"One day you realize that your entire life is just awful, not worth living, a horror and a black blot on the white terrain of human existence. One morning you wake up afraid you are going to live. . . , That's the thing I want to make clear about depression: It's got nothing at all to do with life, in the course of life, there is sadness and pain and sorrow, all of which, in their right time and season, are normal—unpleasant, but normal. Depression is in an altogether different zone because it involves a complete absence: absence of affect, absence of feeling, absence of response, absence of interest. The pain you feel in the course of a major clinical depression is an attempt on nature's part (nature, after all, abhors a vacuum) to fill up the empty space."
In bipolar disorder, depression can occur in "pure" form—in which you feel extremely sad, slowed down, lethargic, fatigued, or numb—or as part of a mixed episode—which means you feel both the symptoms of depression and those of mania. Many writers have described the despair of depression, both bipolar and unipolar (major depressive) forms (for example, Jamison, 1995, 2000a; Manning, 1996; Solomon, 2001; Styron, 1992; Thompson, 1996). What is important for you, however, is that you learn to recognize the early warning signs that your depression is recurring. The central goal of this chapter is to give you psychological self-management techniques that you can use to greatest benefit during the early phases of depression, before it becomes incapacitating. When self-management techniques effectively improve your mood during these early stages, you may be able to avoid the medical interventions that are usually required when depression reaches its most severe point.
Medical interventions usually include antidepressant agents, higher dosages of mood stabilizers, ECT, and hospitalization. For reasons that are discussed in Chapter 6, it's best to avoid some of these alternatives if you possibly can (for example, antidepressants, which can inadvertently lead to rapid cycling). Nonetheless, it's essential to consult your physician about these medical alternatives if self-management or your personal psychotherapy is not keeping your depression from getting worse.
In the next chapter, I talk about suicidal episodes and how to combat them. Suicidal thoughts and impulses are a very common component of the bipolar syndrome. They are nothing to be ashamed of—virtually everyone with this disorder has thought about suicide at some point. Fortunately, there are ways to protect yourself from sinking further when you begin to feel suicidal.
Mostly, this chapter is about hope. Depression is a painful aspect of the human condition, and people with bipolar disorder experience it more intensely than virtually anyone else. To make matters worse, the pain may not be obvious to those around you, and they may want you to just snap out of it. You can't do that, but there are some things you can do—often with the support of others—to help combat it.
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Bipolar is a condition that wreaks havoc on those that it affects. If you suffer from Bipolar, chances are that your family suffers right with you. No matter if you are that family member trying to learn to cope or you are the person that has been diagnosed, there is hope out there.