We have talked about hypomania and mania but I haven’t said much about depression. It is very common in bipolar disorder and often follows right on from a period of mania or hypomania. It is as though the patient crash lands into depression. The higher you were the worse is the fall into depression. Bipolar depressions can last a year or even indefinitely if untreated and can be notoriously hard to treat.
On the plus side they are much easier to recognize than hypomania and so treatment can begin earlier than would otherwise would be the case. They have basically the same symptoms as standard major depression but with some distinct features of their own. So the typical constellation of symptoms includes: low mood, lack of interest, lack of pleasure, insomnia or hypersomnia, lack of appetite or excessive appetite, low energy, low drive, lack of libido, poor concentration, feelings of guilt, agitation or being slowed down thinking. Some distinct features that are commonly but not always present in bipolar depression are overeating and oversleeping and a lot of sensitivity to perceived criticism (called rejection sensitivity). The reason that bipolar depressions are particularly difficult to treat is that antidepressants do not appear to work at all or at least not well. Instead a whole other class of medications called mood stabilizers are the first line treatments. More on that later.