For many people with Bipolar, it started with depressive episodes, at least that’s how it started for me. My first episodes of depression occurred when I was around the age of 13, and they have continued throughout my life.
Sometimes, depressive episodes are forgotten about when discussing bipolar as the hypomanic/manic episodes take precedence but, at least for me, depressive episodes pose the most dangerous risk: suicide.
So, before I continue on this post, if you are in a place where you feel you are depressed, reach out to a doctor or a mental health professional. If you are in a place where you feel people would be better off if you just disappeared, reach out to a professional. If you are in a place where you want to die – call a hotline, talk to loved ones and reach out to your care team.
What is the criteria for a depressive episode?
At least 5 of the following must be present for at least 2 weeks to be considered a depressive episode:
“Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
Insomnia or hypersomnia nearly every day.
Psychomotor agitation or retardation nearly every day (observable by others; not merely subjective feelings of restlessness or being slowed down).
Fatigue or loss of energy nearly every day.
Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The episode is not attributable to the physiological effects of a substance or another medical condition.”
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
So what does this all mean?
1. Depressed Mood
A depressed mood can look like sadness, emptiness, or hopelessness. For me, I flip flop between emptiness and sadness when I’m depressed.
2. Loss of pleasure in activities
This is one of the earliest symptoms I experience. Basically, I start to feel as though none of my hobbies or my things that I do in my life are fun or bring me pleasure. When people ask me what I’m planning on doing for the day I’ll respond with things like “I just want to get home and sleep”. Why? Because nothing brings me joy in those moments.
3. Weight loss or gain
Personally, I binge eat during my depressed episodes. I become like a bear in a cave about to hibernate – no food is enough – I need to eat. For others, eating becomes a chore. When my girlfriend is depressed, for example, I have to force her to eat and she rarely finishes her plate. Either direction (eating too much or eating too little) are symptoms of a depressive episode.
4. Sleeping a lot or a little nearly every day
Just like with food, either direction away from your baseline could be a symptom of a depressive episode. If you’re sleeping a lot more than usual (which is what I personally experience) or if you’re having a hard time sleeping it could be a sign of a depressive episode.
5. Moving a lot (fidgeting, pacing, twitching), or moving very little
Psychomotor agitation, which is things like pacing, twitching, fidgeting, or moving very little and being unusually slow are both signs of a depressive episode.
6. Loss of energy
One of the hallmarks of a depressive episode is a loss of energy. I know that when I’m depressed simple tasks – like cooking dinner – feel impossible, since I’m so tired/fatigued.
7. Feeling worthless or having excessive guilt
There are two parts to this criteria.
Feeling worthless is not a very complicated symptom to understand as it’s pretty self explanatory. When I’m feeling depressed, I feel as though my accomplishments mean nothing and my failures are everything. This leaves me feeling worthless and as though I am a total failure. I frequently will actually make comments to other people that I’m worthless, that I’m a failure, that I am a “waste of space”.
Excessive guilt is harder because the guilt must be excessive and that requires defining what amount of guilt is acceptable/normal. I know I’ve done things in my life that I feel regretful of and I have no idea what amount of guilt is acceptable and where it becomes excessive. That’s why speaking with a psychiatrist/psychologist/therapist becomes very helpful as they are able to help you define where that line is.
8. Unable/less able to think and concentrate
When I’m depressed, I find myself struggling with concentration and with thinking. I remember one notable instance where I found myself spacing out at work. I looked at the wall for what felt like a minute or two and when I looked down at my work, I hadn’t edited it in 15 minutes. I was running so slow compared to my baseline, that what was 15 minutes felt like 1-2 minutes and during that time I was incapable of thinking or concentrating. Decision-making can also become really difficult during depression.
9. Thinking of death
Depression can lead you down dark paths, and one of the darkest are thoughts of death. These thoughts can be suicidal in nature (i.e. I wish I was dead) or they might simply be thoughts along the lines of “What would happen if I died?”.
I know I already said this, but if you are experiencing symptoms of depression PLEASE speak to a doctor. If you don’t have a psychiatrist/psychologist your primary care physician is a great place to start.
I’m depressed….what do I do?
Everyone is different and your skills/coping strategies will be different from mine. If any of mine seem odd/unhelpful, feel free to leave a comment and give your own instead.
Reach Out
Let people know that you’re struggling. In my crisis plan I let my care team know (therapist and psychiatrist) and then reach out to loved ones (my partner and my parents). This allows them to keep an eye out for some of the most dangerous symptoms and will help people be more understanding of your situation and what is going on. I would recommend creating a list of who to reach out to and when BEFORE you are experiencing symptoms.
Record it
While you’re in the episode, it might feel like a monumental task to record what’s going on (your symptoms, your experiences, what led up to it, what you’ve done to help, etc.) but it’s honestly the best time to do it. I keep a living document in which I record all of my episodes: hypomanic, manic, mixed, depressed
Be Understanding
I am not able to accomplish as much as I usually can when I’m in a depressive episode. When this happens I have a couple of options. I could 1. Be angry at myself and feel worse because I’m not capable of completing as much or 2. Understand that I’m in a mood state where I am not able to complete as much. I prefer to be understanding, as it can help the episode from spiraling (i.e. I can’t do as much so now I’m mad at myself, and now I’m mad at myself for being mad at myself, etc.)
If being understanding seems too hard, or if it seems as though it’s impossible, I would recommend working with a therapist to build up those skills.
Overall, depression is a dangerous condition that should be treated by a healthcare provider.
Additional Resources
Defeating Depression with Bipolar Disorder from the Inside Bipolar Podcast