Different mental health conditions often have overlapping symptoms that make it hard to tell them apart. Bipolar 1 disorder and major depressive disorder (also known as unipolar depression) share several symptoms, which may lead to a misdiagnosis. Knowing the differences between these two medical conditions, what symptoms to look out for, and how they’re treated can empower you to get the help you need.
Bipolar 1 disorder and major depressive disorder are conditions that distort your moods or emotions. Known as mood disorders, these conditions can make your daily emotions feel unpredictable and affect your ability to function.
While some symptoms of the two conditions overlap, your doctor will look for some distinct differences between bipolar 1 disorder and major depressive disorder.
Both disorders are associated with depression. However, in bipolar 1 disorder, you may have mood swings brought on by manic episodes and depressive episodes. Manic episodes are characterized by energetic, excited, irritated, or elated feelings that persist for at least seven days or are intense enough to require hospitalization. You may experience hypomania, or hypomanic episodes, which are a milder form of manic episodes. Depressive episodes in bipolar 1 disorder generally occur for two weeks or longer.
If you have four or more manic or depressive episodes within one year, you’re said to be “rapid cycling.” Some people may also experience manic and depressive symptoms at the same time. For example, you may have periods when you feel extremely high or energized but at the same time feel hopeless, empty, or sad. These are called episodes of depression with mixed features or episodes of mania with mixed features, depending on the predominant symptoms.
Manic symptoms are different for everyone, but they can include:
Psychosis can also occur during episodes of mania. You may have hallucinations (seeing things that aren’t there) or delusions (persistent beliefs in things that aren’t true). For this reason, doctors and mental health professionals sometimes misdiagnose bipolar 1 disorder as a type of schizophrenia.
Symptoms of depressive episodes include:
Unlike bipolar 1, major depressive disorder is characterized by only experiencing depressive episodes. Major depression is diagnosed when you’ve had feelings of sadness, worthlessness, or hopelessness for at least two weeks. You may have additional symptoms, such as loss of interest in activities you like or problems with sleep.
For major depressive disorder to get better, you’ll likely need treatment. If severe depression is left untreated, it can lead to self-harm, suicidal thoughts, and, in some cases, death. Many depression symptoms overlap with those seen in the depressive episodes of bipolar 1 disorder.
Other symptoms of depression you may experience include:
There are several types of depression that may be diagnosed, depending on the symptoms you have. Examples include:
Certain risk factors increase your chances of developing bipolar 1 disorder or major depressive disorder. You can control some of these factors — such as your alcohol intake — while others you can’t.
The risk factors for bipolar 1 disorder include having an immediate family member (parent or sibling) who has bipolar 1 disorder. People who have been through stressful or traumatic life events, such as the death of a loved one or being abused, also have a higher prevalence of bipolar disorder. Alcohol and substance use can also put you at a higher risk.
Your risk of developing major depressive disorder is increased if you:
Medical experts in psychiatry use a combination of medication and psychotherapy (talk therapy) to treat both bipolar 1 disorder and major depressive disorder. However, the types of medication and therapy used depend on the disorder and your individual needs.
Doctors prescribe medications for bipolar 1 disorder based on the symptoms you’re experiencing. These may include mood stabilizers, antipsychotics, and antidepressants. Medications from these categories may be combined.
Mood stabilizers help balance your emotions and moods during hypomanic and manic episodes. They often act as a foundation for treatment of bipolar 1 disorder. Examples include:
Antipsychotics can be prescribed to help control and reduce symptoms, including mania, delusions, hallucinations, and disruptive behavior. These are often prescribed alongside mood stabilizers to complement that initial therapy. Examples include:
In some cases, antidepressants can be added alongside antipsychotics or mood stabilizers to help treat depression experienced as a part of bipolar 1 disorder. You may be prescribed a selective serotonin reuptake inhibitor (SSRI), such as:
Psychotherapy can help you learn what triggers manic or depressive episodes and how to manage them. Examples of therapy used to treat bipolar 1 disorder include:
Major depressive disorder is usually managed with antidepressants — including SSRIs — and psychotherapy. There are several types of antidepressants available that work on different neurotransmitters (chemicals in your brain). It’s important to know that it may take multiple tries to find the right type and dosage that work for you.
Your doctor may first prescribe an SSRI, which generally has fewer side effects than other options. If your symptoms don’t improve, you may try another antidepressant.
Serotonin-norepinephrine reuptake inhibitors (SNRIs) are similar to SSRIs, but they work by affecting two chemicals — both serotonin and norepinephrine — in your brain. Examples include:
Tricyclic antidepressants are an effective treatment for depression, but they tend to have more side effects than SSRIs and SNRIs. With this, tricyclics are typically only prescribed after these medications don’t work. Examples include:
Atypical antidepressants don’t fit in with the other types of antidepressants, but they’re known to affect levels of the chemicals serotonin, norepinephrine, or dopamine. Examples include:
Along with medication, psychotherapy is also effective for treating major depressive disorder. Cognitive behavioral therapy and interpersonal therapy are commonly used to help you identify negative thoughts driving depression and learn new ways to cope with stress and your symptoms.
If you think you may have bipolar 1 disorder or major depressive disorder, talk to your health care provider. If needed, they may refer you to a mental health professional for further diagnosis and treatment.
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