Bipolar Disorder or Depression?

Medically Reviewed by Poonam Sachdev on April 05, 2023
Written by Barbara Brody
6 min read

Bipolar disorder and depression have many similarities. But they also have some key differences. It's important to know how to tell one from the other to get the right treatment.

Depression is more than just feeling low. It's a deep sadness or emptiness you can't shake. You might feel hopeless, worthless, and restless. You might lose interest in things that you used to enjoy. Depression (also called major depressive disorder or MDD) often goes hand-in-hand with sleep problems, changes in appetite, and trouble concentrating. It can lead to suicidal thoughts or actions. People with depression might have some days that are better than others. But without proper treatment, their mood tends to remain low.

Bipolar disorder (sometimes called manic depression) is different. If you have it, you have extreme mood swings. You may go through periods of depression (similar to MDD). But you also have periods of great highs.

Bipolar refers to the opposite ends, or poles, of the emotional spectrum -- the highs (mania) and the lows (depression). You might be severely depressed for a period of hours, days, weeks, or even months before entering a manic period. The mania could range from several days to 2 months or longer. It's also possible to have a type of bipolar disorder in which you have manic and depressive symptoms at the same time. You might feel sad and hopeless but also be very agitated and restless.

The highs of bipolar disorder might feel enjoyable. But they also can be dangerous. Risky behavior could put you in physical danger. And mania is usually followed by extreme depression.

About 6 million American adults have bipolar disorder. That might sound like a lot. But bipolar disorder is much rarer than depression, which affects slightly over 17 million American adults in a given year.

The symptoms of bipolar depression are the same as those for major depression. They show up in different ways for different people. You might have trouble sleeping. Or you might sleep too much and even find it hard to get up. The smallest decisions can seem huge. Overwhelming feelings of failure, guilt, or deep loss can trigger suicidal thoughts.

Other signs to look for:

  • You feel like you can’t enjoy anything.
  • You find it hard to focus.
  • You eat too little or too much.
  • You’re weary, and your movements seem slow.
  • You’re forgetful.

For a diagnosis of major depressive disorder, you must have several depression symptoms that make it hard for you to function every day for at least 2 weeks. It's possible to have bipolar disorder without ever having a depressive episode. 

People with depression don't have episodes of mania. But those with bipolar disorder have periods of either mania or a milder form called hypomania.

Mania is a high that goes way beyond “happy” or “joyful.” When you're having a manic episode, you might be very energetic, get very little sleep because you're so wired, and find yourself talking faster because your thoughts are racing. You might feel like the world's best multitasker. You might also take risks that you normally wouldn't take. Examples could include going on a spending spree or driving recklessly.

Sometimes this kind of behavior is easy to spot, but not always. That's especially true if you have hypomania. You might feel good, be happy that you're extra energetic, and think that you're just being productive. Friends and family members may be better able to notice that you're acting out of character. Hypomania doesn’t turn into psychosis (which is when you lose touch with reality) like mania can, but it’s part of a bipolar diagnosis. 

Some people have mania often, others hardly ever. People with bipolar disorder can also go through times when they're neither manic nor depressed.

Signs of manic behavior include:

  • Your mood isn’t comfortable. It might feel good at first, especially after depression. But it quickly becomes erratic and out of control.
  • Your judgment swerves way off. You take extreme risks. You make bad decisions with no thought for what might happen. For instance, you might spend money recklessly or have risky sex.
  • You get bad-tempered and angry.
  • You feel strung-out or edgy.
  • You find it hard to sleep.
  • You feel like your mind is a freeway. You might talk super-fast and hop subjects, or think you can do too many things at once.

People with hypomania may:

  • Talk fast
  • Have lots of energy
  • Need less sleep than usual

Bipolar disorder usually comes on at about age 25, but it can happen earlier. (By contrast, the average age for symptoms of major depression to start is 29.) There are different types of bipolar disorder, too, so it's not always easy to diagnose. Symptoms can happen -- or not happen -- along a wide spectrum.

Also, some bipolar disorder symptoms are a lot like other conditions. For example, mania can feature psychotic symptoms. You might think you’re famous or have superpowers. On the flip side, with manic depression, you might think you’ve ruined your life in some dramatic way.

People with bipolar disorder may also have other conditions that make both diagnosis and treatment more challenging, such as:

  • Anxiety disorder or ADHD
  • An eating disorder
  • PTSD, or posttraumatic stress disorder
  • A physical disorder such as diabetes, obesity, migraine, or thyroid or heart disease
  • Substance use problems

Keep in mind that the chance that you’ll have bipolar disorder goes up if your parents or brothers or sisters have it. But it doesn’t always happen that way. For example, studies of identical twins show that one twin might have the illness, while the other doesn’t.

 

Getting a diagnosis of bipolar disorder isn't always easy. A mental health expert who only sees you at your low points might not know about your manic behavior unless you or someone who knows you well brings it up.

A “life chart” is a good way to track your moods and help your doctor diagnose whether you have bipolar disorder. You’ll record details about your moods, sleep patterns, and events in your life. If you’re on a manic swing, you might feel “up” and capable, but a look at the big picture will show you how a “down” will follow. The info also will give your doctor a window into your day-to-day -- even hour-to-hour -- life to decide how best to proceed with treatment if needed.

Certain phone apps can help you keep up, too. There are quite a few available to help you track your moods, medications, sleep patterns, and more. One even analyzes how you type on your phone: your rhythm and speed, mistakes, corrections, and other dynamics, but not your content. It then uses this data to gauge your mood and predict bipolar episodes. Just remember that these apps don’t take the place of following a treatment plan under your doctor’s care.

If you think you might have bipolar disorder, it's important to raise your concerns with a mental health expert and work closely with them to arrive at the correct diagnosis. Bipolar disorder is a lifelong condition. Proper treatment is often a combination of counseling and medication. It's the best way to manage your symptoms.

A mood-stabilizing medication, such as divalproex or lithium, is often used to manage bipolar disorder. Some people take antidepressants in addition to a mood stabilizer or an antipsychotic medication. Taking an antidepressant by itself could actually trigger a manic episode. That's another important reason to figure out if you have bipolar disorder or depression.

Over time, your condition may shift and your medications may need to be tweaked. Your health care provider may encourage you to track your symptoms. Recording your daily mood, sleep patterns, life events, and other details may help you and your provider stay on top of your condition and make sure you get the most effective treatment.