If you are struggling with low mood, you may be wondering, is this depression? But there’s another question it’s important to consider: could it be bipolar disorder?
The two mental health issues are frequently confused. In fact, research indicates that perhaps a quarter of those diagnosed with depression in primary care settings may actually have bipolar disorder. When analyzed, it’s easy to see why.
Depression (also known by the names major depression, major depressive disorder, clinical depression and unipolar depression) is characterized by a combination of symptoms that impair your functioning, such as these:
- Feelings of sadness, emptiness or hopelessness
- A loss of pleasure in former interests
- Appetite changes, leading to weight loss or weight gain
- Consistent insomnia or oversleeping
- Persistent feelings of fatigue, loss of energy
- Feelings of worthlessness or guilt
- A slowing down or speeding up of thoughts and movement
- Diminished ability to concentrate or make decisions
- Recurrent thoughts of death or suicide
Bipolar disorder, once called manic depression, is characterized by unusual and sometimes extreme shifts in mood, energy and activity levels. And importantly, the lows in those mood shifts correspond to the symptoms of depression.
The highs of bipolar disorder, on the other hand, are characterized by mania and, in some cases, a less severe form called hypomania. A manic episode is identified by an elevated, expansive or sometimes irritable mood that can include symptoms such as:
- Inflated self-esteem or an unreasonable belief in one’s abilities and intelligence
- Distractibility
- Racing thoughts
- Talking more or more quickly than usual
- Increased persistence in goal-related activity
- Less need for sleep
- Reckless involvement in pleasurable activities with the high potential for negative consequences — for example, spending sprees, ill-considered business decisions, sexual encounters and alcohol and drug use.
Assessing the Highs and Lows
For some, this mania is felt as a desirable state, one in which energy surges, shyness vanishes and ideas flow. No surprise, then, that a person is much more likely to seek help only for the low mood, perhaps not even realizing that their “highs” are out of the norm.
A clinician who sees a patient complaining about feeling depressed may not think to ask, do you experience the other extreme too? Instead, the patient may simply be prescribed an antidepressant, the most common medical response to depression, and sent on their way.
But this can come with dangers, said Russ Federman, PhD, ABPP, a clinical psychologist who specializes in working with adults with bipolar disorder. “Antidepressants can precipitate the onset of hypomanic or manic episodes when prescribed to someone with undiagnosed bipolar illness,” he explained. “And once the potential for strong mood elevation has been activated then the individual may be faced with a chronic course of mood instability that may not be reversible.”
Numerous studies, in fact, indicate that antidepressants can sometimes destabilize bipolar disorder, increasing the likelihood of the person experiencing mania, rapid cycling, in which extreme mood changes occur at least four times a year (and sometimes as quickly as over a few days or even hours), or a mixed state, in which highs and lows occur simultaneously.
The Bipolar Diagnosis
All of this points to the need for comprehensive assessment when a person seeks help for depression. “Clinicians should not just be looking at current mood and behavioral symptoms,” Dr. Federman said. “It is just as important for the clinician to be exploring the broader picture of mood patterns in the individual’s life as well as genetic vulnerabilities toward bipolarity.” Do such moods run in the family, for example?
The person seeking help also needs to be open about their history and behavioral tendencies, although it’s not always easy for those dealing with bipolar disorder to quantify what they are experiencing, Dr. Federman noted.
“From the inside of depression there aren’t readily detectible symptoms one would notice that would inform the presence of bipolarity,” he said. “One exception would be the experience of mixed mood symptoms, which entails the presence of depressive symptoms along with increased energy and agitation.” Such mixed moods, he said, are more common in bipolar disorder than in depression.
Depression in bipolar disorder also involves lower energy and sluggishness than in major depression, as well as more acutely impaired thinking, Dr. Federman said. “But again, it’s doubtful the person in the midst of a depressive episode would have the objectivity to recognize these kinds of distinctions while they were occurring.” Often, family and friends are the first to notice symptoms and can help gauge their degree.
Complicating the picture is that bipolar disorder exists in a variety of forms and in a range of severities, and each person’s experience with the illness will be as unique as they are. But they are not alone. An estimated 2.6% of the adult population is dealing with bipolar disorder in any given year, the National Institute of Mental Health reports. But the good news is that bipolar disorder is treatable, usually with a combination of psychotherapy (such as cognitive behavioral therapy) and medications such as mood stabilizers and antipsychotics.
Effective treatment can’t begin, however, until the person who is struggling knows what they are dealing with. Careful diagnostic assessment, Dr. Federman emphasized, “is the key to all of this.”
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