Recognizing the difference between depression and bipolar disorder

Bipolar disorder and depressive disorders, like major depressive disorder, can both cause feelings of depression. While people with depressive disorders only experience depression (which can come and go), people with bipolar disorder swing between two extreme mood states: depression and mania.

It’s essential to get the right diagnosis to get the most effective treatment. Unfortunately, bipolar disorder is often misdiagnosed as depression. By understanding the differences and advocating to get the right diagnosis, you can ensure that you get access to the right treatment that doesn’t make your bipolar symptoms worse.

Can bipolar symptoms be mistaken for depression?

Bipolar disorder and depression are both types of mood disorders. Although they’re distinct conditions, they have significant overlap in their officially recognized symptoms. More specifically, people with bipolar disorder experience depressive episodes that often look identical to the depressive episodes that people with depression go through.

What is bipolar disorder?

There are two types of bipolar disorder — bipolar 1 and bipolar 2 — and bipolar 1 has a higher intensity of symptoms. People with either of these conditions may swing between two extreme mood states, or “poles:” mania/hypomania and depression. This is why bipolar disorder was formerly known as “manic depression” — because people who live with this condition experience both types of moods.

The main differences between the two types of bipolar disorder are that people with bipolar 1 disorder experience both major depressive episodes and manic episodes. In bipolar 2 disorder, people have depressive episodes and hypomanic episodes (which are less intense than manic episodes). 

Signs of a manic or hypomanic episode include:

• Decreased need for sleep
• High energy or feelings of euphoria
• Inflated sense of grandiosity or invincibility
• Increased talkativeness
• Racing thoughts
• Agitated movements 
• Being very driven to complete a goal

These manic or hypomanic episodes can last anywhere from a few days to several months. 

What is “unipolar” depression?

There are several types of depression, with major depressive disorder (MDD) being the most common. Compared to bipolar disorder, which causes mood swings from one extreme, or “pole,” to another, major depressive disorder is considered  “unipolar” depression. In other words, people with depression don’t swing to mania or hypomania — they only experience depressive episodes.

The lack of manic/hypomanic episodes is the primary difference between bipolar disorder and depression. Other than that, the depressive episodes that people with bipolar disorder go through have the same diagnostic criteria as the episodes that people with a depressive disorder go through.

The formally recognized symptoms of a depressive episode include:

• Low mood almost all the time
• Fatigue and low energy
• Loss of interest and pleasure
• Slow movements or speech
• Significant changes in weight and appetite
• Changes in sleep, including not being able to sleep and sleeping too much
• Excessive feelings of worthlessness, hopelessness, and guilt

Differences between bipolar depression and unipolar depression symptoms

Depressive episodes can look very similar in people with bipolar disorder and depression. However, research shows that if you live with bipolar disorder, your depressive symptoms may be even more intense than they are for people with “unipolar depression” or major depressive disorder. 

For example, bipolar depression can come with:

• Increased anhedonia, or the lack of ability to feel pleasure
• Increased risk of psychotic symptoms
• Worse mood in the morning
• Greater difficulty with forming coherent thoughts

People with bipolar disorder are also twice as likely to die by suicide* than people with major depressive disorder.

*The 988 Suicide and Crisis Lifeline provides 24/7, confidential support with trained crisis counselors. If you or a loved one is in emotional distress or a suicidal crisis, please call or text 988. If you’re experiencing a life-threatening emergency or you need immediate help, please call 911.

Can one mood disorder turn into the other?

Depression and bipolar disorder are two distinct conditions. However, many people with bipolar disorder are originally diagnosed with depression. This is because depression symptoms tend to appear at a younger age, so you might have gone through depressive episodes for many years before experiencing your first manic or hypomanic episode.

This doesn’t necessarily mean that your depression has “turned into” bipolar disorder. It’s more likely that you and your healthcare providers weren’t aware that you lived with bipolar disorder when you’d only experienced depressive episodes. Then, when you have a manic or hypomanic episode, it becomes clear that you have bipolar disorder and not MDD or another depressive disorder.

Unlike most other conditions that can coexist, you can’t be diagnosed with both a depressive disorder and bipolar disorder. You go through depressive episodes as part of both conditions, but it’s important to clarify whether these episodes are due to bipolar disorder or if it’s a type of unipolar depression, like MDD. If you’ve gone through even one manic or hypomanic episode, you meet the criteria for bipolar disorder.

However, it is possible to experience features of both a depressive and manic/hypomanic episode at the same time. These are called mood episodes with mixed features. If you experience these mixed mood episodes, you’d likely be diagnosed with bipolar disorder.

Managing depression or bipolar disorder symptoms

Both depression and bipolar disorder are treatable conditions. Regardless of which one you live with, treatment and lifestyle changes can help you manage their symptoms.

However, it’s essential to get the right diagnosis. Research shows that up to 40% of people with bipolar disorder are misdiagnosed, usually with major depressive disorder. This may be both because depressive episodes have an earlier onset and because depressive episodes cause more emotional distress. In other words, a depressive episode might be what drives you to seek professional support, and your manic/hypomanic episodes might fly under the radar for years.

It’s so important to get the right diagnosis because these two conditions are treated very differently. For example, medication used to treat depression can make bipolar symptoms significantly worse.

If you feel like you haven’t received a comprehensive diagnosis, or if you’ve received conflicting diagnoses (for example, one provider diagnoses you with depression while another diagnoses you with bipolar disorder), do your best to advocate for yourself. Treating only the depressive episodes of bipolar disorder is unlikely to help you manage the entirety of your symptoms and can even make symptoms worse.

Find care with Rula

Depressive episodes can be part of both bipolar disorder and depressive disorders like MDD. It can be tricky to know which one you’re dealing with, but getting the right diagnosis is essential to connecting with treatment that works. Left unaddressed, both bipolar disorder and depression may get worse — but treatment provides hope for a better future.

At Rula, we have over 10,000 licensed therapists who are ready to support you with 80+ clinical specialties, including mood disorders like bipolar disorder and depression. Rula’s therapists understand the importance of getting the right diagnosis and using treatment methods that actually work.

Find a therapist on Rula