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Bipolar 1 vs. Depression: Differences in Symptoms and Treatment

Medically reviewed by Paul Ballas, D.O. — Written by Emily Wagner, M.S.
Posted on February 1, 2023

  • Bipolar 1 disorder and major depressive disorder share several symptoms. The correct diagnosis can help you get the most appropriate treatment.
  • Bipolar 1 disorder features manic episodes, which might be serious enough to require hospitalization.
  • Doctors may prescribe mood stabilizers, antipsychotics, or antidepressants to treat bipolar 1 disorder. These medications may be combined.

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.

What Are Bipolar 1 Disorder and Major Depressive Disorder?

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.

Symptoms of Bipolar 1 Disorder

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:

  • Feeling extremely elated or high
  • Talking quickly about many ideas without pause
  • Feeling as if you are unusually powerful or talented
  • Experiencing persistent racing thoughts
  • Sleeping less than usual
  • Eating, drinking, or engaging in sexual activities excessively
  • Feeling wired or overactive

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:

  • Feeling anxious, sad, or down
  • Having a low mood and self-esteem
  • Speaking slowly
  • Forgetting things easily
  • Struggling with decision-making and concentration
  • Losing interest in activities you usually enjoy
  • Feeling worthless or hopeless
  • Having suicidal thoughts

Symptoms of Major Depressive Disorder

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:

  • Irritability or frustration, leading to angry outbursts
  • Loss of appetite, leading to weight loss
  • Increased food cravings, leading to weight gain
  • Unexplained headaches, stomachaches, and muscle aches

There are several types of depression that may be diagnosed, depending on the symptoms you have. Examples include:

  • Anxious distress — Accompanied by excess worry over lack of control or future events
  • Psychotic features — Accompanied by hallucinations or delusions
  • Seasonal depression — Related to seasonal changes, especially in the winter with reduced sunlight
  • Catatonia — Accompanied by uncontrollable muscle movements and issues with posture

Risk Factors for Bipolar 1 Disorder and Major Depressive Disorder

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:

  • Are in your second, third, or fourth decade of life
  • Are a woman
  • Have a family history of depression, suicide, or alcoholism
  • Have low self-esteem
  • Are overly pessimistic or self-critical
  • Have gone through a stressful or traumatic life event
  • Take certain sleeping pills or blood pressure medication
  • Have a history of other mental health conditions, including post-traumatic stress disorder (PTSD), eating disorders, or anxiety disorder
  • Are gay, lesbian, transgender, or bisexual in an unsupportive environment
  • Have a chronic or serious illness, such as chronic pain, heart disease, stroke, or cancer

How Are Bipolar Disorder 1 and Major Depressive Disorder Treated?

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.

Treatments for Bipolar 1 Disorder

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:

  • Cognitive behavioral therapy — Focuses on identifying disruptive behaviors and beliefs that may lead to mania or depression; also teaches new ways to cope in stressful situations
  • Interpersonal and social rhythm therapy — Focuses on creating daily routines and rhythms for meals, sleep, and exercise that can help people better manage their moods
  • Family therapy — Helps build a support group of family and loved ones who are educated about recognizing manic and depressive episodes

Treatments for Major Depressive Disorder

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.

Talk With Others Who Understand

MyDepressionTeam is the social network for people with depression and their loved ones. On MyDepressionTeam, more than 142,000 members come together to ask questions, give advice, and share their stories with others who understand life with depression and bipolar disorder.

Are you or a loved one living with bipolar 1 disorder or depression? What was your path to diagnosis? Share your experience in the comments below, or start a conversation by posting on your Activities page.

Posted on February 1, 2023
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Paul Ballas, D.O. is an attending psychiatrist at Friends Hospital in Philadelphia, Pennsylvania. Review provided by VeriMed Healthcare Network. Learn more about him here.
Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

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