Bipolar depression

Bipolar depression is the name given to the depression experienced in those who have bipolar disorder (in other words, they experience depression as well as manic or hypomanic episodes).

This is in contrast to those who experience unipolar depression, the form of depression where there are episodes of depression only (and no episodes of mania).

The depression that people with bipolar disorder experience is generally of a melancholic or psychotic type - therefore more biological in its nature.

The features of melancholic depression are:

a more severely depressed mood (see signs of depression) than is the case with non-melancholic depression
psychomotor disturbance - where movements are slowed and/or agitated, and concentration impaired. Many people describe an inability at such times to get out of bed, to fire up and do basic chores - thus, a very physical state.

Melancholic depression has a low spontaneous remission rate. It responds best to physical treatments (for example antidepressant drugs) and only minimally (at best) to non-physical treatments such as counselling or psychotherapy.

Depression and bipolar I and II

The depression experienced by sufferers of bipolar disorder is equally as severe for people with bipolar II as for people with bipolar I, and with a similar psychomotor disturbance component. However, younger people with bipolar II are more likely to report increased sleep and food cravings rather than insomnia and appetite/weight loss as uusally experienced in melancholia. Some recent studies have gone further by showing that depression can be both more frequent and more chronic in the case of bipolar II than with bipolar I, and that there is a comparable suicide risk between bipolar I and II sufferers, (with some researchers even reporting a higher risk for bipolar II sufferers). Therefore, for people with bipolar II, treating depression becomes a vitally important issue. Also, rapid cycling tends to be far more common among sufferers of bipolar II than bipolar I, leading both to difficulties in diagnosis and missed treatment opportunities.

(Reported in George Hadjipavlou, Hiram Mok, Lakshmi N. Yatham, 'Bipolar II Disorder: An Overview of Recent Developments', Canadian Journal of Psychiatry, Vol 49, No 12, December 2004)

The descriptor 'bipolar depression' is useful because the management of episodes of bipolar depression can be quite different to managing unipolar depression.