It is critically important that people with bipolar disorder, their loved ones, friends and co-workers all be educated to recognize the signals of depressive episodes. Can you be certain that the episode will be mild? If not, being educated will help make sure you take appropriate action at the beginning of the episode, or urge your friend, loved one or co-worker to do so, and can then keep an eye on the progress of the episode.
In Red Flags II - Warning Signs of Depressive Episodes, Kimberly listed depressive symptoms in six groups. In this article and five more following, we will expand on the symptoms listed in each of those groups. We begin with the first group she listed, "Changes in Activity or Energy Level."
- Decreased Energy - Nothing mysterious here; it is as simple as not having as much get-up-and-go as you had last week or last month - consistently. 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 4:00 p.m. Family members, friends or coworkers may notice that you are flagging earlier in the day than before, 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 during your work day, 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; 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, not in a totally unresponsive, catatonic state, but simply uninterested in doing anything, 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 racing (a sign of a mixed depressive episode). 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 awhile or occur in conjunction 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 an emergency 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. Mary's a fanatic gardener but this spring isn't out there with her trowel and plants the way she usually is. Rick has season tickets to the Mets but has been staying home, and 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.
Related Reading:
- Red Flags II - Top 6 Warning Signs of Bipolar Depression
- Symptoms of Bipolar Depression: Part 2 - Physical Changes
- Symptoms of Bipolar Depression: Part 3 - Emotional Pain
- Symptoms of Bipolar Depression: Part 4 - Difficult Moods
- Symptoms of Bipolar Depression: Part 5 - Changes in Thought Patterns
- Symptoms of Bipolar Depression: Part 6 - Preoccupation with Death
