Bipolar disorder and major depressive disorder are mental health conditions that share some similar features. In some cases, people may confuse the two. However, they are separate disorders that require different treatment approaches.
Some of this misunderstanding may be attributed to the term “bipolar depression,” which is a name given to the depressive episodes that are a part of bipolar disorder. To understand the difference between bipolar and depression, each disorder must be examined on its own. Once a person understands both disorders separately, it becomes easier to identify differences between bipolar and depression.
Bipolar Disorder: Symptoms & Causes
Bipolar symptoms include sudden, extreme changes in mood. The causes of bipolar disorder are ultimately unknown, though it appears to be the result of a chemical imbalance in the brain. Bipolar disorder likely has a genetic component, as the condition often runs in families.
Bipolar disorder is characterized by the presence of manic or hypomanic episodes. A manic episode is defined as a period of elevated feelings and impulsive behavior. Hypomania is a less severe form of mania. During a manic episode, a person may exhibit the following bipolar disorder symptoms:
- High energy
- Elevated mood
- Increase in goal-driven activities
- Inflated sense of self-esteem
- Reduced need for sleep
- Talking more or at a faster pace than usual
- Difficulty concentrating
- Impulsive or high-risk behaviors
These episodes may occur with or without depressive episodes that feature many of the same symptoms of major depressive disorder.
Another possible sign of bipolar disorder is psychosis. While not every person with bipolar disorder will experience a psychotic episode, many do. Psychotic episodes involve experiencing delusions or hallucinations.
Types of Bipolar Disorder
There are two types of bipolar disorder: bipolar I and bipolar II. To be diagnosed with bipolar I, someone must have experienced at least one manic episode. Bipolar II is diagnosed if a person has experienced at least one hypomanic episode that was either preceded or followed by a major depressive episode.
Depression: Symptoms & Causes
Often referred to as depression, major depressive disorder is characterized by persistent low mood, feelings of sadness and loss of interest or pleasure in most areas of life. Some of the most common depression symptoms include:
- Feelings of hopelessness, helplessness or worthlessness
- Inappropriate feelings of guilt
- Decreased self-esteem
- Loss of energy
- Difficulty concentrating and making decisions
- Changes in sleeping patterns (either sleeping too much or too little)
- Changes in appetite (either eating too much or too little)
- Suicidal thoughts
- Decreased talking or slowed rate of speech
- Social isolation
Understanding these key signs of depression can make identifying the disorder easier. However, it’s still important to bear in mind that the symptoms of a depressive episode in bipolar disorder are the same as many of the symptoms of major depressive disorder.
Like bipolar disorder, the exact causes of depression are unknown. However, most people agree that chemical imbalances in the brain play a significant role. Like bipolar disorder, depression tends to run in families.
Types of Depression
There are several types of depression including peripartum depression (formerly postpartum depression), seasonal depression (also known as seasonal affective disorder), and persistent depressive disorder (formerly dysthymia).
Peripartum depression symptoms occur during and after pregnancy. Seasonal depression is confined a specific seasonal pattern, with most people experiencing symptoms in the fall and winter. Persistent depressive disorder is a chronic form of depression in which there is little relief from symptoms without intervention. The relentlessness of symptoms distinguishes it from major depressive disorder, which tends to include periods without depressive episodes.
What Is Bipolar Depression?
Bipolar depression is not a standalone disorder. Instead, bipolar depression symptoms are the symptoms experienced during a depressive episode of bipolar disorder. Because the symptoms of bipolar depression vs. depression are essentially the same, the best way to tell the difference between the two is to determine if manic or hypomanic episodes are also present.
Differences in Diagnosis
The most glaring difference between a bipolar diagnosis and a depression diagnosis is the presence of manic or hypomanic episodes. These do not occur as a part of major depression.
One reason that bipolar disorder and depression are often confused is that few people seek help during a manic or hypomanic episode, likely because these episodes feature increased energy, motivation and productivity.
If someone meets the DSM-5 criteria for depression, their history should be carefully examined to determine if symptoms are better accounted for by bipolar disorder DSM-5 criteria. In many cases, a bipolar disorder diagnosis may not occur for many years, as the treating professional is likely only to see the client when they are feeling depressed.
Common Risk Factors
Risk factors for major depression and bipolar disorder are often the same. Both disorders appear to run in families. In addition to biological and genetic factors, other possible risk factors for bipolar disorder include experiencing childhood trauma, extreme stress, and substance use disorders.
Rates of Occurrence: Bipolar vs. Depression
Bipolar disorder statistics indicate that approximately 2.8 percent of adults are diagnosed with this condition. Bipolar disorder appears to be equally common in males and females. One study estimated the level of impairment from bipolar disorder ranging from moderate to severe, with the majority (82.9 percent) of people experiencing serious impairment.
Depression statistics indicate that major depressive disorder is more common than bipolar disorder. It is estimated that approximately 7.1 percent of adults experience a major depressive episode. Unlike bipolar disorder, major depression is more common among females than males, with a prevalence of 8.7 percent and 5.3 percent respectively. The rate of severe impairment is far lower for depression, though a majority of people with this disorder (64 percent) do experience severe impairment.
Bipolar and depression treatment methods are somewhat similar. Both conditions are best addressed with a combination of medication and therapy. However, the specific drugs used for each condition differ.
Bipolar Disorder Treatment
Bipolar disorder treatment almost always includes medication. Mood stabilizers are the most common type of medication used to treat bipolar disorder. Some common mood stabilizers include Lithium and Lamictal. Additionally, treatment for bipolar usually includes individual and group therapy.
Like treatment for bipolar disorder, depression treatment most commonly involves a combination of medication management and therapy. Medication-based treatment for depression generally consists of using antidepressant medications called selective serotonin reuptake inhibitors (SSRIs). Therapy, especially cognitive behavioral therapy (CBT), is effective in treating depression. In some cases, people find that therapy is sufficient treatment without medication.
Prognosis and Outlook
While the overall prognosis of bipolar disorder depends on many factors, early treatment improves long-term outcomes. Each bipolar episode experienced worsens the long-term prognosis. However, treatment tends to be successful when a prevention plan is put in place.
Major depression prognosis is generally thought to be better than bipolar disorder but without treatment full recovery may not occur. As many as 17 percent of people with major depression never experience another episode after seeking treatment. Even in cases where additional depressive episodes occur, treatment can significantly reduce the severity and duration of these depressive episodes.
Key Differences: Bipolar Disorder and Depression
- Bipolar symptoms include extreme changes in mood, while major depressive disorder is characterized by a persistent low mood.
- The symptoms of major depression are the same for depressive episodes within bipolar disorder; however, a manic or hypomanic episode has to have occurred for a person to be diagnosed with bipolar disorder
- Depressive episodes of bipolar disorder should not be treated as major depression, as antidepressants can trigger manic episodes in people with bipolar disorder
- Bipolar disorder is less common than major depression, but often far more impairing
If you or your loved one has a mental health concern such as bipolar disorder or major depression in addition to a substance use disorder, contact The Recovery Village today to learn more about evidence-based treatment programs available at facilities across the country.
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MacGill, M. “The differences between bipolar and depression.” Medical News Today, February 22, 2019. Accessed March 21, 2019.
Hirschfeld, R. M. “Differential diagnosis of bipolar disorder and major depressive disorder.” Journal of Affective Disorders, December 2014. Accessed March 21, 2019.
Rowland, T. A., & Marwaha, S. “Epidemiology and risk factors for bipolar disorder.” Therapeutic Advances in Psychopharmacology, September 2018. Accessed March 21, 2019.
Mayo Clinic. “Depression (major depressive disorder).” Accessed March 21, 2019.
National Institute of Mental Health. “Bipolar Disorder.” Accessed March 21, 2019.
National Institute of Mental Health. “Major Depression.” Accessed March 21, 2019.
Verduijn, J., Verhoeven, J. E., Milaneschi, Y., Schoeveres, R. A., Van Hermet, A. M., Beekman, A. T. F., & Penninx, B. W. J. H. “Reconsidering the prognosis of major depressive disorder across diagnostic boundaries: full recovery is the exception rather than the rule.” BMC Medicine, December 12, 2017. Accessed March 21, 2019.
Jensen, B., Nguyen, C. T., & Maguire, G. A. “Bipolar Disorder: Increasing the Effectiveness and Decreasing the Side Effects of Treatment.” Psychiatric Times, February 12, 2007. Accessed March 21, 2019.
National Alliance on Mental Illness. “Bipolar Disorder.” Accessed March 28, 2019.