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More Than the Blues: Depression or Bipolar Disorder?

Why bipolar disorder is often mistaken for depression (even by doctors!)

More Than the Blues: Depression or Bipolar Disorder?

Feeling hopeless, losing interest in things, struggling to make decisions, and having to drag yourself out of bed every morning -- these are classic symptoms of depression. But they can also be signs of another disorder, one that you may not know as much about: bipolar disorder. In fact, because bipolar disorder and depression share so many signs and symptoms, bipolar disorder is often mistaken for depression, even by doctors. But the two conditions require very different treatments, so confusing them is never a good situation. Here's a quick comparison:

  • Depression: Persistent low feelings (for more than 2 weeks), such as feeling sad, hopeless, worthless, and uninterested in life.
  • Bipolar disorder: Persistent cycling of moods, from high (mania) to low (depression). Sometimes the manic phase can be so subtle that doctors and patients assume it's depression, not bipolar disorder.

Equal Opportunity Illness
Nearly 3% of adults suffer from some form of bipolar disorder. And the disease does not discriminate -- it's found in all races, ages, and ethnic groups, and it affects an equal number of men and women. The condition tends to develop in late adolescence or early adulthood. For some people, symptoms appear during childhood.

Misdiagnosis
Unfortunately, many people with bipolar disorder suffer for years before they are correctly diagnosed. In fact, nearly 7 of every 10 people with bipolar disorder are misdiagnosed at least once. And women are far more likely than men to be mistakenly told they have depression or schizophrenia.

Why? Any or all of the following factors could be at play:

  • The symptoms of bipolar disorder can mimic the symptoms of depression. This is especially true of bipolar disorder II, which is characterized by severely low mood swings combined with phases of subtle mania (called hypomania). Bipolar disorder can also mimic the symptoms of anxiety disorders, obsessive-compulsive disorder (OCD), attention deficit/hyperactivity disorder (ADHD), and schizophrenia.
  • Bipolar disorder can be masked by coexisting mental health conditions, such as substance abuse problems, panic disorder, OCD, posttraumatic stress disorder (PTSD), and anxiety disorders.
  •  People don't always provide a complete picture of their symptoms to their doctors. It's possible to dismiss a good mood or a bout of depression as normal, even though it may be happening cyclically, so bipolar disorder can easily be missed by doctors.

Is It Hypomania?
Is your depression coupled with hypomania (mild mania)? This checklist may help shed some light on that question. At least 4 days of any of the following symptoms could be considered hypomania:

  • Changes in behavior, dress, or speaking habits
  • Irritable mood
  • High energy
  • Decreased need for sleep
  • Racing thoughts
  • Difficulty concentrating
  • Increased pleasure-seeking behavior (shopping, sex, socializing, etc.)
  • Increased productivity and goal-oriented activity

Getting Treated
If you think you might have bipolar disorder, see your doctor. It's not entirely clear what causes bipolar disorder. It might be a combination of genetics, environment, and abnormalities in areas of the brain that control emotion. Hopefully, further research will shed more light on the condition, making it easier to diagnose. Currently, psychiatrists and general practitioners typically prescribe mood-stabilizing medicines to manage the emotional swings of bipolar disorder. These drugs are often taken for many years, may be combined with anticonvulsant or antipsychotic medications, and require close monitoring. Adding intensive psychotherapy may help people get better more quickly and stay on an emotional even keel longer.

Fortunately, even the most severe bipolar disorder can be treated, and people can live full and productive lives, despite the condition

Medically reviewed in February 2020.

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