Comparing Major Depression and Bipolar Disorder | BrainsWay

Bipolar Disorder vs. Depression

Major depression and Bipolar disorder are mood disorders that can impact children, adolescents, and adults worldwide. These conditions are linked with many health and economic burdens, so an accurate diagnosis and effective treatment are essential. But because of similarities between the conditions, misdiagnosis is common and can extend or delay recovery. Understanding what distinguishes major depression and bipolar disorder is critical for better treatment outcomes.

Read on to review what major depression and bipolar disorders are. Then learn the similarities and critical differences between these disorders. Finally, understand the treatment implications of accurately distinguishing major depression and bipolar disorder.

Bipolar Disorder vs. Depression

Introduction to Major Depression and Bipolar Disorders

Major depression and bipolar disorder are both mood disorders, with some common and distinctive features. Understanding the critical differences between these disorders begins with a review of their core symptoms and features.

Major Depression

Major depression is a mood disorder that can severely impair and interfere with an individual’s ability to participate in major life activities. It is marked by a persistent low mood and the lack of ability to enjoy pleasurable activities.

Individuals must experience these two symptoms and at least three others affecting their mood, cognition (thinking skills), and behavior, for a minimum of two weeks.

Common depression symptoms include persistent sadness, fatigue, feelings of worthlessness, and difficulty concentrating and making decisions. These symptoms should also not be better explained by medical illness, medication, or substance use disorder.

Symptoms of Major Depression Include:

  • Mood Symptoms: Low or sad mood, irritability, poor self-worth, hopelessness, lack of confidence, inability to enjoy pleasurable activities.
  • Cognitive Symptoms: Suicidal thoughts, thoughts of death, poor concentration, difficulty making decisions, memory problems, negative mindset.
  • Behavioral/Physical Symptoms: Slow speaking or body movements, disrupted sleep, changes with eating and appetite, headaches and body pain, persistently low energy.

Bipolar Disorder

The American Psychiatric Association (APA)

describes bipolar disorder as a mental condition with two distinguished, intense mood states; depression and mania. Shifts between these two states can disrupt emotions, energy levels, thinking skills, and the capacity to participate in daily activities.

Many of those with bipolar disorder can remain in one mood state for several weeks or months. Those with rapid cycling bipolar disorder experience four or more episodes of either mania or depression within a single year.

Symptoms of Bipolar Disorder Include:

  • Mood Symptoms:
    • Mania: Unrealistically optimistic mood, irritability, exaggerated self-confidence
    • Depression: Low or sad mood, poor self-worth, hopelessness, lack of confidence, inability to enjoy pleasurable activities.
  • Cognitive Symptoms:
    • Mania: Distractibility, racing thoughts, risky decision making
    • Depression: Suicidal thoughts, thoughts of death, poor concentration, difficulty making decisions, memory problems, negative mindset.
  • Behavioral/Physical Symptoms:
    • Mania: Unusual talkativeness, little need for sleep, jumpy
    • Depression: Slow speaking or body movements, disrupted sleep, changes with eating and appetite, headaches and body pain, persistently low energy.

Bipolar I, bipolar II, and cyclothymia are the three subtypes of bipolar disorder, and each has distinguishing features and symptom patterns.

  • Bipolar I: Fully manic episodes that last at least seven days, or are severe enough to require hospitalization (may cause a break in reality), and major depressive episodes that typically last at least two weeks. Mixed episodes with symptoms of both moods may also develop at times.
  • Bipolar II: Defined by longer and more frequent periods of chronic major depression, and at least one episode of hypomania, which is similar to mania but less severe.
  • Cyclothymia: Pervasive, long periods of depressive or manic symptoms, all without reaching the necessary criteria for major depression, mania, or hypomania. The mood fluctuations seen in between cyclothymia must last for at least two years to qualify for this diagnosis.

bipolar disorder

Bipolar Disorder vs. Depression: Critical Differences

While bipolar disorder and major depression share many symptoms, they can be differentiated by noting the presentation and overall impact of symptoms.

Mood Episodes

Individuals with major depression experience a pervasively low mood most days for at least two weeks with no history of manic or hypomanic symptoms With bipolar disorder, both depressive episodes and at least one episode of manic or hypomanic symptoms are present.

Overall Functioning

A study observed significantly worse overall functioning associated with bipolar I disorder compared to major depression, particularly with more significant work disability. This study determined that resurgent depressive symptoms occurred with both conditions but were more disruptive for individuals with bipolar I disorder.

Major Depression and Bipolar II Disorder

Bipolar II disorder impacts about 1.1% of the US adult population, making it less common than major depression but slightly more common than bipolar I (1%). Diagnostic criteria are identical for major depression and depressive episodes within bipolar II, making misdiagnosis a common occurrence. However, subtle differences in the presentation of these episodes may help clinicians and individuals distinguish the two disorders.

  • More than half of individuals with bipolar II have episodes with atypical depression symptoms, whereas this only occurs for 25% of those with major depression.
  • In various studies, bipolar II has been associated with:
    • Earlier age of onset.
    • Higher suicide attempt rates.
    • Higher rates of recurrent symptoms.
    • Higher rates of physical symptoms, such as excessive sleeping, weight gain, and leaden paralysis (heavy feeling in arms and legs).

The Importance of Diagnostic Accuracy

Getting an accurate diagnosis has significant implications for treatment, and the appearance of some symptoms can be complex and misleading. For certain diagnoses, such as bipolar disorder, long observation periods and deeper investigation are needed to reveal complete symptomatology.

Some researchers have hypothesized that bipolar disorder is often misdiagnosed as major depression, which accounts for a significant number of individuals resistant to depression treatments. Studies have revealed between 43.9%57.4% of individuals diagnosed with major depression screened positively for mania symptoms, a primary feature of bipolar disorder. Given these odds, potential misdiagnosis can present a significant problem when considering treatment.

Using a treatment that is not recommended for a specific diagnosis may lead to less-than-ideal results and prolong the treatment process. But more importantly, some treatments may not be recommended because of safety issues, lack of adequate research support, or they may not have completed clearance or approval processes. Understanding these risks can help reduce unnecessary adverse impacts.

Using Antidepressants to Treat Bipolar Disorder

Knowing which treatments are appropriate for certain conditions is essential with bipolar and major depression. For example, selective-serotonin reuptake inhibitor (SSRI) antidepressants are deemed safe and effective for treating major depression. They can also be used to treat bipolar disorder, though only in limited situations, due to the potential for triggering emergent manic episodes.

Using TMS to Treat Major Depression and Bipolar Disorder

Another well-tolerated, safe, and effective treatment for major depression is deep transcranial magnetic stimulation (Deep TMS), a form of magnetic therapy that utilizes magnetic stimulation to provide symptom relief. Deep TMS has been FDA-cleared to treat major depressive disorder in the U.S., and has been CE-marked in Europe for the treatment of bipolar disorder, indicating that it has met the European Union (EU) health, safety, and environmental requirements. While perhaps frustrating for some, these differences are a reminder that diagnostic standards and treatments are continually evolving.

Better Outcomes for Major Depression and Bipolar Disorder

Untreated mood disorders, such as major depression and bipolar disorder, create lifelong health burdens on individuals across the world. Understanding how to better identify and diagnose these disorders gives individuals their best opportunity for recovery.