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How is major depression different from bipolar disorder?

Dr. Charles J. Sophy, MD
Adolescent Medicine Specialist

With bipolar disorder you have symptoms of depression as well as hypomania or mania. Instead of having just major depression, you will have periods of normal mood and then high mood swings.

Most people will seek medical treatment if they have major depression. But who wants to take medication to calm down the high energy of hypomania or mania? Bipolar disorder used to be called "manic depression". Today, experts understand that people with bipolar disorder experience all types of symptoms on the bipolar spectrum.

The different types of bipolar symptoms are outlined in the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. Using this diagnostic manual, your doctor can determine if you have depression only (unipolar depression) or bipolar disorder (depression with hypomania or mania). 

  

Bipolar disorder has episodes of depression as described below, alternating with episodes of racing thoughts, poor sleep, increased energy, at times grandiose thoughts, severe irritability and distractibility.

  • Depressed mood or irritable most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful).
  • Decreased interest or pleasure in most activities, most of each day
  • Significant weight change or change in appetite (it could be increased or decreased appetite/weight)
  • Change in sleep: Poor sleep or sleeping too much
  • Change in activity: Thinking or moving slower than usual
  • Fatigue or loss of energy
  • Guilt/worthlessness: Feelings of worthlessness or excessive or inappropriate guilt
  • Concentration: diminished ability to think or concentrate, or difficulty making decisions
  • Suicidality: Thoughts of death or suicide, or having a plan to end your life

People that have major depression feel sad, lack energy, lose interest in doing things they enjoy, and feel physical pain. People with bipolar disorder also go through periods with the same symptoms. However, the difference is that sometimes they go into a period of mania characterized by high risk behavior, agitation, high energy levels, and increased impulsivity. Some people who are diagnosed with clinical depression may actually suffer from bipolar disorder because doctors can only make a diagnosis using the current symptoms.

Ms. Julie A. Fast
Mental Health Specialist

The main difference between major depression and bipolar disorder is mania. 

  • A person absolutely can’t have bipolar disorder unless they have had a manic episode. There are no exceptions. I’ve heard people say their doctor thinks they might have bipolar. I say, “What is your mania like?” If the person says, “What’s mania?” there is a problem and I tell them to get online and take a mania test and then see a person with psychiatric diagnosis experience.
  • Another difference is that bipolar depression is usually much more difficult to treat than unipolar depression. (Unipolar is the term used to differentiate the difference between major depression and bipolar.) For example, people with bipolar disorder can’t take anti depressants alone as a treatment for the illness due to the danger of mania caused by the anti depressants. (Anti depressants can be used with great caution in combination with mood stabilizers and/or anti psychotics.) One of my goals as a bipolar educator is to let all health care professionals know they must screen for mania in the family before prescribing an anti depressant.
Dr. Ruth White, MPH
Social Work Specialist
Major depression is one aspect of bipolar disorder but bipolar disorder also includes mania, which is a high mood that is not necessarily a 'happy' mood but in its extreme can cause psychosis. Sometimes people with bipolar disorder is diagnosed with major depression because that is when they seek help and so the mania aspect of their illness is not diagnosed because the practitioner may not have asked the questions about mania. This is becoming less so as doctors are getting more aware of the risks of prescribing anti-depressants to people with bipolar disorder who may become manic as a result.
Sheri Van Dijk
Psychiatrist (Therapist)

Major depression can occur alone (known as major depressive disorder, or "unipolar depression") or as part of bipolar disorder. Bipolar depression is the same as unipolar depression—both meet the criteria for a major depressive disorder. A depressive episode includes symptoms such as low mood, problems with sleeping and eating, feelings of hopelessness and helplessness, and suicidal thoughts.

Whether depression is part of bipolar disorder or simply occurs on its own, it can be debilitating, making it more difficult for a person to function like they normally would—sometimes people can't get to work or school; and even getting out of bed and doing things like showering can be challenging.

Dr. Jeffrey Gardere, PhD
Psychology Specialist

Major depression is different from bipolar disorder in that the main symptom for depression is unipolar, while bipolar disorder has symptoms of both depression and mania. Watch psychologist Jeffrey Gardere, PhD, explain these important differences.


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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.