Bipolar Disorder and Depression: Understanding the Difference

Depression and Bipolar disorder are two mental health conditions often confused with each other due to certain similarities in the nature and phases of both. There are mixed views about the two disorders, as some sources claim Bipolar disorder just to be a type of Depression, while others think they are two completely different branches of Mental disorders.

Bipolar Disorder is a mental health condition characterized by sudden and extreme mood changes. Bipolar Disorder can range from mild hypomania to severe mania, which can significantly interfere with everyday life. Due to this disorder’s possible effect on one’s perception of reality, it might require hospitalization or immediate treatment under a psychiatrist’s supervision.

Bipolar disorder can be further divided into four types. These include:

1. Bipolar I Disorder: Bipolar 1 Disorder is characterized by having at least one manic episode, irrespective of any associated symptoms of depression.
2. Bipolar II Disorder: Bipolar 2 disorder is characterized by a minimum of one depressive episode and one episode of hypomania characterized by an unusual elevation of mood. However, the periods of hypomania and depression are not the same in this disorder. It is characterized by significantly shorter hypomania bouts and much longer episodes of depression or a lower mood.
3. Cyclothymic Disorder: Cyclothymic Disorder involves a long term disturbance and fluctuation of mood, ranging from hypo-manic symptoms to severe depressive symptoms. However, these symptoms do not meet the full criteria of the full-fledged hypomanic episodes or depressive episodes that may be usually associated with a bipolar disorder.
4. Unspecified Bipolar Disorder: Unspecified Bipolar disorder is characterized by abnormal mood elevation that may be recognized at a clinical level; however, these mood changes do not correspond to any other type of bipolar disorder and do not meet the criteria.

Depression is a severe medical illness associated with a feeling of heaviness, being low, or feeling down. (1). The mental health condition does not only have an impact on one’s mood and feelings but also the way they see the world around them, how they think, and that action they take. Due to its ability to cause one to lose interest in their surroundings and back away from society, it may also significantly affect their work and quality of life.

1. Depression with Anxious distress: Anxious Distress is associated with constant anxiety about upcoming events and everything that is out of one’s control.
2. Depression with Mixed Features: A mixed distress condition includes depression and mania, which may be seen alternating with each other.
3. Depression with Melancholic features: Melancholic Depression is associated with an inability to wake up and get out of bed in the morning, inability to find pleasure in anything around you, and being in a constant low mood. This severe form of depression may also involve a change in appetite and constant guilt and agitation.
4. Depression with Atypical features: Atypical depression may be associated with an increased appetite and an increased need to sleep, a feeling of constant heaviness in arms and legs, and extreme emotional sensitivity, especially to rejection of any kind.
5. Depression with Psychotic features: Psychotic symptoms associated with depression may involve hallucination and delusions, leading one to harm themselves or others around them.
6. Depression with Catatonia: Catatonia is associated with motor movements in clinically depressed individuals, where they might either express themselves via uncontrolled and aimless movements or become entirely rigid with a stiff posture.
7. Peripartum Depression: Peripartum depression is a severe form of depression that may be seen during pregnancy or a few weeks after giving birth to the baby due to the mother’s extreme hormonal changes. It can negatively impact the mothers’ health and relationship with the baby and may require proper treatment under a health professional’s supervision.
8. Seasonal Depression: A seasonal pattern of depression may also be noticed in some individuals who may be triggered by a change of season or the degree of exposure to the sun.

Depression, which may also be referred to as Unipolar Disorder, is associated with symptoms of low, as opposed to Bipolar disorder, which is related to symptoms of high as well- known as hypomania.

Common Symptoms Associated with Depression

• Constant feeling of sadness
• Loss of interest in things around you
• Inability to gain pleasure from things that used to make you happy previously.
• Sudden loss or gain in weight may or may not be related to diet changes.
• Either sleeping too much throughout the day, or inability to sleep at all.
• Feeling fatigued all the time.
• A feeling of worthlessness and guilt all the time
• Inability to concentrate and make decisions
• Purposeless Motor movements

Common Symptoms of Bipolar Disorder

While bipolar disorder may be associated with symptoms of depression stated above, the  patients also experience symptoms of hypomania, which may include:

• Being in an abnormally high energy
• Feeling immensely agitated and jumpy.
• Being in a euphoric state
• Inability to sleep
• Excessive socializing and talkativeness
• Constant racing thoughts
• Risky behavior and poor decisions
• Getting distracted and inability to concentrate.

The DSM diagnostic system classifies Unipolar Disorder, which is also referred to as major depression and bipolar disorders, as separate branches of the diagnostic tree’s mood disorder. The bipolar branch of the diagnostic tree includes categories like Mania and Bipolar disorder, which is considered separate from Depression with mania and unipolar depression.

Moreover, another way to differentiate the two mental disorders is the genetic predisposition of Bipolar disorder and a lack of ones associated with depression. Previous research conducted on Bipolar disorders has proven a genetic link as a causative factor for the disease and how it may be passed on within the family. This was also seen in a twin study, where the genetic vulnerability of Bipolar type 1 disorder between Monozygotic twins and Dizygotic twins was investigated. The results showed that while it between 33% to 80% for Monozygotic twins, the average concordance rate for Dizygotic twins was between 30 to 80%. This led to the conclusion that the average heritability rates of Bipolar 1 disorder were about 30 to 80%. (2)

Treatment for Bipolar Disorder
Bipolar Disorder is a long-term condition that may relapse again and again unless a proper treatment is considered. Due to the nature of the illness, it requires proper medication to even out the sudden changes in the mood one may experience. Previous studies have shown that the best treatment option for Bipolar disorder is a carefully crafted treatment plan containing medication and therapy. The drugs that are currently used for the treatment of Bipolar disorder include a combination of Olanzapine and Fluoxetine, Immediate or extended-release type of Quetiapine, and Lurasidone, which may be given as an adjunct to Lithium and Valproate. (3)

Treatment for Unipolar Depression
Due to the different kinds and severity of Depression, the treatment plan for depression may vary from person to person. While some studies have shown effective treatment of depression with therapy, however, others suggest the need for proper medications to treat it. However, the most popular method involves a combination of the two, as it has shown the most effective results.

REFERENCES

1. Kanter JW, Busch AM, Weeks CE, Landes SJ. The nature of clinical depression: symptoms, syndromes, and behavior analysis. Behav Anal. 2008;31(1):1-21. doi:10.1007/BF03392158
2. Shen YC. Treatment of acute bipolar depression. Ci Ji Yi Xue Za Zhi. 2018;30(3):141-147. doi:10.4103/tcmj.tcmj_71_18
3. Cuellar AK, Johnson SL, Winters R. Distinctions between bipolar and unipolar depression. Clin Psychol Rev. 2005;25(3):307-339. doi:10.1016/j.cpr.2004.12.002