Depression often occurs as part of bipolar disorder. As with mania, early diagnosis is important so that treatment may be started promptly. Someone who has been depressed for a long time may have stopped seeing their friends and lost all interest and pleasure in their usual activities: they may feel that their life will never be any better. Therefore they may not seek medical advice and suicide is a real danger.

Characteristics of depression:

During this phase, a person may feel sad, hopeless, and miserable. They may feel helpless or simply feel nothing at all. Appetite becomes disturbed (either over-eating or under-eating), sleep is disturbed (too much or too little) and pleasure and interest in life disappears. The person feels tired, worthless, filled with guilty feelings, and concentration is difficult. This mood may begin gradually, developing over weeks or months.

Depression can result from a number of factors:

Most people have experienced the depression which is a response to grief, loss or other painful life experiences. This depression usually lasts a short time, is related to specific circumstances and may cause disturbed sleep, loss of appetite, tearfulness and unhappiness around the event. Some supportive counselling may be necessary but symptoms often lessen and disappear with time. People usually recover without the need for medication.

Other types of depression may occur secondary to an illness, medicine or a drug. It may develop with a physical illness or it may be caused by the medication used to treat these illnesses, by the contraceptive pill, by some tranquillisers, or by alcohol.

Bipolar depression may occur in association with any of these or there may be no obvious issues or events that take place before it.

People describe depression:

Lack of energy

Not being able to get out of bed, everything seems like too much trouble, small tasks seem tremendously difficult.
‘I lie in bed till about four in the afternoon – and then I only get up because my husband comes home from work and I’m too ashamed to admit that I’ve been in bed all day. I can’t even sweep the floor without panicking that I’d do it wrong and I cower under the bedclothes if anyone comes to the door.’

Terrible sadness that never lifts

‘After I came out of hospital I felt so sad – I wept for the ecstasy I’d had and lost, I wept because it seemed like the end of the world and I wept often for no reason really except that everything was so black and seemed so hopeless ...’

Worthless thoughts

Being convinced that one is worthless, has done dreadful things, will do dreadful things.
‘I get caught in the same awful trap every time I get depressed. I know I’m worthless, then I tell myself it’s the depression making me feel that way, then it seems I’m making excuses for myself and not facing up to the moral failure of me and my life ...’

Feeling dead emotionally

Unable to experience pleasure or feel the concern or love of others.
‘I didn’t bother keeping contact with anyone – what was the point? I knew I wasn’t worth knowing anyway. I was lousy company and nothing anyone said made any difference to anything ...’

Guilt

Feeling guilty about doing things and about not doing things; having second thoughts about everything one does.
‘...the terrible physical lethargy, the mind still active but always a tormentor rehearsing the past with all its wrong turnings and regrets, full of self-hate mocking even the tiniest ray of hope...how much am I sick and how much just a boring old self-pitying failure? And perhaps the most nagging of all: won’t I even try?’

Inability to concentrate, slowed thinking, indecisiveness

‘I go to the supermarket to buy some yoghurt and stand in front of the refrigerator looking at the seemingly endless variety of brands available. I stand there for five minutes: regular or non-fat? plain or flavoured? I can feel the tears begin to sting in my eyes. Empty-handed I leave, apologising profusely to the checkout girl on my way past ...’

Wanting to escape one’s mind

Many depressed people take overdoses/get drunk/try to sleep as much as they can, just to escape the feeling of being awake and depressed. Unfortunately some escape through suicide.

Cowardly or brave, it is the act of a person who has reached their limit of endurance; whose thinking has been turned upside-down to such a degree that the action presents itself as a sensible action and the ‘loophole’ of the chance of someone saving them is just that – a chance. To attempt suicide is not a ‘plea for help’, as is now popularly described, it is a flat statement of ‘I’ve had enough. My threshold has been reached, broached.’

‘The overdose I took wasn’t really killing myself, I just wanted to blot out the rest of the day.’