Editing Bipolar disorder (section)

=== Depressive episodes ===
{{Main|Depression (mood)}}
[[File:'Melancholy' by W. Bagg Wellcome L0022594.jpg|thumb|left|''Melancholy'' by [[William Bagg]], after a photograph by [[Hugh Welch Diamond]]]]

Symptoms of the [[Major depressive episode|depressive phase]] of bipolar disorder include persistent feelings of sadness, irritability or anger, [[Anhedonia|loss of interest in previously enjoyed activities]], excessive or inappropriate [[Guilt (emotion)|guilt]], [[Depression (mood)|hopelessness]], [[Hypersomnia|sleeping too much]] or [[Insomnia|not enough]], changes in appetite or weight, [[fatigue]], problems concentrating, self-loathing or feelings of worthlessness, and thoughts of death or suicide.<ref name="Muneer2013" /> Although the DSM-5 criteria for diagnosing unipolar and bipolar episodes are the same, some clinical features are more common in the latter, including increased sleep, sudden onset and resolution of symptoms, significant weight gain or loss, and severe episodes after childbirth.<ref name=Lancet2016/>

The earlier the age of onset, the more likely the first few episodes are to be depressive.<ref name="Bowden">{{cite journal | author = Bowden CL | title = Strategies to reduce misdiagnosis of bipolar depression | journal = Psychiatr Serv | volume = 52 | issue = 1 | pages = 51–55 |date=January 2001  | pmid = 11141528 | doi = 10.1176/appi.ps.52.1.51 }}</ref> For most people with bipolar types 1 and 2, the depressive episodes are much longer than the manic or hypomanic episodes.<ref name="Carvalho" /> Since a diagnosis of bipolar disorder requires a manic or hypomanic episode, many affected individuals are initially [[misdiagnosed]] as having [[Major depressive disorder|major depression]] and treated with prescribed antidepressants.<ref name=Muzina2007>{{cite journal |vauthors=Muzina DJ, Kemp DE, McIntyre RS | title = Differentiating bipolar disorders from major depressive disorders: treatment implications | journal = Ann Clin Psychiatry | volume = 19 | issue = 4 | pages = 305–312 | date = October–December 2007 | pmid = 18058287 | doi = 10.1080/10401230701653591 }}</ref>