One of the reasons why it is problematic to talk about depression, mania and hypomania is that those words may mean many different things.
For instance, bipolar and unipolar depression are called the same, but they are not the same. In most cases, unipolar depression is caused by past events, and dealt with using anti-depressants and therapy. In fact, therapy is the better solution of dealing with unipolar depression, as it offers a possibility of removing the trigger that’s been hidden deep inside for years, sometimes decades. Anti-depressants deal with the symptoms, and are sometimes absolutely necessary because a person in deep depression is unlikely to respond to therapy (or to anything at all).
Bipolar depression is caused by a chemical imbalance in the brain. In most cases bipolar depression does not have a trigger (which is what helps doctors find out whether the patient suffers from bipolar or borderline personality disorder). It just comes. And stays. Personally I suffer from ultra-ultra-rapid-cycling version of BP, which means my mood swings last hours, sometimes days, but depression seems to be an exception: without correct medication I get into a deep depression and stay there indefinitely.
I was originally diagnosed in 2004 with major depression and put on a MAOI type of antidepressant, Aurorix (moclobemide). It worked its job — it got rid of the symptoms, made it possible for me to actually function, as side effects it gave me a massive weight gain and some hallucinations, which perhaps should have made my doctor think, but didn’t. (I can’t remember if I bothered reporting them, to be honest.) After two years I tapered off Aurorix and started attending therapy, which has proven extremely helpful. I stayed in remission until 2011, when I fell back into something that was either a burnout or depression. I was put on the same medication, but the results were not the same; I got hypomanic (which I did not realise), then all of a sudden dropped into a mixed ultra-ultra-rapid-cycling episode which you could compare to taking all the feelings in the world, putting them in the blender, then turning them into a kaleidoscope.
When I think about this 11 years later, I think I might have been suffering both from bipolar AND unipolar depression. In 2004 we took care of the unipolar depression; my bipolar was still in development stage, and the therapy I undertook proved extremely helpful. The depression that came in 2011 was very different. I didn’t have the typical “I’m a piece of shit” sort of thinking going on. I felt heavy, energy-less, down, exhausted by simplest things like putting on socks. But my thinking was, if anything, surprised: “Why the hell is this going on? I should be feeling great, why am I not feeling great?” I was genuinely convinced that my hypomania was my natural state, and that the mixed episode meant something was wrong with my anti-depressants. A few weeks later I got diagnosed with BP2.
Initially I was taken off the anti-depressant cold turkey, because I dyed my hair, beard and eyebrows red. A word of explanation: I always experimented with my hair, no matter what mood I was in. This was the first time I did my eyebrows and boy did I regret it — they looked ridiculous. But my doctor didn’t know that, didn’t know me, and assumed immediately I am in the middle of a florid mania. Taking me off antidepressants was a terrible decision — in hindsight — which landed me in the lowest pits I have seen so far. I couldn’t walk. I couldn’t talk. I couldn’t get dressed. I couldn’t eat. I sure as hell couldn’t cook anyway. I spent an awful time laying on my sofa waiting to die. Then the anti-depressant has been reintroduced bit by bit, and I got better bit by bit, then I got hypomanic again.
The next year was constant fiddling with the dosage. Aurorix comes in 150 and 300 mg pills. 375 mg was a bit too little. 450 mg was a bit too much. I would take 375 mg for 2-3 weeks, notice I am getting depressed, go to 450 mg for 2-3 weeks, notice I am getting hypomanic, repeat. Finally my doctor decided to get me off Aurorix forever, and as the dosage was decreasing my mood was going up, until I landed in hospital with full-blown mania.
There are studies showing anti-depressants are not useful for treating bipolar disorder. This proved true in my case. My Aurorix has been replaced with lithium. While lithium did nothing to actually stabilise my moods — I continued cycling up and down like Lance Armstrong on a camel — it worked as a safe anti-depressant alternative. I was convinced that without Aurorix I would again land in a pit of depression. I did not. I consider both my unipolar and bipolar depression to be in remission; the first due to therapy, the second due to correct choice of medication.