A depressed mood that lasts at least two weeks is a big part of bipolar disorder. However, depression is not necessary to receive a bipolar 1 disorder diagnosis. This is rare because the severe impact of manic episodes on an affected individual's life can spiral them into a depressed mood. For example, the effects of impulsive acts like maxing out a credit card or engaging in hypersexual activities can push patients into a depressive episode. During a depressive episode, bipolar disorder patients can feel some or even all of the classic symptoms of major depression. An individual may become consistently sad, have a low interest in normal activities, persistent low self-esteem, and feelings of hopelessness.
After a manic episode, depressive episodes can hit much harder, making a patient's suicide risk rise. Some patients may experience a mixed state, in which they have symptoms of both mania and depression. The mixed state is incredibly dangerous, as it has a seventy-one percent higher risk of suicide.