Bipolar Disorder vs Depression

by Andrea Blundell
Reviewed by Dr Sheri Jacobson

The stereotype of someone with bipolar disorder is someone who is deeply depressed one minute, then bouncing off the walls the next.

But bipolar disorder is often far more subtle. And sometimes it can be misdiagnosed as depression, and vice versa. The similarities between the two is made clear if you look at the original name of bipolar disorder, manic depression'.

What is depression?

Depression means that your ability to function has been affected for a few months or more because of negative, gloomy thoughts, feelings of hopelessness, and a lack of interest in things you once enjoyed. These come along with physical symptoms like fatigue, and changes to eating and sleeping patterns.

Depression can be mild. Sometimes it is so mild we can mask it to the point others never know and carry on, what can be referred to as ‘walking depression’.

On the other end of the depression spectrum is severe depression, where you are so decimated by it you are no longer able to keep up appearances or even cope. You might even struggle to get out of bed at all some days, or constantly have flus and cold and need to take time off work and away from any form of socialising.

What is bipolar disorder?

Bipolar disorder often (but actually not always) involves depression. You tend to go through periods of depression but also of mania.

Mania means your moods are elevated to the point your coping is again affected, but this time it’s because your mood is not too low but too high. You will have racing thoughts, feel more energised than normal, make poor decisions, have poor boundaries, or be out of touch with reality.

More about mania

Like depression, mania can come on a spectrum, and depends on your own personality and mood baseline.

For some people mania can look not very unusual, but just hyper. If someone doesn’t know you well, they might not even realise you are experiencing mania. It can mean endless chatter, forgetting important things like appointments, and taking on big projects like deciding to clean your whole house in a day, with a feeling that you can't 'turn off'. It often involves less of a need to sleep. This less evident form of mania can be referred to as ‘hypomania’.

For others mania is evidently abnormal even to the point of being hospitalised or having psychosis with delusions and/or hallucinations. It can be far more destructive and look like week-long party binges, sleeping with people you don’t even like or practicing unsafe sex, splurging your savings on a big purchase that you wouldn’t even usually be interested in, walking out of your job, or believing you have a superpower and can do something others can’t.

Bipolar 1 vs bipolar 2

Severe mania, particularly severe enough to mean you end up hospitalised, is diagnosed as ‘bipolar 1 disorder’. Some people with bipolar 1 disorder don’t even experience depression at all, but only mania.

If you have hypomania, the less severe form, it generally comes along with depressive episodes, and would be a diagnosis of ‘bipolar 2’ disorder. Some people with bipolar 2 disorder experience very little mania and more just depression.

So it is bipolar 2 that can be misdiagnosed as depressive disorder.

Bipolar disorder vs depressive disorder -how does misdiagnosis happen?

Sound clearly different? Not so fast. Yes, the difference between bipolar and depression is that with only depression, you will never have a manic episode.

But depression can be episodic. If you haven't felt good in ages, you could feel strange to feel okay again, and convince yourself you are manic, followed by depression again. When really it's just feeling normal after so long and then having another bout of depression.

On the other hand, if you only have one manic episode in a year, and perhaps didn't do anything too destructive? You can convince yourself you just felt good and don't have bipolar. But even one manic episode is enough to mean you are bipolar.

What to look for if you are not sure

A giveaway would be that with only depression, when you are normal and worry you are hypomanic, you'd actually still have your regular ability to have boundaries and make decisions. And your thoughts would not be racing.

Also note with mania, when your 'up' ends there is often a sense of ‘snapping out of it’. As if you were temporarily someone else. Or even 'crashing', coming down from something. You might feel embarrassed or regretful.

Why does a misdiagnosis matter?

It can matter as the wrong medication can cause problems. If you are only diagnosed with depression and given antidepressants, but actually have bipolar disorder? They can actually trigger mania.

And it also matters even if you are not taking medication as all. If you are only treating your depression with therapy, you can be sabotaging your life when manic but never connecting it to your issues so not talking about it. Meaning you will continue to struggle despite best efforts.

Still not sure you have depression or bipolar disorder and want to talk to someone who knows both? Use our easy booking tool now to book a therapy session.

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