A common question asked of clinicians is, “What’s the difference between bipolar disorder (also known as manic depression) and plain old depression? It’s a simple question to answer, because depression can either be a stand-alone diagnosis, or a part of another disorder, like bipolar. Therefore a mental health professional is going to examine whether there are other symptoms present (or have occurred in the past), to see if the depression is just depression, or whether it’s a part of a larger disorder.
Bipolar Includes Mania & Depression
If bipolar disorder includes a depressed mood, what else does bipolar include? We can find the answer to this question by looking at the old name for bipolar disorder, manic depression. The old name is pretty descriptive — bipolar is a combination of mania and depression, alternating in cycles.
What is mania? If we examine the symptoms associated with mania, we see that it includes the following:
- Inflated self-esteem or grandiosity
- Decreased need for sleep (e.g., one feels rested after only 3 hours of sleep)
- More talkative than usual or pressure to keep talking
- Flight of ideas or subjective experience that thoughts are racing
- Attention is easily drawn to unimportant or irrelevant items
- Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
- Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
If three or more of these symptoms are present, then a person is considered to have a “manic episode” (or, if it is of less severity and length, a “hypomanic episode”). A manic episode also needs to have lasted for at least a week (a hypomanic episode, just four days) in order to be diagnosed. If an individual has signs that suggest he or she is having or has had a manic or hypomanic episode, in addition to episodes of severe depression, then typically that individual will quality for a bipolar diagnosis.
Depression Has no Mania
In ordinary depression, which clinicians refer to as “major depression” (sorry, there’s no equivalent “minor depression”), no manic or hypomanic episode is prevalent and the individual has no record or indication of having a manic or hypomanic episode in the past. A depressive episode is characterized by the following symptoms:
- Depressed mood most of the day, nearly every day
- No interest or pleasure in all, or almost all, activities most of the day, nearly every day
- Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
- Insomnia (inability to sleep) or hypersomnia (sleeping too much) nearly every day
- Psychomotor agitation or retardation nearly every day
- Fatigue or loss of energy nearly every day
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day
- Diminished ability to think or concentrate, or indecisiveness, nearly every day
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
Five or more of these symptoms for longer than two weeks are needed in order to qualify for a depressive diagnosis, with no accompanying manic episode.