To an outsider, bipolar disorder and depression might seem very similar, with periods of intense sadness, hardly any energy to do the things you used to love and difficulty concentrating on work, relationships or even daily tasks. But if you look a bit closer, you will see obvious differences, which are also key for accurate diagnosis and treatment.
Unlike people diagnosed with depression alone, those with bipolar disorder must also contend with disruptive cycles of hyperactivity and impulsivity, and at times, with a reduced hold on reality. During these periods of high “highs,” referred to as mania, someone with bipolar disorder might find themselves going for long periods without sleeping or being overconfident or overexcited about something. In contrast, depression is more of a constant state of having low energy, sadness and inability to enjoy your everyday activities. The mania is the distinguishing factor between the two mental health conditions, as both conditions include that depressive state.
“While depression and bipolar disorder can share overlapping symptoms, such as low mood, fatigue, changes in appetite or sleep and feelings of worthlessness, bipolar disorder is distinguished by the presence of mood episodes that cycle between depression and mania or hypomania,” says Jennifer Kim Penberthy, a clinical psychologist and professor of psychiatry and neurobehavioral sciences at the University of Virginia School of Medicine in Charlottesville. “Mania involves periods of elevated or irritable mood, increased energy or activity, decreased need for sleep, impulsivity, and at times grandiose thinking. Hypomania is a milder form of mania. The key difference lies in the presence of these elevated mood states in bipolar disorder, which are not seen in major depressive disorder.”
Though it can feel scary to learn more about mental health conditions, know you aren’t alone. According to the National Institutes of Health, 1 in 4 Americans have a diagnosable mental health condition in any given year. If you suspect you or a loved one might have bipolar disorder or depression, familiarize yourself with differences, treatment options and other key information to seek the help you might need to feel better.
[READ: What to Do During a Mental Health Crisis]
Bipolar Disorder vs. Depression
Around 8.3% of American adults have had at least one major depressive episode, according to the Centers for Disease Control and Prevention. In contrast, bipolar disorder is a little less common. About 2.6% of adults in the U.S. experience bipolar disorder annually, according to the National Institute of Mental Health.
“Bipolar disorder includes depressive episodes plus periods of mania (or hypomania). Mania involves elevated or irritable mood, reduced need for sleep, impulsivity like reckless spending and grandiosity,” says Dr. Jeffrey Ditzell, a psychiatrist in New York City. If you aren’t sure if you are having manic episodes, Ditzell says to watch for a milder form of mania — hypomania — that can still be disruptive to everyday functioning. “If someone has ever had a manic/hypomanic episode, it shifts the diagnosis to bipolar disorder.”
Key symptoms of bipolar disorder include:
— Depressive state including sadness and low energy
— Periods of mania involving reckless or impulsive behavior, irritability and/or lack of sleep
— Bursts of energy that Ditzell says “may be mistaken for being productive or upbeat, but it’s often paired with risky behavior or poor judgment.”
Those manic episodes can make self-diagnosis tricky.
“Sometimes, these elevated periods may feel “good” to the person and go unreported unless loved ones help recognize them,” Penberthy says.
Another notable trait of bipolar disorder is a strong genetic component, increasing the likelihood that close relatives might get it as well. For example, if an identical twin is diagnosed with bipolar disorder, there’s a 60% to 80% chance of the identical twin developing it too. That heritability is nearly twice that of major depression.
Ditzell shares that it doesn’t mean you will get it for sure, but just that “if a parent has it, be vigilant. Pay closer attention to mood patterns.”
[READ: What’s the Difference Between Bipolar Disorder and Borderline Personality Disorder?]
Major depressive disorder
Having major depressive disorder is more than just a sad day or a difficult period of your life. It involves more of a constant feeling of sadness, low energy or other symptoms for over two weeks. More women experience depression than men — over 10% of women compared to over 6% of men. The most common age for this to happen is between ages 18 and 25, with over 18% of depressive episodes happening in that time frame.
You might have depression if you are having one or more of the following symptoms:
— Difficulty with eating
— Feelings of low self-worth
— Low energy
— Inability to concentrate or focus
— Feeling you can’t take care of yourself or go about your normal daily activities
“Unipolar depression is when people feel sad or they’re irritable. They don’t feel like doing anything. They don’t sleep right and they don’t eat right, and when I say sleep or eat right that means they can either sleep too much or sleep too little or they can eat too much or eat too little,” says Dr. Sid Khurana, psychiatrist and medical director at Nevada Mental Health. “Their energy is always low, so they’re tired, they don’t want to do anything, they don’t enjoy anything, they cannot focus on anything or make decisions, and they want to be left alone.”
[READ: What Not to Say to Someone With Depression.]
Can a Person Be Diagnosed With Both Conditions?
People should not be diagnosed separately for both depression and bipolar disorder because depressive episodes are included in bipolar disorder.
“Bipolar disorder includes episodes of depression, so yes, depression is a core part of bipolar disorder. However, a person cannot have a diagnosis of both major depressive disorder and bipolar disorder at the same time,” Penberthy says. “The key is understanding the full mood cycle, which is why thorough assessment over time is so crucial: A patient may initially be diagnosed with depression and later be found to meet criteria for bipolar disorder when symptoms of mania or hypomania appear.”
“That said, bipolar disorder often includes depressive episodes, and they can sometimes look different from classic depression. For example, people might experience atypical symptoms” like sleeping too much, increased appetite or feeling extremely slowed down,” Ditzell says. “There’s also a newer specifier in the DSM-5 called ‘with mixed features,’ which applies when someone has depressive symptoms alongside things like racing thoughts, irritability or impulsive behavior. Recognizing those subtleties can really help tailor the right treatment and support.”
What Are the Treatments for Bipolar Disorder?
One interesting way some people determine they might have bipolar disorder versus depression is if anti-depressants aren’t working, or are even making things worse.
“A clear, accurate diagnosis is essential because treatments that work well for unipolar depression (like some antidepressants) may not be appropriate alone for bipolar disorder and can even trigger mania,” Penberthy says. “Self-awareness, tracking mood over time and honest conversations with clinicians can make a significant difference.”
One of the most common treatments for bipolar disorder is lithium, a mood stabilizer, which you might be prescribed under drug names including Eskalith, Lithobid, Lithonate or others. Other treatments include types of mood stabilizers beyond lithium.
No solution is one size fits all, and sometimes there are periods of trial and error to determine the most effective mental health medicine, alongside a skilled health care provider. People who suspect they have bipolar disorder can use a journal or note on their device to track their symptoms, feelings, side effects and more to help their health care professional treat them best.
[READ: Types of Therapy: Choosing the Right One for You.]
What Are the Treatments for Depression?
Unfortunately, only around 61% of adults with depression get treatment, according to the National Institute of Mental Health. Treatments for depression range from therapy to medication, including antidepressants, such as SSRIs, or selective serotonin reuptake inhibitors
It’s key to wait the allotted time based on your medication to determine if a depression medicine is working. Sometimes antidepressants can even take up to two months to start working. If two medicines or more haven’t worked, health care professionals might recommend a medication for “treatment resistant depression.” Around half of people who take an antidepressant feel better in 6 to 8 weeks.
How to Get Help Now
Both bipolar disorder and depression carry with them an increased risk of suicidal ideation, suicide attempts and death by suicide. Males are more likely to die by suicide, and account for 80% of these deaths. Those who are having suicidal ideations or feel like they might commit suicide should call their health care professional, the suicide hotline 988, or 911 right away. Those recovering from suicidal thoughts or suicide attempts might also be interested in reading about stories of hope and recovery from the suicide hotline compilation.
Though diagnosing and treating depression or bipolar disorder can be a long road, understanding the difference and seeking help as soon as possible can get you back on track to a happy and healthy life.
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What?s the Difference Between Bipolar Disorder and Depression? originally appeared on usnews.com
Update 04/14/25: This story was published at an earlier date and has been updated with new information.
