Understanding Bipolar Depression

Depression has been a long-standing disorder which traces back to texts in the second millennium B.C.

In older times, depression was thought of as a spiritual ailment rather than a physical one and was often diagnosed by a priest who would try expel the demons and spirits that were conflicting your spirituality from your body.

It was Hippocrates, a Greek physician who had discovered that mental disorders and personality traits were caused by an imbalance in fluids known as humors (1). The four fluids were commonly phlegm, black bile (melancholy), yellow bile (choler), and blood. Hippocrates had thought that the result of depression was due to an overproduction of black bile in the spleen and often used a bloodletting technique which involves blood being removed from the body.

Thankfully, in today's world, medicine has advanced and depression is diagnosed with a variety of physical and psychiatric exams which is usually treated with medication.

Common Conditions Of Depression

Depression is an umbrella term used for most conditions, however, symptoms and traits vary with each disorder and some require more attention than others. The common conditions which fall under this umbrella term are:

Sad Woman Looking at the Window

Major depression - This is usually referred to as a unipolar illness and is characterized by negative emotions of sadness, insomnia, and lack of interest. This is usually easily treated with medication and talk therapy.

Dysthymia - A mild long-term form of depression that is persistent and can be characterized by feeling sad most days (which lasts for at least 2 years), having low self-esteem and experiencing a lack of interest in normal activities.

Postpartum Depression - This is a common disorder which affects an estimated 1 in 9 women who are new mothers (2). This form of depression is characterized by extreme sadness, loneliness, anxiety, fatigue and suicidal thoughts which develop weeks or months after the birth of a baby. This disorder is usually treated with medication and talk therapy.

Psychotic Depression - This disorder is a subtype of major depression and is characterized by psychosis which may involve hallucinations and hearing voices. The feelings of worthlessness, failure, and illogical thoughts are often common symptoms (3). This disorder usually requires hospitalization, antipsychotic medications, antidepressants and mood stabilizers.

Bipolar Disorder - This disorder was formerly known as manic depressive disorder because symptoms resemble that of mania (4). Bipolar disorder is characterized by periods of extreme negativity and lows which is then followed by periods of extreme positivity and highs. Depending on whether it is bipolar type I or II, extreme depression may be followed by mania a few times within a yearly cycle.

Depression dates back to texts in the second millennium B.C. and was thought of as a spiritual disorder rather than a physical or mental disorder. It was Hippocrates, a Greek physician who had suggested that depression and personality traits could be a result of an imbalance in bodily fluids. Currently, depression can be treated with a variety of medications and therapy depending on which depressive disorder you are suffering from.

What Causes Bipolar Depression?

While the exact cause of bipolar is unknown, experts believe that there are strong links between the disorder and factors such as neurochemical, environmental, medication and genetics.


Photo of Neurotransmitters

Intensive studies have shown chemical and structural changes in the brains of bipolar patients. Some studies believe that the fluid volume in the hippocampus region of the brain differs to those who have the disorder (5). This is the part of the brain which is responsible for moods, impulses, and memory. An imbalance in chemicals called neurotransmitters also has an effect on the functioning of the brain. Low levels of these chemicals, namely noradrenaline, dopamine and serotonin, contribute to mood disorders, psychosis, and schizophrenia (6).


Studies have revealed that bipolar depression runs in families. This information came to light when a study was performed on identical twins. One of the twins had shown symptoms and had been diagnosed with bipolar disorder while the other had shown a 40% to 70% risk of developing it than any other sibling in the family. Other studies have also concluded that those who have a close relative or parent suffering from the disorder have an increased chance of developing the disorder as well (7).


Antidepressants and mood stabilizers can trigger a manic episode depending on how the patient reacts to the medication. Since antidepressants are used to treat a depressive disorder, it may cause a 'high' which resembles a manic episode (8). In cases of bipolar, an antidepressant is usually prescribed with an antimanic drug to prevent the patient from experiencing mania induced by the antidepressant.


This can usually be classified as an altered lifestyle which involves alcohol and drug abuse (9). In some cases, severe trauma or life changing event can trigger the disorder. The risks are much higher if there is a genetic link to the disorder.

The exact cause of bipolar is unknown, however, studies have shown links between the disorder and factors such as medication, genetics, neurochemicals and environmental changes.

Telltale Signs

There are a few things to look out for if you suspect that a loved one or you may be suffering from bipolar depression (10). These symptoms include:

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  • Mood swings which are associated with depression and mania. For example, extreme sadness, lethargy, worthlessness, loneliness, anger, anxiety, and apathy, which are then followed by a cycle of euphoria, extreme happiness, Inflated self-esteem and an increased interest in goal driven activities.
  • Impulsive behavior
  • Reduced need to sleep
  • Self-harm
  • Delusion
  • Manic or hypomanic episodes

If you suspect that these symptoms are prevalent you will need to consult with a doctor who will determine if you have the disorder with certain evaluations which include:

  • A physical exam
  • Psychiatric assessment
  • Mood charting
Take note of any signs of bipolar depression you may be feeling in order to get the best possible help.

Our Ultimate Take Home Message

Understanding that bipolar depression is not just a feeling of sadness can ultimately help you or your loved one get the treatment they need. While bipolar is a form of depression it is important not to confuse this disorder with another, as 'depression' is only an umbrella term used to classify other depressive disorders which don't have the same characteristics. If you suspect that your loved one may be suffering from any depressive disorder, it is important to look for telltale signs. There are many support groups available online to help you understand and deal with this disorder. It is important to know that you are not alone and that there are ways to manage your disorder and improve your quality of life.

Brought to you by our expert team at Authority Health.

Juno received an MSc in Dietetics from Robert Gordon University in Scotland and is registered with the British Dietetic Association (BDA) and the Health and Care Professions Council (HCPC). As someone who has learned the value of healthy eating later in life, her passion is teaching younger children about the value of eating well. She offers hands-on, instructional classes to both children and adults to prepare healthy meals. In addition, she consults with local institutions and schools to promote healthy eating and advice on healthy meal preparation.

She has traveled the globe and been privileged to experience a wealth of cuisines, the Mediterranean diet being her favored (and healthiest) option. Juno loves creating in the kitchen and that is where she comes alive. According to Juno, “Food is medicine” and thinks that the adage of “we are what eat” should be the mantra we all should live by. Her big dream one day is to pen a cookbook with recipes from her travels but, for now, she is happy writing on her health and wellness blog.

She is married with 3 beautiful children, 2 Airedale Terriers, 4 cats and a guinea pig. She lives in the countryside of Southern England and loves nothing more than walking on the coast on a blustery day to blow away the cobwebs!