Diagnosing either bipolar disorder or major depressive disorder is challenging and may take some time. However, the effective management of both conditions is possible.
In this article, we explain how to tell the difference between depression and bipolar disorder and discuss how to treat and manage each condition.
People who have major depressive disorder do not experience hypomanic or manic episodes. This is, however, a feature of bipolar.
Some primary differences separate bipolar disorder from major depressive disorder, such as:
- People with a bipolar I disorder diagnosis will have had at least one manic episode, but they might not ever have an episode of major depressive disorder.
- People with a diagnosis of bipolar II disorder will have had at least one hypomanic episode, which preceded or followed a major depressive episode.
- People with major depressive disorder do not experience any extreme, elevated feelings that doctors would classify as mania or hypomania.
Bipolar disorder is not always easy to diagnose. People may go to their doctor for the first time when they have a depressive episode, rather than during a manic or hypomanic episode.
For this reason, doctors often misdiagnose bipolar disorder as depression in the first instance.
It may take some time for a doctor to make a definite diagnosis. They may need to monitor an individual for months or even years before diagnosing bipolar disorder.
Depression is one state of bipolar disorder. However, some people might experience different aspects of bipolar at once. For example, they might have feelings of emptiness and low motivation alongside racing thoughts and high energy.
In some cases, a person who is experiencing a severe manic episode may require hospitalization to prevent dangerous behavior that puts them or others at risk. A doctor may diagnose bipolar disorder at this point. However, before making a diagnosis, they will need to rule out other conditions, such as anxiety, substance use disorder, and thyroid disease.
Another difference between bipolar disorder and depression is how doctors treat the conditions.
Each condition requires different medications. While a doctor may prescribe antidepressants to someone with depression, these drugs can trigger a manic episode in people with bipolar disorder. Mood stabilizers or antipsychotic medications are standard treatments for bipolar disorder.
Causes and symptoms
Understanding what causes each mental health problem and how the conditions present is important when registering the differences between them.
Bipolar disorder is a serious condition that involves extreme changes in mood.
Scientists do not fully understand what causes bipolar disorder, but they believe that many different factors are at play.
There is evidence that bipolar has a pattern of genetic inheritance, meaning that it can run in families.
Research also suggests that an imbalance or malfunction in two brain chemicals called serotonin and norepinephrine is common in people with bipolar. Norepinephrine, for example, can trigger a manic episode.
People usually develop bipolar disorder during adolescence or before the age of 40 years in adulthood, although some individuals may receive a diagnosis outside of this typical age range. The condition appears to last for life.
People with bipolar disorder tend to experience cycles of symptoms. A person with this condition may experience an episode of severe low mood, which may follow or precede an episode of feeling elated and extremely positive.
Periods of reduced or absent symptoms punctuate episodes of illness.
People with bipolar II disorder usually experience symptoms of either depression or mania during one mood episode. However, some people may experience "mixed" episodes in which the symptoms of depression and mania occur at the same time. People with bipolar I disorder may never experience depression.
Doctors will only term a manic episode as such if it lasts for at least 7 days or if the person's symptoms are so severe that hospitalization is necessary.
These symptoms generally include:
- high mood
- high energy
- more goal-driven activity
- enhanced self-esteem
- reduced sleep
- talking more than usual
- a rapid flow of speech and racing thoughts
- becoming easily distracted
- being irritable
- engaging in risk-taking behavior without thinking of the consequences
Some people can also experience psychosis during either a manic or depressive episode.
Psychosis involves having strange, delusional ideas or occasional hallucinations.
A milder form of manic symptoms, which doctors refer to as hypomania, occurs in people with bipolar II disorder.
During a depressive episode in bipolar I (if it occurs) and bipolar II, a person experiences the symptoms of major depressive disorder.
Depression might lead to loss of appetite
Persistent depression does not have a known cause. As with bipolar disorder, depression has hereditary factors and might also involve neurotransmitter imbalances in the brain.
The core symptoms of depression are:
- feeling very down or low for most of the day
- having a loss of interest or pleasure in things for most of the day
- feeling hopeless
- inappropriate feelings of guilt, worthlessness, or helplessness
- loss of energy
- difficulty concentrating or deciding on things
- changes in sleeping patterns, such as an inability to sleep, oversleeping, or waking early in the morning
- loss of appetite leading to weight loss
- suicidal thoughts or actions
- restlessness and irritability
- slowed movement and speech
There are two primary forms of bipolar disorder:
- Bipolar I disorder: The person has had at least one majorly disruptive manic episode, which lasted at least 7 days or was so severe that the person needed to go to the hospital.
- Bipolar II disorder: The person experiences hypomania, which precedes or follows a major depressive episode.
Other forms include "unspecified" disorder, which a doctor would diagnose if the features of the condition are not distinctly characteristic of either bipolar I or bipolar II.
A mild form of bipolar disorder called cyclothymic disorder involves episodes of hypomania and depression that are less severe and last for shorter periods. Some people with cyclothymic disorder have mania and depressive symptoms at the same time.
The symptoms may be mild enough to avoid the attention of a doctor. As a result, a person may never seek a diagnosis.
No single medical test can identify the condition. To diagnose bipolar disorder, a doctor needs to observe the individual and evaluate the signs and symptoms that they and the people around them report.
The same is true of depression. A doctor will take a history of the person's symptoms to decide whether they may have bipolar disorder or major depressive disorder.
For a doctor to diagnose major depressive disorder, the person must experience relevant symptoms nearly every day for at least 2 weeks. The symptoms need to include low mood and loss of interest, plus at least five of the other typical symptoms that we list above.
People who have major depressive disorder do not experience mania.
Treatments for both bipolar disorder and depression include medications and psychotherapy.
Psychotherapy involves talking to counselors or other healthcare professionals on a one-to-one basis or in a group situation. A person seeking help can choose from a wide range of counselors who practice different techniques, including cognitive-behavioral therapy (CBT), which may help with thinking processes.
Lithium is a drug that can treat bipolar disorder but not major depressive disorder. The same is true of other mood stabilizers, which may include carbamazepine, lamotrigine, and valproate.
For major depressive disorder, doctors may prescribe selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or drugs from other categories of medication. People usually take these alongside talking therapy.
A person with bipolar disorder will typically need help, medication, and support for the rest of their life. For those with major depressive disorder, the support may need to be short- or long-term, depending on whether or not their depression is recurrent.
A support network can be central to managing bipolar disorder and depression.
Early diagnosis of bipolar disorder or depression provides the best opportunity to improve a person's quality of life.
Successful medical management of the condition helps minimize its worst effects and opens up access to wider support. Doctors and other healthcare professionals should help by treating the "psychosocial" effects in addition to the symptoms.
They may be able to help people with bipolar or depression access group therapies or find assistance in the workplace.
Some people find that taking part in a support group with others who have the same condition can be beneficial. These groups can help reduce the feeling of isolation that might result from severe mental health disorders.
The challenges of mental health issues can also impact on those close to the person with the condition. Living with a person who has severe depression or managing the consequences of manic behavior can be difficult.
Sometimes, family members seek medical care on behalf of the individual with the condition.
The effect of a mental health condition on daily life will vary from person to person. Not everyone experiences changes in their life and relationships in the same way.
Severe mental illness does not equate with failure or an inability to achieve, and some people may experience positive outcomes from their condition. During hypomania, for example, high energy, creativity, and confidence are symptoms that some people find useful.
However, both conditions can be dangerous without treatment. Anyone who notices signs of either bipolar or depression in a friend or family member should try to connect them with local services to help treat the condition.
Contact the Substance Abuse and Mental Health Services Administration (SAMSHA) National Helpline on 1-800-662-4357 for information on the services in your area.
What are the links between depression, bipolar disorder, and substance abuse?
In some instances, people who have depression or bipolar disorder may try to “self-medicate” with substances. For example, a person who is experiencing manic or hypomanic symptoms may use alcohol in an attempt to calm themselves down and help them sleep.
These strategies are unsuccessful in the long run and could create additional problems for the individual. Anyone experiencing any symptoms of a mental health condition should seek medical help.Timothy J. Legg, PhD, CRNP Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.