How To Tell The Difference Between Bipolar Disorder And Depression

Bipolar disorder and depression can severely disrupt a person's life. Both conditions can negatively affect relationships, work, and one’s ability to complete everyday tasks. Individuals with bipolar disorder may experience erratic mood swings, making it difficult to maintain stability. Those with depression may struggle with consistently low energy and interest in daily activities.

Bipolar disorder and depression share similar symptoms, which can sometimes make it challenging to tell the difference between the two. However, they are different conditions that may benefit from other treatment approaches.

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Understanding symptoms of bipolar disorder

People with bipolar disorder, formerly known as manic depression or “bipolar depression,” typically experience extreme mood swings that include both manic and depressive episodes. There are three types of bipolar disorder: bipolar I disorder, bipolar II disorder, and cyclothymic disorder. Only bipolar I disorder involves mania symptoms. Bipolar II disorder causes hypomania, a lesser form of mania. All types of bipolar disorder can cause symptoms of depression. 

Bipolar disorder can cause depression. During depressive episodes, individuals may experience a sense of hopelessness, low energy, and decreased interest in daily activities. These cycles of manic and depressive symptoms can be intense and challenging to cope with. 

Bipolar disorder symptoms can vary in severity and duration, making it challenging to diagnose. Some people may experience mixed episodes, in which symptoms of mania, hypomania, and depression occur at the same time.

What is a manic episode?

A manic episode may involve high energy, a reduced need for sleep, and an overt sense of confidence or euphoria. Severe manic episodes can cause psychosis and paranoia. Someone experiencing a manic episode may also show risky behavior. People experiencing hypomania experience the same symptoms on a lesser level and do not experience psychotic symptoms unless caused by another mental illness. 

Understanding symptoms of depression

Depression is an umbrella term used to refer to various depressive disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). However, it is most commonly used to refer to major depressive disorder (MDD). This condition causes persistent sadness and a lack of interest in previously enjoyed activities. Unlike bipolar disorder, which includes manic episodes, depression is characterized solely by depressive symptoms.

People with depression often experience a depressed mood for most of the day on most days of the week. They may experience fatigue, trouble sleeping, or sleeping too much. Concentration problems and a sense of worthlessness or excessive guilt are also common in depression. Depression is a symptom of bipolar disorder, but depressive disorders are separate from bipolar disorder and can cause a unique cluster of symptoms and do not cause mania or hypomania. 

Causes and risk factors for mood disorders

Both bipolar disorder and depression have various causes and risk factors that may include genetic and biological causes. 

Genetic factors

Bipolar disorder is more common in people with a family history of the condition. The condition can be inherited from one's parents or grandparents. Depression also runs in families, suggesting a genetic link. For example, if a parent has depression, their child has a significantly higher risk of developing the condition compared to the general population. Similarly, twin studies have shown that identical twins are more likely to develop depression than fraternal twins.

Biological factors

Both bipolar disorder and depression may involve imbalances in brain chemicals like serotonin, dopamine, and norepinephrine. Studies show that people with bipolar disorder may have different brain structures compared to those without the condition. Similar changes can be found in people with depression. 

For instance, the hippocampus, which is involved in memory and emotion regulation, is often smaller in individuals with depression. Additionally, research indicates that people with bipolar disorder may have altered functioning in the prefrontal cortex, which controls decision-making and impulse control. Brain scans cannot be used to diagnose mental illness and are still being studied. 

Environmental factors

Stressful life events, such as trauma or loss, can cause or correlate with depression and bipolar disorder episodes. Substance misuse can also increase the risk and severity of mood disorders.

For example, the loss of a loved one may lead to a major depressive episode in a person predisposed to depression. Similarly, experiencing a traumatic event, such as an accident or assault, might trigger manic or depressive episodes in individuals with bipolar disorder. Chronic stress from different situations, like financial struggles or relationship issues, may worsen both conditions.

Understanding the difference between bipolar disorder and depression

Diagnosing mental illnesses such as bipolar disorder and depression involves specific criteria. A mental health professional may look at an individual’s overall condition when determining an appropriate diagnosis. 

Diagnostic criteria for bipolar disorder

Bipolar I disorder involves at least one manic episode, which may last for at least one week or require hospitalization. During manic episodes, individuals might experience elevated mood, increased activity, or risky behavior.

Bipolar II disorder includes at least one hypomanic episode and one major depressive episode. Hypomanic episodes are similar to manic episodes but are less severe and don’t require hospitalization. 

Cyclothymic disorder involves periods of hypomanic symptoms and depressive symptoms that do not meet the full criteria for hypomanic episodes or depressive episodes. Diagnosis often includes a detailed psychiatric evaluation and medical history review.

Diagnostic criteria for depression

Major depressive disorder (MDD) is diagnosed when a person experiences a depressive episode lasting at least two weeks. Symptoms may include persistent sadness, loss of interest in daily activities, changes in weight or appetite, and a sense of worthlessness, among other symptoms. These symptoms must cause significant distress or impairment in daily functioning.

A depressive episode in bipolar disorder may have similar symptoms. However, for MDD, there are no manic or hypomanic episodes. The diagnosis relies on a thorough clinical evaluation and symptom assessment. The DSM-5 criteria are often used, which list specific symptoms and duration needed for a diagnosis.

Differential diagnosis: How to tell the difference between bipolar disorder and depression symptoms

Differentiating between bipolar disorder and depression can be difficult because of their overlapping symptoms. Bipolar disorder includes manic or hypomanic episodes, which are absent in depression. Manic episodes involve elevated mood and increased energy, which can distinguish bipolar disorder from depression. In some cases, individuals with bipolar disorder may initially be misdiagnosed with depression if their hypomanic or manic episodes are not reported or observed. 

How are bipolar disorder and depression treated?

Treating bipolar disorder and depression involves different strategies. While medications, psychotherapy, and lifestyle changes are often recommended for both, the specific approaches might differ according to the diagnosis and individual.

Medications

For bipolar disorder, mood stabilizers are commonly prescribed to manage manic episodes. Antipsychotic medications may also be used to control severe symptoms. 

On the other hand, antidepressants are often the first line of treatment for depression. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are popular choices. 

Antidepressants may sometimes be prescribed alongside mood stabilizers for bipolar depression. Taking antidepressants without mood stabilizers can sometimes incite manic episodes in individuals with bipolar disorder.

Psychotherapy

Bipolar disorder and depression may benefit from psychotherapy, but the focus can vary. Cognitive-behavioral therapy (CBT) is widely used for both bipolar disorder and depression. This modality helps patients identify negative thought patterns and behaviors that may contribute to their symptoms. 

Dialectical behavior therapy (DBT) can be particularly effective for mood regulation in bipolar disorder. For both disorders, interpersonal therapy (IPT) may be used to manage relationship problems that contribute to feelings of sadness. 

Support groups for mood disorders 

Several organizations offer online support groups that provide emotional help and a sense of community. The Depression and Bipolar Support Alliance hosts online and in-person groups where participants can share their experiences. A support group may help individuals find others with similar life experiences. 

Lifestyle changes

Lifestyle changes may be recommended for managing both conditions. Regular exercise, a balanced diet, and sleep hygiene may improve mood and overall mental health. In bipolar disorder, creating a stable daily routine may help individuals manage mood swings. 

Stress management techniques like mindfulness and meditation may also be beneficial for bipolar disorder and depression. Avoiding substances like alcohol and drugs may also reduce the risk of worsening symptoms. 

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Support options after a mental health diagnosis

Receiving therapy can be helpful for people living with symptoms of depression and bipolar disorder. However, symptoms can sometimes prevent people from seeking in-person care. In these cases, online therapy platforms like BetterHelp may be more accessible. 

Some people may prefer online therapy for its accessibility and convenience. This form of support allows individuals to receive professional help from the comfort of their homes. In addition, they can access unique resources like support groups and worksheets assigned by the therapist. Studies show that online therapy can be as effective as traditional in-person therapy for many mental health conditions.