Despite all the attention mania gets, most of us with bipolar know all too well that depression is far more common than either mania or hypomania. It’s a particularly annoying that people with “bipolar I” experience more mania than depression. Having bipolar I, I can personally attest to this. I spend about thrice (yes, I just used the word thrice) as much time depressed as I do manic or hypomanic.

What’s worse, not only is depression more common than mania or hypomania, it can also be a hell of a lot trickier to treat. Granted, mania can be devastating. But it can also be treated relatively quickly with anti-psychotics and other medications. When it comes to bipolar depression, however, medications often fall notoriously short. Don’t get me wrong. Mood stabilizers and anti-convulsants can work wonders, but they are still far from wonder drugs. Furthermore, anti-depressants can be risky. They can potentially pull us out of a depressive episode only to push us into a manic or mixed one.

And I haven’t even mentioned depression’s evil twin: anxiety. Mix that into the pot, and you’ve got a pretty stubborn (and ridiculously common) soup. Try treating the anxiety and you may worsen the depression. Try treating the depression and you may aggravate the anxiety or worse yet, find yourself in a land of agitated, dysphoric mania.

So, what to do? My best advice is to make sure you have an accurate diagnosis, ask LOTS of questions, do your own research, adopt a healthy lifestyle, cultivate coping skills (therapy can be a HUGE help here), and find a psychiatrist who is willing to get to know you and spend more than 20 minutes with you when necessary. Yeah, it sounds like a lot. That’s only because it is.