Clinical depression and bipolar disorder can be confusing for everyone: the diagnosed person, their friends and family, and people seeking to learn more about mental health. Depression and bipolar disorder often have overlapping symptoms, but this is not always the case. Two people battling the same mental disorder may also exhibit symptoms in different ways. While seeking help from licensed mental health professionals is one of the best options, learning the basic differences between these two mental illnesses is a great first step.
What is Major Depressive Disorder (Clinical Depression)?
Clinical depression is a mood disorder that is a combination of symptoms: feelings of intense sadness, guilt, or hopelessness, restlessness or anxious movements, a lack of interest or pleasure in activities that were once enjoyable, irritability, fatigue or a lack of energy, difficulty concentrating, changes in normal sleeping and eating behavior (usually dramatic increases or decreases) and, in some cases, suicidal thoughts and actions (National Institute of Mental Health 2017). Symptoms must persist in a person for at least two weeks before they can be diagnosed with depression (American Psychiatric Association 2017).
What is Bipolar Disorder?
Bipolar disorder (bd) is another mood disorder characterized by heightened, often intense emotional states called mood episodes (National Institute of Health 2020). These mood episodes fall into manic, hypomanic (a less intense manic state), or depressive categories (American Psychiatric Association 2017). The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) breaks bipolar disorder down into the following three categories:
Bipolar I Disorder
People must experience a manic episode lasting at least seven days or extreme enough to require immediate medical attention to be diagnosed with bipolar I disorder. People with bipolar I disorder usually experience depressive episodes in two-week cycles (National Institute of Health 2020).
Bipolar II Disorder
Bipolar II disorder is characterized by at least one hypomanic episode and at least one major depressive episode, both of which are not as severe as bipolar I disorder (American Psychiatric Association 2017).
BD Unspecified and BD Otherwise Specified
If a patient’s symptoms do not fall under bipolar I or II disorder, they may be categorized as BD unspecified or BD otherwise specified (National Institute of Health 2020).
There is one final disorder that is often included when discussing bipolar disorder:
People with cyclothymic disorder experience mood swings that are less severe than bipolar I or II. In order to be diagnosed with cyclothymic disorder, people must experience hypomanic and depressive states without breaks of more than two months for at least two years (American Psychiatric Association 2017).
What are the Differences Between Depression and Bipolar Disorder?
1: Manic Episodes
The major difference between depression and bipolar disorder is the presence of manic episodes. A manic episode is a mood episode categorized by the following symptoms: extreme multitasking, grandiose or egotistical feelings, faster speech patterns, distracted thoughts, periods of less sleep, and risky behavior such as gambling or spending sprees (American Psychiatric Association 2017). People with depression never experience manic episodes. People with bipolar disorder usually experience both manic and depressive episodes, but those diagnosed with bipolar I disorder may never experience a depressive episode. Sometimes, people with bipolar disorder may experience a manic episode and a depressive episode at the same time (National Institute of Mental Health 2020).
Depression is more common than bipolar disorder. According to the American Psychiatric Association, about 16.6% of people (one in six) will experience depression at some point in their lives (2017). In contrast, only 4.4% of people will experience bipolar disorder in their lifetime (National Institute of Mental Health 2017). Because depression is more common, there is a chance that people with bipolar disorder could be misdiagnosed with depression if they seek treatment during a depressive episode (National Institute of Mental Health 2020). For this reason, it’s very important that mental health professionals inquire about patients’ histories so they can identify possible manic episodes and avoid misdiagnosis.
According to the American Psychiatric Association, psycho (“talk”) therapy is used to treat both depression and bipolar disorder (2017). Antidepressants are also commonly prescribed for both. However, antidepressants can trigger manic episodes in people with bipolar disorder (National Institute of Mental Health 2020). To help prevent this, mood stabilizers are paired with the antidepressants in treatment for people with bipolar disorder. This is another reason why a proper diagnosis is so important. If psychotherapy and prescription medications are still not enough to treat a patient’s depression or bipolar disorder, doctors may suggest electroconvulsive therapy (ECT) (National Institute of Mental Health 2018 and Butler 2018).
4: Causation and Duration
Bd is a lifelong disorder and although it cannot be cured, it can be managed over time. Most people are diagnosed with bipolar disorder in their late teens, but diagnosis can also occur at later ages depending on when people recognize their symptoms and seek professional diagnosis (National Institute of Mental Health 2020). In contrast, depression can occur at any time throughout a person’s life. While depression can last for a long time, many people are able to cure their depression, and begin by taking antidepressants for six months to a year and then slowly weaning themselves off the medication to see how they are progressing. Both disorders are caused by a variety of factors, from genetics to substance abuse to traumatic experiences (American Psychiatric Association 2017).
5: Co-occurring Mental Disorders
Many people with bipolar disorder have a co-occurring mental disorder. According to a literature review published by an agency of the U.S. Department of Health and Human Services, about 92% of individuals with bipolar disorder will experience a co-occuring mental disorder in their lifetime (Butler 2018). The most common mental disorders people experience at the same time as bipolar disorder are anxiety disorders, ADHD, substance abuse disorder, and eating disorders (National Institute of Mental Health 2020). While people can experience co-occuring mental disorders with depression, depression is often the co-occuring disorder, meaning that people with co-occurring disorders often get depression on top of their preexisting disorder, and the depression can be cured without curing the other disorder (Mental Health America). With bipolar disorder, it’s the other way around.
Bipolar disorder and depression are both treatable given the right psychiatric care, but it’s important to know the differences between them in order to get proper treatment. While they may look similar at first due to their shared depressive episodes, their differences, especially the presence of manic episodes, are significant.
- American Psychiatric Association (2017). What is depression? Retrieved 11 April 2020 from www.psychiatry.org/patients-families/depression/what-is-depression.
- American Psychiatric Association (2017). What are bipolar disorders? Retrieved 11 April 2020 from www.psychiatry.org/patients-families/bipolar-disorders/what-are-bipolar-disorders.
- American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (DSM-5), 5th ed.
- Butler, M., Urosevic, S., Desai, P., Sponheim, SR., Popp, J., Nelson, V.A., Thao, V., Sunderlin, B (2018). Treatment for bipolar disorder in adults: A systematic review. Comparative Effectiveness Review (208, 18-EHC012-EF). Rockville, MD: Agency for Healthcare Research and Quality. doi: 10.23970/AHRQEPCCER208.
- Mental Health America. Co-occurring disorders and depression. Retrieved 11 April 2020 from www.mhanational.org/co-occurring-disorders-and-depression.
- National Institute of Mental Health (2020). Bipolar disorder. Retrieved 11 April 2020 from www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml.
- National Institute of Mental Health (2018). Depression. Retrieved 11 April 2020 from www.nimh.nih.gov/health/topics/depression/index.shtml
- National Institute of Mental Health (2017). Prevalence of bipolar disorder among adults. Retrieved April 2020 from www.nimh.nih.gov/health/statistics/bipolar-disorder.shtml#part_155458.
- National Suicide Prevention Hotline: 1-800-273-8255
- Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Referral Helpline: 1-800-662-HELP (4357).