About this term
- Quick definition
- A depressive episode in a person who has bipolar disorder, which also includes episodes of mania or hypomania at some point in life.
- Full clinical definition
- Bipolar disorder is a mood disorder characterized by episodes of mania or hypomania alongside, in most cases, episodes of depression. Bipolar I disorder requires at least one episode of full mania. Bipolar II disorder requires at least one hypomanic episode and at least one major depressive episode. A depressive episode in either case is called a bipolar depressive episode, often shortened to bipolar depression.
The depressive episodes themselves can look identical to those of major depressive disorder. The difference is the rest of the picture. Without a careful history that asks about elevated, expansive, or irritable mood with associated symptoms, bipolar disorder can be missed and treated as unipolar depression. Studies have estimated that the average delay between first symptoms and a correct bipolar diagnosis is several years.
- Epidemiology
- Lifetime prevalence of bipolar I and II together is estimated at about 2.8 percent of U.S. adults (NIMH). The first episode commonly occurs in late adolescence or early adulthood, though it can begin earlier or later.
- What it can feel like
- A long depressive episode in someone who, when asked, also describes past periods of decreased need for sleep, racing thoughts, faster or pressured speech, increased goal-directed activity, riskier financial or sexual decisions, and high energy. Those earlier periods may have felt like productivity or charisma at the time and may not have been brought up in prior visits. Family members often notice them first.
- Why it matters
- Standard antidepressants used alone can sometimes destabilize bipolar disorder, triggering elevated mood, mixed states, or rapid cycling. Treatment for bipolar depression is different from treatment for major depressive disorder. Recognizing the underlying condition is the most important single decision in the workup.
- How clinicians assess it
- A careful longitudinal history is the central tool. The Mood Disorder Questionnaire (MDQ) is one common screening instrument. Family history is important because bipolar disorder has a strong heritable component. Age of first episode, response to past antidepressants (especially any prior mood elevation on an antidepressant), and any history of postpartum mood symptoms all contribute. A second opinion is sometimes appropriate before settling on a diagnosis.
- Treatment implications
- Treatment for bipolar depression typically involves mood stabilizers such as lithium or lamotrigine, certain atypical antipsychotics with evidence in bipolar depression (quetiapine, lurasidone, cariprazine, olanzapine-fluoxetine combination), and structured psychotherapy. Antidepressants are used carefully and usually only in combination with a mood stabilizer under specialist care. Sleep regularity is unusually important because sleep loss can precipitate mood elevation.
- Bipolar I, bipolar II, and cyclothymia at a glance
Diagnosis Required mood elevation Required depression Functional impact of elevation Bipolar I disorder At least one full manic episode lasting 7 or more days (or any duration if hospitalization is required) Not required for diagnosis but present in most patients Marked impairment, sometimes psychosis, often hospitalization Bipolar II disorder At least one hypomanic episode lasting 4 or more days (no psychosis, no hospitalization) At least one major depressive episode required Noticeable change but does not cause marked impairment Cyclothymic disorder Numerous periods of hypomanic symptoms not meeting full hypomanic episode criteria, for at least 2 years Numerous periods of depressive symptoms not meeting full episode criteria, for at least 2 years Symptoms present at least half the time, with no symptom-free period longer than 2 months Source: DSM-5-TR. Diagnosis is made by a clinician.
- Related terms
- Major depressive disorder. Treatment-resistant depression. Relapse. Remission.
- Related articles
- Bipolar depression (Types). Treatment.
Sources
- American Psychiatric Association. DSM-5-TR.
- National Institute of Mental Health. Bipolar Disorder statistics.
- Yatham LN, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. 2018.
- Goodwin GM, et al. Evidence-based guidelines for treating bipolar disorder: revised third edition. J Psychopharmacol. 2016.