By Donna Jackel
It is the manic phase of bipolar disorder that attracts-no, demands-attention. But those who have the illness, or love someone who does, know it is depression that most disrupts and devastates lives-and ominates the course of the illness.
"Few people understand [that] depression sucks the life out of you," says C.A., 52, of Oregon. "Desires, self-esteem, motivation, self-worth-any of those qualities that keep you going in life-disappear." Since her 2002 bipolar diagnosis, she has gone only 18 consecutive months without depression.
When P.S. of Halifax, Nova Scotia, is sad, she sometimes avoids bike riding with her seven-year-old daughter. The guilt she feels at withdrawing from her child only intensifies her depression.
"You look at the functional outcomes, such as the ability to work, family life, being an active participant in society-this is largely driven by depressive, rather than manic, symptoms," notes Roger S. McIntyre, MD, associate professor of psychiatry and pharmacology at the University of Toronto, and head of the Mood Disorders Psychopharmacology Unit at the University Health Network in Toronto.
One reason depression is more debilitating than mania is that it lasts longer; another is that it occurs more frequently: According to a 2002 study by Lewis L. Judd and colleagues at the University of California at San Diego published in the Archives of General Psychiatry, people with bipolar I experience depression three times as often as mania. For bipolar II, the ratio of time spent in depression versus mania is a whopping 40:1...
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