page_title: Bipolar disorder
section_title: Depressive episodes
hierarchical_section_title: Bipolar disorder / Signs and symptoms / Depressive episodes
caption_attribution_description: 'Melancholy' by W. Bagg after a photograph by H. W. Diamond Wellcome Images Keywords: Psychiatry; W. Bagg; Hugh Welch Diamond
context_page_description: Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and abnormally elevated moods. If the elevated mood is severe or associated with psychosis, it is called mania; if it is less severe, it is called hypomania. During mania, an individual behaves or feels abnormally energetic, happy, or irritable. Individuals often make impulsive decisions with little regard for the consequences. There is usually a reduced need for sleep during manic phases. During periods of depression, individuals may experience crying, a negative outlook on life, and poor eye contact with others. The risk of suicide is high; over a period of 20 years 6% of people died by suicide, while 30–40% engaged in self-harm. Other mental health issues, such as anxiety disorders and substance use disorders, are commonly associated with bipolar disorder.
  While the causes of bipolar disorder are not clearly understood, both environmental and genetic factors are thought to play a role. Many genes, each with small effects, may contribute to the development of disorder. Genetic factors account for about 70–90% of the risk of developing bipolar disorder.
context_section_description: Symptoms of the depressive phase of bipolar disorder include persistent feelings of sadness, irritability or anger, loss of interest in previously enjoyed activities, excessive or inappropriate guilt, hopelessness, sleeping too much or not enough, changes in appetite and/or weight, fatigue, problems concentrating, self-loathing or feelings of worthlessness, and thoughts of death or suicide. Although the DSM-5 criteria for diagnosing unipolar and bipolar episodes are the same, some clinical features are more common in the latter, including increased sleep, sudden onset and resolution of symptoms, significant weight gain or loss, and severe episodes after childbirth.
  The earlier the age of onset, the more likely the first few episodes are to be depressive. For most people with bipolar types 1 and 2, the depressive episodes are much longer than the manic or hypomanic episodes. Since a diagnosis of bipolar disorder requires a manic or hypomanic episode, many affected individuals are initially misdiagnosed as having major depression and incorrectly treated with prescribed antidepressants.
caption: 'Melancholy' by William Bagg, after a photograph by Hugh Welch Diamond
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