What should you know about manic bipolar depression?

In bipolar disorder, a depressive episode can include low mood, loss of pleasure, slowed thinking, fatigue, changes in appetite or sleep and reduced concentration. A manic episode is a distinct period of elevated or irritable mood with increased drive, faster speech, racing ideas, reduced need for sleep and impaired judgement. The shift may be noticed first by family or colleagues. The label does not describe ordinary moodiness, and a diagnosis requires a careful clinical history. Depression can also occur without mania, so a person should not self-diagnose from a single symptom. Insomnia, Daytime Sleepiness and Difficulty Concentrating may appear around mood episodes but can have other explanations.

Record daily sleep, mood, activity, speech, spending and medication use. Bring the record and, if you agree, a trusted person’s observations to an appointment. Protect sleep by keeping regular waking times and limiting alcohol or stimulant use. During a high-energy period, pause major financial, driving or relationship decisions and ask someone you trust to help review them. Continue prescribed treatment as directed and discuss side effects rather than making changes alone. A clinician may screen for Fatigue and Feeling Anxious as well as physical causes.

Get urgent help for suicidal thoughts, self-harm, dangerous impulsivity, inability to care for basic needs, hallucinations, severe confusion or rapidly worsening agitation. Several nights of very little sleep with escalating energy or risky behaviour also calls for urgent assessment. In an immediate emergency, contact local emergency services; do not leave someone at imminent risk alone if you can remain safely present.

Useful questions include: What features distinguish bipolar depression from unipolar depression? What is my personal early-warning pattern? Which sleep changes should prompt a call? How should medicines be handled if I feel unusually energised? Who should be included in my safety plan?