These mood disorders are similar, but a key symptom sets them apart.
Bipolar disorder might be known for causing two “extremes” of the mood spectrum—mania and depression—yet recognizing symptoms of bipolar disorder can still be challenging. Manic episodes often occur infrequently, and some types of manic symptoms (like impulsive spending) may fly under the radar to friends and family. In fact, to an outsider, someone’s bipolar disorder may seem indistinguishable from depression.
One possible reason for the confusion? Americans are more familiar with what depression looks like. Approximately 6.7 percent of adults in the United States have had at least one major depressive episode, while only 2.8 percent of U.S. adults have had bipolar disorder in the past year, according to the National Institute of Mental Health (NIMH).
“Bipolar disorder is a mental illness that involves both having had an experience of a manic episode, as well as experiencing depressive episodes,” says Susan Samuels, MD, psychiatrist at New York-Presbyterian Hospital, Weill Cornell Medicine. Learn more about the types of bipolar disorder here.
How Bipolar Differs from Depression
Since bipolar disorder and depression both include depressive symptoms, the difference really boils down to mania. It only takes one manic episode to classify someone as having bipolar disorder instead of depression.
“The difference between bipolar disorder and depression is [the] presence of a manic episode,” says Ben Michaelis, PhD, a psychologist in New York City. “Once you have a manic episode, [the diagnosis] moves immediately from a depressive disorder to a bipolar disorder.”
Manic episodes can fall on a spectrum of severity. What most people consider a manic episode is actually on the severe end of the spectrum. Here are symptoms of a severe manic episode, according to Dr. Samuels:
Not needing sleep
Feeling invincible and on top of the world
But someone with bipolar depression may also experience hypomanic episodes, which are much less severe and may be less obvious to outsiders—or even to the person experiencing them. Being easily agitated, having trouble with budgeting, racing thoughts, or poor sleep habits are all signs of a hypomanic episode.
Someone with depression, on the other hand, doesn’t flip to mania. “Depression is unipolar depression, meaning you only go to the one pole of low mood,” says Gail Saltz, MD, psychiatrist at New York-Presbyterian Hospital, Weill Cornell Medicine. Learn more about the symptoms of depression here.
Why Knowing the Difference Really Matters
Despite the similarities in the two mood disorders, recognizing bipolar disorder is critical and even lifesaving. Severe manic episodes can be destructive and dangerous, and dealing with them can be exhausting.
Among those with bipolar disorder, more than 80 percent experience “serious impairment” that affects their personal and professional lives, according to the NIMH, which is the highest among all mood disorders. This means treating bipolar disorder demands careful methods and targeted medication.
“Medications that you choose that might treat the depressive episode can cause one to move into a hypomanic state if you are not aware that you have bipolar disorder,” explains Dr. Saltz. Instead of antidepressants, doctors may prescribe mood stabilizers or antipsychotic drugs for someone with bipolar disorder.
If you have depression or bipolar disorder and are experiencing thoughts of self-harm or suicide, call 911, go to the emergency room, or call the National Suicide Prevention Lifeline: 1-800-273-8255.
Dr. Samuels is an assistant professor of clinical psychiatry and clinical pediatrics at Weill Cornell Medicine and an assistant attending psychiatrist at NewYork-Presbyterian Hospital.Ben Michaelis
Dr. Michaelis is a clinical and media psychologist in New York City.Gail Saltz
Dr. Saltz is a clinical associate professor of psychiatry at the NewYork-Presbyterian Hospital and Weill Cornell Medicine and a psychoanalyst with the New York Psychoanalytic Institute.
00:00:00,000 --> 00:00:02,394
00:00:02,394 --> 00:00:07,509
Bipolar disorder is a mental illness that
involves both having had an experience
00:00:07,509 --> 00:00:11,810
of a manic episode, as well as
experiencing depressive episodes.
00:00:11,810 --> 00:00:16,836
00:00:16,836 --> 00:00:19,967
So the difference between
bipolar disorder and
00:00:19,967 --> 00:00:23,340
depression is by that
presence of a manic episode.
00:00:23,340 --> 00:00:24,865
Once you have a manic episode,
00:00:24,865 --> 00:00:28,454
it moves immediately from a depressive
disorder to a bipolar disorder.
00:00:28,454 --> 00:00:32,610
Because the assumption is that you
have had both of those things.
00:00:32,610 --> 00:00:35,530
And someone that has a manic
episode is very likely to also have
00:00:35,530 --> 00:00:37,060
a depressive episode.
00:00:37,060 --> 00:00:42,500
a severe manic episode would look like
somebody with extreme distractibility,
00:00:42,500 --> 00:00:46,910
impulsivity, speaking excessively fast,
00:00:46,910 --> 00:00:51,070
not needing to sleep,
feeling like they're on top of the world.
00:00:51,070 --> 00:00:52,560
00:00:52,560 --> 00:00:56,370
all of these symptoms to the most
extreme that you could possibly imagine.
00:00:56,370 --> 00:00:59,840
With a hypomanic episode, they'll have
some of these very same symptoms, but
00:00:59,840 --> 00:01:04,040
they won't be quite as severe.
Depression is unipolar depression,
00:01:04,040 --> 00:01:07,890
meaning you only go to
the one pole of low mood.
00:01:07,890 --> 00:01:10,820
You have serious sadness, hopeless,
00:01:10,820 --> 00:01:14,920
weeks on end episodes of depression.
00:01:14,920 --> 00:01:20,470
And it is different from having this
other pole where you feel expansive or
00:01:20,470 --> 00:01:22,900
high or irritated or agitated.
00:01:22,900 --> 00:01:27,915
And you need to have episodes of
that intermittently, at least,
00:01:27,915 --> 00:01:32,220
or once or twice,
in order to call it bipolar disorder.
00:01:32,220 --> 00:01:33,810
And why is that important?
00:01:33,810 --> 00:01:37,280
It is important because medications
that you choose that might treat
00:01:37,280 --> 00:01:41,930
the depressive episode can cause
one to move into a hypomanic state
00:01:41,930 --> 00:01:45,010
if you are not aware that
you have bipolar disorder.
00:01:45,010 --> 00:01:48,130
So knowing that is important
in terms of treatment.
00:01:48,130 --> 00:01:49,720
Bipolar disorder can be very,
00:01:49,720 --> 00:01:50,990
00:01:50,990 --> 00:01:54,970
The reason for that is during a manic
episode, or even during a depressive
00:01:54,970 --> 00:01:58,850
episode, if it's particularly severe,
there can be negative and
00:01:58,850 --> 00:02:03,466
perhaps risky behaviors that can lead
to very, very serious consequences.
00:02:03,466 --> 00:02:06,202
00:02:06,202 --> 00:02:11,571
If you ever feel like you might want
to harm yourself or somebody else,
00:02:11,571 --> 00:02:17,780
please call 911 immediately or
proceed to your nearest emergency room.
00:02:17,780 --> 00:02:24,040
It's also good to have on hand
the National Suicide Prevention Lifeline,
00:02:24,040 --> 00:02:27,088
which is 1-800-273-8255.
Altamura AC, Lietti L, Dobrea C, Benatti B, Arici C, Dell-Osso B. Mood stabilizers for patients with bipolar disorder: the state of the art. Expert Rev Neurother. 2011 Jan;11(1):85-99.
Bipolar disorder. Bethesda, MD: National Institute of Mental Health. (Accessed on April 15. 2021 at https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml.)
Prevalence of bipolar disorder among adults. Bethesda, MD: National Institute of Mental Health. (Accessed on April 15. 2021 at https://www.nimh.nih.gov/health/statistics/bipolar-disorder.shtml.)