Mental health disorders are becoming increasingly common, and people today are developing higher rates of co-occurrence, where they struggle with multiple conditions at the same time. Getting a correct diagnosis for any mental health disorder you have is an important step in finding the most appropriate treatment. With the right treatment, you can learn to manage your symptoms most effectively.
However, there is often common confusion between Major Depressive Disorder (MDD) and Bipolar Disorder (BD) because they share similar traits, particularly those with BD who experience depressive disorders.
Understanding MDD (Major Depressive Disorder)
Major depressive disorder is one of several disorders categorized as Depressive Disorders in the DSM. The common feature associated with all disorders of this type has to do with the presence of irritable mood, sadness, emptiness, and related changes that significantly impact your ability to function. The difference in terms of the diagnosis you get within this category has to do with the duration of the symptoms, the timing, and the cause.
Major depressive disorder is the primary condition within this group of disorders, the episodes for which have to last at least two weeks, although they can be considerably longer with distinct changes in cognitive function and regular remission.
Understanding Bipolar Disorder
Bipolar disorder is one of several disorders categorized as Bipolar and Related Disorders in the DSM. Diagnostically speaking, it serves as a bridge between schizophrenia and other psychotic or depressive disorders. This means that it is closely related to depressive disorders, including major depressive disorder.
There are several types, but the most prominent are bipolar 1 and bipolar 2. Bipolar 1 is characterized by manic depressive episodes, whereas bipolar 2 is characterized by at least one major depressive episode with symptoms the same as a major depressive disorder episode and at least one hypomanic episode.
Bipolar vs MDD: Key Differences Between MDD and Bipolar Disorder
One difference between MDD and bipolar disorder is that bipolar can present with manic and depressive symptoms, whereas MDD only has depressive symptoms. Another key difference between MDD vs. bipolar disorder is that the causes of bipolar are not well known, but the causes of depression are vast and much more well-documented.
Treatment for both may have overlapping medications, but the purpose behind the therapy and medication differs, too.
Co-occurrence and Diagnosis Challenges
Diagnostically, it can be a challenge to determine whether a person has bipolar or MDD because of the overlap in symptoms.
Can you have MDD and bipolar?
Is MDD and bipolar the same? No, these are not the same condition, although they share several features.
But can you have MDD and bipolar at the same time? No. You cannot be diagnosed with both at the same time.
MDD and bipolar disorder specifications
Major depressive disorder can appear with other distinct features, such as:
- Anxious distress
- Melancholic features
- Catatonia
- Seasonal patterns
Bipolar 1 can appear with other distinct features such as:
- Anxious distress
- Mixed features
- Melancholic features
- Rapid cycling
- Psychotic features
- Catatonia
- Peripartum onset
- Seasonal pattern
Bipolar 2 can appear with other distinct features such as:
- Anxious distress
- Mixed features
- Rapid cycling
- Peripartum onset
- Seasonal patterns
MDD and bipolar comorbidity
There can be diagnostic challenges because of the comorbidity as well. Major depressive disorder frequently co-occurs with several other disorders, including:
- Substance abuse
- Panic disorder
- Generalized anxiety disorder
- PTSD
- OCD
- Anorexia
- Bulimia
- Borderline personality disorder
Note: Women are more likely to report comorbidity related to anxiety or eating disorders than men; however, men are more likely to report comorbidities related to substance abuse and depression.
For bipolar 1, it is quite common for individuals to have a history of three or more mental health disorders, including anxiety disorders, substance abuse disorders, or ADHD.
The challenge in diagnosing due to overlapping symptoms
It is possible to diagnose major depressive disorder after a single episode, but in most cases, people get diagnosed following recurrent episodes.
However, there are distinct challenges in diagnosing MDD vs bipolar in large part because the symptoms of a depressive episode for bipolar can be the same as the episodes of MDD.
Major depressive episodes with a history of manic episodes indicate that someone likely has a diagnosis of bipolar rather than major depressive disorder. Major depressive episodes with a history of hypomanic episodes but no history of manic episodes could indicate bipolar 2 disorder, whereas someone with major depressive episodes and a history of manic episodes would indicate a bipolar 1 diagnosis.
However, presentations of major depressive episodes with a history of hypomanic periods that don’t meet the requirements for a hypomanic episode could be another form of specified bipolar disorder. Still, it could also be a major depressive disorder based on a clinical diagnosis. As such, this presents severe diagnostic challenges due to the overlapping symptoms.
Diagnostic criteria used by healthcare professionals
The bipolar vs. MDD diagnostic criteria are as follows:
MDD
In order to be diagnosed with major depressive disorder, you must have five or more of the following symptoms present for at least 2 weeks at a time, which cause significant changes in your daily function, and of the five symptoms, one of them has to be either the first one or the second one:
- Depressed mood the majority of the day, almost every day, with feelings of hopelessness, sadness, and emptiness, as well as depression observed by other people.
- A loss of interest or pleasure in all or nearly all activities that you do throughout the day.
- Significant weight loss or weight gain is not the result of an attempt at diet but rather because of changes in appetite, usually a change of 5% of your body weight or more in a given month.
- Insomnia or hypersomnia nearly every day during that time frame.
- Cognitive struggles and psychomotor agitation, with feelings of restlessness or fatigue observable by other people.
- Feelings of worthlessness, inappropriate guilt, or excessive guilt nearly every day.
- A diminished ability to focus and think, with a lot of indecisiveness nearly every day, something that can be severe enough if it’s observed by others.
- Recurrent thoughts of death or suicidal ideations.
All of the symptoms of major depressive disorder must cause clinically significant impairment or distress in important areas of function like your work or relationships. They also can’t be the result of any other condition.
Bipolar 1
In order to be diagnosed with bipolar 1, you must meet all of the criteria for the following:
Manic Episodes
- Individuals have a distinct period of persistent and abnormally elevated or irritable mood with increased activity and energy that presents nearly every day for a minimum of one week.
- During the distinct manic period, individuals have at least three of the following symptoms, which are significant enough to represent a noticeable change in behavior:
- Inflated sense of self-esteem.
- A decreased need for sleep, typically feeling well-rested after just 3 hours of sleep.
- Feeling pressured to keep talking and being more talkative than normal.
- Experiencing racing thoughts and flights of ideas.
- Being easily distracted with attention drawn to irrelevant or unimportant external stimuli.
- Having an increase in goal-oriented activity at work or school as well as psychomotor agitation.
- Struggling with excessive involvement in activities that could have painful consequences.
With these episodes, the symptoms of the manic episode cannot be better explained by other conditions and must be severe enough that they cause a significant impairment in occupational or social functioning and in some cases, need hospitalization to prevent harm.
Hypomanic Episodes
- Individuals must have a distinct period of persistent and abnormally elevated or irritable mood with increased activity and energy that lasts a minimum of four consecutive days, presenting every day.
- During this time frame, an individual must have at least three of the following symptoms:
- Inflated sense of self-esteem.
- A decreased need for sleep, usually feeling rested after just 3 hours.
- Feeling pressured to keep talking or being more talkative than normal.
- Experiencing racing thoughts or flights of ideas.
- Being easily distracted with attention drawn to irrelevant or unimportant external stimuli.
- Having an increase in goal-oriented activity at work or school as well as psychomotor agitation.
- Struggling with excessive involvement in activities that could have painful consequences.
With these episodes, the symptoms cause disturbances in mood and daily function that are observed by others, are uncharacteristic when an individual is not experiencing the symptoms, but are not severe enough to necessitate hospitalization or cause significant impairment in occupational or social function. it also cannot be better described by other conditions.
Depressive Episodes
Five or more of the following symptoms present for at least 2 weeks at a time, which cause significant changes in your daily function, and of the five symptoms, one of them has to be either the first one or the second one:
- Depressed mood the majority of the day, almost every day, with feelings of hopelessness, sadness, and emptiness, as well as depression observed by other people.
- A loss of interest or pleasure in all or nearly all activities that you do throughout the day.
- Significant weight loss or weight gain is not the result of an attempt at diet but rather because of changes in appetite, usually a change of 5% of your body weight or more in a given month.
- Insomnia or hypersomnia nearly every day during that time frame.
- Cognitive struggles and psychomotor agitation, with feelings of restlessness or fatigue observable by other people.
- Fatigue or reduced energy every day.
- Feelings of worthlessness, inappropriate guilt, or excessive guilt nearly every day.
- A diminished ability to focus and think, with a lot of indecisiveness nearly every day, something that can be severe enough if it’s observed by others.
- Recurrent thoughts of death or suicidal ideations.
These symptoms must cause clinically significant distress or impairment in important areas of function, including social and occupational function, and not be the result of other conditions.
Note: The criteria for a major depressive episode is the same as MDD criteria, but it is not a requirement for bipolar 1 diagnosis.
Bipolar 2
In order to be diagnosed with bipolar 2, you must meet all of the criteria for the following:
Hypomanic Episodes
- Individuals must have a distinct period of persistent and abnormally elevated or irritable mood with increased activity and energy that lasts a minimum of four consecutive days, presenting every day.
- During this time frame, an individual must have at least three of the following symptoms:
- Inflated sense of self-esteem.
- A decreased need for sleep, usually feeling rested after just 3 hours.
- Feeling pressured to keep talking or being more talkative than normal.
- Experiencing racing thoughts or flights of ideas.
- Being easily distracted with attention drawn to irrelevant or unimportant external stimuli.
- Having an increase in goal-oriented activity at work or school as well as psychomotor agitation.
- Struggling with excessive involvement in activities that could have painful consequences.
With these episodes, the symptoms cause disturbances in mood and daily function that are observed by others, are uncharacteristic when an individual is not experiencing the symptoms, but are not severe enough to necessitate hospitalization or cause significant impairment in occupational or social function. it also cannot be better described by other conditions.
Depressive Episodes
Five or more of the following symptoms present for at least 2 weeks at a time, which cause significant changes in your daily function, and of the five symptoms, one of them has to be either the first one or the second one:
- Depressed mood the majority of the day, almost every day, with feelings of hopelessness, sadness, and emptiness, as well as depression observed by other people.
- A loss of interest or pleasure in all or nearly all activities that you do throughout the day.
- Significant weight loss or weight gain is not the result of an attempt at diet but rather because of changes in appetite, usually a change of 5% of your body weight or more in a given month.
- Insomnia or hypersomnia nearly every day during that time frame.
- Cognitive struggles and psychomotor agitation, with feelings of restlessness or fatigue observable by other people.
- Fatigue or reduced energy every day.
- Feelings of worthlessness, inappropriate guilt, or excessive guilt nearly every day.
- A diminished ability to focus and think, with a lot of indecisiveness nearly every day, something that can be severe enough if it’s observed by others.
- Recurrent thoughts of death or suicidal ideations.
These symptoms must cause clinically significant distress or impairment in important areas of function, including social and occupational function, and not be the result of other conditions.
Misdiagnosis for MDD and bipolar
One of the most profound challenges in getting a correct diagnosis between these two conditions is the fact that both bipolar 1 and bipolar 2 have a requirement for a major depressive episode. This means that part of the symptoms are the exact same as the full range of symptoms for a major depressive diagnosis.
Studies have found that over 40% of people with bipolar disorder are misdiagnosed with major depressive disorder.
How does this happen? Because an individual goes to get an assessment and treatment during one of the major depressive episodes and without a history of manic or hypomanic episodes, many clinicians will review the diagnostic criteria for a major depressive disorder as the most logical explanation and provide a diagnosis from there.
Can you have both conditions at the same time? With MDD and bipolar disorder, there are distinct overlapping features, and each condition can present with a co-occurring mental health disorder; however, they cannot occur together.
Treatment Options
The treatment options for MDD and bipolar are the same: therapy and medication. However, the type of therapy and the type of medication are different because they address slightly different things.
Conventional treatment strategies for MDD
Conventional treatment for MDD includes therapy and medication.
- Medications can often include SSRIs, which help ease the general symptoms of depression, as well as antidepressants.
- Medication can include anxiolytics to help reduce tension and encourage sleep.
- Sometimes, antipsychotics are prescribed to reduce specific symptoms.
Medication is more effective when used in conjunction with therapy. One of the most common therapies is cognitive behavioral therapy. Cognitive behavioral therapy helps you understand the automatic negative thoughts you have in your mind which contribute to unhelpful emotions and behaviors. This is built on an understanding of how your automatic thoughts control your emotions and can make certain depressive symptoms worse and thereby, encourage maladaptive behaviors.
For example:
- Cognitive behavioral therapy can help you address things like emotional reasoning. Emotional reasoning is where you believe that if you feel an emotion, it must be true, so during a depressive episode, if you feel like you are worthless, then you assume that is true.
- Cognitive behavioral therapy can also help you with things like labeling, where you label that you are worthless and, therefore, continue to believe it and behave based on that incorrect premise.
Other forms of talk therapy can be equally useful in helping you recognize the link between your automatic thoughts, negative emotions, and negative actions. If you are struggling with feelings of hopelessness, difficulty sleeping, and suicidal thoughts, it might lead to skipping work or school, avoiding your friends, ignoring your bills, and fighting.
Individual therapy provides an opportunity to explore factors in your childhood or upbringing that may have contributed to your current depression symptoms, as well as environmental factors in your current lifestyle.
Conventional treatment strategies for Bipolar Disorder
Bipolar disorder is not something that has a cure at this time, which means that the treatment you receive is designed to help you manage your symptoms. This is greatly juxtaposed with major depressive disorder, which can potentially be cured depending on the cause.
People who do not suffer from severe enough symptoms to impede their independent function can participate in medication and therapy programs.
- Medication can include mood stabilizers if you have bipolar 1 and need to manage manic symptoms.
- Medication can include antidepressants, the same as what would be prescribed for major depressive disorder, in order to help you manage the symptoms of a depressive episode.
- If you experience hallucinations or delusions, you might be prescribed antipsychotics as well.
The medications you are given are designed to help you manage your symptoms in such a way that they do not remain severe enough to impede your daily function. However, getting through daily life is something managed by therapy. Therapy can help you:
- Determine what your personal triggers are and things that cause different mood swings so that you can learn to avoid these, minimize them, or, in the worst of cases, prepare yourself for the subsequent mood swing that happens.
- Learn coping mechanisms that you can apply to daily challenges. These are often personalized to the types of episodes with which you struggle the most, such as cultivating communication skills with others if you are feeling depressed, learning to utilize social skills so that manic episodes don’t get out of hand, and more.
The type of therapy in which you participate can include individual or group therapy and, at any time, can be modified to fit your needs better. Talk therapy can take place in person or virtually and provide you with help from qualified mental health professionals and other individuals who are going through similar struggles and have a similar diagnosis.
This can provide a strong network of people who can offer emotional support and help you develop your communication skills and social skills.
Individual therapy can provide a chance to figure out personal coping mechanisms and different triggers, learn to communicate with your family more effectively, and establish a supportive environment at home.
As part of your therapy, you might be encouraged to adapt your lifestyle so that you can reduce the number or severity of episodes. This can include things like:
- Avoiding alcohol or drugs
- Building a support system with friends or family
- Creating good sleep hygiene
- Incorporating a healthy diet
- Exercising regularly
- Writing a mood journal
- Meditating daily
- Spending time outside
Can MDD turn into bipolar?
Yes, in some cases, MDD can turn into bipolar, in which case, a patient who previously had symptoms of MDD would now have more severe symptoms and occurrences of depressive episodes linked with MDD instead.
Some estimates state that:
- Within one year of having MDD, 3.9% of patients convert into bipolar.
- Within five years of having MDD, another 1% of patients convert into bipolar.
- Within ten years of having MDD, a final 0.8% of patients convert into bipolar.
These figures would suggest that while it is possible for MDD to become bipolar, it is very unlikely. Moreover, if it happens, it is most likely to happen within the first year, and very few people experience a conversion thereafter.
Importance of re-assessments
Given that there are different treatment options for both, it is important that if you have either condition, you are receiving the best-personalized care.
Moreover, since those with MDD can develop bipolar, someone with a diagnosis should consider getting more than one assessment at various intervals to monitor the progress of symptoms.
Individuals who have previously been diagnosed with major depressive disorder should consider having their symptoms assessed a second time within one year following the initial diagnosis to see if their major depressive disorder has converted into bipolar disorder, particularly if the original diagnosis was a challenge and symptoms have progressed during the first year. The same can be done at the 5-year mark and the ten-year mark.
Living with MDD or Bipolar Disorder
If you are living with bipolar vs. MDD, it’s important that you have a support system and that you continue to pursue therapy. This is particularly true of any bipolar disorder because bipolar is something you have to learn to live with.
Support can come from having a good network of family and friends on whom you rely, as well as those within individual support groups specific to your mental health condition. You can find local resources for MDD and bipolar support groups, or individuals in the sessions are people who have the same conditions.
It is also very likely that coping mechanisms will need to be a regular part of your life moving forward with lifestyle adjustments to accommodate for things like improved sleep, diet, and stress management. The techniques you utilize for each of these may be different from time to time. Someone with bipolar might have different coping mechanisms for a manic episode compared to a depressive episode.
When you continue to pursue personalized treatment with holistic therapy and other therapies, you can make adjustments to your coping mechanisms as your symptoms adjust. This can give you the empowerment you need to change your relationship with MDD and bipolar disorder.
Conclusion
There are many issues distinguishing between MDD and Bipolar Disorder. However, there is hope for those with MDD and bipolar to find treatment and effective management opportunities with proper diagnosis and ongoing care. Consult healthcare providers if you or someone you know are experiencing symptoms.