Symptoms and Signs of Bipolar Depression: What to Be Aware of?

All people are familiar with mood swings. There are days when we feel depressed, when we experience tension and our self-consciousness is somehow “broken”. And, on the contrary, a person who is strongly in love is in a state of euphoria, experiences a spiritual uplift, is on a wave of cheerful and carefree mood. Sometimes, such mood swings can be one of the signs of bipolar depression.

When a person falls ill with bipolar or, in other words, manic-depressive disorder these mood swings go far beyond the norm and do not correspond to real life circumstances.

Bipolar Depression

Bipolar disorder (manic-depressive psychosis) is a mental illness of endogenous nature. It is manifested by a change in the affective phases: manic and depressive one. In some cases, bipolar depression occurs in the form of different variants of mixed states which are characterized by a rapid change of manic and depressive manifestations. Sometimes the symptoms of depression and mania are distinctly expressed at once (for example, melancholic mood combined with intense excitement, mental inhibition with euphoria).

Individual episodes (phases) of bipolar disorder go immediately one after another or manifest through a “light” gap in the mental state of the individual called the intermission (or interphase). This asymptomatic period occurs with the full or partial resumption of mental functions, with the restoration of personal qualities and individual traits of the patient’s character. Numerous scientific studies have identified the presence of other concomitant mental pathologies in 75% of patients having bipolar affective disorder. In most cases, these are anxiety-phobic disorders.

The Study of Bipolar Depression

The study of manic-depressive psychosis as an independent unit has been conducted since the second half of the 19th century. At first, this disease was described as a circular psychosis. Later it was interpreted as “mental insanity in two phases”. With the introduction of the International Classification of Diseases in 1993, the disease was renamed into a more correct, reflecting the scientific essence name – bipolar affective disorder. However, to this day there is no single definition in psychiatry. As well as there is no confirmed by research understanding of the probable clinical limits of this depression in connection with the expressed heterogeneity (the presence of completely opposite parts in the structure) of the disease.

It is difficult to estimate the real prevalence of bipolar depression because of the variety of criteria for its diagnosis. However, according to different studies, it can be assumed that even with a conservative approach to the criteria of pathology bipolar disorder affects from 5 to 8 people out of 1000. Moreover, the percentage of sick people is approximately the same for both men and women. Also, among people suffering from the disorder, there was no significant dependence on being in a particular age category, social status or ethnic group.

According to World Health Organization, the likelihood of developing bipolar depression during life is 2 to 4%. Around 47% of patients with a bipolar affective disorder diagnosis get sick at the age of 25-45 years. Scientific research has established that the bipolar type of disorder develops, as a rule, at the age of up to 30 years, the unipolar form – after the thirty-year threshold. The depressive phases prevail in people over 50 years old.

Causes of Bipolar Depression

To date, the probable causes of bipolar disorder have not been established and completely investigated. At the same time, some scientific hypotheses have been confirmed. Among theories, the most likely factors in the formation of pathology are genetic inheritance (predisposition) and neurochemical processes occurring in the body. So, the disease can be provoked by the disturbances in the exchange of biogenic amines, pathologies in the endocrine system, disruption of circadian rhythms or failure in water-salt metabolism. The likelihood of bipolar affective disorder development is also influenced by the specifics in the course of the childhood period and the constitutional features of the individual’s organism. Accumulated scientific data showed that the share of genetic factors in the formation of mental pathology reaches 75% and the contribution of “environment” does not exceed 25%.

Bipolar Depression Symptoms

It is impossible to predict the character and the number of phases with which bipolar disorder develops in a patient. The disease can manifest itself in one single episode or proceed according to various schemes. The ailment can show only manic or depressive states, manifest itself by correct or incorrect changes of these states.

The duration of a single phase in an intermittent variant of the disease can fluctuate over a wide time range: from 2-3 weeks to 1.5-2 years. On average it lasts from 3 to 7 months. As a rule, the manic phase is 3 times shorter than the depressive episode. The duration of the intermission period can vary from 2 to 7 years. Although the “light” period – the interphase – in some patients is absent in general.

The following progress of events is also possible: an atypical variant of the course of the disease in the form of incomplete phase opening, disproportionality of the core indicators, attachment of the symptoms of obsession, hypochondria, senestopathy, and paranoid, hallucinatory, catatonic syndromes.

The Course of the Manic Phase

Hyperthymia is persistent high mood accompanied by increased social activity and vitality. In this state, an individual is characterized by abnormal, inappropriate to the actual situation cheerfulness, a sense of complete well-being, excessive optimism. A person may have a distorted high self-esteem, confidence in their uniqueness and superiority. The patient considerably embellishes or ascribes nonexistent their own dignity, does not accept any criticism.

Psychomotor agitation is a pathological condition, in which painful fussiness, anxiety, incontinence in speech and inconsistency in actions take place. An individual can simultaneously take up several activities but bring none of them to a logical conclusion.

Tachypsychia is an acceleration of thought processes with characteristic spasmodic, inconsistent, illogical ideas. The patient has a tendency to verbosity. Their speech has a bright emotional coloration, is often angry or of aggressive content.

In the clinical course of the manic syndrome, psychiatrists conditionally distinguish five phases which have specific manifestations.

The Main Signs of the Manic Phase:

PhaseNameSigns1HypomanicElevated mood;
A rush of strength, energy, vivacity;Higher than normal energy levels;Verbose accelerated speech;Decreased inhibitions;Increased appetite;Decrease in need for sleep;Increased distractibility of attention.2ManiaIncrease of manic symptoms;

Pronounced speech excitement;

Over-elated mood with features of gaiety;

Rare bursts of anger;

Increased self-esteem or confidence, grandiosity;

Formation of fantastic “prospects” for the future;

Uncontrollable excitement in investing and spending money;

Decrease in the duration of sleep up to 3 hours.

3Manic frenzyMaximum symptom load;

Lack of focus and productivity;

Intense motor restlessness of disorderly character, movements are sweeping, inaccurate;

Externally incoherent speech consisting of sets of individual words or syllables.

4Motor sedationElevated mood;

Reduction (weakening) of motor restlessness;

Ideational excitement gradually fades.

5ReactiveReturn to normal state;

Asthenic manifestations can take place;

Some patients forget some episodes of the previous stages.

The Course of the Depressive Phase

The main symptoms of the depressive phase are completely opposite to the manifestations of the manic syndrome:

Hypothymia is abnormally diminished emotional tone;

Psychomotor retardation;

Bradypsychia is the slowness of mental reactions.

During the depressive episode of the Bipolar Affective Disorder, patients note the daily fluctuations of the emotional background. Dreary mood, an irrational anxiety, indifference are present in the first half of the day with some “enlightenment” and improvement in well-being, an increase in activity in the evening. In most patients, appetite worsens and there is a sense of lack of taste in the food they eat. Many women in the depressive phase have amenorrhea (lack of menstruation). Sick people note unmotivated excitement, anxiety, foreboding of imminent misfortune.

A complete depressive episode consists of four consecutive phases.

PhaseNameSigns1InitialMinor weakening of vitality;

Uneven mood deterioration;

Decreased efficiency;

Difficulties with falling asleep, superficial sleep.

2Increasing depressionBad mood;

Irrational anxiety;

Significant deterioration of working capacity;

Motor and mental retardation;

Slowdown of speech;

Persistent insomnia;

Significant deterioration of appetite.

3Severe depressionMaximum development of depressive symptoms;

Excruciating pathological anxiety;

Intense persistent gloom;

Quiet, slow speech;

The onset of a depressive stupor;

The appearance of delusions of self-deprecation, self-blame, hypochondriacal moods;

Appearance of suicidal thoughts and actions;

Often there are auditory hallucinations.

4ReactiveGradual weakening of depressive symptoms with preservation of asthenia;

In rare cases, there is a slight psychomotor agitation.

In bipolar disorder, the depressive phase can proceed in the form of depressions: simple, hypochondriac, delirious, agitated or anesthetic.

Causes and Signs of Bipolar Depression

There is an opinion that the disease has a hereditary origin. The environment of a person and the microclimate of their life also play an important role in the onset of the disease.

Also, doctors are considering another version of the onset of bipolar depression: neuro-biochemical brain disorders. A possible cause may be a violation of the hormonal balance against the background of stressful life situations. However, so far 100% correlation has not been revealed.

The first sign which one should pay attention to is the alternation of attacks of acute depression turning into euphoric manic behavior.

Simply put, these are short changes in the polar states of deep grief and excessive emotional excitement.

Phases can be short-run (several hours) and longstanding (several days, weeks, months). They tend to repeat. Specialists call it a cyclothymia. It is impossible to cope with this disease without medical intervention.

Often the patient and the people around them do not even realize that the person is sick. After all, between attacks, they feel normal and act adequately according to a situation. And mood swings are understood as a person’s inability to control their emotions and their reluctance to change their character.

The cycle does not have a clear pattern, so it is not easy to recognize the disease. A wrong diagnosis complicates treatment.

Symptoms of Manic Disorder

The manic stage is characterized by the fact that the patient denies the disease. The people around also do not always understand that the person is sick. After all, the person does not look unhealthy, on the contrary, they charge everyone with optimism and energy.

This stage has a number of characteristic symptoms which one can recognize:

• euphoric state or irritability;
• greatly exaggerated self-esteem and the state of omnipotence;
• pathetic expression of thoughts and sudden leaps from one idea to another;
• excessive talkativeness, pressure to keep talking;
• a greatly reduced need for a night’s rest, insomnia;
• frequent distractions to non-essential details which are irrelevant to the case;
• hyperactivity in official affairs, in communication, uncontrolled sexual behavior;
• irrepressible waste of money and unjustified desire for pleasure, risk;
• unexpected outbursts of irritation, anger, aggression; an illusory vision of life, hallucinations (at acute stages of the disease).

The Depressive Stage Is Characterized by Other Symptoms:

• sharply understated self-esteem, a sense of worthlessness, inferiority;
• inadequate attacks of tearfulness, confusion of thinking;
• a sense of desperate anguish, despair, and guilt;
• apathy, lack of vitality, energy;
• poor coordination of movements, very slow speech, blurred consciousness;
• the desire for suicide, thoughts of death;
• lack of appetite or excessive overeating;
• drug use and self-medication;
• loss of energy, apathy, loss of interest in life events and hobbies;
• chronic pain of incomprehensible origin.

If these symptoms are so strong that they complicate the performance of duties and normal communication with people, then we can talk about a diagnosis of manic depression.

Signs of Bipolar Depression: Early Warning Signs of Depression

• Fatigue, a sense of exhaustion, lack of energy
• Depressed mood, depression
• Increased need for rest
• Lowered self-confidence, self-doubt
• Increased wisdom and concern
• Lack of interest and desires
• Sleep disorder and sleep disturbances
• Negligent attitude to daily duties
• Attention breakdown (thinking is difficult)
• Decrease in sexual interest
• Fear, nervousness
• Reduced resistance to stress
• Changes in the daily routine
• Physical ailment
• Increased consumption of alcohol
• Stress, anxiety
• Irritability

Signs of Bipolar Depression: Early Warning Signs of Mania

• Elevated mood, euphoria
• New ideas, acceleration of the flow of thoughts
• Increased loquacity
• Increase in activity and energy
• Changes in perception (sensitivity to noise, a sharper perception, a sense of being in another world)
• Increase of creative activity
• Decreased need for sleep
• Increased willingness to communicate
• A sense of self-worth and a sense of self in the limelight
• Increased use of alcohol and drugs
• Increased self-confidence, the feeling that you can fulfill all plans
• Irritability, tension, impatience
• Increased sexual interest
• Increased waste of money
• Violation of attention, distraction
• Anxiety, worry
• Frequent conflicts
• Non-observance of the daily routine

The distinctive feature of manic depression is a confusion of thoughts, the difficulty of perceiving the world and functioning in it. People with bipolar depression experience difficulties in the performance of their duties at work. Frequent exacerbation of depression can lead to a suicidal outcome. So, patients need hospitalization. Psychological help from relatives is good, but it is still necessary to use the help of medical services. After all, if one ignores a sharp form of manic behavior and doesn’t treat it, relapses with unfavorable outcomes can occur.

A sick person suffers from a feeling of uselessness, helplessness, irritability, indifference, hopelessness, guilt, and, in this connection, a sad tearful mood and refusal of fun, a fanatical desire to commit suicide. A characteristic symptom of this disorder is lack of appetite or a great desire for food as well as fatigue, various forms of sleep disorders, physical pain of various origins, and problems with the intestines.

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