Bipolar Disorder: Signs, and How It Differs From Depression
A doctor explains mania and hypomania in plain words, how bipolar depression differs from ordinary depression, and why past highs matter to your doctor.
See a doctor promptly if
- Hearing or seeing things others do not, or fixed beliefs others find untrue, such as having special powers or being watched. Seek urgent help the same day
- Risky behavior during a high, such as large debts, reckless driving, unsafe sex or giving money away
- Several nights of very little sleep without feeling tired, especially after a past episode
- Thoughts of suicide or self-harm. Call your local emergency number or a crisis line now
The short version
- Bipolar disorder means episodes of depression plus at least one period of mania or hypomania: days of unusually high or irritable mood, high energy and little need for sleep.
- Bipolar depression can look just like ordinary depression. The difference is the history of highs, so tell any doctor about past spells of unusual energy, even ones that felt good.
- Antidepressants alone can sometimes trigger highs in bipolar disorder. Assessment by a psychiatrist, and mood stabilizers, are the usual foundation of care.
Try the mood check2 min, free, nothing to installThe PHQ-9 and GAD-7, the two questionnaires doctors screen low mood and anxiety with, scored privately on your device.
Bipolar disorder is a long-term condition in which mood moves between episodes of depression and episodes of unusually high mood, called mania or hypomania. Between episodes, many people feel well. The highs are what set it apart from ordinary depression, and they are also what most often gets missed.
Mania and hypomania in plain words#
Mania is a spell of at least a week when mood is unusually high, expansive or irritable, with far more energy than normal. During mania, people may:
- Need very little sleep, yet feel full of energy
- Talk fast, jump between ideas, and feel their thoughts racing
- Feel unusually confident, even grand or special
- Start many projects, spend heavily, or take risks they normally would not
Severe mania can include psychosis. That means hearing voices, or firmly believing things that are not true. It often needs hospital care.
Hypomania is a milder version lasting at least four days. Life still works, sometimes better than usual, at least at first. People often enjoy it and do not see a problem. Family and friends usually notice before the person does.
How bipolar depression differs#
| Depression | Bipolar depression | Hypomania | |
|---|---|---|---|
| Mood | Low, flat, hopeless | Low, flat, sometimes with agitation | High, upbeat or irritable |
| Sleep | Often poor, with early waking | Often sleeping much more than usual | Much less sleep, without tiredness |
| Energy | Low | Very low, heavy, slowed down | High, restless |
| Thinking | Slow and negative | Slow and negative | Fast, full of ideas |
| Past highs | None | Past mania or hypomania | This is the high |
These are tendencies, not rules. The only reliable way to tell bipolar depression from ordinary depression is the history of highs. That is why your doctor needs to know about any past spell of unusual energy, even if it felt good at the time.
Why antidepressants alone can be a problem#
In bipolar disorder, an antidepressant taken without a mood stabilizer can sometimes tip a person into hypomania or mania. It can also make moods cycle faster. That is why doctors ask about past highs before treating depression.
If you have ever had days of very little sleep with racing energy, mention it, even if no one asks. If you already take an antidepressant and this sounds familiar, raise it with your prescriber. Do not stop or change it on your own.
Sleep is the early warning sign#
Sleep often changes first. A few nights of needing much less sleep, without feeling tired, can be the first sign of a high. Sleeping far more than usual can signal a low. Many people learn their own early signs and agree a plan with their care team. A steady sleep routine protects mood, and the sleep check can help you spot patterns worth mentioning.
Assessment and treatment#
Bipolar disorder is diagnosed by a psychiatrist. There is no blood test or scan for it. The psychiatrist takes a detailed history of moods over years, often with input from family. Blood tests may be done to rule out thyroid problems and other causes.
Treatment usually rests on mood stabilizers. These are medicines that smooth the swings in both directions and help prevent new episodes. Some antipsychotic medicines are also used this way. Many need regular blood tests to check levels and side effects. Talking therapy, learning about the condition, steady routines and cutting back on alcohol and drugs all help too. Care is usually long term, because the aim is to prevent episodes, not just treat them.
When to get help now#
Psychosis, or dangerous risk-taking during a high, needs urgent help the same day. If someone is in immediate danger, call your local emergency number. Depression in bipolar disorder can also bring thoughts of suicide. These feelings can pass, and help works.
- If you might act on thoughts of suicide or self-harm: call your local emergency number now.
- US and Canada: call or text 988, any hour.
- UK and Ireland: Samaritans, 116 123, any hour.
- Anywhere else: findahelpline.com lists free lines by country.
What I see in clinic#
The people I see with missed bipolar disorder usually come in about depression. The highs come out only when I ask directly, and often a partner remembers them better. "Was there ever a time you needed hardly any sleep and felt on top of the world?" is one of the most useful questions I ask.
Where to take this next#
If low mood is the main problem right now, the fuller guide to the signs of depression explains how it is assessed and treated. If you are unsure whether past highs matter, a psychiatrist on our team can answer one question in writing within 24 hours for $29.
Should this go to a doctor?
Three honest answers, a plain answer back.
Before you buy anything for sleep
No gadget fixes sleep apnea. But if your score above suggests a sleep study, a simple pulse oximeter can give your doctor useful overnight numbers for under $30.
Buying through this link supports the free library with a small commission. It never changes a pick.
Something on your mind?
A psychiatrist answers one question privately, in writing, within 24 hours. Or talk it through on a 20 minute video call.
Common questions
Can you have bipolar disorder without full mania?
Is bipolar disorder the same as mood swings?
Can bipolar disorder be treated?
People also ask
Not what you were looking for?
Say what you came for and we will take you there.
