Bipolar Depression: Key Signs, Symptoms and Pre-Symptoms

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What Makes Bipolar Depression Different?

Around 90 percent of people with bipolar disorder experience depression. All sorts of clusters and combinations of depression are possible but one thing that unites them all is the negative effect they have on activities, thinking and emotions. Many of the characteristic symptoms of depression, such as disinterest, fatigue, irritability, anxiety and changes in diet and sleep patterns are exactly the same for people with bipolar disorder. However, those who experience bipolar depression not only contend with these symptoms, but they often have a pattern of ‘atypical depression’. Atypical means unusual or abnormal, so for example, a person with bipolar depression may want to sleep a lot, eat a lot and may feel flat and sluggish, whereas someone with depression may have insomnia, a loss of appetite and feel sad and tearful.

More Features of Bipolar Depression

Some people experience psychotic symptoms during this type of depression. Although hallucinations can occur, more common symptoms involve psychotic delusions. These delusions typically involve guilt and/or paranoia. For example, a person may believe they have been involved in some terrible crime, or are being sought by the police, or some other agency.

One of the more unusual aspects of bipolar depression is a feature called mixed depression. In mixed depression the person experiences some of the symptoms of major depression at the same time as some of the symptoms of mania. This may appear counter-intuitive but symptoms can reveal themselves, for example, in rapid mood swings, less need for sleep, but with feelings of guilt and suicidal thoughts. It is not uncommon for people who are depressed to have manic symptoms like racing thoughts.

Likewise, during a manic episode, isolated moments of depression and suicidal thoughts may appear. People who experience mixed states are considered more vulnerable to the psychotic symptoms previously mentioned.

Watch out for Prodromes

The experience of bipolar depression varies from person. Some may experience a full major depressive episode lasting a minimum of weeks, whilst others cope with milder symptoms, but which last for years. Whilst depression can hit a person rapidly and out of the blue it often slowly develops and eventually takes hold. Very early signs of signs of depression are known as ‘prodromes’, as they precede the formal symptoms. The useful thing about these prodromes is they act as warning signs and can help you identify that your mood is starting to change. It isn’t always easy identifying pre-symptomatic changes but, like depression itself, they affect thoughts, behavior and emotions. Examples might be that you find yourself canceling social activities, or you feel more tired and irritable than usual. Perhaps comments made by others make you feel more sensitive? Getting to know your prodromes can take time and effort, but sometimes others see things in you that you can’t see yourself.

Key Point Summary

  • Most people with bipolar disorder get depressed
  • Bipolar depression is different because it can cluster with other symptoms which include those of hypomania or mania
  • The symptoms of bipolar depression may be ‘atypical’, that is, they differ in form to those of unipolar (depression only) symptoms
  • Symptoms of depression may occur quickly or may occur more gradually. In some cases it is possible to monitor your mood by careful observation of pre-symptom changes or prodromes.


Berk Lesley, Berk Michael, et al. Living With Bipolar Disorder. Vermilion (2009)

Sachs Gary & Thase Michael. Bipolar Disorder a systematic approach to treatment. Martin Dunitz (2000)