Bipolar Depression

Bipolar Depression, also known as manic depression, is a mood disorder. While it is normal for people to experience periods of elevated mood in response to exciting events and depressed mood in response to sad or painful events, abrupt mood swings and extraordinarily severe symptoms are not normal and may signal bipolar depression. This article gives an overview of bipolar depression.

What Are Depression, Mania, and Hypomania?

Depression is a period of low spirits, characterized by sadness or lack of emotion, accompanied by feelings of worthlessness, insomnia, loss of appetite, and withdrawal from the world. At it’s most severe, a person may be suicidal and experience hallucinations or delusions. For a fuller description of major depression, see the article “Major Depression.” Mania is an emotional state at the other extreme, characterized by elation, energy, euphoria, feelings of invincibility, and sometimes by creativity and reckless and irrational behavior, choices, and spending. Hypomania is a period of increased energy and impulsivity that is not as extreme as mania.

Types of Bipolar Disorder

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) from the American Psychiatric Association (APA) and the International Classification of Diseases (ICD-10) from the World Health Organization (WHO) each provide a classification of the subtypes of bipolar disorder.

The DSM-IV first categorizes bipolar disorder as being of type one, type two, not otherwise specified, or cyclothymic.

  • Bipolar I Disorder has mood changes that range from depression to full mania.
  • Bipolar II disorder ranges from depression to hypomania.
  • Cyclothymic disorder is a less severe, but chronic, form of bipolar disorder, with mood swings from hypomania to mild depression (it is, in some ways, comparable to dysthymia).

It further specifies whether the disorder is active or in remission, whether it is mild, moderate or severe, and whether or not it is accompanied by psychotic features (hallucinations or delusions). It is also possible to have depressive and manic states occur either in close succession or simultaneously in what is known as a mixed state, and this is also included as a subcategory. Bipolar disorder is further categorized by the most recent episode that has occurred.

Symptoms of Bipolar Disorder

The symptoms of bipolar disorder include both the symptoms of depression on the one hand and the contrasting symptoms of mania or hypomania on the other hand.

            Depression Symptoms

  • Sadness and depressed mood
  • Pessimism and hopelessness
  • loss of appetite and insomnia
  • withdrawal from normal activities
  • feelings of guilt, worthlessness, helplessness, or self-hatred
  • feelings of fatigue or lack of energy
  • irritability, agitation, or restlessness
  • confusion, indecisiveness, mental sluggishness
  • suicidal thoughts or actions

            Manic or Hypomanic Symptoms

  • elevated mood
  • increased self-esteem; delusions of grandeur
  • binge eating and drinking or drug use; little need for sleep
  • indulgence in activities; overspending; sexual promiscuity
  • increased energy; hyperactivity
  • irritability, agitation, distractability
  • impaired judgment, racing thoughts, lack of self control

In between these mood swings, the person with bipolar disorder may have periods during which he or she functions normally.

Causes and Risk Factors

There is a familial risk for bipolar disorder. A child whose parent of sibling has the disorder has a 4 to 6 times greater chance of having bipolar disorder than a child with no history of the disorder in the family. However, identical twins do not always both have the disorder if one does, which points to other factors besides genetics being involved. Research has pointed to some brain development issues that may also contribute.


Bipolar disorder is treated with psychotherapy - which may be cognitive behavioral therapy, interpersonal therapy, social rhythm therapy, or other types of  “talk” therapy that help the person with bipolar disorder understand their situation and learn how they can best function. Medications are usually used as well. The types of medication most often used are mood stabilizers, atypical antipsychotics, and antidepressants.


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