Sleep and energy
Days in which you needed much less sleep without being tired, being noticeably active or constantly making new plans.
Depression · bipolarity
Bipolar depression: symptoms and treatment
A depressive period within a bipolar disorder requires a different assessment. Previous periods of high energy and little sleep are important.
This page is about depression in bipolarity, not about normal mood swings. Read how the assessment works, which treatments are discussed and how to monitor signals and safety together.
Zorgfuik provides general information and does not make a diagnosis. Discuss personal symptoms, treatment and medication with a qualified healthcare provider.
Sources checked for , including the Dutch guideline of March 2026. Information for adults; no personal medication advice.
What makes depression bipolar?
The depressive symptoms can resemble a unipolar depression: sadness, little pleasure, little energy and problems with sleeping or concentrating. The difference is mainly in the course of your life: with a bipolar disorder there are also manic or hypomanic periods. It's not the same as having a changing mood within one day.
In bipolar I there has been a manic episode; in bipolar II there are hypomanic and depressive episodes, without previous mania. 'II' does not mean that daily life suffers little. Depressive episodes can be serious.
Hypomania can feel like a productive or pleasant period in retrospect. That is why it is important not only to ask about gloomy days. Relatives sometimes notice changes that you yourself did not see as a symptom.
What changes do you tell the psychiatrist?
Behaviour and consequences
Unusual talking, irritability, excessive spending or risky decisions. It is about a clear change towards yourself.
The whole process
Previous episodes, recovery between them, reactions to antidepressants, substance use and mood problems in the family. None of these clues by themselves prove the diagnosis.
If possible, make a timeline with periods of sadness, a lot of energy, little sleep and treatments. A questionnaire can provide support, but cannot independently determine bipolarity. The psychiatrist also looks at other explanations.
What medications are used for bipolar depression?
A psychiatrist makes a choice based on the current episode, existing maintenance medication, previous effect, side effects and your health. Treating the depression and preventing new episodes are related, but different goals.
Medicines for the depressive episode
The Dutch guideline of 2026 mentions quetiapine, lamotrigine, lurasidone, cariprazine and olanzapine, with or without fluoxetine, as options. Not every product is registered in the Netherlands for every application; sometimes it involves off-label prescribing.
Lithium and maintenance
Lithium can play a role in treatment and prevention. This includes blood level checks and checks of kidney and thyroid function, among other things. Other medicines can also be part of a maintenance plan.
Lamotrigine takes time
Lamotrigine is built up slowly due to the risk of serious skin reactions. This makes it less suitable when an effect is needed very quickly. Report new skin rashes to the prescriber immediately, especially with fever or mucous membrane symptoms.
Antidepressants are not an automatic first step
An antidepressant alone is not recommended for bipolar I depression and for bipolar II depression with multiple manic symptoms. Sometimes an antidepressant is added under specialist guidance. Do not stop an existing drug yourself.
Ask about each medicine what the purpose is and what monitoring is needed. Drowsiness, weight gain, restlessness or other side effects differ per drug. Also discuss pregnancy, desire to have children and contraception in a timely manner; valproate in particular has strict safety restrictions. This page is not a list of options to combine yourself.
Guideline 2026: acute bipolar depression, Apotheek.nl: lithium and lamotrigine.
Treatment is more than medication
Explanation of the condition, psychological treatment and guidance from loved ones help to recognise patterns and deal with the consequences. Discuss what you need around relationships, work, finances and confidence in yourself after an episode.
Sleep protection and a regular daily rhythm are important. Don't make your own experiment with sleep deprivation, extreme fasting or intensive light therapy. Light therapy for bipolarity is only something to plan with an expert. Read about the safety considerations for light therapy.
Severe depression may require more intensive care or admission. Sometimes other specialist treatments are considered. That decision depends on severity, safety and previous results, not on an internet checklist.
A early warning plan for both sides
Preferably make this plan with your clinician at a relatively stable time. Use your previous experiences, not just a general list.
- My early depression signs: for example, canceling appointments, eating less or not starting anything.
- My early dysregulation signals: for example, sleeping less, sending a lot of messages or unusual purchases.
- My first step: Who do I call and what agreed support do we provide?
- The role of loved ones: who gets to name a change and how do we do that without struggle?
- Medication and safety: Who can be reached if you have questions and which emergency arrangements have already been made?
A loved one may say: 'I notice that you sleep three nights less and make more plans. Do you recognise that? Shall we discuss our plan?' That is more concrete than a discussion about whether someone is 'manic again'.
When should you seek help immediately?
Call your treatment team, GP or out-of-hours GP service in case of rapid disruption, sharply decreasing sleep with increasing energy, psychotic experiences or thoughts of suicide. Do not wait for a regular follow-up appointment if safety is uncertain.
Questions for your doctor: what are we treating now, what is intended as maintenance, when do we evaluate and what changes should I report immediately?
Frequently asked questions
What is bipolar depression?
A depressive episode within bipolar disorder. The assessment also looks at previous manic or hypomanic episodes; these change the choice of treatment.
Is bipolar the same as rapidly changing emotions?
No. These are recognizable episodes with changes in mood, energy, sleep and behaviour. Habitual mood swings do not prove bipolar disorder.
What is the difference between bipolar I and II?
In bipolar I there has been a manic episode. In bipolar II there are hypomanic and depressive episodes, without a previous manic episode. Bipolar II is not automatically a mild condition.
Why not just an antidepressant?
With bipolarity this requires a different risk assessment. Antidepressant monotherapy is not recommended for bipolar I and bipolar II with multiple manic features. Do not change existing medication yourself.
What medications are discussed for bipolar depression?
The Dutch guideline mentions, among others, quetiapine, lamotrigine, lurasidone, cariprazine and olanzapine, possibly with fluoxetine. The choice and registration differ; a psychiatrist tailors the plan to your situation.
Why are controls important for lithium?
The difference between an effective and a harmful amount can be small. Blood levels, kidney function and other checks are needed. Dehydration and interactions can increase the risk.
When should I seek help quickly?
If you notice noticeably less sleep without fatigue, increasing disinhibition or restlessness, psychotic symptoms or suicidal thoughts, contact your clinician or GP quickly. In case of immediate danger to life, call 112.
Sources