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Bipolar disorder features depressive episodes, but is nonetheless very different from depression. What do you need to know?

Bipolar disorder — which used to be called "manic depression" — has an awful lot in common with major depressive disorder. The current incarnation of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5, treats it as a completely separate entity, however, its authors having decided to address bipolar disorder in the chapter that comes between depressive disorders and psychotic disorders. Why is it so important to distinguish between the two? 

If you have recently been diagnosed or are trying to understand a loved one better, you may wonder just how bipolar disorder differs from depression, as well as what it shares in common with major depressive disorder.

A quick look at the symptoms of bipolar disorder

To begin understanding, it's important to look at the (fairly complex) diagnostic criteria for bipolar I disorder, which we'll simplify a bit for your benefit:

  • People with bipolar disorder experience manic episodes characterized by increased energy and focus as well as feelings of euphoria or irritation, for at least one week at a time. These episodes can induce feelings of grandiosity, a racing mind, and the immediate and uncontrollable urge to engage in various activities, including having lots of ideas and taking a lot. People with bipolar disorder may be physically restless and don't sleep a lot during these times. These episodes are severe enough to interfere with daily functioning and may require hospitalization. 
  • They also have hypomanic episodes, which have pretty much the same symptoms, but not to the extent where other people necessarily notice or to require hospitalization. 
  • Depressive episodes are another characteristic symptom of bipolar disorder. When a person with bipolar is in the middle of a depressive episode, they'll meet the diagnostic criteria for major depressive disorder. These include a depressed mood, loss of interest in previously meaningful activities, weight and appetite changes, a physical slowing down or speeding up, sleep disturbances, feelings of worthlessness or guilt, trouble concentrating and making decisions, and suicidal feelings or thoughts about death. 
Bipolar disorder can be diagnosed when a person has had at least one manic episode that cannot better be explained by some other mental disorder, physical health problem, or by substance abuse, as well as episodes of depression. People with bipolar disorder, essentially, swing between two extreme states of mind. Manic episodes may make a person with bipolar disorder feel like they're on top of the world and they can do almost anything. Depressive episodes, meanwhile, do the opposite — make nearly everything seem impossible. 

What do bipolar disorder and depression have in common?

The obvious one is that bipolar disorder and depression both involve depressive episodes, but there's more:

  • Bipolar disorder and depression can both be treated.
  • Left untreated, the risk of poor outcomes, including suicide, are high in both depression and bipolar disorder. 
  • Antidepressants are sometimes employed in the treatment of both depression and bipolar disorder (during a depressive episode). However, they can induce manic episodes as well, and should therefore be used with caution. 
  • Bipolar disorder and depression share some risk factors — having a family history of the condition and being low-income. 

Bipolar disorder vs depression: The differences

While bipolar disorder and depression share many common features, there are also key differences. 

  • While depressed people who recover feel better, they do not experience manic episodes. This is why diagnoses depression is also sometimes referred to as "unipolar", in contrast to bipolar disorder. 
  • People with bipolar disorder can quickly cycle through different extreme moods, while the mood of depressed people remains more constant. 
  • Mood stabilizing medications like lithium and divalproex are the treatment of choice for bipolar disorder, and they are not used to treat depression. The differences in medications that are most likely to be effective is one of the key reasons why it is important for people with bipolar disorder to be diagnosed correctly, as opposed to being slapped with a label of major depressive disorder. Though antidepressants can sometimes be used in the treatment of bipolar disorder, they can also trigger the onset of a manic episode. 
  • People with bipolar disorders are more likely than depressed people to have what is described as "atypical features" during a depressive episode. These features include sleeping more rather than less, having a physical feeling of heaviness, and being psychotic. People with bipolar are also likely to be depressed for shorter periods of time than those diagnosed with a depressive disorder. 
  • People with bipolar disorder are more likely to feel suicidal during a depressive episode. 
  • Bipolar patients have a higher risk of abusing substances such as alcohol and drugs. 

What should you do if you think you may have bipolar disorder?

Here's another important difference between bipolar disorder and major depressive disorder — while nearly one in 10 people will be suffer from depression in any given year, bipolar disorder occurs in less than one percent of people over their lifetimes. Bipolar being the rarer diagnosis, it is possible for people to initially be misdiagnosed with depression. If you suffer from states of mind that sound an awful lot like manic episodes as well as going through bouts of depression, it is very important to let your treating healthcare provider know about your past and present experiences to increase your chance of receiving the right diagnosis. Like depression, bipolar disorder can be managed — but there's a reason the two don't even share a chapter in the DSM-5. Bipolar disorder and depression are two different beasts, and to get the help you need, your doctor needs to know what you are dealing with. 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  • Photo courtesy of SteadyHealth

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