By Hedy Marks, MPH
Medically reviewed by Cynthia Haines, MD
Bipolar disorder can easily be confused with depression because the two mental health conditions share a common component — a depressed mood. But to receive a diagnosis of bipolar disorder, you must experience episodes of mania, an elevation in mood and energy, with or without depression.
“For a person to be diagnosed with bipolar disorder, they just need to have one manic episode,” says Gabriela Corá, MD, MBA, a managing partner at the Florida Neuroscience Center, in Fort Lauderdale and Miami, and president of the Executive Health and Wellness Institute.
What Is Bipolar Disorder?
Bipolar disorder, also called manic-depressive disorder, is an illness that causes extreme shifts in mood. A person may spend weeks or months feeling as if he or she is on top of the world (the manic state) and then feel utterly hopeless (the depressive state), perhaps with a few weeks of normal mood in between.
Symptoms of mania include:
Being overly happy, optimistic, and excitedBeing easily angered and irritatedHaving rapid speech and racing thoughtsBeing overly energetic and needing little sleepUsing poor judgment, acting impulsively, and taking excessive risksFeeling all-powerful and invincibleExperiencing restlessness, and being easily distracted and unable to focus on one thingHaving an increased sex drive“Typically, a manic phase of bipolar disorder will last six to nine months, during which time the person with bipolar disorder will act out of character and seem off,” explains Dr. Corá. For example, a normally reserved and dedicated family man may suddenly start flirting with his daughter’s friends and seeking sexual relations with other women, explains Corá. Or he may suddenly decide it’s time to buy not just one new car but three new cars, spending money recklessly.
Confusing Bipolar Disorder With Depression
Bipolar disorder can be misdiagnosed as depression because people with the condition often seek help only when they are feeling depressed. During a manic episode, a person usually feels good, is productive, and doesn’t recognize a problem — and therefore doesn’t seek medical help. On the other hand, friends and family may notice abnormal behavior during such an episode.
Feelings of depression are more likely to cause someone to turn to a doctor or therapist. Symptoms of depression include:
Feeling sad, hopeless, guilty, and worthlessCrying often and for no reasonHaving trouble thinking clearly, making decisions, and remembering thingsLosing interest in activities previously enjoyedChanges in sleep patterns, eating habits, and energy levelsUnexplained headaches, stomachaches, and other painsThoughts of dying and suicideWhen someone with bipolar disorder reports symptoms of depression, major depressive disorder can mistakenly be diagnosed if the patient doesn’t disclose or recognize previous manic symptoms. To avoid an incorrect diagnosis, the doctor must ask the right questions and talk to the right people, such as family members and close friends.
Getting the correct diagnosis is important for proper treatment. A misdiagnosis of depression would probably lead to treatment with antidepressants, which, if used alone, can make bipolar disorder symptoms worse.
Bipolar Disorder or Depression: Making the Diagnosis
There is no single test that can be used to make a diagnosis of bipolar disorder. Often, the diagnosis is made after other conditions that could be causing the symptoms have been ruled out, such as thyroid disease; certain medications can produce mood swings and would have to be ruled out as well.
Once other possible causes of your condition are eliminated, your doctor may refer you to a mental health professional for a more comprehensive mental health exam. This practitioner will ask about your symptoms and any family history of mental illness, including bipolar disease and other mood disorders, and will want to speak to a close family member or spouse about your behavior.
Corá says she typically will diagnose a person with bipolar disorder only if the person’s ability to function is impaired. “I would not call someone who is moody bipolar,” she says. “You have to see how their behavior is affecting their level of functioning.”
If you experience symptoms of depression, talk to your doctor. Think carefully about your moods and behavior — if you recall acting even the slightest bit out of character, discuss this as well. Mild mania, called hypomania, can progress to severe mania if left untreated, so be honest with yourself and your doctor. “The earlier we intervene with the right treatment, the better the chance we have of preventing the progression of the illness,” says Corá. Bipolar disorder, like depression, can be treated and managed once an accurate diagnosis has been made.
