Breaking Down Syptoms of Bipolar Disorder: DepressionDepression is a term that the vast majority of people are familiar with. That’s probably because around 10% of the population suffers from depression at any given time. It’s not something we can just “snap out of.” It’s an illness. The Diagnostic and Statistical Manual of Mental Disorders(or DSM-5) gives us a list of symptoms, but what do they really mean? The experience is different for each person, but here is what it feels like for me.

In order to qualify as a depressive episode for bipolar disorder, five of the symptoms must be present for at least two weeks. It cannot be due to another physical illness or related to substance use (medication/alcohol/recreational drugs). If it’s triggered by a situation like bereavement, it’s up to a mental health professional to make the call as to whether it’s due to a mental illness or the natural process.

1 Depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others. (Note: In children and adolescents, can be irritable mood.)
It’s an empty feeling, almost like your body is hollow and the tissue, organs and life blood that used to make up “you” are gone but you don’t know how to find them or even where to start looking. Some of us are really good at hiding it from others. We have a lot of practice.

2 Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
“I don’t feel like it.” I have no interest in going out. If I try to do something I normally enjoy, there is no joy. All I want to do is curl up in a ball and try to be nothing. When you are nothing, you feel nothing, right?

3 Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
You have no interest in food or the idea of eating. That is, unless you want to eat everything just to see if you can get some pleasure out of it.

4 Insomnia or hypersomnia nearly every day.
Insomnia: you repeatedly can’t sleep even though you want it or need it. Hypersomnia: All you want to do is sleep:

“For in dreams we enter a world that is entirely our own. Let them swim in the deepest ocean or glide over the highest cloud.” -J.K. Rowling

5 Psychomotor agitation or retardation nearly every day (observable by others; not merely subjective feelings of restlessness or being slowed down).
When you’re agitated, you can’t stop moving. You pace; you move your hands and feet. I tend to hold my hand to my neck almost like I’m choking myself without noticing. Other times you find it hard to move at all, like you have a lead blanket draped over your body.

6 Fatigue or loss of energy nearly every day.
It’s like feeling you never had energy to begin with. Everything takes more than twice the effort that it normally does. Who knew that brushing your teeth could make you feel like you just ran a marathon?

7 Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
Depression tells you that you don’t deserve the space you’re taking up. You don’t understand why anyone would want to have anything to do with you. You feel guilty for existing at all.

8 Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
There’s a fog in your brain so that it takes too much energy to navigate towards normal, rational thought. Occasionally a light pops up that makes you think you’ve found a way out, but it turns out to be merely a distraction.

9 Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
Suicide is a selfish act. At least some people think so. But really, it’s not about selfishness when you truly think people are better off without you. I think more commonly it’s just a desperate desire for the pain to stop. Death itself provokes no fear.

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Photo credit: Bill Strain

Primary source: American Psychiatric Publication (2016-02-13). Diagnostic and Statistical Manual of Mental Disorders (DSM-5(tm)): American Psychiatric Pub; 5 edition). American Psychiatric Pub; 5 edition.