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Going through a mental health struggle is difficult enough on its own, but it's even more frustrating when you're misdiagnosed or treating the wrong issue, especially when it comes to mood disorders. Although they are quite different illnesses, there are some subtle differences between bipolar disorder and depression that mean they can be confused for each other. Knowing what differentiates the two can help people get the right treatment they need.
Since one hallmark of bipolar disorder is depressive periods, it's not uncommon for people to miss the signs and treat it as depression instead. In fact, nearly seven out of 10 people with bipolar disorder are misdiagnosed at least once, according to 2006 research published in the journal Psychiatry, with women more likely to be misdiagnosed than men.
"It’s common for people to confuse bipolar disorder and depression in someone because bipolar disorder is the combination of depression and mania or hypomania, which can present separately or together," says Dr. Laurel Steinberg, PhD, a psychotherapist and adjunct assistant professor of psychology at Columbia University, over email. "If someone sees a person in a purely depressed phase of bipolar disorder, there would be no evidence that the person experiences mania other times."
If you're experiencing depressive symptoms but aren't sure which disorder you might have, here are some ways to tell the difference as you're talking with your doctor. They may seem subtle, but they matter.
1How It Feels To "Feel Better"
Depression and bipolar disorder tend to be confused because the "highs" of bipolar disorder can simply look as if a patient is feeling better. "Sometimes milder episodes of mania — called hypomania — can resemble seasons of health, as individuals are often highly productive and cheerful during these seasons," says psychologist Dr. Marie Fang, PsyD over email.
Clinical psychologist Dr. Joshua Klapow Ph.D tells Bustle that periods of mania are often distinguished by extremely good feelings. "It's a high, with elation or agitation — a mood state that is the opposite of depression," he says.
"It's possible for loved ones to interpret a hypomanic episode as a sign of health rather than a symptom of bipolar disorder," Dr. Fang says. "Further, it's common to miss these episodes of elevated mood if they're relatively infrequent and short-lived compared to the depressive episodes."
2The Typical Length Of A "Low"
Depressive "lows" are a component of both depression and bipolar disorder. However, in depression, the lows are constant, while individuals with bipolar disorder cycle between periods of low moods and high moods — or intense irritability along with high energy — even if the highs are short-lived. A depressed mood in bipolar disorder can last three months to two years at a time, and sometimes longer, says Dr. Fang. Studies have found that depressive periods tend to last longer in bipolar disorder than manic episodes.
3The Cycle Through Emotions
"Manic episodes can be mild, where you have sudden pockets of energy, all the way to severe, where you feel grandiose and don't sleep for days on end," says psychologist Dr. Wyatt Fisher, Psy.D. over email. "Depressive episodes can be mild where you feel down and lack motivation all the way to severe where you can't get out of bed and feel like harming yourself. Those with bipolar experience cycles between manic and depressive pockets whereas those with depression only have depressive symptoms."
Depression and mania can both incorporate many different emotions. People with depression, Dr. Klapow says, can experience feelings including sadness, hopelessness, irritability, difficulty concentrating, and lack of energy. Those with bipolar disorder, on the other hand, will experience these emotions in their depressive pockets and then feel a range of "highs," which can include feelings of euphoria, bliss, anger, or paranoia.
4The Effects Of Different Medications
If someone is mistaken to have depression when they actually have bipolar disorder, it could explain why antidepressants wouldn't have an effect — or even more unfortunately, make matters worse. "Antidepressants help those with depression, but they can aggravate bipolar disorder and cause patients to become manic," says Dr. Steinberg. Recognizing that these medications aren't working can help your doctor pinpoint exactly what type of disorder you have as well as recommended the more appropriate treatment.
If you or someone you know is seeking help for mental health concerns, visit the National Alliance on Mental Illness (NAMI) website, or call 1-800-950-NAMI(6264). For confidential treatment referrals, visit the Substance Abuse and Mental Health Services Administration (SAMHSA) website, or call the National Helpline at 1-800-662-HELP(4357). In an emergency, contact the National Suicide Prevention Lifeline at 1-800-273-TALK(8255) or call 911.
Experts:
Dr. Marie Fang, Psy.D., clinical psychologist
Dr. Wyatt Fisher, Psy.D., clinical psychologist
Dr. Joshua Klapow Ph.D., clinical psychologist
Dr. Laurel Steinberg, Ph.D., psychotherapist and adjunct assistant professor of psychology at Columbia University
Studies cited:
Singh, T., & Rajput, M. (2006). Misdiagnosis of bipolar disorder. Psychiatry (Edgmont (Pa. : Township)), 3(10), 57–63.
McIntyre, R.S. & Calabrese, J.R. (2019) Bipolar depression: the clinical characteristics and unmet needs of a complex disorder. Current Medical Research and Opinion, 35:11, 1993-2005.
Solomon, D. A., Fiedorowicz, J. G., Leon, A. C., Coryell, W., Endicott, J., Li, C., Boland, R. J., & Keller, M. B. (2013). Recovery from multiple episodes of bipolar I depression. The Journal of clinical psychiatry, 74(3), e205–e211. https://doi.org/10.4088/JCP.12m08049
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