How to Recognize the Signs of Bipolar Depression
The terms “manic depression” and “manic depressive” get tossed around quite a bit. This is despite the fact that the real technical title of the diagnosis got changed to bipolar disorder back in 1980. Bipolar depression exists in the context of a larger bipolar disorder.
While a bipolar disorder may seem like a far-off concept, it may be closer to home than you think. A study by Harvard Medical School in 2007 found that 2.8% of American adults experience bipolar disorder.
In 2013, The American Psychological Association estimated that 0.6% are diagnosed with bipolar I and 0.8% are diagnosed with bipolar II. Considering the larger size of the US, these small percentages show there are plenty of individuals out there suffering from these types of disorder.
What Exactly is Bipolar Disorder?
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, there are three types of Bipolar disorder: Bipolar I Disorder, Bipolar II Disorder, and Cyclothymic Disorder.
Bipolar I Disorder
In order for someone to be diagnosed with Bipolar I Disorder, they must have experienced one manic episode in their lifetime. (APA, 2013). A manic episode consists of a major increase in energy and an elevated or irritable mood, both of which last for at least a week.
In some circumstances, Bipolar I Disorder will vacillate between moods quickly going from depressed, to angry, to euphoric very quickly.
Symptoms of mania may include (APA, 2013):
- Higher levels of self-esteem this can be as simply as higher levels of self-confidence and go all the way up to a delusional god complex.
- Talking more or speaking loudly and rapidly if angry, this may look like a rant.
- Getting less sleep, but still feeling rested (staying up all night). This lack of sleep, according to the DSM-5 authors, is a common symptom for manic episodes and can foreshadow a manic episode.
- Ceaseless thoughts
- More easily distracted
- Feeling restless
- Increased activity (e.g., fixation on new hobbies, working all night). An increase in sex drive is also common.
- Risky behavior (e.g. reckless driving, sexual promiscuity, gambling, shopping binges)
For activity and behavior to be considered a manic episode, the changes in behavior and mood must cause some level of impairment (relationally, financially, physically) or require hospitalization. If significant changes like these are only related to a substance or medical condition, then they are not the result of a bipolar disorder.
An episode of major depression is not always associated with bipolar I disorder. Although, it is not uncommon for someone who has experienced a manic episode to also experience a major depressive episode.
Major Depressive Episode
Bipolar depression is an episode of major depression that takes place in association with a hypomanic or manic episode. A major depressive episode consists of a group of symptoms that are present overtime for at least two weeks. (APA, 2013).
Common symptoms of depression include (APA, 2013):
- Feeling depressed or in despair
- Lack of interest in hobbies
- Difficulty concentrating or making decisions
- A sense of worthlessness or inappropriate guilt
- Thoughts of suicide or recurring thinking about death
- A significant change in weight, either weight loss or weight gain
- Altered sleep schedule: Either sleeping too much or too little.
- Decreased psychomotor activity or more agitated psychomotor activity
- Increased fatigue and feelings of exhaustion
Someone suffering from a major depressive disorder will be considered bipolar if they also experience a manic or hypomanic episode. While the symptoms of mania, or hypomania, can still exist with MDD, the full criteria cannot be met for the diagnosis to remain MDD.
Bipolar II Disorder
Bipolar II disorder is similar to Bipolar I disorder but with a slight difference. Bipolar II is diagnosed when someone has had both a major depressive episode and a hypomanic episode. A hypomanic episode is very similar to a manic episode, however, it only needs to last at least four days to be diagnosed. Symptoms of a hypomanic episode are very similar to that of a manic episode but do not cause the same level of impairment or result in hospitalization.
Cyclothymic Disorder
Cyclothymic disorder is more complex. This disorder is when someone experiences hypomanic symptoms and a period of depressive symptoms over at least two years, but never experiences the full hypomanic criteria or a major depressive episode.
For children and teenagers, the time frame is shortened to one year. Someone dealing with a cyclothymic disorder will never fully meet the criteria for major depression, a hypomanic episode, or manic episode, making it somewhat harder to diagnose (APA, 2013).
Bipolar Disorders and Suicide
Bipolar disorder is serious because it increases the risk of suicide. It has been shown that people with bipolar disorder are 15 times more likely to commit suicide. (APA, 2013). An even more sobering statistic is that 1 in 3 people diagnosed with a Bipolar II disorder report having attempted to commit suicide during their lifetime (APA, 2013).
Suicide is the greatest risk for those who have previously attempted it and who have experienced depression within a year, according to the DSM 5 authors. Suicidal thoughts will not always be present, but they can be and often are important warning signs of suicidal thinking.
Examples of warning signs include (SAMHSA, 2019; The American Foundation for Suicide Prevention, 2019):
- Verbalizing thoughts about dying or wanting to commit suicide.
- Saying they have no reason to keep living
- Looking up ways to commit suicide
- A sense of “unbearable pain” or “being trapped”
- Increased use of substances or alcohol
- Expressing that they feel like a burden
- A significant shift in sleep schedule (either more or less than usual)
- Anxiety and agitation
- Reckless behavior
- Increased isolation from friends and family
- Extreme anger, for example, stating a need to get revenge
- Extreme swings in mood
- Telling people goodbye
- Getting rid of belongings
- Irritability, depression, humiliation
- Loss of interest in activities
By no means is this list comprehensive, other warning signs can also be present that are not listed. What is important is to remember to seek professional help if you think suicidal thinking is present. If you are aware of someone who is actively suicidal, then you should immediately contact 9-1-1 or go to a local emergency room.
Coping with Bipolar Depression
If you are dealing with the symptom of depression brought on by bipolar disorders, consider these strategies to help you cope:
- Learn about your diagnosis so you can begin to understand your triggers. A lot of information is available on bipolar disorders and knowing more can help your process and deal with the symptoms. A doctor or therapist can also help you get headed in the right direction.
Keep your goals attainable. Depression often makes people lose motivation and interest in life. But giving into a sense of helplessness actually makes depression worse. By making realistic, daily goals, you can help break through some of the despair.- Be with people, don’t go this alone. Isolation and loneliness only make depression worse. As relational beings, we are meant to be with people and find support through family and friends. Reach out to your community and find ways to surround yourself with people.
- Keep track of what is going through your mind. Depression can cause negative thinking, which only makes things worse. Try to analyze your thoughts so you can discern what you are thinking and why.
- If you’re thoughts feel uncontrollable, mindfulness can help you take back control. Mindfulness can be anything from sitting in silence to meditation, to yoga. There is a lot of free online content that can help you develop the practice of mindfulness.
- Relaxation exercises like intentional breathing or guided meditation.
- Exercise has been proven to provide many health benefits. Consult your physician to find out what is best for you.
- Taking time to process your experience through self-expression (e.g. art, journaling, dance)
- Reading and meditating on the Bible:
Don’t be afraid, for I am with you. Don’t be discouraged, for I am your God. I will strengthen you and help you. I will hold you up with my victorious right hand. – Isaiah 41:10
Then Jesus said, “Come to me, all of you who are weary and carry heavy burdens, and I will give you rest. – Matthew 11:28
Come quickly, LORD, and answer me, for my depression deepens. Don’t turn away from me, or I will die. Let me hear of your unfailing love each morning, for I am trusting you. Show me where to walk, for I give myself to you.. – Psalm 143:7-8
How to Treat Bipolar Depression
While it might be tempting to ignore the symptoms of bipolar disorder, it isn’t helpful to do so. If you know someone who is experiencing bipolar disorder symptoms, or see them in yourself, it is best to get diagnosed and receive medical treatment. The disorder will only worsen if untreated. (NAMI, 2019).
To achieve a proper diagnosis, you will need to receive a medical evaluation to ensure it is bipolar disorder and not something else. The treatment for a bipolar disorder will likely be a combination of psychotherapy and medication management.
One of the most effective approaches for treating bipolar disorder is cognitive behavioral therapy (CBT). CBT teaches people how to alter their way of thinking. It allows you to combat negative ways of thinking and behaving, thereby helping you to cope with your emotions in a healthy way.
The role of a therapist is to be an outsider observer who can help you explore what triggers episodes so you can learn to manage your stress and triggers. This can include a variety of different techniques and strategies. Another helpful form of therapy is family therapy because it can teach families about the disorder while also exploring different family dynamics that may lead to increased levels of stress.
Conclusion
Bipolar disorders are no small thing. They can carry very serious consequences. That being said, they are treatable. If you think someone you love is dealing with a bipolar disorder, then get in contact with a counselor today. We are ready to walk with you down the road of healing and growth.
Photos:
“Alone,” courtesy of Zulmaury Saavedra, unsplash.com, CC0 License; “Depressed,” courtesy of HolgersFotographie, pixabay.com, CC0 License; “Snowstorm,” Courtesy of Magda Ehlers, Pexels.com, CC0 License; “Depressed”, Courtesy of Rawpixel, Unsplash.com, CC0 License
“Alone,” courtesy of Zulmaury Saavedra, unsplash.com, CC0 License; “Depressed,” courtesy of HolgersFotographie, pixabay.com, CC0 License; “Snowstorm,” Courtesy of Magda Ehlers, Pexels.com, CC0 License; “Depressed”, Courtesy of Rawpixel, Unsplash.com, CC0 License
How to Actively Fight Depression
When depression strikes, it infiltrates every area of life including your thoughts, feelings, and actions. According to the World Health Organization (WHO), there are more than 300 million people who suffer from depression across the globe.
Depression has a way of preventing people from even seeking out healthy ways to combat its effects. For the person experiencing depression, it can literally feel like nothing will make your situation better. However, there are some practical steps to actively fight depression in your life.
Depression is serious and identifying a proper treatment plan and finding help is going to improve your chances of recovery significantly. Unfortunately, depression is multifaceted and simply trying to “change your attitude” often isn’t the remedy for such a dynamic disorder.
The first step is to understand the common symptoms of depression and determine if you are experiencing these systems regularly. These symptoms must be present for at least two weeks to be diagnosed. Some symptoms of depression described by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) are:
- Depressed, negative or sad mood
- Dwindling interest or excitement in things you once enjoyed
- Serious weight loss or weight gain
- Insomnia or hypersomnia
- Energy levels plummet
- Feelings of worthlessness or inappropriate guilt
- Difficulty staying focused
- Indecisiveness and suicidal thoughts
These symptoms can interrupt your abilities to work, complete personal tasks, or interact with friends.
Depression is extremely common and is not a sign of weakness. Many of those who suffer from depression battle the disorder in isolation due to feelings of being ostracized by others. Unfortunately, a big stigma around depression still exists today.
When a person is in a car accident and injured, family and friends might gather around at the hospital to show their support. However, because depression often isn’t defined in tangible ways, people find it hard to discuss it with others. Many people who would have compassion on someone with a broken arm, don’t have the same compassion on someone facing a mental disorder.
People learn to suffer in silence instead of searching for someone they can trust to share their experiences with. Every individual is unique and finding ways to overcome depression might look different than someone else’s approach. Find safe people in your circle that you can confide in and extend grace to yourself as you learn to actively fight depression. The good news is that many people are finding ways to cope and hope is not lost.
Identify Fact vs. Opinion
Everybody has an opinion about depression and how to manage the disorder. Usually, people who have never experienced depression or interacted with someone who has, believe people can just shake depression off and suck it up. Misinformation is circulated frequently about depression and how it influences people.
If depression were that simple, then millions of people wouldn’t find themselves struggling with it daily. You can’t just stop being depressed on command. If someone has told you to stop feeling depressed or that if you just had more faith you would be healed, it is unfortunate that you were subjected to such narrow-minded perspectives.
God does not love you any less because you are battling depression. He is with you. He hurts to see you hurting. He can help you on your journey toward recovery.
9 Ways to Actively Fight Depression
It’s important to note that this journey requires patience. Everybody experiences depression symptoms differently and each person will discover the process that works best for their unique circumstances.
Allow your mind, body, and spirit to heal the way that is best for YOU. Refrain from comparing your journey to someone else’s journey. Let’s take a look at what other people have done to fight their depression.
Avoid isolating yourself
This is major. It’s natural to want to isolate yourself when you’re depressed. It’s almost like keeping to yourself becomes the default during a depressive state. Your thoughts become trapped in your mind and you avoid connection with others.
Depression can worsen when you are around joyful people. You begin to wonder if you’ll ever be that person enjoying an abundant life. You are not alone in this way of thinking and behaving. Isolation increases the severity of depression.
You will have to push through your discomfort to connect with people. This can be hard and feel like you are going against the grain, but having face-to-face time with those that care about you eases the symptoms of depression. Find those that remind you that you are loved and valuable.
It’s okay to have time to yourself, but don’t be afraid to bring your whole self to the dinner table with a friend. A genuine friend cares about you during the valleys and mountaintops. Getting outside of those conflicting thoughts and talking to someone else will help.
Leave your house
Many people who are experiencing depression lock themselves in their house, pull the covers over their head and watch shows that aren’t beneficial in their current state. Do what you can to get out of the home and participate in a life-giving activity. Even if you don’t feel any different, removing yourself from isolation helps gradually over time. Even if it’s taking a walk in a nature park or driving to a place you’ve never been. Staying in the house is comfortable, but counterproductive to your healing and progress.
Don’t believe the lies in your head
The mind is a battlefield and a constant tug-of-war between good and evil. Being lost in your own thoughts is incredibly dangerous in a depressive state. It’s easy to succumb to lies during this time. These thoughts might sound like, “Nobody likes me,” “Why am I even still here,” “I’m worthless,” or “I’ll never get anything right.”
Our internal dialogues determine our direction. These thoughts are not from God and can derail your healing. Lies can be hard to reject when depressed. It’s important to have someone else who can speak truth into your life and remind you who you are in Christ. Other people will be able to pinpoint the thoughts that are blatant lies. These lies can consume your mind and eat away at your mood.
Get active
Even on a good day, most people dread exercising. It’s normal to have to give yourself a pep talk to make it to the gym. That being said, incorporating movement in your day is going to be challenging, but critical to fighting depression symptoms. Exercise is known to release your body’s chemicals that help you feel better.
Depression makes it incredibly hard to get motivated because of a lack of energy. Even if you can lace up your tennis shoes and walk around the neighborhood for 15 minutes. That is a great start to getting moving. This movement, when done consistently, will benefit you tremendously. Fresh air, a dose of sunlight, moving and immersing yourself in nature boosts moods. You might even want to invite someone else along to keep you accountable.
Practice proper nutrition
Food is fuel. What we put into our body contributes toward our overall health emotionally, mentally and physically. If we fill our bodies with unhealthy food or drinks we can’t expect that our body will be efficient. Our bodies will become sluggish as a result. Adding enough protein, vegetables, fruit and eating balanced meals is important. Hydrating yourself with water is also a big deal.
I know this suggestion might seem elementary, but often when people are depressed they skip meals or binge on food that isn’t healthy. When energy levels are low, attempting to cook a meal for yourself seems like an insurmountable task. Find prepared foods that are healthy that you can rely on to fuel you.
Some people turn to alcohol or drugs to numb their pain or make them feel alive. Alcohol is a depressant and will make things worse. Any substance that alters your mood should be avoided. If you are self-medicating, please know that other options exist to help manage depression and overcome its power.
Talk to God
Depressed people often drift away from God instead of clinging to him. You might begin to question why God would let you suffer from depression or why he won’t just make your pain go away. God doesn’t want you to live a depressed life. He wants you to live an abundant life.
He is by our side in the good and bad times.
When depression hits, it’s more important than ever to seek him minute-by-minute to be your strength and guide you every step of the way. If you are involved in a church, reach out to your community to provide comfort and encouragement. You might want to look for a church program like Celebrate Recovery to get involved with. Don’t give up asking God and His people for help. Believers are here to comfort those with the same comfort they have received.
Read God’s Word
Absorb God’s Word and meditate on his promises. God gives us life-giving words on the pages of the bible that we can access and apply. Here are a few verses that display God’s promises.
I waited patiently for the Lord; he turned to me and heard my cry. He lifted me out of the slimy pit, out of the mud and mire; he set my feet on a rock and gave me a firm place to stand. He put a new song in my mouth, a hymn of praise to our God. Many will see and fear the Lord and put their trust in him. – Psalm 40:1-3
The righteous cry out, and the Lord hears them; he delivers them from all their troubles. – Psalm 34:17
He heals the brokenhearted and binds up their wounds. – Psalm 147:3
A bruised reed he will not break, and a smoldering wick he will not snuff out. – Isaiah 42:3
Try Therapy for Depression
It can be useful to have an outsider’s perspective on depression. A trained therapist has the experience to help you navigate the complexities of depression and even uncover the source of the pain. Therapy is another good tool to use in addition to the others mentioned in this article.
A professional therapist has years of experience and training and can give you resources custom-tailored to your situation. A therapist also provides a safe place to share and be vulnerable without any repercussions. Talking is an important way to combat depression.
Talk with a medical provider
If you find medication is the best solution for you, this does not mean that you’ve failed or even that you will need to take medication forever. Many people I know have weaned themselves off medication after some time. Medical intervention is necessary at times and not something to be ashamed about.
There are also other options to treat depression that a professional medical provider could review with you. Remember, using medicine doesn’t mean that you aren’t still trusting God for your healing. God can provide healing in a variety of ways.
Christian Counselors are Ready to Help
Christian counselors are ready to talk with you today in a judgment-free environment. You are not alone and you do not have to battle this alone either. Now is the time to find someone you trust and begin the journey to actively fight depression. Find someone who will be by your side no matter what. Reach out today to a trusted friend, family member or professional. Help is only a phone call or text away.
Photos:
“Depressed”, Courtesy of Rawpixel, Unsplash.com, CC0 License; “Down”, Courtesy of Ethan Sykes, Unsplash.com, CC0 License; “Depressed”, Courtesy of Nathan Cowley, Pexels.com, CC0 License; “Help,” courtesy of Ben White, unsplash.com, Public Domain License
“Depressed”, Courtesy of Rawpixel, Unsplash.com, CC0 License; “Down”, Courtesy of Ethan Sykes, Unsplash.com, CC0 License; “Depressed”, Courtesy of Nathan Cowley, Pexels.com, CC0 License; “Help,” courtesy of Ben White, unsplash.com, Public Domain License