Severe Bipolar Depression: Is There Any Treatment?

Severe bipolar depression is a chronic, life-altering symptom of bipolar disorder that occurs in people with types I and II of the illness. According to medical research, depression is the “predominant pole” of disability in bipolar disorder, compared with mania or hypomania. Many people in manic or hypomanic states can function normally as they have more energy and drive and a reduced need for sleep. In depressive episodes, however, doing just about anything can feel impossible. According to the National Institute of Mental Health, severe bipolar depression affects 82.9% of people with bipolar disorder to the point of "serious impairment." So is there any treatment for severe bipolar depression that can help?

What Does Severe Bipolar Depression Feel Like?

Severe bipolar depression is a disabling and chronic part of bipolar disorder that is associated with various mental and medical problems. According to the National Institute of Health, it is one of the most life-threatening psychiatric disorders in the world. Both people with bipolar I and bipolar II experience more depressive episodes than manic or hypomanic ones.

In severe bipolar depression (also known as “acute bipolar depression”), it sometimes feels as though someone has switched the chemicals in your brain overnight. Other people experience a depressive episode as a gradual decline into depression. Either way, bipolar depression can greatly impact social and occupational functioning. In other words, it can be so severe that you may not have the motivation or energy to go to work, socialize with friends or even return a phone call.

Because bipolar depression is often unpredictable, it can be more challenging to manage than regular depression. Symptoms of a severe bipolar depressive episode include:

• Low mood
• Intense feelings of sadness
• Feelings of helplessness and worthlessness
• Lack of energy
• Fatigue
• Sleeping too much or too little
• Irritability and anger
• Difficulty concentrating and retaining information
• Lack of appetite/increased appetite
• Loss of interest in daily life/activities
• Delusions
• Suicidal thoughts and/or actions

(These symptoms can also indicate unipolar depression. The diagnostic criteria for bipolar disorder include at least one episode of mania or hypomanic in addition to symptoms of moderate to major depression.)

Severe Bipolar Depression Treatment and Recovery

Severe bipolar depression is difficult to diagnose and treat. Firstly, bipolar disorder is often misdiagnosed as unipolar – or “regular” – depression. Secondly, there is a high rate of treatment-resistant bipolar depression in people with bipolar disorder, most of whom do not respond to conventional antidepressants.

What's more, despite the detrimental and often devastating impact of bipolar depression, it is more difficult to treat than a manic episode. This is partly because, in mania, patients require hospitalization if they are a danger to themselves or others. Severe bipolar depressive episodes can be isolating, making the warning signs harder to spot.

Bipolar disorder is a lifelong condition for which there is no cure. However, there are plenty of treatments available that can help stabilize your mood and relieve depressive symptoms. These include:

Medication: The most common medicines used to treat bipolar disorder are mood stabilizers, antipsychotics and antidepressants like fluoxetine. Your doctor may combine medications depending on your symptoms and diagnoses. For example, many people with bipolar disorder take mood stabilizers alongside antidepressants.

Therapy: Psychotherapy may be offered alongside medication to help you manage the emotional effects of bipolar disorder. Common treatments include talk therapy, cognitive behavioral therapy (CBT), interpersonal therapy and psychoeducation (evidence-based therapeutic intervention for you and your loved ones).

Electroconvulsive therapy (ECT): Electroconvulsive therapy has been used successfully to treat a number of mental health conditions. However, it is only advised for people with severe bipolar depression who have not responded to other treatments. This is because the side-effects of brain stimulation can cause other mental and physical health problems, such as muscle pain and problems with memory loss.

What to Do When Severe Bipolar Depression Takes Hold

Talk to your doctor if you are experiencing a severe bipolar depressive episode, and make sure you tell friends and family members how you are feeling. If you are feeling suicidal, you can call the Suicide Prevention Lifeline (1-800-273-8255) 24 hours a day, seven days a week, or you can chat with a representative online. You can also call your local emergency services if you need help in a crisis.

For more information about bipolar disorder, here’s a list of all the bipolar articles on the HealthyPlace website. For bipolar support in your community,  contact your local chapters of the Depression and Bipolar Support Alliance and National Alliance on Mental Illness.

article references