Depression isn’t limited to full bipolar episodes. It is possible to feel depressed and have symptoms of depression before the experience can be qualified as an episode. You can start to check off the symptoms as they come whether mild or moderate, and the waiting for the worst can begin. This limbo between feeling well and moving into a full depressive episode can be discouraging and anxiety-inducing. During periods of euthymia (between episodes), breakthrough symptoms are common and can be just as painful as a full blown episode.
I’ve been feeling completely fatigued and down for days now. Sometimes I feel like I’m in a fully depressed mood, but other days my mood is fine. This would not be considered a depressive episode by a mental health care professional. However, these symptoms could be considered precursors to an episode.
To qualify as a full depressive episode, the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) lists the following symptoms and guidelines:
A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
- Depressed mood most of the day, nearly every day (e.g., feels sad, empty, or hopeless)
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
- Significant weight loss when not dieting or weight gain
- Insomnia or hypersomnia nearly every day.
- Psychomotor agitation or retardation nearly every day
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
- Diminished ability to think or concentrate, or indecisiveness, nearly every day
- 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.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The episode is not attributable to the physiological effects of a substance or another medical condition.
Having breakthrough symptoms may be a sign that medication may need to be adjusted. It’s important to keep seeking treatment, whether with medication, therapy or both.
For me, I will stick to therapy for now. I have not yet hit the two week mark that would qualify what I’m feeling as a full depressive episode. My psychiatrist would not yet be worried about my well-being or consider a medication change. I’m not even at point where I feel I need to call her. People get depressed. There are many reasons for depression aside from having an episode. For example, there is dealing with a physical illness, experiencing grief or even medication side effects.
These feelings could go away at any moment or they could continue into a period of major depression. Because of this, it is important for me to continue monitoring these symptoms. It’s possible to do this with the help of an app or journal to keep it more accurate. Feelings of depression can sometimes cloud judgement. It’s helpful to have the data to back it up.
In the meantime I can hope that this is just a short phase and wellness will come back soon.