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Are you familiar with the terms “manic depressive” and “manic depression”? Up until 1980, when the third edition of the Diagnostic and Statistical Manual of Mental Disorders was published, bipolar disorder was known as manic depression. There are different types of bipolar disorder, and one of the aspects of bipolar disorder is known as bipolar depression.Researchers from Harvard Medical School (2007) have estimated that 2.8% of adults in the United States experience the symptoms of bipolar disorder. The American Psychological Association (2013) gives more conservative estimates: for Bipolar I Disorder, 0.6%, and for Bipolar II, 0.8%.
According to the United States Census Bureau (2019), the population of the United States is over 300 million which means there are an awful lot of people experiencing bipolar disorder every year.
Defining Bipolar Disorder
Bipolar disorder is split into three different types. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM 5) (APA 2013) specifies these as Bipolar I disorder, Bipolar II Disorder and Cyclothymic Disorder.
Bipolar I Disorder
With Bipolar I Disorder, a person is diagnosed when they have experienced at least one manic episode at some point in the course of their illness (APA 2013). Manic episodes are characterized by an extremely elevated, euphoric or irritable mood and a dramatic increase in energy. These symptoms need to persist for a minimum of one week.
With Bipolar I Disorder, it is quite common for people to experience rapid and frequent mood changes. This may include swinging from feeling absolutely euphoric to being angry and then depressed all within a short period of time.
Common Symptoms of Mania
- Increased self-esteem. This can range from a considerably greater level of self-confidence to delusions of grandeur.
- Being more talkative, loud or speaking rapidly. This occurs with euphoric and irritable mania – but with irritable mania, this tends to present as angry rants or hostility.
- Decreased need for sleep. When someone is manic, they may feel like they don’t need to sleep at all (and stay up all night) or they may feel that they only need a little sleep without feeling tired. This is one of the most common early warning signs of a manic episode.
- Rapid thoughts
- Being very distractible
- Feeling restless
- Starting lots of new activities and projects and working at them excessively.
- Increase in sex drive and sexual fantasies
- Taking more risks – such as driving in a reckless manner, being sexually promiscuous or spending excessively.
To meet the criteria of a manic episode, symptoms have to be severe and have a significant impact or impairment. Impairment can include financial difficulties as a result of reckless spending, relationship difficulties, and suffering harm due to reckless behavior. Mania can also require hospitalization. It’s also necessary to rule out substance abuse or medical causes for the symptoms.
People with Bipolar I Disorder do not have to experience major depression in addition to mania to be diagnosed, but a majority of people who experience mania will go on to experience bipolar depression at some point (APA 2013).
Major Depressive EpisodeIf someone has previously experienced a manic or hypomanic episode and then experiences an episode of major depression, this is known as bipolar depression. A diagnosis of a major depressive episode is made when a number of symptoms occur most days for at least a two-week period (APA 2013).
Symptoms of Depression
- Experiencing a depressed mood, including feelings of sadness, hopelessness, and tearfulness
- Losing interest in the things you used to enjoy
- Struggling to concentrate or make decisions
- Feeling that you’re worthless
- Feeling guilty without good reason
- Experiencing suicidal thinking
- Changes in appetite – either an increased appetite or a loss of appetite. Weight loss or gain may occur
- Changes in your sleep pattern, for example, sleeping excessively or experiencing insomnia
- Fatigue and exhaustion
- Changes in psychomotor activity – this can be decreased or agitated
It is quite common for people who have been diagnosed with major depressive disorder (MDD) to go on to experience a manic or hypomanic episode that results in a change of their diagnosis to that of bipolar disorder.
Bipolar II Disorder
While bipolar I disorder requires a manic episode for diagnosis, bipolar II disorder is diagnosed when someone has experienced hypomanic episodes but not fully manic episodes, in addition to major depressive episodes.
Similar to mania but not as extreme, hypomania can be diagnosed after a period of four days. The level of impairment is less with hypomania, and there are no psychotic symptoms such as hallucinations and delusions. Hypomania does not usually require hospitalization.
Often regarded as less severe than either Bipolar I or Bipolar II disorders, cyclothymic disorder is diagnosed in people who experience multiple periods of hypomanic-like symptoms (which don’t meet the full criteria for hypomania) and depressive symptoms that are not severe enough to be classified as a major depressive episode.
In adults, these symptoms must occur for a minimum of two years. Children and teenagers only need to experience the symptoms of cyclothymia for a year in order to be diagnosed.
People with cyclothymic disorder will never fully meet the criteria for manic episode, hypomanic episode or major depression (AP, 2013).
The Connection Between Bipolar Disorders and SuicidePeople with a diagnosis of bipolar disorder are more likely to experience suicidal thinking and ideation. In fact, the American Psychological Association (2013) claim that those with bipolar disorder are 15 times more likely to attempt suicide.
More than 30% of people with bipolar II disorder have admitted to attempting suicide one or more times during the course of their illness (APA 2013). If someone has previously made an attempt to end their life, they are at a much greater risk of further attempts on their life. Those who experience prolonged periods of depression are also at greater risk.
Suicidal thoughts are not the only warning signs to be aware of. In fact, suicidal people may try to hide their suicidal thinking, so looking out for less obvious signs of suicidal thinking is important.
Examples of warning signs
(SAMHSA, 2019; The American Foundation for Suicide Prevention, 2019)
- Expressing a desire to die
- Claiming that they have no reason to live
- Looking up potential suicide methods
- Claiming to feel trapped
- Claiming to be in unbearable (emotional) pain
- Increased substance abuse
- Describing themselves as being a burden
- Sleeping too much or too little
- Expressing agitation and anxiety
- Reckless behavior
- Withdrawing or isolating themselves
- Expressing rage
- Extreme mood swings
- Making an effort to “say goodbye” to people
- Giving away their possessions
This list is only an example, and there may be a variety of other warning signs particular to different individuals. It is vital that the appropriate professional help is sought if someone that you care about is experiencing suicidal thinking. In cases of a person being actively suicidal, you need to dial 9-1-1 immediately or take the person to the nearest emergency room.
How to Cope with Bipolar Depression
There are a variety of different strategies that you can use to cope with bipolar depression. These include:
- Developing an understanding of your illness and recognizing things that can trigger your symptoms. Your doctor or counselor will be able to help you find the information that you need.
- Ensuring that you have a daily routine or schedule. You’ll need to set yourself goals that you can easily attain. Depression causes you to lose interest in things, but without any structure your day your symptoms are likely to worsen. Breaking tasks into smaller chunks can help make them seem more achievable.
- Ensuring that you don’t isolate yourself, no matter how tempting that seems. When you are isolated, your symptoms will worsen because humans are created to be in relationship with one another. Reaching out to supportive friends and family can help you to cope with the overwhelming feelings of depression.
- Making an effort to track your thought patterns. Depression affects the way that we think and this, in turn, can worsen symptoms. Interrogate your thoughts to see whether they are based on truth or on feelings.
- Learning to practice mindfulness is a useful means of regaining control over negative thinking. It can be helpful to download an app that guides you through the steps of practicing mindfulness.
- Using relaxation techniques to control your breathing and relax tensed muscles. Guided meditation is another option.
- Trying to get more exercise. Getting out in the fresh air can help to break cycles of behavior that worsen depression. Exercise also releases endorphins which can help alleviate depressive symptoms. However, you should ask your doctor for advice about the best type of exercise for you.
- Spending time journaling and meditating 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
How Bipolar Depression is TreatedGetting the right diagnosis and treatment for bipolar disorder is really important. If you or a loved one are experiencing the symptoms of bipolar disorder but haven’t been diagnosed, you should seek professional advice. When bipolar disorder goes untreated, it has been shown to progressively get worse (NAMI, 2019).
To get a diagnosis of bipolar disorder, you’ll need a medical evaluation to rule out any possible physical causes of the symptoms you’re experiencing. Some medical conditions and medicines can cause symptoms that can be mistaken for bipolar disorder.
Following a psychiatric assessment and diagnosis, a treatment plan that includes both medication and therapy is usually recommended. Psychotherapy such as individual, group and family therapy are helpful.
One of the most common psychotherapy approaches to the treatment of bipolar disorder is cognitive behavioral therapy (CBT). This therapy teaches methods for combatting patterns of negative thinking and the behaviors that result from negative thinking. CBT promotes healthy coping strategies for handling emotions.
With a therapist, you can explore the things that may trigger your symptoms. For example, stress is one of the most common triggers, and a counselor can help you to learn ways of handling the stress trigger. It can also be helpful to include your family in therapy so that your loved ones can learn more about how they can help support you with your bipolar symptoms. Family therapy may reveal additional triggers that lie in the family dynamics, too.
Bipolar depression and other types of bipolar symptoms can have a severe and negative impact on many areas of life. Not only is treatment readily available, but it is also necessary. It can be daunting to consider the possibility that you may have bipolar disorder, but help is available, and a caring counselor can help you to reduce the impact that symptoms have on your life.
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 on Mental 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.
United States Census Bureau (2019). U.S. and world population clock. https://www.census.gov/popclock/. Retrieved on 3/29/19.
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