Bipolar disorder is marked by contrasting manic (excessive energy, euphoria) and depressive (low mood, fatigue) episodes. ¹ With the latter episodes, symptoms are largely similar to those of depression. You may not feel yourself and have difficulty doing things you normally enjoy. ²

Luckily, there are ways to manage depressive episodes. Throughout this article, we’ll look at various techniques and what treatment measures are best suited for bipolar depression.

Symptoms of a Bipolar Depressive Episode

Depressive symptoms of bipolar disorder include: ³

• Difficulty getting out of bed
• Eating too much or too little
• Fatigue (lack of energy)
• Feelings of sadness, worry, and emptiness
• Inability to focus and retain memory
• Lack of interest in activities you once enjoyed
• Suicidal thoughts
• Too much sleep or not enough sleep
• Trouble making decisions

You may not experience every symptom on this list. However, if you experience at least five, followed by a manic or hypomanic episode, these are signs of bipolar disorder.

On top of this, depressive symptoms can be sporadic. For example, you may feel sadness but retain a lot of energy. Or, you may experience more manic episodes rather than depressive ones. ⁴

Initial Steps to Take

When you first recognize the signs of bipolar disorder, there are some prevention measures to reduce symptoms. While these measures are to be taken into your own hands, it remains key to continue with bipolar treatment.

So, what are some important things to remember to offset depression?

Avoid Drugs and Alcohol

You may turn to drugs and alcohol as a means of self-medication. This is a common mental practice among all mental health conditions, especially in those who struggle with depressive symptoms. ⁵

However, substance abuse can lead to addiction behaviors and physical dependencies. As such, this can worsen your bipolar condition and result in the need for further treatment. ⁶

Keep Away from Major Life Changes

Naturally, we can’t always avoid major life changes. Sometimes, sudden occurrences happen (i.e. a loved one passing) and inevitably have an effect on our mental health.

However, there are some life changes we can keep away from, including:

• Falling in love
• Finding a new job
• Moving

While these circumstances can be rewarding in the long run, they can also deeply affect depressive episodes. More specifically, major life events can cause relapse and a slower recovery rate. ⁷ Especially if these situations don’t play out as we expect them to.

To make the most of your bipolar treatment, it’s best to keep away from big life changes until you’re in a healthier mindset.

Develop a Routine

Depressive episodes can make it difficult to have a routine in place. ⁸ As such, your life may feel like a mess.

Keeping up with consistent habits can be an effective means of promoting positive brain chemistry. On top of this, healthy routines, such as exercising and spending time in nature, can also help to diminish depressive symptoms. ⁹

Seek Support

In difficult times, it can help to have someone to talk to. Reaching out to family and friends is an effective way to know you’re not alone in your struggle. Furthermore, they may provide resources to help in your bipolar treatment.

Handling Suicidal Thoughts

Depressive symptoms can lead to suicidal thoughts and actions. Or, you may participate in acts of self-harm. ¹⁰ As such, handling this symptom is one of the most important steps. If you or someone you love is currently in this position, it’s vital to:

• Call 911 or go to an emergency room.
• Call your doctor.
• Call your mental health professional.
• Reach out to someone who can help you immediately.
• Reach out to the 988 Suicide & Crisis Lifeline.

Professional Treatment for Depressive Episodes

As you take the initial steps to relieve bipolar depression, it’s highly advised you also find professional treatment. This will help to ease symptoms and give you the tools you need to properly battle this condition.

To get a sense of how treatment works, we’ve provided a detailed step-by-step analysis of the entire process:

1.) Diagnosis

If you believe you struggle with bipolar disorder, a medical professional will evaluate you to:

1. Determine if you struggle with bipolar disorder or another condition (i.e. major depression).
2. Regulate the best course of treatment for you.

To gain a bipolar diagnosis, you’ll be provided with: ¹¹

• Physical Exam – To better understand your current health, any medical problems you might have, and specificities about your body (i.e. weight and height).

• Psychiatric Assessment – A psychologist will talk to you to learn more about your thoughts, feelings, and behavior patterns. If talking to someone else makes you uncomfortable, you also have the option to take a self-assessment or questionnaire. With your permission, family members and close friends may be contacted.

• Mood Charting – Some patients are asked to take daily records of their mood, sleep patterns, and other important factors. This information helps medical professionals with diagnosis and developing the right treatment plan.

Once you’ve completed these steps, your results will be compared to the criteria designed for bipolar published by the American Psychiatric Association.

2.) Medications

If you receive a diagnosis, you’ll likely be offered bipolar medication. For depressive episodes, the most common include: ¹²

• Antidepressants – Helps to reduce symptoms of depression. However, it may also induce manic symptoms. As such, healthcare providers often prescribe this alongside a mood stabilizer or antipsychotic. ¹³

• Antipsychotics – While not the first line of treatment, antipsychotics can help to reduce manic and depressive symptoms. The most common include olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), and aripiprazole (Abilify).

• Antidepressant-Antipsychotic – In severe cases, antidepressant-antipsychotics are prescribed. The most common of these is Symbyax, a combination of fluoxetine (antidepressant) and olanzapine (antipsychotic).

Please note that if your primary symptoms are manic or hypomanic, then mood stabilizers are a better option. These include lithium (Lithobid) or valproic acid (Depakene). ¹⁴

3.) Psychotherapies

Alongside medication, psychotherapies are a great way to get to the core of your depressive symptoms. The most common include:

• Cognitive Behavioral Therapy (CBT) – Recognizes unhealthy behaviors and thought patterns. Through this knowledge, you’ll develop techniques for healthier thinking and conduct. ¹⁵

• Family Therapy – To strengthen your support system as you go about treatment. Through this, you’ll develop better communication with loved ones and they’ll learn the best strategies for supporting you. ¹⁶

• Interpersonal and Social Rhythm Therapy (IPSRT) – Helps you develop a stabilized routine in various areas of life, including sleeping and eating. The goal is to make this routine a habit and, in turn, help to diminish depressive symptoms. ¹⁷

• Psychoeducation – Teaches you (or loved ones) about bipolar disorder. With this understanding, you (and loved ones) can develop the tools necessary to stick to treatment. ¹⁸

References

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