Recently I have spoken a lot about mania and mixed episodes, referring most of my depression related segments to Major Depressive Disorder. In this post I outline the similarities and differences between Bipolar Depression and Major Depressive Disorder, and tips and tricks to dealing with it.
Major Depressive Disorder vs Bipolar Depression
For the most part Bipolar depression and MDD have the same set of symptoms, and Bipolar Disorder is often misdiagnosed as MDD due to this fact. These symptoms include the following
- Decreased brain functioning in depression leads to a difficulty in concentrating, making decisions and focusing and completing everyday tasks.
- Fatigue and feeling decreases in energy, you feel sluggish and heavy, it becomes difficult to move
- Feelings of guilt, worthlessness, helplessness and despair that are often unwarranted, that is they have no logical place or trigger.
- Feelings of hopelessness and pessimism, the world feels so dark around you.
- Insomnia or excessive sleeping is another symptom of the decrease in brain functioning. In depression the sleep cycle is reversed and the quality of sleep is dramatically reduced leading to a decrease in energy and an increased need to sleep.
- Irritability and restlessness, known as agitated depression where you feel snappy at everything and unable to relax or calm your mind down.
- Anhedonia, a loss of interest in activities including sex, this is horrible to experience as you try to do things you once enjoyed to feel better and it doesn’t work, the whole thing feels hopeless
- Changes to appetite, overeating or appetite loss is caused by the shift in brain functioning and the brains craving for endorphins released during eating.
- Persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment. Depression can cause physical ailments as well as mental ones.
- Persistent sad, anxious and “empty” feelings of loneliness are common in depression despite being surrounded by loved ones
- Thoughts of suicide, suicide.
However Bipolar depression differs to major depression, it is often preceded by a manic episode meaning the crash feels significantly increased. Crashing from neutral is hard enough, crashing from euphoria is devastating. The initial stages of Bipolar depression are often more physical, tired, sleep disturbances, appetite changes, than emotional, crying, loneliness etc. Bipolar depression is also treated differently to major depression which is treated with antidepressants. Typically for Bipolar depression the standard treatment is a mood stabiliser which may supplement an antidepressant in cases of persistent depression. Antidepressants alone in Bipolar patients are known to trigger manic episodes.
Choosing to go on medication should not be taken lightly, there are significant costs and side effects to consider when starting any new medication. However medication can be an exceptionally useful tool in managing Bipolar depression when the time calls for it.
Is medication right for me?
Please note here that I am not a doctor and cannot offer any medical advice. However personally I would say if you have tried everything and cannot shift your depression or you feel hopeless or suicidal that you should seek professional help, who may or may not recommend medication to you.
Without further ado here are a few ways you can manage Bipolar depression.
Sleep is tricky in depression, we can sleep too much making us irritable and feeling as if we have wasted the day, or we can under sleep and feel lethargic all day making functioning impossible. Sleep is an important factor in overcoming depression however in agitated depression can onset heightened irritability in bipolar patients or even lead to a mixed episode. The key is to find the correct balance for you, for me this is between six and nine hours a night. Any less and I am too tired, if I wake up before this I will try to fall back to sleep. If I can’t then I will at least rest. Any more than this and I feel irritable and agitated.
Another key factor in recovery is nutrition, your brain requires a certain amount of vitamins and minerals to function properly and this need is intensified in depression. B vitamins play a specifically important role in recovery from depression and are exceptionally difficult to get in the right quantities in your diet. It is also difficult to eat well in depression, a lack of eating at all is common and in cases of an increased appetite the nutritional value of the food is often poor. Your body needs carbohydrates for energy, proteins to heal and vitamins and minerals to function properly. For this reason I recommend taking a vitamin supplement in depression to help your body get what it needs.
Secondly to your physical meds are your social ones, depression makes us feel lonely and unable to socialise however if we are able to successfully force ourselves out forma little bit, we often feel better and less alone. It is important to get out when you can, I would recommend short simple tasks such as getting a coffee, these have little pressure and will not take so long as to drain your energy levels.
In order to gain the most benefit from your socialising it is important to properly communicate your mental health needs. See my post on the topic here.
Support from loved ones is great but in times of serious need may not be enough, especially if they are not supportive or understanding enough. In these cases it may be time to seek out the support from a therapist or councillor who can help you work through your emotions and work towards recovery. This can be costly and finding the right therapist can take time but the benefits are worth it if you can.
It is so much easier to recover if you accept that you are in depression and stop beating yourself up about it, denying it, expecting too much from yourself, etc. You are depressed, that is okay, and it is not your fault you did not ask for it. You cannot achieve what you normally can, but this is not you and is temporary, it will pass as soon as you accept it and work towards your recovery.
It can be so tempting to turn to alcohol to make you feel better when you are low, however alcohol is a depressant and should be avoided at all costs in depression as you will crash and feel so much worse than before you drank. You also risk becoming dependant on alcohol to manage your depression which is not healthy.
Aside from proper nutrition Vitamin D requires time spent in the sun. I recommend getting outside every day for at least 20 minutes to benefit from the effects of vitamin d as this boosts endorphins and combats depression. A quick walk at lunch time is all it takes.
Another way to boost endorphin levels in the brain is exercise. Studies show 20 minutes+ of cardio is the most beneficial for bipolar patients however I personally find I feel much more energised and accomplished after a weights session, I always have. The most important thing with exercise is to find something you enjoy enough to keep doing it.
Depression reduces your ability to function and this can be incredibly frustrating as your ability to achieve things is dramatically reduced. To combat the associated low self-esteem that comes with this lack of accomplishment is to set yourself small, manageable goals. Nothing too much, but something like workout three times this week, eat every day at least once, can help you make positive steps and help you feel better about doing so.
Challenge negative thinking
Depression makes us talk to ourselves in such a horrible manner, in ways we would never speak to others. These negative thoughts tell us we are useless, it is hopeless, pointless. It is so important to challenge and talk back to these feelings. See my post on the topic here.
All of these are natural ways to lift the symptoms and slowly overcome depression, however as with any recovery it takes time and persistence to feel the benefits of your actions. It is beneficial to build habits to include these in to your routine as best as you can allow for to ensure you look after your depression and recover as quickly as possible.