Bipolar depression includes a complex array of symptoms - far more than just "feeling sad" or "feeling bad." While no one experiences all the symptoms of depression together, even a mild depressive episode of bipolar disorder will include enough of them to have an impact on life almost every day.
In another article, Red Flags II - Warning Signs of Depressive Episodes, we grouped the symptoms of bipolar depression into six areas. In this article, we explore the first group in more detail.
Bipolar Depression Symptoms: Changes in Activity or Energy LevelsMost of these symptoms are fairly easy for a patient or others to notice. Examples of each are given to help you or family, friends and others to recognize when loss of energy and decreased activity may signal the onset or presence of a bipolar depressive episode.
- Decreased Energy - Nothing mysterious here; it is as simple as consistently not having as much get-up-and-go as you had last week or last month. A month ago, you still felt good enough after work most nights to go out to a movie or to dinner. Now, you run out of steam every day at 4 p.m. Family members, friends or coworkers may notice that you are flagging earlier in the day or that you are choosing, for example, to read rather than exercise in the evenings.
- Fatigue - This is the next stage after decreased energy. Depression can cause physical fatigue. Sleep becomes unrefreshing, so that you are tired even when you get up in the morning. You feel tired during the day. You may perk up at some point, but the moment you get home you feel as if you've been run over by a train. You don't know why you are so tired, either. Family members/friends see you yawning, hear you saying how tired you are, notice that your posture is slumping or that you're stretching during the day. They hear you sighing and notice that you are working more slowly and hesitantly.
- Lethargy - Lethargy is a more serious symptom. It is defined as "abnormal drowsiness or stupor; a torpid, apathetic state." In terms of depression, both of these definitions can apply. Someone in a depressive episode may be unusually drowsy. Or a person can be what is more commonly thought of as lethargic - spending hours just sitting in a chair. The person may not be in a totally unresponsive, catatonic state, but is simply uninterested in doing anything, and feeling physically and mentally heavy.
This symptom is one that would interfere with your normal daily responsibilities, so your loved ones, friends or coworkers would be able to identify it with little difficulty, as should you.
- Diminished Activity - This may be a result of decreased energy, fatigue and lethargy, or it may occur independently of those symptoms. In either circumstance, you and those around you should notice if your level of activity begins to drop - for example, if you normally do the laundry and simply begin to leave it undone or if you go to a diet group three times a week and then just stop going.
- Insomnia or Hypersomnia - Insomnia means having trouble sleeping. It's a common symptom of depression: lying awake worrying, unable to get comfortable, feeling tense or just having your mind race. Hypersomnia is just the opposite: sleeping too much. People in depressive episodes have been known to sleep more than 20 hours a day.
Insomnia may or may not affect your daily routine. Because many factors can cause insomnia, it may have to go on for a while or occur along with other symptoms for you to realize that it is a depressive symptom. Hypersomnia, on the other hand, stands out immediately and is a signal for a call to your psychiatrist.
- Loss of Interest in Pleasurable Activities - The name of this symptom describes it well. You normally love to go bowling but start turning down every invitation. Here are a couple of fictional examples: Mary's a fanatical gardener, but this spring she isn't out there with her trowel and plants the way she usually is. Rick has season tickets to the New York Mets baseball team, but he's been staying home. When you ask him why he missed the last game, he just shrugs and says, "I didn't feel like going." This symptom may be easier for others to spot than for the person who is going through it.
- Social Withdrawal - This symptom is easy to describe, but it may be hard to notice, depending on whether the bipolar person's personality between episodes is more outgoing or reserved, more "party animal" or more "quiet evening alone with a book." Someone who is naturally solitary may become more social during a manic or hypomanic episode, then withdraw too far during depression. But since this person is known for being something of a "loner," no one may realize that this time the withdrawal is more serious than usual.
Other changes in activity or energy not listed may also occur, but the ones above are those most commonly associated with bipolar depression.