Depression and bipolar disorder, once called manic depression, have many overlapping symptoms. Here’s how to tell the difference.
Most people go through a range of emotions over days or weeks. But if you live with depression or bipolar disorder, what you feel can adversely impact how you live.
Depression and bipolar disorder are distinct diagnoses, but there’s a significant overlap of symptoms. This overlap may make it difficult to determine which condition you may be experiencing.
Bipolar disorder used to be called manic depression, but healthcare professionals don’t use this term anymore.
People with bipolar disorder often experience both symptoms of depression and mania or a high-energy period. But people with clinical depression typically don’t experience symptoms of mania.
Depression and bipolar disorder are complex conditions that can share symptoms. It may take some time to receive the proper diagnosis.
Clinical depression is named major depressive disorder (MDD) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Doctors also recognize other types of depression, such as:
- persistent depressive disorder (PDD)
- premenstrual dysphoric disorder (PMDD)
- postpartum and peripartum depression
- seasonal affective disorder (SAD)
- depression with mixed features
These conditions are related to MDD but have different diagnostic criteria. Depending on what you experience, you may receive a diagnosis of another kind of depression and not MDD.
The DSM-5 recognizes three main types of bipolar disorder, each of which has unique diagnostic criteria:
- bipolar I disorder
- bipolar II disorder
- cyclothymic disorder
Doctors look for the
- Manic episode: Mania is a period lasting at least 7 days of high energy combined with several, specific behavior changes. The changes cause dysfunction at work or in a person’s social life.
- Hypomanic episode: Hypomania is similar to mania, but with a shorter period of less severe changes. The changes do not cause trouble with daily living and last at least 4 days.
- Major depressive episode: At least 2 weeks of several symptoms of depression. The criteria for a major depressive episode mirrors that for a diagnosis of MDD.
Manic episodes are characterized by irritability or increased energy levels on most days, for the majority of each day. People must also experience at least three of these behavior changes to be considered for a bipolar disorder diagnosis:
- boundless energy and less need for sleep
- racing thoughts or switching topics during conversation
- speaking more or speaking rapidly
- increased activity
- increase in risk-taking behavior
- becoming easily distracted
Symptoms of MDD
For a clinical diagnosis of MDD, a person must experience a persistent depressed mood or reduced ability to experience pleasure, called anhedonia, for at least 2 weeks.
In addition, someone must experience at least four of the following, or three if they are living with both anhedonia and depressed mood:
- feelings of guilt or worthlessness
- low or decreased energy
- changes in appetite
- poor or reduced concentration
- trouble sleeping or sleep pattern changes
- feeling sluggish or agitated
- suicidal thoughts
Symptoms of bipolar I disorder
To meet the criteria of bipolar I disorder, a person must experience:
- one or more manic episodes lasting 7 days or more each, or
- shorter manic periods but with severe symptoms that require hospitalization
Many people with bipolar I disorder also experience depressive episodes or mixed episodes of manic and depressive symptoms.
Symptoms of bipolar II disorder
To receive a diagnosis of bipolar II disorder, someone must experience:
- one or more hypomanic episodes, and
- one or more major depressive episodes
People with bipolar II disorder do not experience manic episodes.
Symptoms of cyclothymia
Cyclothymic disorder, or cyclothymia, is diagnosed when someone experiences:
- periods of hypomanic symptoms, but no hypomanic episodes
- periods of depressive symptoms, but no depressive episodes
To receive a diagnosis, these periods take place over 2 years or more.
What’s the difference between mania and depression?
Bipolar disorders include periods of manic or hypomanic symptoms. These high-energy periods include increased activity, less sleep, and racing thoughts. Depressive symptoms may include a low mood, lack of energy, increased sleep, and sluggishness.
The main difference between MDD and bipolar disorder is the presence of mania or hypomania symptoms. When you experience depression, your doctor may diagnose bipolar disorder if you also have periods of high energy or manic indicators.
It’s also possible for people with MDD or mixed features depression to experience mania, but they often experience depression and symptoms of mania at the same time. People with bipolar disorders tend to swing between high and low moods.
These symptoms must last for a defined period to fit the diagnostic criteria for an episode and therefore form the basis of a bipolar disorder or depression diagnosis.
Once a doctor diagnoses bipolar I disorder, according to the DSM-5, they must also
- 4 mood episodes in 12 months (rapid cycling)
- delusions, phobias, hallucinations, or paranoia
- mixed episodes of mania, hypomania, or depression
- distressing anxiety
- seasonality or association with onset during pregnancy
- atypical features
The typical age of onset for bipolar disorders is 25 years old. The criteria for diagnosing children and adolescents is similar to that for adults with some exceptions. For example, children can
MDD and bipolar disorders are typically treated with one or a combination of psychotherapy and medication. There are also self-care strategies that help with day-to-day management and increased well-being.
A treatment plan is always developed individually that takes your unique experiences and wellness goals into account.
Talk therapy is often used to treat MDD and bipolar disorders. For mild depression, psychotherapy alone — such as cognitive behavioral therapy (CBT) or another type of therapy — often significantly reduces the frequency and intensity of symptoms.
For more severe cases of depression, psychotherapy may be combined with medication.
Medication is a cornerstone treatment for bipolar disorders and is almost always used alongside psychotherapy. Therapy and medication serve different but important roles in your long-term wellness.
Medications prescribed for bipolar disorder include mood stabilizers, commonly lithium, and atypical antipsychotics.
People with MDD are typically prescribed antidepressants. Your doctor may also work with you to find the right medication for your experience.
You and your healthcare team will likely communicate regularly about your medications and whether your prescription needs to be changed or updated to find the right match for you and your diagnosis.
Electroconvulsive therapy (ECT) involves brain stimulation while you are under anesthesia. This is a safe and well-researched therapy that can be helpful for those living with bipolar disorder or severe depression.
Healthy eating and exercise can support feeling well. You may also want to keep a journal that records how you feel and what you experience daily. This record can give you and your healthcare team information that helps tailor your treatment.
Other things you can do to support your mental health include:
- getting enough sleep
- staying hydrated
- getting regular sunlight
- regular exercise
MDD and bipolar disorders are distinct diagnoses. Someone living with bipolar disorder may experience symptoms of depression, but someone with MDD does not experience mania or hypomania.
It can be difficult to distinguish between the two conditions on your own, but working with a mental health professional can help. Even then, it may take a while to receive the correct diagnosis.
Both conditions respond well to treatment. Medication, talk therapy, and self-care strategies are essential tools for people with either condition and can help you lead a more fulfilling life.