Bipolar vs. depression: Differences and treatments

Receiving the correct diagnosis of depression or bipolar disorder can be challenging. They share many similarities, so it is important to know how to tell them apart and receive the best treatment for you.  

According to the National Institute of Mental Health (NIMH), 4.4% of adults in the United States experience bipolar disorder at some point in their lives.

If you have bipolar disorder or experience manic and depressive episodes, you may have extreme “up” episodes of mania, with a significant increase in energy levels. Between these manic episodes, depressive episodes can occur, which coincide with low energy. You also may experience hypomanic episodes, which are like manic episodes, but not as severe.

However, if you have depression or major depressive disorder (MDD), you may notice more consistent symptoms. Feelings of hopelessness, fatigue, and sadness are common. The difference between depression and bipolar disorder is that depression contains no episodes of mania or hypomania.

Symptoms of bipolar disorder

People with bipolar disorder experience different symptom phases.

Manic episodes

According to the American Psychiatric Association, a manic episode can last at least 1 week, and you may notice signs like:

• decreased need for sleep
• faster speech
• distractibility
• increased recklessness
• restlessness
• disorganized thoughts
• racing thoughts, like changing topics frequently during conversation

These behaviors are typically a change from your usual behaviors and can involve a hospital stay. Episodes of mania and hypomania differentiate bipolar disorder from depression.

Major depressive episode

Major depressive episodes include intense sadness or a loss of interest in activities that typically excite you. You may experience both.

Other symptoms you may experience include:

• worthlessness
• guilt
• increased or decreased sleep
• difficulty concentrating
• frequent thoughts of suicide
• changes in appetite

According to the American Psychiatric Association, you must have at least 3 of the listed symptoms to receive a diagnosis. Around 60% of people with bipolar disorder receive an incorrect diagnosis of depression, which can result in the wrong treatment, especially if your depressive episode lasts a long time.

If you ever experience thoughts of suicide, do not wait to get help. Call 911 or an emergency healthcare professional as soon as possible.

Hypomanic episodes

These periods can feel like manic episodes but will have less severe symptoms. They tend to last for shorter periods and may not be present even if you have bipolar disorder. These episodes should not cause major disruptions to daily life, unlike manic episodes.

Symptoms of depression

Depression is a serious, yet common mood disorder that can cause frustrating disruptions to your daily life. Your doctor will only make a diagnosis of a depressive disorder if you have been experiencing any of the following signs for at least 2 weeks:

• anxiousness
• hopelessness
• loss of interest in hobbies
• unplanned weight changes
• difficulty remembering or concentrating
• aches or pains without a clear cause
• thoughts of suicide

Symptoms of depression are the same or very similar to depressive episodes seen in people with bipolar disorder. If you experience manic episodes before or after depressive episodes, you may have bipolar disorder, not depression. You may also have bipolar disorder but experience no symptoms of depression.

It is important to discuss all symptoms with your healthcare team to ensure the correct treatment.

Treatments for depression and bipolar disorder

Receiving the right diagnosis is critical for getting the best treatment and medication to help manage your symptoms. Some antidepressants that can help people with depression can worsen symptoms of other conditions, like bipolar disorder.

Depression

Antidepressants that your doctor may recommend include selective serotonin reuptake inhibitors (SSRIs). These medications help to boost levels of serotonin in your brain. Common SSRIs include:

• fluoxetine (Prozac)
• paroxetine (Seroxat)
• sertraline (Zoloft)
• vilazodone (Viibryd)
• citalopram (Celexa)

Doctors may not recommend SSRIs if you are pregnant or have any form of epilepsy. If you have bipolar disorder, SSRIs may worsen your condition, so speak with your doctor about which medications are best for you.

Bipolar disorder

Doctors use mood-stabilizing medications to help treat bipolar disorder. These medications differ from those used to treat depression as antidepressants may worsen manic episodes of bipolar disorder.

Lithium

Lithium is an effective treatment for bipolar disorder and helps to stabilize moods. It can reduce the frequency of manic and mixed episodes.

It is available as the following medications:

• lithium carbonate (Lithobid)
• lithium ER, which is a slow-release version

Your doctor will help you determine which type is best for you.

Quetiapine 

Quetiapine is approved for treating all phases. Two forms include:

• Quetiapine (Seroquel): 50 milligrams (mg) twice on day 1; 100 mg twice for day 2; 150 mg twice on day 3; and 200 mg twice for day 4. Dosage should increase by 200 mg per day onwards, with a maximum of 800 mg per day.
• Quetiapine ER (Seroquel XR): This is a slow-release form. The dosage will be different from the standard form of Seroquel.

Paliperidone

Also known as Invega, this medication is an antipsychotic, but can be effective for stabilizing moods. Invega is not FDA approved for bipolar disorder, but some doctors may prescribe it off-label.

The recommended dosage for Invega is 1.5 mg, 3 mg, 6 mg, or 9 mg per day.

When to see a doctor

If you think you are experiencing depression or bipolar disorder, you should seek help from your doctor as soon as possible. This is especially important if your symptoms are not improving.

In either condition, you should seek emergency medical help if you experience any of the following:

• suicidal thoughts
• thoughts of self-harm
• you no longer feel that your medications are effectively managing your episodes or symptoms

Advice and resources are available through the Substance Abuse and Mental Health Services Administration (SAMHSA) Helpline at 800-622-HELP (4357) or by calling 988 for the 988 Suicide and Crisis Lifeline.

Summary

Major depression presents as a consistent and unwavering episode of sadness and lack of energy.

If you have bipolar disorder, you may experience depressive episodes. However, they may be paired with manic episodes of high energy and extreme “up” periods.

Medications for major depression cannot treat bipolar disorder episodes and may make episodes of mania worse.

It is important to try and recognize your feelings and know that there is help available at all times. If you ever experience thoughts of suicide or self–harm, call the 988 Suicide and Crisis Lifeline or emergency medical assistance right away.