The dramatic mood episodes of bipolar disorder do not follow a predictable pattern. Depression does not always follow mania. A person may experience the same mood state several times -- for weeks, months, even years at a time before experiencing a remission or change in mood state. Also, the severity of mood phases can differ from person to person.
The periods of depression can be equally intense. Sadness and anxiety affect every aspect of life -- thoughts, feelings, sleeping, eating, physical health, relationships, and ability to function at work. If depression is not treated, it often only grows worse until it may suddenly go away. However, there may seem to be no way out of this overwhelming mood.
People with bipolar disorder often have cycles of elevated and depressed mood that fit the description of "manic depression." When a person's illness follows this classic pattern, diagnosing bipolar disorder is relatively easy.
But bipolar disorder can be sneaky. Symptoms can defy the expected manic-depressive sequence. Infrequent episodes of mild mania or hypomania can go undetected. Depression can overshadow other aspects of the illness. And substance abuse can cloud the picture.
These depressed feelings have been described this way:
Depression:I doubt completely my ability to do anything well. It seems as though my mind has slowed down and burned out to the point of being virtually useless... . [I am] haunt[ed] ... with the total, the desperate hopelessness of it all. Others say, "It's only temporary, it will pass, you will get over it," but, of course, they haven't any idea of how I feel, although they are certain they do. If I can't feel, move, think, or care, then what on earth is the point?
An episode of depression involves five or more of these symptoms most of the day -- nearly every day -- for two weeks or longer:
Thoughts of death or suicide or attempting suicide
In addition, people experiencing a major depressive episode may also feel anxious, irritable, and tearful or have trouble making everyday types of decisions.
When a person experiencing a depression has psychosis, there may be delusions of guilt or worthlessness -- perhaps there is an inaccurate belief of being ruined and penniless, or having committed a terrible crime or sin.