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Whether you live with bipolar disorder or major depressive disorder, you experience periods of depression. This can make it hard to tell them apart. 

But the bi- in bipolar means “two” because it has two phases: mania and depression. Major depressive disorder only has one phase: depression. Knowing the symptoms of each can help you understand which is which and how best to treat them.


Major Depressive Disorder Symptoms

Also called depression or clinical depression, this is more than just feeling low. It’s a serious mood disorder caused by a chemical imbalance in your brain. Symptoms last for long periods. They may include: 

  • Feeling sad, hopeless, or “empty”
  • Bouts of crying
  • Irritability and frustration
  • Low or no interest in activities you usually enjoy
  • Sleeping too much or not being able to sleep
  • Lack of energy 
  • Low appetite or overeating
  • Anxiety and restlessness
  • Feeling guilty or worthless 
  • Trouble thinking, concentrating, making decisions, and remembering things
  • Unexplained aches and pains
  • Thoughts of death

These symptoms are usually so severe that they get in the way of your everyday life. When you have this condition, you tend to have several of these symptoms at one time. Doctors diagnose it when you have at least five of them for 2 weeks or longer.

Symptoms of Depression in Bipolar Disorder

Bouts of depression that come with this condition typically involve the same symptoms as major depressive disorder. The difference is that you also experience an “up” phase, which may include:

  • Feeling overly confident and optimistic
  • Feeling irritated and acting aggressively
  • Not being tired and staying awake for long stretches
  • Grand thoughts, inflated sense of self-importance
  • Talking quickly
  • Having racing thoughts 
  • Acting impulsively, often with poor judgment that leads to reckless behavior
  • Delusions and hallucinations (during severe mania)

Bipolar disorder usually falls into one of three categories:

  • Bipolar I, which means you have manic phases that last at least 7 days and hypomania or depressive phases that can also occur but aren’t required for the diagnosis 
  • Bipolar II, which involves hypomanic and depressive moods 
  • Cyclothymia, periods of high and low moods that don’t reach the same levels as bipolar I or II

Some people have symptoms that fit bipolar disorder but don’t fit these categories. This is called bipolar disorder-not otherwise specified (BP-NOS).

Differences in Treatment

Both major depressive disorder and bipolar disorder can benefit from some form of psychotherapy, such as cognitive behavioral therapy (CBT). This can help reduce your negative thoughts and behaviors and replace them with healthy, positive ones. 

Lowering stress and taking good care of yourself with a healthy diet, sleep, and exercise can help with management of both disorders, too.   

However, the types of medications that are most effective are different. 

The most common medications doctors prescribe for major depressive disorder are antidepressants, including:

  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Atypical antidepressants that don’t fit into the other categories, such as bupropion and trazodone
  • Monoamine oxidase inhibitors (MAOIs)
  • Tricyclic antidepressants (less common)

Starting an antidepressant may trigger a manic episode if you have bipolar disorder. Although doctors may prescribe them in some cases, they typically only do this in combination with a mood stabilizer. 

Common medications for bipolar disorder include: 

Mood stabilizers. These can help control mania. Examples include: 

  • Carbamazepine (Equetro, Tegretol)
  • Divalproex sodium (Depakote)
  • Lamotrigine (Lamictal)
  • Lithium
  • Valproic acid (Depakene)

Antipsychotics. Doctors first used these to treat schizophrenia, but now they’re used to treat bipolar. Although they’re also primarily for mania, you may also see a difference in your depressive symptoms. Some can be taken alone or in combination with a mood stabilizer. Examples include:

  • Aripiprazole (Abilify)
  • Asenapine (Saphris)
  • Cariprazine (Vraylar) 
  • Lumateperone (Caplyta)
  • Lurasidone (Latuda)
  • Olanzapine (Zyprexa)
  • Quetiapine (Seroquel)
  • Risperidone (Risperdal)
  • Ziprasidone (Geodon)

Antidepressant-antipsychotic. Although antidepressants alone have a risk of triggering a manic episode, the medication Symbyax combines the antidepressant fluoxetine and the antipsychotic olanzapine to treat depression and work as a mood stabilizer. The FDA approved it for the treatment of depressive episodes associated with bipolar I disorder.

The most common side effects these medications cause include:

  • Dizziness or nausea
  • Drowsiness or fatigue
  • Frequent urination, dry mouth, or increased thirst
  • Muscle twitching in your hands, face, or other muscles 
  • Weight gain
  • Acne or skin rash
  • Blurred vision

Your doctor will likely start you on a low dose and increase it gradually to see how your body reacts.

Ask Your Doctor

As you figure out your treatment plan, talk to your doctor to find out:

  • Which medications will be best for me?
  • What are the possible side effects?
  • What are the goals of my treatment?
  • How will I know my medication is working?
  • How long can I take the medication?
  • What lifestyle changes can I make to support my treatment?

Show Sources

Photo Credit: valentinrussanov / Getty Images


Psycom: “Bipolar Disorder and Depression: Understanding the Difference.”

John Hopkins Medicine: “Major Depression.”

Mayo Clinic: “Depression (major depressive disorder),” “Bipolar treatment: Are bipolar I and bipolar II treated differently?”

Depression and Bipolar Support Alliance: “Bipolar Disorder.”

National Institute of Mental Health: “Bipolar Disorder.”