What is Bipolar Depression?

Bipolar disorder can be a life-long mental health problem that predominantly affects mood. Bipolar disorder used to be called manic depression, and symptoms can be quite severe, impacting important areas of your life, such as work, school, and relationships. If you are concerned about your mental health, we recommend getting in touch with a therapy matching service, like Advekit, today. 

What is bipolar depression like? People who have bipolar disorder can have periods in which they feel overly happy and energized and other periods of feeling very sad, hopeless, and sluggish. In between those periods, they usually feel relatively normal. You can think of the highs and the lows as two "poles" of mood, which is why it's called "bipolar" disorder.

The word "manic" describes the times when someone with bipolar disorder feels overly excited and confident. These feelings can also involve irritability and impulsive or reckless decision-making. About half of people during mania can also have delusions (believing things that aren't true and that they can't be talked out of) or hallucinations (seeing or hearing things that aren't there). "Hypomania" describes milder symptoms of mania, in which someone does not have delusions or hallucinations, and their high symptoms do not interfere with their everyday life.

The word "depressive" describes the times when the person feels very sad or depressed. Those symptoms are the same as those described in major depressive disorder or "clinical depression," a condition in which someone never has manic or hypomanic episodes. If you are interested in learning more about depression and are wondering “what does depression feel like?”, we’ve written about this topic in detail. Furthermore, clinical depression should be taken very seriously and we have also written about why it is important to identify and treat clinical depression as soon as possible. 

In terms of bipolar, most people with bipolar disorder spend more time with depressive symptoms rather than with manic episode symptoms or hypomanic episode symptoms. Bipolar disorder typically reveals itself before 20 years of age. Though it can develop in later life, it rarely shows up after the age of 40.

It’s possible to exhibit symptoms of bipolar mood disorder for some time before a doctor gives a diagnosis. It’s also common to receive a diagnosis of depression before receiving a bipolar disorder diagnosis.

Types of bipolar disorder

Bipolar I disorder

A diagnosis of bipolar I disorder is denoted by at least one episode of mania that lasts longer than one week. Ninety percent of people will also have periods of depression. Manic episodes will generally last 3-6 months if left untreated. Depressive episodes will generally last 6-12 months without treatment.

Bipolar II disorder

A diagnosis of bipolar II disorder means it is common to have symptoms of depression with at least one period of major depression, and at least one period of hypomania instead of mania.

Bipolar I or II disorder with mixed features

Bipolar I or II with mixed features shows symptoms of mania or hypomania and depression at the same time. This can also be called ‘mixed bipolar state’. It’s typical to feel very sad and hopeless at the same time as restless and overactive.

Bipolar I or II disorder with rapid cycling

Rapid cycling means there have been four or more depressive, manic, hypomanic episodes in a twelve month period.

Bipolar I or II with seasonal pattern

Seasonal pattern means that either the depression, mania or hypomania is regularly affected in the same way by seasons. For example, a person may find that each winter brings a depressive episode but the mania does not regularly follow a pattern. 


Cyclothymia, or cyclothymic disorder, is a chronically unstable mood state in which people experience hypomania and mild depression for at least two years. People with cyclothymia may have brief periods of normal mood, but these periods last less than eight weeks. This might be diagnosed instead of bipolar disorder because it may be milder, but it can last longer. Cyclothymia can develop into bipolar disorder.

Symptoms of bipolar disorder

Bipolar disorder symptoms can make it difficult for bipolar patients to deal with day-to-day life. It can have a bad effect on your relationships and work. The different types of symptoms are described below:


Symptoms of mania can include feeling happy or excited, even if things are not going well, being full of new and exciting ideas, moving quickly from one idea to another, hearing voices that other people can’t hear, and being more irritable than normal. A person might start feeling much better about themselves than usual, talking very quickly, jumping from one idea to another, experiencing racing thoughts, being easily distracted, and struggling to focus on one topic. 

Episodes of many often come with lack of sleep, with the person thinking they can do much more usual. They tend to make big decisions without thinking them through, like spending a lot of money, having casual sex with different people, using drugs or alcohol, gambling or

making unwise business decisions.


Hypomania is like mania but you will have milder symptoms. Treatment for hypomania is similar to the treatment for mania.


Symptoms of depression can include low mood, less energy and chronic exhaustion that doesn’t get better with rest. So, if you’re wondering, “Does depression make you tired?” the answer is yes. Depression can leave someone feeling hopeless or negative,

feeling guilty, worthless or helpless. It causes a person to be less interested in things they normally like doing or enjoying them less, and creates difficulty concentrating, remembering or making decisions. There are often feelings of restlessness or irritability, caused by sleeping too much or not being able to sleep. It can even induce thoughts of death, suicidal thoughts, or suicide attempts.


Sometimes during a severe episode of mania or depression psychosis can present itself. Symptoms of psychosis can be hallucinations (hear, see, or feel things that are not there) and

delusions (believing things that are not true). Psychotic symptoms in bipolar mental disorder can reflect whether a person is in a period of mania or depression.

Causes of bipolar disorder

The cause of bipolar disorder is not clear, though research suggests that a combination of different things can make it more likely to develop bipolar disorder.

Genetic factors

A person is five times more likely to develop bipolar disorder if someone in their immediate family, like a parent, brother or sister, has bipolar disorder. This risk is higher if both of your parents have the condition or if a twin has the condition. Researchers have not found the exact genes that cause bipolar disorder, but different genes have been linked to the development of bipolar disorder.

Brain chemical imbalance

Different chemicals in your brain affect your mood and behavior. Too much or too little of these chemicals could make you develop mania or depression. We’ve also written an article discussing the opposite of this titled, “How Does Depression Affect the Brain?”. 

Environmental factors

Stressful life events can trigger symptoms of bipolar disorder, such as childhood abuse and the loss of a loved one. They can increase your chances of developing depressive episodes.

Diagnosing bipolar disorder 

To diagnose bipolar disorder, a doctor may perform a physical examination, conduct an interview and order lab tests. While bipolar disorder cannot be seen on a blood test or body scan, these tests can help rule out other illnesses that can resemble the disorder, such as hyperthyroidism. If no other illnesses (or medicines such as steroids) are causing the symptoms, the doctor may recommend mental health care.

To be diagnosed with bipolar disorder, a person must have experienced at least one episode of mania or hypomania. Mental health care professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose the “type” of bipolar disorder a person may be experiencing. To determine what type of bipolar disorder a person has, mental health care professionals assess the pattern of symptoms and how impaired the person is during their most severe episodes.

Treating bipolar disorder

The first step in getting help is to speak to your general practitioner. It can also be a good idea to track and keep records of your moods and episodes over a period of time. This can help you and your GP to understand your mood swings. To be clear, a GP can’t diagnose bipolar disorder; only a psychiatrist should make a formal diagnosis. However, they can evaluate the symptoms and make a recommendation of whom to see next. 


Finding the right dosage of mood stabilizers, antidepressants, and antipsychotics are usually used to manage mania, hypomania and depressive symptoms. Psychiatrists will use different dosages and combinations depending on what works best for you. 

Psychological treatments

In addition to medication support, therapy for bipolar depression will be recommended as part of ongoing treatment to manage symptoms. Regular talk therapy is typical, as well as cognitive behavioral therapy (CBT) or interpersonal therapy in addition to medication. It’s not uncommon to have a psychologist or therapist, in addition to a psychiatrist who manages medicative treatment. You could have individual or group therapy, or even a combination of both.

Bipolar disorder is a life-long and often recurring illness. It’s possible to need long term support to help manage your condition. The aim of therapy is to stop you from becoming unwell again. This is known as relapse. Therapy should help to:

  • provide a deeper understanding of the condition
  • show how thoughts and behavior affect mood
  • monitor mood, thoughts and behavior
  • identify risk and distress
  • make plans to stay well
  • manage difficulties in day to day life.

If you live with your family or are in close contact with them you should also be offered family intervention, where you and your family work together with mental health professionals to help to manage relationships. The support that you and your family are given will depend on what problems there are and what preferences you all have. This could be group family sessions or individual sessions. Your family typically gets support for three months to a year and should have at least ten planned sessions.

Lifestyle changes

Aside from being closely monitored by a supportive team of healthcare providers, you can learn to manage your symptoms by looking after yourself by paying attention to diet, sleep, exercise, daily routine, relationships and how you are feeling.

Making small lifestyle changes can improve wellbeing and can aid in recovery. Routine helps many people with their mental wellbeing. It will help to give a structure to your day and may provide a sense of purpose. This could be a simple routine such as eating at the same time each day, going to bed at the same time each day, and buying fresh food once per week. Your healthcare professionals should give you advice about exercise and diet and sleep.

Mindful meditation is another practice that has been shown to improve and manage symptoms of bipolar depression, reducing overall stress levels to leave you better equipped to manage negative emotions.

Make a Wellness Recovery Action Plan (WRAP)

Your healthcare team should help you to make a recovery plan. The plan should help you to identify early warning signs and triggers that may make you unwell again, in addition to ways of coping. Your plan should also have people to call if you become very distressed.

Learning to spot early signs of mania or depression is important in self-management. The idea of the WRAP is to help you stay well and achieve your goals. The WRAP looks at areas like how you are affected by your mental illness and what you could do to manage them. There are guides that can help with this. You can ask your healthcare professional to make one with you or request a template.

If you’re looking for a therapist for bipolar depression, Advekit can help you get matched with a great mental health professional today. 


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