The basics of depression and bipolar disorder

Depression

Depression is a mood disorder. It can:

 cause feelings of extreme sadness and despair

 interfere with your sleep and appetite

 lead to overwhelming fatigue

 make it difficult to fulfill your daily responsibilities

Effective treatments for depression are available.

Bipolar disorder

Sometimes, we feel energetic. At other times, we feel unmotivated and sad. Experiencing a range of
emotional highs and lows is normal.

If you have bipolar disorder, these ups and downs can be extreme and not necessarily related to
anything going on in your life. They’re severe enough to interfere with daily life and can lead to
hospitalization.

Bipolar disorder is sometimes called manic depression. Most people with bipolar disorder can function
well if they get treatment.

Types of depression and bipolar disorder

Types of depression

The following are some types of depression:

 When depression lasts more than two years, it’s called persistent depressive disorder.

 Postpartum depression is a form of depression that occurs after giving birth.

 If you have depression during a specific season of the year and then ends in another season, it’s
called “major depressive disorder with seasonal pattern.” This used to be called seasonal
affective disorder.

Types of bipolar disorder

If you have bipolar 1 disorder, you’ve had bouts of major depression and at least one manic episode.
Bipolar 1 disorder can cause you to alternate between depressive and manic episodes.

If you have bipolar 2 disorder, it means you’ve had at least one bout of major depression and one
episode of hypomania, which is a milder form of mania.
Bipolar Disorder 1 Bipolar Disorder 2

major bouts of depression at least one bout of major depression

at least one manic episode at least one episode of hypomania

can alternate between episodes of depression and mania

Symptoms of depression and bipolar disorder

Symptoms of depression

A depressive episode involves five or more symptoms. They last most or all of the day for two weeks or
more. The symptoms include:

 sadness, hopelessness, worthlessness, or an empty feeling

 pessimism

 guilt

 a lack of interest in things you used to enjoy

 insomnia or sleeping too much

 restlessness or a lack of concentration

 irritability

 eating too much or too little

 headaches, or various other aches and pains

 thoughts of death or suicide, or suicide attempts

Symptoms of bipolar disorder

If you have bipolar disorder, you may alternate between depression and hypomania or mania. You may
also have periods in between when you have no symptoms. It’s also possible to have the symptoms of
mania and depression at the same time. This is called a mixed bipolar state.

Some of the symptoms of hypomania and mania are:

 restlessness, high energy, or increased activity

 racing thoughts or being easily distracted

 grandiose ideas or unrealistic beliefs

  euphoria

 irritability, aggressiveness, or being quick to anger

 needing little sleep

 a high sex drive

Severe mania can cause delusions and hallucinations. Poor judgment during a manic episode can lead to
alcohol and drug abuse. You’re not likely to recognize that you have a problem. Mania lasts at least a
week and is intense enough to cause major problems. People who have it often need hospitalization.

Hypomania lasts at least four days and is less severe.

Risk factors for depression and bipolar disorder

Anyone can have depression. You may be at an increased for it if you have another serious illness or if
there’s a family history of depression. Environmental and psychological factors may also increase your
risk.

The exact cause of bipolar disorder is unknown. However, you’re more likely to have it if someone else
in you family does. The symptoms usually become noticeable during adolescence or early adulthood,
but it can appear later in life.

If you have bipolar disorder, you’re at increased risk of:

 substance abuse

 migraines

 heart disease

 other illnesses

People with bipolar disorder may have other conditions as well, such as:

 post-traumatic stress disorder (PTSD)

 attention deficit hyperactivity disorder

 social phobia

 anxiety disorder

A common question asked of clinicians is, “What’s the difference between bipolar disorder (also known
as manic depression) and plain old depression? It’s a simple question to answer, because depression can
either be a stand-alone diagnosis, or a part of another disorder, like bipolar. Therefore a mental health
professional is going to examine whether there are other symptoms present (or have occurred in the
past), to see if the depression is just depression, or whether it’s a part of a larger disorder.

Bipolar Includes Mania & Depression

If bipolar disorder includes a depressed mood, what else does bipolar include? We can find the answer
to this question by looking at the old name for bipolar disorder, manic depression. The old name is
pretty descriptive — bipolar is a combination of mania and depression, alternating in cycles.

What is mania?
 If we examine the symptoms associated with mania, we see that it includes the following:

 Inflated self-esteem or grandiosity

 Decreased need for sleep (e.g., one feels rested after only 3 hours of sleep)

 More talkative than usual or pressure to keep talking

 Flight of ideas or subjective experience that thoughts are racing

 Attention is easily drawn to unimportant or irrelevant items

 Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor

agitation

 Excessive involvement in pleasurable activities that have a high potential for painful
consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish
business investments)

If three or more of these symptoms are present, then a person is considered to have a “manic episode”
(or, if it is of less severity and length, a “hypomanic episode”). A manic episode also needs to have lasted
for at least a week (a hypomanic episode, just four days) in order to be diagnosed. If an individual has
signs that suggest he or she is having or has had a manic or hypomanic episode, in addition to episodes
of severe depression, then typically that individual will quality for a bipolar diagnosis.

Depression Has no Mania

In ordinary depression, which clinicians refer to as “major depression” (sorry, there’s no equivalent
“minor depression”), no manic or hypomanic episode is prevalent and the individual has no record or
indication of having a manic or hypomanic episode in the past. A depressive episode is characterized by
the following symptoms:

 Depressed mood most of the day, nearly every day

 No interest or pleasure in all, or almost all, activities most of the day, nearly every day
  Significant weight loss when not dieting or weight gain, or decrease or increase in appetite
nearly every day.

 Insomnia (inability to sleep) or hypersomnia (sleeping too much) nearly every day

 Psychomotor agitation or retardation nearly every day

 Fatigue or loss of energy nearly every day

 Feelings of worthlessness or excessive or inappropriate guilt nearly every day

 Diminished ability to think or concentrate, or indecisiveness, nearly every day

 Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a
specific plan, or a suicide attempt or a specific plan for committing suicide

Five or more of these symptoms for longer than two weeks are needed in order to qualify for a
depressive diagnosis, with no accompanying manic episode.

On first impression bipolar disorder is easy to understand. It’s a disorder where a person experiences
extreme mood changes, highs and lows, with periods of normality in between.

But, when we look further into the disorder, or we hear people talk about their experiences, it starts to
get a little more complex, and the terms bipolar I and bipolar II emerge.

So, what’s the difference? And how do these symptoms affect people living with the disorder?

Criteria for bipolar

The premise of bipolar disorder is relatively straightforward.

To be diagnosed a person must experience at least one episode of either ‘mania’ or ‘hypomania’.

For most people diagnosed with bipolar disorder depressive symptoms are also present prior to the
emergence of their highs (mania or hypomania). These lows may not always be obvious and the person
may not deem them severe enough to seek help.

It’s important to note that everyone’s experience of bipolar is unique. The length and intensity of moods
vary from person to person, some people experience mainly highs, others experience more lows, while
some ‘rapidly cycle’ between these states. Symptoms may also affect people's insight and understanding
in different ways and at different times.

Symptoms specific to bipolar I

Where bipolar I and II differ is the length and intensity of the high and the presence of major depression.
Bipolar I requires one experience of mania, but does not require an episode of major depression
(however many people do experience symptoms of depression).
The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM)
classifies mania to be a period of abnormality, featuring an elevated, persistent or irritable mood, severe
enough to impair functioning, with three or more symptoms of:

 Inflated self-esteem or grandiosity

 Decreased need for sleep

 More talkative than usual

 Flight of ideas

 Distractibility

 Increased goal-directed activity

 Excessive involvement in activities that have high potential for painful consequences.

For an episode to be defined as manic it must last at least one week. Someone experiencing mania may
not know they are ill or in need of treatment, and occasionally an episode will include an experience of
psychosis or delusional thoughts.

Many people who experience mania describe their actions as euphoric, a feeling of invincibility, where
no idea is too big or too optimistic.

Dov is a SANE Speaker who was diagnosed with bipolar disorder while completing his medical degree.
Dov describes mania as a highly traumatic roller coaster ride.

Symptoms specific to bipolar II

For bipolar II a person must experience at least one of major depressive episode lasting two-weeks, and
one experience of hypomania that lasts at least four days.

Similar to mania, a hypomanic episode features an elevated, persistent or irritable mood, with increased
energy, and three or more symptoms of:

 Inflated self-esteem or grandiosity

 Decreased need for sleep

 More talkative than usual

 Flight of ideas

 Distractibility

 Increased goal-directed activity

  Excessive involvement in activities that have high potential for painful consequences.

Unlike mania, an episode of hypomania is not considered severe enough to impact social functioning or
to require hospitalisation. It does not include psychosis and the impact of an episode is not considered a
‘significant impairment’. In fact, it is possible for people who experience hypomania to continue to
operate within their regular, although modified, routine.

This is not to say bipolar II is a ‘milder’ disorder. The impact and trauma associated with hypomania is
just as real and just as debilitating. The experience of depression and the impulsivity associated with
bipolar II can also contribute to suicide attempts.

Because someone may not consider their highs to be ‘out of the ordinary’, symptoms of hypomania are
not always easy to identify. Therefore, friends and relatives, those who witness someone's symptoms,
offer important information required for diagnosis.

What Makes Bipolar Depression Different from Regular Depression?

Did you notice how many other symptoms I listed that can go along with unipolar or situational
depression such as anxiety and irritation? In bipolar depression, we have another one that complicates
the illness further: mania.

Regular depression, whether it be situational or unipolar, can have irritation and anger, sadness,
weepiness, lack of focus, catatonic and restless days, but it will NEVER have mania or the risk of mania in
the mix.

With bipolar depression, there is alway the risk of our depression already being mixed with
some mania or flipping into mania at any moment. Mania is the biggest difference between unipolar
depression and bipolar depression. We can’t take many of of the mediations used for depression alone
as they cause mania. And, we often have an episode that is actually depression and mania at the same
time called dysphoric or mixed mania. Whew!

Depression and bipolar depression are not the same thing when it comes to symptoms. Bipolar
depression can have different and more complex symptoms than unipolar or situational depression. It
has to be treated differently.

When you explain bipolar disorder, it helps to let your listener know the differences between
depression and bipolar depression. They are NOT the same and the treatments are very different.