A depressive episode in bipolar disorder (occurring in both bipolar 1 and bipolar 2) is a period of intense sadness, hopelessness, and loss of interest in activities that a person typically enjoys. It is one of the two main mood states that people with bipolar disorder experience, the other being manic or hypomanic episodes.
During a depressive episode, a person may experience:
- Intense sadness and despair: They may feel hopeless, worthless, and overwhelmed by negative emotions.
- Loss of interest in activities: They may lose interest in activities that they typically enjoy, including hobbies, socializing, and spending time with loved ones.
- Fatigue and loss of energy: They may feel tired all the time, even after getting enough sleep, and may struggle with everyday tasks.
- Changes in appetite and sleep: They may experience changes in appetite and sleep patterns, including overeating or loss of appetite, and insomnia or oversleeping.
- Difficulty concentrating: They may have difficulty concentrating, making decisions, and remembering things.
- Thoughts of self-harm or suicide: They may experience thoughts of self-harm or suicide, and may even make plans to harm themselves.
A depressive episode can be a very difficult and distressing experience for individuals experiencing it and for those around them. It’s important to seek professional help from a mental health provider if you or someone you know is experiencing symptoms of depression or bipolar disorder.
The DSM-5 Criteria for a Depressive Episode
According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition), a depressive episode is characterized by the presence of five or more of the following symptoms for at least two weeks, and represent a change from previous functioning. One of the symptoms must be either depressed mood or loss of interest or pleasure in activities:
- Depressed mood most of the day, nearly every day
- Markedly diminished interest or pleasure in nearly all activities most of the day, nearly every day
- Significant weight loss or gain, or significant decrease or increase in appetite
- Insomnia or hypersomnia nearly every day
- Psychomotor agitation or retardation nearly every day
- Fatigue or loss of energy nearly every day
- Feelings of worthlessness or excessive or inappropriate guilt
- Diminished ability to think or concentrate, or indecisiveness nearly every day
- Recurrent thoughts of death, recurrent suicidal ideation, or a suicide attempt or a specific plan for committing suicide
These symptoms must cause clinically significant distress or impairment in social, occupational, or other areas of functioning, and cannot be due to a medical condition or substance use.