What Makes Bipolar Depression Different?
It may be convenient to think of depression as simply a low or very low mood - but the real picture is more complex. In fact symptoms of depression tend to cluster differently and this is one of the reasons why depression in bipolar is different to the classic symptoms associated with unipolar depression. In this Sharepost I focus on just three of the combinations of depression associated with bipolar disorder.
One of the most obvious differences between unipolar and bipolar depression is that people with unipolar depression have no symptoms of hypomania or mania. Moreover, whereas unipolar depression is associated with symptoms of low mood, insomnia and tearfulness, people with bipolar may find they want to sleep more, eat more, and emotionally, they feel flat. They also show a marked level of sensitivity to rejection. At first glance these symptoms may sound like typical depression but in fact they are atypical in nature. What makes atypical depression different is the fact that fewer of the classic depression symptoms are seen. Other differences are seen in what is known as‘mood reactivity', that is, mood will improve at the time of some positive event or situation. By contrast, people with unipolar depression will have no change in mood resulting from positive changes around them.
Although negative thinking is typically associated with depression, some people with bipolar experience such an extreme form that it becomes psychotic in nature. In this context psychotic depression commonly refers to delusions (false beliefs). It is also the case that people experiencing such delusions will keep their thoughts to themselves. This makes diagnosis more difficult and adds to the delays in effective treatment. Psychotic depression may involve delusions that the person is fundamentally a bad or sinful individual, perhaps contaminating the lives of anyone they come into contact with. Paranoid delusions such as the feeling of being watched, recorded or followed might also occur. Psychotic delusions due to depression tend to be responsive to treatment.
Bipolar is mostly associated with alternating extremes of mood over a period of time. In mixed states, both extremes occur either in rapid succession or at the same time. The exact combination of symptoms required for a diagnosis of mixed depression is still a matter of some debate although recent studies suggest that depression, along with at least three hypomania or manic symptoms, is required. The signs and symptoms of mixed depression are certainly complex. Having a person who is jolly and laughing tell you they feel miserable and suicidal seems paradoxical. Equally, the sometimes rapid extremes of mood, elation followed by misery - closely followed by elation, are just as much a feature.
Depression also affects people at different levels of severity and over varying periods of time. This Sharepost only touches on three possible variations.