Most depressed people need antidepressant medications to treat their depression. However, less than 10% of people with depression are treated adequately with medication. Antidepressants can improve or completely relieve the symptoms of depression. Several medication options are available to treat depression, depending on your age and tolerance of the medications.

Medication Choices

Antidepressant medications used to treat depression include:

• Selective serotonin reuptake inhibitors (SSRIs).
• Tricyclic (TCAs) and heterocyclic antidepressants.
• Monoamine oxidase inhibitors (MAOIs).

What to Think About

If you and your doctor decide that you need medication therapy, there are several considerations in choosing the right medication.

• Understand the side effects of the medication.
• Tell your doctor about all medications you are taking for other illnesses so the doctor can determine whether there are drug interactions.
• If you are an older person, you may need less medication, and it may take longer to be effective.
• Your health care professional will need to monitor your progress every two weeks until it can be determined whether a particular medication is working for you.
• It may take several trials of different medications before you and your doctor find the right medication to treat your depression.
• Once you have begun to feel better, you will need to continue taking your medication for a minimum of 16 to 36 weeks to help reduce the likelihood of another depressive episode.
• Some people need to remain on maintenance medication therapy for the remainder of their lives.

When deciding which medication to prescribe, your doctor will consider:

• Your response to medications in previous depressive episodes.
• Whether you have other illnesses that need to be treated, so you are not given a depression medication that will interact poorly with other medicines you may be taking.
• Which symptoms you are experiencing. Some antidepressants work better than others, depending on the person's symptoms.
• Your age and general state of physical health. Older adults and adults who are taking prescription medications usually need to take lower doses of medications for depression.
• How much the side effects of the medication bother you.

Up to 35% of people with depression do not continue taking their medications for depression. It is important to continue taking medications for your depression as prescribed, even after symptoms go away, to prevent recurrence of depression.

Antidepressant medications often need to be taken for as long as 4 to 6 weeks before they start to relieve the symptoms of depression. During this time, you may experience side effects of the medication. Do not stop taking the medication on your own. If your side effects are particularly bothersome, talk with your doctor to see if you should continue the medication or try another. Often, the side effects will go away in time. There are many things you can do to reduce the bothersome side effects of medications.

Most antidepressant medications need to be started at low doses and increased gradually, especially in older adults. Medications should also be stopped gradually by decreasing the dose. If antidepressant medications are stopped abruptly, you may suffer negative effects or the symptoms of depression may return.

Sometimes people on antidepressants need to be very careful when changing from a brand name medication to a generic medication (or vice versa), or when changing from one manufacturer of a medication to another. Making these changes may cause changes in the amount of medication their bodies absorb.

Older adults who are depressed and taking medications for other health conditions (not related to depression) need careful monitoring of their medications. Older adults are more likely to develop harmful side effects from taking many different medications (because it can be more difficult for the older person's body to break down all the different medications).

Introduction Research has enabled many men and women, and young people living with human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS), to lead fuller, more productive lives. As with other serious illnesses such as cancer, heart disease or stroke, however, HIV often can be accompanied by depression, an illness that can affect mind, mood, body and behavior. Treatment for depression helps people manage both diseases, thus enhancing survival and quality of life.

Despite the enormous advances in brain research in the past 20 years, depression often goes undiagnosed and untreated. Although as many as one in three persons with HIV may suffer from depression,1 the warning signs of depression are often misinterpreted. People with HIV, their families and friends, and even their physicians may assume that depressive symptoms are an inevitable reaction to being diagnosed with HIV. But depression is a separate illness that can and should be treated, even when a person is undergoing treatment for HIV or AIDS. Some of the symptoms of depression could be related to HIV, specific HIV-related disorders, or medication side effects. However, a skilled health professional will recognize the symptoms of depression and inquire about their duration and severity, diagnose the disorder, and suggest appropriate treatment.

Depression Facts Depression is a serious medical condition that affects thoughts, feelings, and the ability to function in everyday life. Depression can occur at any age. NIMH-sponsored studies estimate that 6 percent of 9- to 17-year-olds in the U.S. and almost 10 percent of American adults, or about 19 million people age 18 and older, experience some form of depression every year.2,3 Although available therapies alleviate symptoms in over 80 percent of those treated, less than half of people with depression get the help they need.3,4

Depression results from abnormal functioning of the brain. The causes of depression are currently a matter of intense research. An interaction between genetic predisposition and life history appear to determine a person's level of risk. Episodes of depression may then be triggered by stress, difficult life events, side effects of medications, or the effects of HIV on the brain. Whatever its origins, depression can limit the energy needed to keep focused on staying healthy, and research shows that it may accelerate HIV's progression to AIDS.5,6

HIV/AIDS Facts AIDS was first reported in the United States in 1981 and has since become a major worldwide epidemic. AIDS is caused by the human immunodeficiency virus (HIV). By killing or damaging cells of the body's immune system, HIV progressively destroys the body's ability to fight infections and certain cancers.

The term AIDS applies to the most advanced stages of HIV infection. More than 700,000 cases of AIDS have been reported in the United States since 1981, and as many as 900,000 Americans may be infected with HIV.7,8 The epidemic is growing most rapidly among women and minority populations.9

HIV is spread most commonly by having sex with an infected partner. HIV also is spread through contact with infected blood, which frequently occurs among injection drug users who share needles or syringes contaminated with blood from someone infected with the virus. Women with HIV can transmit the virus to their babies during pregnancy, birth, or breastfeeding. However, if the mother takes the drug AZT during pregnancy, she can reduce significantly the chances that her baby will be infected with HIV.

Many people do not develop any symptoms when they first become infected with HIV. Some people, however, have a flu-like illness within a month or two after exposure to the virus. More persistent or severe symptoms may not surface for a decade or more after HIV first enters the body in adults, or within two years in children born with HIV infection. This period of "asymptomatic" (without symptoms) infection is highly individual. During the asymptomatic period, however, the virus is actively multiplying, infecting, and killing cells of the immune system, and people are highly infectious.

As the immune system deteriorates, a variety of complications start to take over. For many people, their first sign of infection is large lymph nodes or "swollen glands" that may be enlarged for more than three months. Other symptoms often experienced months to years before the onset of AIDS include:

Lack of energy Weight loss Frequent fevers and sweats Persistent or frequent yeast infections (oral or vaginal) Persistent skin rashes or flaky skin Pelvic inflammatory disease in women that does not respond to treatment Short-term memory loss Many people are so debilitated by the symptoms of AIDS that they cannot hold steady employment or do household chores. Other people with AIDS may experience phases of intense life-threatening illness followed by phases in which they function normally.

Because early HIV infection often causes no symptoms, a doctor or other health care worker usually can diagnose it by testing a person's blood for the presence of antibodies (disease-fighting proteins) to HIV. HIV antibodies generally do not reach levels in the blood which the doctor can see until one to three months following infection, and it may take the antibodies as long as six months to be produced in quantities large enough to show up in standard blood tests. Therefore, people exposed to the virus should get an HIV test within this time period.

Over the past 10 years, researchers have developed antiretroviral drugs to fight both HIV infection and its associated infections and cancers. Currently available drugs do not cure people of HIV infection or AIDS, however, and they all have side effects that can be severe. Because no vaccine for HIV is available, the only way to prevent infection by the virus is to avoid behaviors that put a person at risk of infection, such as sharing needles and having unprotected sex.

Get Treatment for Depression While there are many different treatments for depression, they must be carefully chosen by a trained professional based on the circumstances of the person and family. Prescription antidepressant medications are generally well-tolerated and safe for people with HIV. There are, however, possible interactions among some of the medications and side effects that require careful monitoring. Specific types of psychotherapy, or "talk" therapy, also can relieve depression.

Some individuals with HIV attempt to treat their depression with herbal remedies. However, use of herbal supplements of any kind should be discussed with a physician before they are tried. Scientists recently discovered that St. John's wort, an herbal remedy sold over-the-counter and promoted as a treatment for mild depression, can have harmful interactions with other medications, including those prescribed for HIV. In particular, St. John's wort reduces blood levels of the protease inhibitor indinavir (Crixivan®) and probably the other protease inhibitor drugs as well. If taken together, the combination could allow the AIDS virus to rebound, perhaps in a drug-resistant form.

Treatment for depression in the context of HIV or AIDS should be managed by a mental health professional, for example, a psychiatrist, psychologist, or clinical social worker who is in close communication with the physician providing the HIV/AIDS treatment. This is especially important when antidepressant medication is prescribed so that potentially harmful drug interactions can be avoided. In some cases, a mental health professional that specializes in treating individuals with depression and co-occurring physical illnesses such as HIV/AIDS may be available. People with HIV/AIDS who develop depression, as well as people in treatment for depression who subsequently contract HIV, should make sure to tell any physician they visit about the full range of medications they are taking.

Recovery from depression takes time. Medications for depression can take several weeks to work and may need to be combined with ongoing psychotherapy. Not everyone responds to treatment in the same way. Prescriptions and dosing may need to be adjusted. No matter how advanced the HIV, however, the person does not have to suffer from depression. Treatment can be effective.

It takes more than access to good medical care for persons living with HIV to stay healthy. A positive outlook, determination and discipline are also required to deal with the stresses of avoiding high-risk behaviors, keeping up with the latest scientific advances, adhering to complicated medication regimens, reshuffling schedules for doctor visits, and grieving over the death of loved ones.

Other mental disorders, such as bipolar disorder (manic-depressive illness) and anxiety disorders, may occur in people with HIV or AIDS, and they too can be effectively treated. For more information about these and other mental illnesses, contact NIMH.

Remember, depression is a treatable disorder of the brain. Depression can be treated in addition to whatever other illnesses a person might have, including HIV. If you think you may be depressed or know someone who is, don't lose hope. Seek help for depression.

Bipolar II disorder symptoms are different from the symptoms of bipolar I. Most people assume that having bipolar disorder means episodes of mania followed by depression, but this isn't the case with bipolar II. Bipolar II disorder is marked by major depressive episodes that last for two weeks or more in addition to at least one hypomanic episode. Understanding the symptoms of bipolar II disorder is a crucial step toward accessing the right help and treatment, so it's important to be aware of the facts.

Bipolar II Disorder Symptoms: How Are They Different?

Bipolar II disorder symptoms are more varied than the symptoms of bipolar I. In-between episodes, many people with bipolar II disorder live normal and functional lives.

The main difference between bipolar I and bipolar II is that people with bipolar II don’t experience full-blown mania. Instead, their “up” periods manifest as hypomania – a milder form of mania that presents as either euphoria or irritability.

Common symptoms of hypomania include:

• Being unusually talkative and loud
• Hyperproductivity
• "Flying" from one idea to the next
• Exaggerated self-confidence
• Increased energy
• Decreased need for sleep

However, people experiencing hypomanic episodes may not experience all of these symptoms, and they are often extremely pleasant to be around. Hypomania can, however, lead to erratic and impulsive decision-making, including compulsive spending, promiscuity and other unhealthy behavior. What’s more, untreated hypomania can trigger full-blown mania, which has potentially dangerous consequences.

In bipolar II, depression can be just as severe as in bipolar I. The ratio of time spent in depression versus mania for those with bipolar II is 40:1. Not only are depressive episodes more frequent than hypomanic ones, but they also last longer. For this reason, depression is often considered the most debilitating part of this illness.

How to Treat Bipolar II Disorder Symptoms

Bipolar II disorder symptoms aren’t curable, but they can be treated. The difficulty lies in diagnosing bipolar II in the first place, as it is often misdiagnosed as regular depression. This is mainly because hypomanic episodes don’t draw much attention unless they’re causing unhealthy behavior.

If you are diagnosed with bipolar II disorder, your doctor may prescribe you medications to help stabilize your moods. These medications can help treat symptoms of depression while also limiting the negative effects of hypomania.

Mood stabilizers

Mood stabilizers, such as lithium, have been used for over 60 years to treat bipolar disorder. They are most effective when taken long-term, rather than in the treatment of an acute episode. Anti-seizure drugs like carbamazepine (Tegretol) can also be used to treat bipolar depression and prevent future episodes. Lamotrigine is especially helpful at preventing lows but can also help delay hypomanic episodes.

Antipsychotics and Antidepressants

Seroquel and Seroquel XR, which are antipsychotics, are the only FDA-approved medications specifically for the treatment of bipolar II depression.  Latuda, another antipsychotic medication, is also approved for bipolar depression.

Antidepressants are often prescribed alongside mood stabilizers to help patients prevent and manage episodes of depression. They are sometimes used in bipolar II depression. Other medications used to treat bipolar II may include other antipsychotics and benzodiazepines.

Therapy

Therapy alongside medication, specifically psychotherapy and cognitive-behavioral therapy (CBT), are often used to treat the emotional symptoms of bipolar II disorder.

Although bipolar II disorder symptoms cannot be cured, there are plenty of treatment options available – whether for help with specific episodes or on an ongoing basis. If you’re experiencing symptoms of bipolar II, such as hypomanic and major depressive episodes, it’s important to talk to your doctor. They will run tests to rule out other causes and refer you for a psychiatric assessment. Once it is diagnosed and treated, there is no reason why you cannot live a fulfilling and stable life with bipolar II disorder.

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The best medications for bipolar depression are those that decrease symptoms of depression without inducing a manic or hypomanic episode. These medications can improve depression while keeping moods stable. Non-pharmaceutical treatments for bipolar depression have the same goals in mind, but additionally, they help people deal with the challenges, frustrations, and limitations of the disorder while developing coping skills to live well despite episodes of bipolar depression.

Bipolar depression treatment is usually a long-term approach. Mood stabilization, symptom reduction, and the development of coping strategies is best done with a combination of medication and psychotherapy.

Medication and psychotherapy are the primary approaches to treat bipolar depression; however, other treatments exist that can augment medication and therapy. These include complementary treatments like light therapy, brain stimulation procedures, peer support, and lifestyle changes.

Given the importance of medication in treating bipolar depression, let’s look at some of the best medications, some which you or a loved one might be prescribed.

Best Medication for Bipolar Depression

Multiple types of medication are used to treat bipolar depression; however, five stand out as first-line treatments. This means that medications in these groups are the go-to medications when a doctor has diagnosed bipolar depression.

Quetiapine (Seroquel) is an atypical antipsychotic and one of the first medications approved by the Food and Drug Administration (FDA) to treat bipolar depression. It does carry the risk of quite a few side effects, the most common of which are:

• Increased triglycerides in the blood
• Increased diastolic blood pressure
• Tiredness
• Dry mouth

The top two side effects in combination with increased cholesterol and increased appetite, which are also common, can cause rapid weight gain and create secondary health problems. That said, not everyone will experience these side effects and keeping a close eye on weight and bloodwork can sometimes make these side effects manageable.

Olanzapine (Zyprexa) is an atypical antipsychotic that is FDA approved to treat bipolar depression. Olanzapine has proven success in reducing symptoms; unfortunately, this medication carries a risk of significant weight gain that can lead to type two diabetes and a dangerous health condition called metabolic syndrome. Sometimes, monitoring weight, eating healthy, and exercising can keep side effects to a minimum so you can continue to use olanzapine to reduce bipolar depression.

Cariprazine (Vraylar), is another atypical antipsychotic that can also be used to treat depression in bipolar disorder. Unlike the major metabolic concerns associated with quetiapine and olanzapine, with cariprazine, the main concern is involuntary movement disorders (extrapyramidal symptoms) with almost half of people taking the drug experiencing them. The most common specific side effects include:

• Parkinsonism (any condition that causes a combination of the movement abnormalities seen in Parkinson's disease, such as tremor, slow movement, impaired speech or muscle stiffness)
• Akathisia (a movement disorder characterized by a feeling of inner restlessness and a compelling need to be in constant motion, as well as by actions such as rocking while standing or sitting, lifting the feet as if marching on the spot, and crossing and uncrossing the legs while sitting)
• Headache

The olanzapine-fluoxetine combination known as Symbyax is also FDA approved to treat bipolar depression. Because this medication is a combination of an atypical antipsychotic and an antidepressant, the list of common side effects experienced is extensive. The more common side effects include:

• Bloating or swelling of the face, arms, hands, lower legs, or feet
• Body aches or pain
• Confusion
• Congestion
• Cough
• Delusions (beliefs in things that aren’t true in spite of evidence to the contrary)
• Dementia
• Dryness or soreness of the throat
• Fever
• Hoarseness; voice changes; trouble with swallowing
• Rapid weight gain
• Runny nose
• Shakiness in the legs, arms, hands, or feet
• Tender, swollen glands in the neck
• Tingling, trembling and/or shaking of the hands or feet
• Unusual weight gain or loss

While that list can seem daunting, it’s important to remember that an individual will typically only experience a subset of the above and the severity can range from mild to severe ("List of Bipolar Depression Medications and Their Side-Effects").

Lurasidone (Latuda) is one of the newer atypical antipsychotics approved to treat bipolar depression by the FDA. While it does have a number of adverse effects surrounding involuntary movement, these appear to be dose-related. In other words, if the following side effects are an issue, they may be relieved by decreasing the dose of lurasidone:

• Tiredness
• Akathisia
• Extrapyramidal disorder
• Parkinsonism
• Fasting glucose increased
• Nausea
• Insomnia

To be sure, there are other medications and a great many medication combinations that can be prescribed to help treat and prevent bipolar depression that are outside of the FDA approved list. Mood stabilizers, anticonvulsants, and antipsychotics are common starting categories, but each person is different and what works for one person may not work for the next. There is usually a period of trial-and-error as you and your doctor work together to discover what medications are best for you. Further, the body responds differently to medication over time, so adjustments in dose or types are often made as treatment continues.

Overall, medication is the best treatment for bipolar depression because medication works on the brain to meet the disorder at its source. Medication alone, though, is usually insufficient in thoroughly treating bipolar depression. Psychotherapy is extremely helpful in bipolar disorder treatment.

Best Treatment for Bipolar Depression: Therapy

While medication works at the neurological level to ease mood swings and depression symptoms, therapy allows you to process the frustrations of living with bipolar depression and to develop tools and coping skills to move forward.

Some of the helpful aspects of therapy include:

• Identifying negative thought patterns and replacing them with more positive ones
• Learning stress management skills
• Discovering your personal values and goals
• Creating a treatment plan to follow when depression strikes
• Learning how to chart your symptoms, mood, stress, and healthy lifestyle habits
• Learning depression-fighting techniques like mindfulness, deep breathing, and progressive muscle relaxation

Bipolar depression makes life seem grim and hopeless. Working with a therapist can help you recover hope and create a life of purpose and meaning.

Living with bipolar depression is difficult, but you don’t have to remain stuck in its trap. Bipolar depression medication helps you reclaim your brain, and therapy helps you reclaim your life.

Additional Resources

1. Drugs.com, Symbyax Side Effects. Jan. 26, 2019. https://www.drugs.com/sfx/symbyax-side-effects.html
2. Matsumoto, J. MD, Parkinsonism: Causes and Coping Strategies. Mayo Clinic. April 23, 2019. https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/expert-answers/parkinsonism/faq-20058490
3. Medscape, Cariprazine. Accessed June 14, 2019. https://reference.medscape.com/drug/vraylar-cariprazine-999874#4
4. Medscape, Lurasidone. Accessed June 14, 2019. https://reference.medscape.com/drug/latuda-lurasidone-999605#4
5. Medscape, Quetiapine. Accessed June 14, 2019. https://reference.medscape.com/drug/seroquel-xr-quetiapine-342984#4
6. Shiel, W. MD, FACP, FACR, Medical Definition of Akathisia. MedicineNet. Accessed June 14, 2019. https://www.medicinenet.com/script/main/art.asp?articlekey=33264
7. Soreff, S., Bipolar Disorder Treatment and Management. Medscape. May 30, 2019. https://emedicine.medscape.com/article/286342-treatment#showall

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The term “bipolar relationships” is often thrown around to describe partners that blow hot and cold with each other or who are always in conflict. In reality, being in a relationship with someone who has bipolar disorder is a lot more complicated than this. Many people with bipolar can and do have successful, fulfilling relationships, but more often than not, the illness presents some problems in their romantic lives. So, what is the impact of bipolar on relationships, and are there ways to avoid the common challenges?

Bipolar in Relationships: What Are the Challenges?

Bipolar relationships can be problematic for many reasons. While no relationship is easy, having a mental health condition can significantly add to the typical challenges of a partnership and test even the strongest of bonds.

These are some of the main challenges of bipolar relationships:

Emotional highs and lows

Bipolar symptoms and behaviors are often unpredictable, and not all episodes follow a specific pattern. This makes it difficult for the partner of someone with bipolar to know where they stand. Symptoms of mania can even be frightening to witness, and it's normal to feel worried about a person's safety if they're acting impulsively or don't seem like themselves.

If your partner exhibits this kind of behavior, you may also feel detached, confused, and like you can't keep up. When bipolar swings the other way, symptoms of depression are also worrying to witness – especially if your partner talks about suicide. Hearing your partner talk this way can be upsetting, but try to remember that it's not personal – it is a symptom of bipolar disorder that requires treatment.

If you're worried that your partner may harm themselves, you should contact the National Suicide Prevention Lifeline (1-800-273-8255) or dial the emergency services right away.

Irritability and anger

There is a misconception that people in mania are always fun and exciting to be around. However, anger and extreme irritability are also symptomatic of mania, and they can be especially challenging to live with.

Unsurprisingly, abrupt mood changes can lead to communication problems with your partner, so it's important to make yourself aware of their triggers and try to avoid conflict during an episode.

Destructive behavior

Destructive or impulsive behavior is one of the hallmark symptoms of bipolar mania, and it often causes problems in romantic relationships. Examples include abusing alcohol and/or drugs, excessive spending, gambling and engaging in risky sex ("Bipolar Disorder and Infidelity: Why It Happens"). These behaviors, with or without bipolar, would cause strain and conflict in most long-term relationships.

Bipolar Effects on Relationships: Finding Solutions

The effects of bipolar on a relationship are complex and far-reaching, so there is no catch-all solution. What’s more, not everyone with bipolar disorder exhibits the same symptoms. While some people struggle to hold down long-term relationships, others navigate romance and intimacy with few problems – or else they find the challenges posed by mental illness help to bring them and their partner closer together.

If you have bipolar disorder, you may be worried about telling your partner or entering into a new relationship. Alternatively, if you have a long-term partner, you may be concerned that your mental illness will eventually cause the relationship to end.

It’s important to remember that relationships end for a number of complex reasons, and mental health is only part of the picture. The best course of action you can take with any of these scenarios is to be open, honest and self-aware.

What to Do If You Have Bipolar In a Relationship

Having bipolar in a relationship isn’t easy, but helping your partner understand what it’s like to live with the condition can be beneficial.

Honesty is important in this scenario, so be clear about your limitations when mania/hypomania or depression strikes and tell your partner what to expect. You should also stick to your treatment plan and try to involve your partner in your care whenever possible.

Seeing a relationship counselor can help you work through some of the challenges caused by bipolar in relationships, but if your partner doesn't support you, then you may need to accept that the relationship isn't going to work.

What to Do If Your Partner Has Bipolar Disorder

If you find out you're in a relationship with someone who has bipolar disorder, the first thing you should do is educate yourself. Firstly, learn everything you can about the condition so that you know what your partner is dealing with and how it might affect your relationship. Secondly, be sure to ask about your partner's personal experience, and don't assume to know what they're going through just because you've done your research.

Going forward, patience, support and open communication are the pillars of any successful relationship. Mental illness can take its toll on the loved ones of those affected, so it’s important to have your own support network in place for when bipolar causes strain in your relationship.

See Also

• Signs the Man You’re Dating Has Bipolar Disorder
• How Bipolar Disorder Symptoms Affect Women Uniquely

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Bipolar I disorder symptoms are different for everyone, and they can affect people in various ways. Because the condition is traditionally known as "manic depression," many people think they have a good idea of what bipolar I disorder looks like. However, there is a full spectrum of bipolar I symptoms, and each person has their own unique experience of living with the disorder. Being bipolar doesn't always mean swinging from one mood to the next – in reality, bipolar I disorder symptoms are much more complex. Let's take a closer look at what it's like to have bipolar I.

Bipolar Disorder I Disorder Symptoms: The Basics

Bipolar I disorder symptoms can be severe and life-altering. This is why bipolar I is considered to be the sixth leading cause of disability worldwide ("Is Bipolar Disorder a Disability? Can I Get Benefits?"). It also has a relapsing and remitting course, meaning most people experience cycles of manic and depressive episodes that occur throughout their lives. The tell-tale symptoms of bipolar I are as follows.

Manic episodes (mania)
 
A manic episode is a period of extremely high energy and elevated mood, accompanied by abnormal or impulsive behavior that disrupts life.

Common symptoms of mania include:

• Fast, uncontrolled speech and hyperactivity
• Grandiose ideas or feelings of extreme self-importance (“It’s up to me to save the world. This is my destiny.”)
• Making lots of plans that don’t come to fruition
• Compulsive spending
• Reckless behavior, such as drink-driving
• Substance abuse
• Hypersexuality
• Not needing as much sleep as usual, typically less than four hours per night
• Feeling agitated and restless

Depressive episodes (major depression)

Most people with bipolar I disorder symptoms also experience periods of major depression that last for two weeks or more.

Bipolar depression is characterized by:

• Feelings of low self-worth
• Guilt
• Hopelessness
• Lack of interest and pleasure in activities once enjoyed
• Sleeping too much or too little
• Appetite changes
• Suicidal thoughts and feelings

Why Bipolar I Symptoms Are Not the Same for Everyone

To be diagnosed with bipolar I disorder, you only need to have experienced one manic episode in your life. While this technically means you could be diagnosed with bipolar disorder and only ever experience one manic episode, most people who have one episode of mania go on to have more. The average number of episodes someone with bipolar I will have in a lifetime is nine. Some people experience rapid cycling – with four or more depressive or manic episodes per year.

Because of the differing regularity in which bipolar I disorder symptoms occur, they will look and feel different for everyone. You may also have particular triggers, such as stress, grief or lack of sleep, which are different from another person’s. Like other mental health conditions, bipolar disorder exists on a scale or spectrum, and you do not necessarily need to have all of the symptoms to fit the diagnostic criteria. Your experience of bipolar I disorder symptoms will be different from someone else's, simply because your genetic make-up and environment are different.

However, the signs and symptoms of bipolar I disorder are more marked than in bipolar II or cyclothymic disorder. To be given a bipolar I diagnosis,  you must have experienced full-blown mania at least once; to the point where it disrupted your life. The term given to a manic episode that does not meet the criteria for full mania is "hypomania," which is characteristic of bipolar type II. Cyclothymic disorder – or cyclothymia – is where you experience regular swings that alternate between hypomania and depression, where neither episode meets the full criteria for bipolar I or II.

If you experience symptoms of bipolar I, bipolar II or cyclothymic disorder, it’s important to consult your doctor so you can be directed to the right course of treatment.

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Managing bipolar depression symptoms and treatment is always a challenge. However, some bipolar depression symptoms are more dangerous and require immediate treatment. That’s what this article focuses on.

Bipolar depression symptoms are different from regular depression symptoms. When someone is depressed, they usually experience fatigue, low self-esteem, feelings of hopelessness and a number of other physical and emotional challenges. Regular depressive episodes are often described as "unipolar," meaning they are not accompanied by "up" periods. When depression occurs in bipolar disorder, it also includes symptoms of hypomania or mania.

There are different types of bipolar disorder, and symptoms tend to vary from person to person. However, bipolar depression symptoms can be severe, and left untreated they can have a significant impact on social and occupational functioning. It's important to understand these dangers if you or someone you love has bipolar disorder. So let’s take a look at bipolar depression symptoms and treatment and see which symptoms are most dangerous.

Bipolar Depression Symptoms: How Do They Vary?

Bipolar depression symptoms exist on a sliding scale, and there are three main types of bipolar disorder. It's important to know the difference, as treatment may vary depending on your diagnosis.

Bipolar I disorder: Bipolar I is characterized by symptoms of depression accompanied by at least one episode of full mania. Manic symptoms include restlessness, poor sleep, euphoria and impulsive behaviors such as substance abuse, reckless spending or hypersexuality.

Bipolar II disorder: For a person to be diagnosed with bipolar II, they must have experienced at least one major depressive episode lasting two weeks or more, and a minimum of one hypomanic episode. Hypomania is usually described as a lesser version of mania and is not usually considered dangerous. Depressive episodes, on the other hand, can be severe. Studies show that depression symptoms outweigh hypomanic symptoms by about 35 to one in people with bipolar II disorder.

Cyclothymic disorder: Cyclothymia is a chronic and fluctuating mood disturbance in which neither depressive episodes or hypomanic episodes meet the full criteria of bipolar disorder.

Although no type of mental illness is better or worse than another, people with bipolar type I tend to experience more pronounced manic episodes, while those with bipolar type II are more prone to major depression. Those with cyclothymia usually experience both depression and hypomania to a lesser degree than those with bipolar I or II.

Dangerous Bipolar Depression Symptoms and Their Treatment

Certain bipolar depression symptoms can wreak havoc on your life. The most dangerous bipolar depression symptoms include:

• Substance abuse: Some studies indicate that around 60% of people with bipolar disorder also abuse drugs or alcohol.
• Periods of anger and bipolar depression: Aggressive or irate behavior can be a symptom of bipolar depression. This can lead to violence if left untreated.
• Impulsive behavior: People with bipolar disorder can act impulsively during periods of mania/hypomania and depression. This can lead to poor decision-making, compulsive spending or hypersexuality.
• Eating too much or too little: Eating disorders are most common in teenagers and young adults with bipolar disorder.
• Suicidal thoughts and actions: Suicidal behavior is perhaps the most dangerous symptom of bipolar depression, occurring in around one-quarter of people with the disorder. Long-term treatment can reduce the likelihood of suicidal thoughts and actions in people with bipolar disorder, and there are specific drugs that can be taken to tackle depressive symptoms during an episode.

How to Treat Bipolar Depression Symptoms

Treatment for bipolar depression symptoms varies from person to person. If your doctor decides that medication is your best option, an antidepressant may be prescribed. If chronic, fluctuating moods disrupt your life, you may also be given a mood stabilizer. These two types of medication are often taken together.

Psychological treatments, such as therapy, can also help, as well as adjustments to diet, physical activity and lifestyle. Many people with bipolar disorder rely on routines to keep them feeling well, while others stay away from stimulants like caffeine and alcohol to avoid triggering a depressive episode.

If you need advice about bipolar disorder or you’re worried about symptoms of bipolar depression and treatment, you should talk to your doctor or therapist.

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A list of bipolar depression medications can be a useful reference to help you navigate the world of bipolar medication. After all, medication is often referred to as first-line treatment because it is the first remedy someone receives once they’ve received a diagnosis of bipolar disorder. The below bipolar depression medications list contains commonly prescribed drugs by category as well as information about their uses and side effects.

List of FDA-approved Bipolar Depression Medications

You’re about to see that numerous medications are prescribed to help bipolar depression. Only five, though, are FDA-approved medications for bipolar depression:

• Cariprazine (Vraylar) – an atypical antipsychotic approved for medical use in the United States in 2015
• Lurasidone (Latuda) – an atypical antipsychotic approved for medical use in the United States in 2010
• Olanzapine (Zyprexa) – an atypical antipsychotic approved for medical use in the United States in 1996
• Olanzapine-fluoxetine combination (Symbax) – an atypical antipsychotic and antidepressant combination approved for medical uses in the United States in 2003
• Quetiapine (Seroquel) – an atypical antipsychotic approved for medical use in the United States in 1997

While lurasidone, olanzapine, the olanzapine-fluoxetine combination, quetiapine and cariprazine are FDA approved for the treatment of bipolar depression, they’re not the only medications used. Many other medications may be used in treating the depression symptoms of this debilitating disorder. Sometimes anticonvulsants and other atypical antipsychotics are used to treat bipolar depression as is lithium (a mood stabilizer). Antidepressants are occasionally used but are contraindicated in many cases and should never be used without the addition of a medication that can act as mood stabilizer.

Bipolar Depression Medications List

Below is a list of commonly-prescribed medications used for bipolar depression, grouped by category.  Each category in this list of bipolar depression medications contains multiple bipolar depression drugs.

Antipsychotics: The are primarily used as mood stabilizers in treating bipolar disorder, and they can also help treat psychotic episodes that can happen in both mania and depression.

Most side-effects are mild annoyances such as dry mouth, drowsiness, constipation, and sexual dysfunction. However, some of the newer, atypical antipsychotics—especially clozapine (Clozaril) and olanzapine (Zyprexa)—can cause significant weight gain that can contribute to type 2 diabetes and metabolic syndrome. First generation, typical psychotics, can cause problems with movement, a cluster of symptoms called extrapyramidal side effects.

Atypical antipsychotics:

• Aripiprazole (Abilify)
• Cariprazine (Vraylar)
• Clozapine (Clozaril)
• Lurasidone (Latuda)
• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Risperidone (Risperdal)
• Ziprasidone (Geodon)

Typical (first-generation) antipsychotics:

• Chlorpromazine (Thorazine)
• Fluphenazine (Prolixin, Permitil)
• Fluepnthixol (Fluanxol)
• Haloperidol (Haldol)
• Zuclopenthixol (Opixol)

Anticonvulsants: These are used as mood stabilizers, preventing swings from depression to mania. Typical side-effects are weight gain, drowsiness, gastrointestinal discomfort, and dizziness.

• Carbamazepine (Carbatrol, Equetro, Tegretol)
• Lamotrigine (Lamictal)
• Valproic acid (Depakote, Depakene, Stavzor)
• Topiramate (Topamax)

Antidepressants: This class of medication seems like a logical choice to treat bipolar depression; unfortunately, antidepressants can sometimes cause more problems than they solve. Sometimes, they induce mania or mixed episodes.

Side effects of antidepressants in general range from mild to serious. Fatigue, dizziness, constipation, weight gain, difficulty sleeping, reduced sex drive, blurred vision, and dry mouth can be irritating. If you experience any of these more serious symptoms, it’s important to contact your doctor right away: suicidal thoughts, increased depression, anxiety or panic, agitation or restlessness, hallucinations, increased irritability, and other signs that your mood is destabilizing.

While there are numerous classes of antidepressants, three are most likely to be used to treat bipolar depression. One type is the selective serotonin reuptake inhibitors (SSRIs):

• Citalopram (Celexa)
• Escitalopram (Lexapro,Cipralex)
• Sertraline (Zoloft)
• Fluoxetine (Prozac, Sarafem)
• Fluvoxamine (Luvox)
• Paroxetine (Paxil)

Another antidepressant sometimes used with bipolar depression is the serotonin-norepinephrine reuptake inhibitors (SNRIs):

• Venlafaxine (Effexor)
• Duloxetine (Cymbalta)
• Desvenlafaxine (Pristiq, Desfax)

Tricyclic antidepressants include:

• Amitriptyline (Amitrip, Elevil, Endep, Levate, Amitril, Enovil)
• Amoxapine (Asendin)
• Clomipramine (Anafril)
• Desipramine (Norpramin, Pertofrane)
• Doxepin (Sinequan)
• Imipramine (Tofranil)
• Nortriptyline (Aventyl, Pamelor)

Bipolar depression is often treated with a combination of medications. Usually, finding the blend of medications that work for you and your brain takes patience, trial-and-error, and open communication with your doctor. When you discover what works for you, bipolar depression medications tend to work well.

See also: "What Are the Best Medications, Treatments for Bipolar Depression?"

article references

• What is Masturbation?
• Is Masturbation Normal?
• I Heard if You Masturbate Too Much, You'll Go Blind or Have Hairy Palms. Is this True?
• Does Masturbation Cause The Penis to Grow?
• I Heard if You Masturbate a Lot, You Can Use Up All Of Your Sperm. Is this True?

What is masturbation?

The act of touching your genitals for the purpose of feeling good or receiving pleasure is called masturbation. It is based on the fact that pleasure centers are found in various parts of our bodies. When we touch these centers in various ways, we feel good! Humans have specific pleasure centers in genital parts-such as the penis and testicles, the breast nipples and the vagina. These areas have highly specialized nerve endings, which, after being stimulated by touching, can send signals to the brain that result in a sense of well-being or pleasure. If you touch your genitals for the specific purpose of feeling good, it is called masturbation or masturbatory activity. Sometimes the person does not use his/her hands, but uses various objects that touch and stimulate the genitals.

The use of the word masturbation usually suggests that the person is manipulating his/her genitals to the point of intense pleasure, called, orgasm. Orgasm refers to a period of intense excitement in which genital muscles enter in to a series of highly-pleasurable contractions or movements; this involves release of sperm by the male during ejaculation or movements of the vagina and other genital parts in the female. Parts of the genitals that are particularly sensitive to touch include the tip of the penis in the male and a structure in the front of the vagina in the female, called the clitoris. The word masturbation itself also implies that the pleasure is obtained by genital touch or manipulation and not sexual intercourse or penis-vaginal penetration, called coitus.

Is masturbation normal?

Yes, it is normal for you to masturbate as a way of pleasuring yourself. However, society has placed many restrictions around the whole issue of masturbation. Why? For many reasons! Here are some, and you will encounter others as you read about this topic and hear from others. Behavior that is considered sexual, including masturbation and coitus, produces much concern in society. This is a natural reaction that has occurred over thousands of years-or as long as humans have been around! Because masturbation can lead to ejaculation and the spreading of sperm, society has many concerns about this activity. If this sperm is placed inside a female's vagina, pregnancy can result. If you only practice masturbation and not coitus, pregnancy will never result. In any event, masturbation can be an important part of your own expression as a sexual being, and various attitudes about this and other forms of sexual expression, have developed over thousands of years. Religions have looked at this behavior and developed various rules that allow or discourage masturbation.

It is a normal behavior from a medical viewpoint. However, it is important for you to be aware of the teachings of your culture, religion, parents, and others about this subject. If you engage in this behavior so much that other important aspects of your life are being affected, or if you use such force that injury results, then it is not normal.

I heard if you masturbate too much, you'll go blind or have hairy palms. Is this true?

No! Masturbation has nothing to do with becoming blind or developing hairy palms! If there is no medical truth in this, then why has this myth been around for so long? It is based on issues raised in question and answer number two. Because masturbation is part of sexual expression and because sexuality is an intimate part of procreation ("making babies"), society (including various religions) has expressed sincere and deep concern about masturbation. A wide variety of opinions have emerged over the past many centuries in regards to sexual expression and its consequences; this includes masturbation, pregnancy, birth control (pregnancy prevention) and abortion (pregnancy termination). Sometimes deep concern results in opinions being formed that later are discovered to be not accurate-such as linking blindness or hairy palms to masturbation.

A famous Roman physician, Galen, wrote this in the later part of the second century, about a male who masturbated: "Watch carefully over this young man, leave him alone neither day nor night... When he has contracted this fatal habit (masturbation), the most fatal to which a young man can be subject, he will carry its painful effects to the tomb-his mind and body will be enervated (weakened)." Well, Galen was quite wrong about this. However, many people have believed him over the past centuries! Perhaps the prediction of blindness from masturbation developed as a way to tell people not to do this. Perhaps the prediction of hairy palms was started to warn people that touching your genitals in this way would result in a way of "identifying" people who did-since hairy palms are not a normal finding!

It is important to note that, if your religion states that masturbation is "wrong," you can examine your beliefs to learn what you believe is wrong or right. However, if someone says that masturbation is wrong because it will make you blind or give you hairy palms, that is incorrect. It does not!

Does masturbation cause the penis to grow?

As the myths of the effects of masturbation have developed over the past thousands of years, some of the myths have noted that masturbation will cause harm while others have claimed positive effects. For example, it has been stated again and again that manipulating the penis will stimulate it to grow. This claim comes from the idea that touching one's genitals causes pleasure and may result in the penis developing an erection, thus enlarging! When the male becomes sexually stimulated, engorgement of the penis with blood, or an erection, is a normal result. However, the erection is not a permanent event (fortunately!) and eventually the penis will return to its "normal" state, with or without an ejaculation (release of fluid from the genitals through the penis). The hope of some is that continued masturbation will cause the penis to become larger than it otherwise would be. Some have wondered if the penis could be stimulated to become its normal adult size sooner if masturbation occurs.

The answer is no in both cases! The size of your penis is determined by factors inherited from your parents-much like various other traits you inherit from your family. When you become a teenager and various hormones are increasing in your body-your body then changes from a child's body to an adult's body-over several years. Your penis will develop into its adult size as you go from a young teenager to an older one. The size will not be affected by masturbation. If you develop an erection, the penis will get larger for a period of time, and then return to its normal non-erect (flaccid) state. However, though you cannot affect its size, you can injure your penis by very rough manipulation and/or by using dangerous instruments as part of the masturbation act.

I heard if you masturbate a lot, you can use up all of your sperm. Is this true?

This is another myth which, though might make some sense to some, is not true! When you use the term masturbation, you usually imply that orgasm occurs--in the case of the male, that means ejaculation and release of sperm as well as other genital fluids. Males often fear that they only have a very limited amount of sperm and that it is easily used up, making them less of a man. It is also another example of myths that have developed indicating a negative result from masturbation. Over the past centuries, doctors and various members of society were so convinced and worried that masturbation was harmful, that doctors developed various "treatments" for those who masturbated. These treatments included removing the testicles, placing the person's penis in a ring with spikes in the center to cause terrible pain during erection, and other very harmful measures.

Well, it is important to point out that masturbation is a normal aspect of one's sexual behavior and does not harm you unless you do it to the exclusion of other behavior and/or injure yourself because you are too rough. Most males have plenty of sperm and masturbation (with ejaculation) will not cause a decrease in their sperm. If someone is touching their genitals a lot, it may be because of medical problems, such as having certain infections or a severe itch for some reason. This is sometimes found in young children who touch themselves a lot because of a constant genital discomfort. But, do not worry that masturbation will affect your sperm count or your ability to someday have children. It will not!

Some bipolar patients find significant relief by managing their symptoms effectively that, to their detriment, they forget to remain vigilant.

After giving many valid reasons in a previous article for medication non-compliance, I now realized that I left one out. I realize this now because I've spent the last few weeks trying to get restabilized after slipping on my meds. No, it wasn't the side effects. Yes, I knew I needed it. I had ready access to it. I wasn't opposed to taking it. The demon? Complacency.

You see, I was so good at managing my bipolar disorder I forgot I was bipolar. Oh, if you asked me, I would assure you that the key to my good health was my medication cocktail. But I felt well enough to stop making the management of my disorder the top priority in my life. Complacency.

It all started, I think, when I lost my alarm watch. No bother. I didn't really need it, I thought. But without that alarm going off, I started to forget taking doses. Then I stopped filling my weekly pillboxes. It was too much trouble. But without my pillboxes, I started to forget whether or not I had taken a dose, and I was afraid of double dosing. But it didn't matter. I wasn't manic. I wasn't depressed. I would do better the next day. Complacency.

First, the hypomania hit me which was a shame, since I liked the sensation and wasn't keen on stopping it. Luckily, some rational, reasonable part of my brain realized what was going on and with some medication adjustments, I was able to stop that freight train before it crashed.

Unfortunately, depression followed. That soft, gentle depression that you sink into like an oversized leather sofa. Again, not serious enough to send me to the doctor. But when I'm depressed, I start to forget things. Little tasks, like opening five pill bottles, become enormous tasks. No surprise when I started to miss more doses. Then the depression was a little more noticeable. By this time, the illogical hopelessness set in and I couldn't see how getting back on my medicine could help anything.

But I did. My therapist gave me two pillboxes, one for my at-home meds and a small one for my afternoon meds. My doctor didn't get angry. My mother bought me a new alarm watch and reminded me gently when my doses were due.

And it's amazing how well those medicines work when you take them right!

My doctor suggested that I write about this because it is so common. We're all warned about the day when we feel better and think we don't need the medicine. No one warns us about the day when we feel better and we don't think at all about the medicine. The nurse pointed out to me that sometimes the combination doesn't work the second time around. When you've gone through as much trouble as I have to work out that combination, the thought of having to start over is daunting.

And doctors, nurses, therapists, be aware. Getting angry or scolding doesn't work. Helping a person work out solutions does.

About the author: Melissa has been diagnosed with bipolar disorder and shared her experiences for the benefit of others. Please remember, do NOT take any action based on what you have read here. Please discuss any questions or concerns with your healthcare professional.