Bipolar disorder or depression – what’s the difference?

Bipolar disorder is a serious but manageable mental health condition that impacts millions of people across the world. Getting diagnosed with bipolar disorder can be tricky since it shares many symptoms with other mental illnesses, including Major Depressive Disorder (depression).

With the proper treatment, people with bipolar disorder can mitigate their symptoms and live fulfilling lives. Knowing the differences between bipolar disorder and depression is key to getting the best help possible.

Why is Bipolar Disorder Often Confused with Depression?

If you are not too sure about the differences between bipolar disorder and depression, you’re not alone. There are a couple of reasons why confusing the two conditions is so common.

1.Words like “depression” or “depressive” are sometimes used to describe bipolar disorder.

One reason for the confusion between bipolar disorder and depression is that bipolar disorder was previously known as manic-depression. This term was abandoned by the mental health community in the 1980s, but some people still refer to bipolar disorder by its old name.

So if bipolar disorder isn’t the same as depression, why was it once called manic depression? The answer leads us to the next reason why it’s difficult to distinguish between the two illnesses.

2. People with bipolar disorder also experience depressive episodes

The term “bipolar” refers to the two types of psychological episodes that people with this disorder may experience. Manic episodes, or extreme emotional highs, represent one end, while depressive episodes represent the other.

On the surface, it can be tough to tell the difference between a person with bipolar disorder in a depressive episode and someone with depression. In fact, bipolar is often misdiagnosed as depression.

Types of Bipolar Disorders

Bipolar disorder is actually an umbrella term for several disorders. All bipolar disorders can exhibit a fluctuation between elevated manic episodes and periods of low mood.

Manic and hypomanic episodes are the distinguishing characteristic of bipolar disorder. Having just one such episode in your life will eliminate major depressive disorder as a possibility.

When mental health professionals diagnose a patient, they follow the guidelines of the Diagnostic and Statistical Manual of Mental Disorders, or the DSM for short. As research uncovers more about a disorder, its definition in the DSM also adapts. Right now, the fifth edition of the DSM defines three types of bipolar disorders:

Bipolar I: People with bipolar I disorder have experienced at least one episode of mania, which can manifest in different ways. During a manic episode, it is common for people to feel invincible and extremely high energy. This can lead to poor judgment and risky behaviors.

Mania can also cause symptoms like racing thoughts, insomnia, and disorganized speech. Manic symptoms are usually severe enough to interfere with daily responsibilities. Sometimes, mania is so serious that people will need to spend some time in a hospital.

While people with bipolar I can also experience debilitating depressive episodes, it is not necessary for a diagnosis.

Bipolar II: People with bipolar II disorder experience a milder form of mania, known as hypomania. Hypomania doesn’t usually require hospitalization, but people in hypomanic states can engage in harmful behaviors, like spending sprees or staying awake for days at a time.

In bipolar II, periods of hypomania are often interspersed with periods of depression. The depressive episodes tend to be more severe and disruptive than the hypomanic periods. Some people may only experience hypomania and depression once in their lifetimes. For many others, it is a repeating cycle.

Cyclothymic Disorder: People with cyclothymic disorder go through similar emotional ups and down as people with bipolar II. However, the episodes of low mood are never severe enough to classify as depression. A diagnosis of cyclothymic disorder requires a pattern of hypomanic and low-mood episodes over the course of two years.

Cyclothymic disorder is the mildest type of bipolar disorder, but it can affect an individual’s quality of life if left untreated. In some cases, both the hypomanic and depressive episodes can become worse and progress into bipolar disorder.

Comparing the Signs of Bipolar Disorder and Major Depressive Disorder (Depression)

Depression and bipolar depressive episodes share some features. The alternative name for major depressive disorder, unipolar depression, can help you remember the difference.

Unipolar depression only has lows, while bipolar disorder can have highs and lows.

Depressive episodes also tend to manifest differently in bipolar disorder and major depressive disorder.

• Shared symptoms: Loss of interest, lethargy, pervasive low mood
• Bipolar disorder mainly: Hypersomnia (excessive sleeping), weight gain
• Major Depressive Disorder mainly: Insomnia, weight loss

If you’ve been experiencing a persistent low mood, you can take the MADRS-s depression test to assess the severity of your symptoms.

While manic episodes are the defining difference between bipolar disorder and depression, the highs of hypomania can be subtle and difficult to notice. Here are a few scenarios that can indicate a hypomanic episode:

• Drastically reduced sleep, suddenly staying awake for days at a time
• Talking very fast, interrupting others, and having difficulty following a train of thought
• Sending out excessive amounts of text messages or posts on social media
• Starting multiple projects and working on them for hours without rest or sleep

Since hypomania produces an elevated mood, people experiencing an episode may feel excited and productive. Further, many people with bipolar disorder experience a condition known as anosognosia, which makes it hard for them to realize that anything is wrong when they are in mania. As a result, they are more likely to get professional help when depressed.

This can be problematic, as treatments for major depressive disorder are not necessarily suitable for bipolar disorder. Some treatments can trigger or exacerbate manic episodes.

Also, treatments approved for depression may not be effective for bipolar disorder.

For these reasons, it is so important for people to seek help if they have ever experienced symptoms of mania or hypomania. If you recognize any of the symptoms of hypomania or mania in yourself, talk to a clinician to get the right help.

Different Treatment Types for Bipolar Disorder and Depression

Today, both manic and depressive episodes are treated with prescription drugs and psychotherapy. There are also a few therapies that are safe and recommended for both bipolar disorder and depression.

Treatments for both disorders:

• Psychotherapy

Treatments for bipolar disorder:

• Prescription mood stabilizers and antipsychotics, such as lithium and Seroquel

Treatments for major depressive disorder:

• Prescription antidepressants such as selective serotonin reuptake inhibitors (SSRIs)
• Light therapy boxes for seasonal depression
• At-home brain stimulation, such as the Flow tDCS headset. This is a safe, effective treatment that can help reduce depressive symptoms without side effects. The device is easy to order online and is compatible with other depression treatments.

Read more about 14 treatments for depression.