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.
A Diagnosis Depends on Subjective Report
The diagnosis of depression or bipolar disorder will be made largely upon the subjective report of the individual when they go to see a mental health professional for the first session. Often referred to as an “intake interview” or the “initial evaluation,” this session is first and foremost an information-gathering session for the clinician. Gathering information about you, your history and your symptoms helps the clinician make a more reliable diagnosis.
For instance, if a person is depressed and goes to the first session complaining of depression, the clinician will ask questions to see if they’ve ever experienced anything that might be considered a manic or hypomanic episode. If they do not find such an episode in the individual’s history, they are likely to diagnose the individual with a type of depression or depressive disorder (the exact diagnosis will depend on the individual’s history).
If, on the other hand, the individual reports they have experienced manic (or hypomanic) episodes in the past, a bipolar diagnosis is more likely. There may be other factors that affect the diagnosis beyond the simple lists of symptoms above. The clinician, however, is trained to ask you the right questions to ensure they arrive at the most accurate diagnosis.
Great, I’ve Been Diagnosed. Now What?
Once properly diagnosed with bipolar disorder or depression, an individual will be prescribed a course of treatment consistent with their own unique needs, background, and severity of the disorder. In both cases, a course of medications and psychotherapy is likely to be recommended, as the combination of the two seems to be the most effective in helping most people feel better more quickly.
While some bipolar medications may begin working within a few weeks, medications that work on depressive feelings generally take longer for most people to feel their full therapeutic effects. Research has shown that this period of time can be anywhere from 6 to 8 weeks for most people who take antidepressant medications. In the meantime, a person is generally prescribed a course of psychotherapy to help deal with the depression with other methods (such as cognitive-behavioral therapy and techniques).
Most people diagnosed with either bipolar disorder or depression generally feel better within a few months and many people can safely discontinue treatment with their doctor’s recommendation within a year. The actual length of treatment varies widely, however, based upon the severity of the disorder, the effectiveness of the treatment for that individual, and other factors.