alternating periods of mania or hypomania. Mania is the extreme "up" mood in BPD, and hypomania is a less extreme version of it.1
What depression looks like
Depression in bipolar is much more extreme than having a down day. It is a serious mood disorder that affects a person’s ability to work, go to school, perform daily activities, or socialize. A person with depression may:1-3
- Feel so tired they do not get out of bed or bathe for days
- Have trouble concentrating or making decisions
- Cry uncontrollably or be overwhelmingly sad
- Feel worthless or hopeless
- Actively plan to kill themselves or wish they were dead
- Gain or lose weight because they are eating too little or too much
- Drop out of school or quit work because they feel unable to cope
- Drink too much or take drugs to feel better
For people with bipolar 1 disorder, these periods of depression may swing to mania or hypomania. If the person moves between depression and mania 4 or more times a year, it is called rapid cycling.1
People with bipolar 2 disorder have major depression and experience only hypomania. If someone exhibits signs of both depression and mania or hypomania at the same time, it is called having mixed features.1
Symptoms of depression
The book that doctors use to diagnose mental health conditions is known as the DSM-5. According to the DSM, to be diagnosed with the depression of bipolar requires that symptoms last every day or nearly every day for at least 2 weeks. They also must include at least 5 of the following symptoms:3
- Noticeably low mood and loss of interest or pleasure in once enjoyable activities
- Feeling sad, hopeless, empty, or tearful most of the day, nearly every day
- Significant weight loss or weight gain, or loss or increase in appetite
- Problems sleeping, either too much (hypersomnia) or not enough (insomnia)
- Other people noticing that you seem restless or “slowed down”
- Extreme tiredness (fatigue)
- Feelings of worthlessness or inappropriate guilt
- Problems concentrating or making decisions
- Lack of response to the environment (catatonia)
- Recurring thoughts of death and dying
What triggers depression in bipolar?
While everyone with BPD has a different combination of symptoms, many people can learn to predict when depression or mania will kick in. Depression in bipolar can be triggered by the same things that trigger mania. They may include:1,4
- Death of a parent, child, or pet
- Job loss
- Stress or lack of sleep
- Divorce or other relationship breakups
- Serious illness
Tracking your moods and habits in a mood diary over time can help you learn what triggers your depression or mania. For example, you may discover that exercise improves your moods and helps you sleep better at night. Or keeping a consistent schedule for eating and sleeping may help keep your moods more even.4
It is vital for people with BPD to be diagnosed accurately. This is because they need to be treated differently from those with major depressive disorder (MDD). Treating bipolar disorder with only an antidepressant and no mood stabilizer is known to trigger mania or hypomania. It also can make mood swings worse. A mood stabilizer is the treatment of choice for people with bipolar episodes, including depression.1