Symptoms of Bipolar Depression

Part 6: Preoccupation with Death

Preocupation With Death
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Although the three symptoms listed under this heading - thoughts of death, suicidal ideation, and feeling dead or detached - may sound like different terms for the same thing, they actually are distinct forms of preoccupation with death.

Thoughts of Death

Thinking about death to a marked degree may take the form of imagining oneself dead. For example, a person may envision himself lying in a casket. He may imagine what will happen at his funeral, obsess about what to leave people in a will, and even begin giving away possessions.

"I wish I were dead" is a common phrase that most people utter without meaning, but in a depressed person, the thought becomes fact. I knew a 7-year-old boy who told his mother, "I wish I had never been born, or if I had to be, I had died right away." Fortunately, his mother wasted no time getting help for her child.

Suicidal Ideation

In suicidal ideation, "I wish I were dead" progresses to thoughts of making it happen. A depressed person may be tipped over the edge by a stressful event, or the progress of the illness may be to blame. She may begin thinking of and actually making plans for suicide.

Whether or not the person has a plan in mind for suicide, these thoughts must be taken very seriously. Some of the highest risk factors for completing suicide include a history of previous suicide attempts, the presence of significant life stressors, and access to firearms.

Feeling Dead or Detached

A person who feels dead or detached experiences a group of symptoms that have been mentioned in some of the previous five articles in this series. They include:

  • Despair/hopelessness
  • Indifference
  • Loss of interest in pleasurable activities
  • Lethargy
  • Social withdrawal

In addition, the person may feel like he or she is simply an observer of what is going on around him or her. There may be a sensation of "standing behind" oneself and watching what happens.


Bipolar depression is similar to major depression. The depressed bipolar person may be more likely than a person with unipolar depression to have a "mixed" type of depressive episode, including agitation (both mental and physical), irritability, anger, and anxiety.

Single symptoms are rarely present. For example, a depressed bipolar person might experience any of the following and have no symptoms of preoccupation with death (group 6):

  • Group 1 - Changes in Activity Levels:
  • Group 2 - Physical Changes
  • Group 3 - Emotional Pain
  • Loss of self-esteem
  • Feelings of helplessness
  • Group 4 - Difficult Moods
  • Irritability
  • Worry / Anxiety
  • Group 5 - Changes in Thought Patterns
  • Indecision
  • Disorganization

Another person could have an entirely different combination of symptoms and be no less depressed than the first. The important thing is to be aware of what the symptoms of bipolar depression are so that you can identify them in yourself or someone you care for and seek help accordingly.

Related Reading:

View Article Sources
  • American Academy of Family Physicians (1999). Evaluation and Treatment of Patients with Suicidal Ideation.