Can Depression Turn Into Bipolar Disorder?

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Bipolar disorder and depression share many of the same symptoms, but there are several key differences between the conditions. Depression (sometimes referred to as unipolar depression) and bipolar disorder (or bipolar depression) are two distinct conditions that need to be treated differently.

It's very important that a person gets the correct diagnosis so they can receive proper treatment. Unfortunately, it can be difficult to tell the difference between the conditions, and misdiagnosis can happen.

While depression cannot "turn into" bipolar disorder, a person who was previously diagnosed with depression may find out that they actually have a type of bipolar disorder. It can be difficult to cope with a new or unexpected diagnosis, but having an accurate diagnosis is necessary to ensure the condition is treated properly.

Why Misdiagnosis Happens

While there are some characteristic features of each condition, many symptoms of bipolar disorder and depression overlap. When people have both conditions at the same time, or another factor such as substance use, making an accurate diagnosis can be challenging.

Symptoms of Bipolar Disorder

Bipolar disorder is a mental disorder in which a person experiences alternating periods of depression and mania. Periods of mania are defined by elevated mood and high energy.

While in a manic state, a person can feel very good. Compared to feelings of depression, manic symptoms may not be especially troubling. Manic episodes can also be infrequent, with gaps as long as several years occurring in between them. When symptoms do occur, they can be mild.

In some cases, a person with bipolar depression may not mention manic symptoms to a doctor or therapist unless, or until, they become severe.

Bipolar Types

It's important to know that there are two types of bipolar disorder: bipolar 1 and bipolar 2. While the symptoms of each type are similar, they differ in frequency and duration.

difference between bipolar i and bipolar ii
Illustration by Hugo Lin. © Verywell, 2018.

Bipolar 1 disorder typically involves at least one major depressive episode. How it's different from depression is that people with bipolar disorder have also experienced at least one manic episode. In bipolar 1, people may alternate between periods of depression and mania.

In bipolar 2 disorder, a person may not experience mania. Rather, they may have a lesser form (hypomania) interspersed with depression. When symptoms are subtle, people may not realize they are experiencing mania. The "lows" of depression may be more obvious or recognizable, which can contribute to a misdiagnosis of depression.

People with either type of bipolar disorder can experience the following symptoms, depending on whether they are experiencing a manic or depressive phase.

Mania Symptoms

  • Feeling restless, increased activity or energy
  • Euphoria, excitement, "big" ideas (grandiosity)
  • Having trouble focusing, getting distracted, thinking about many different things
  • Aggression, getting angry or irritated easily
  • Sleeping less but still having energy
  • Increased sex drive
  • Delusions, hallucinations (severe mania)

Depression Symptoms

  • Feeling tired, fatigued, having trouble getting out of bed
  • Sleeping too much or not being able to fall or stay asleep
  • Feeling guilty, ashamed, sad, or hopeless
  • Trouble paying attention to school or work
  • No appetite or eating more than usual
  • Decreased sex drive
  • Feeling physically sick or having pain (headaches, stomachaches) that aren't caused by a known medical condition

Symptoms of Depression

depression-symptoms
Illustration by Joshua Seong. © Verywell, 2018.

Although there are different types of depression, which can have unique characteristics, there are some symptoms that most people with depression feel at one time or another, such as:

  • Feeling profoundly sad, hopeless, or empty
  • Getting angry, irritated, or frustrated easily
  • Sleeping too much or having insomnia
  • Poor concentration or trouble focusing
  • Not feeling hungry or overeating
  • A lack of interest in hobbies, work, socializing
  • Low or no sex drive
  • Self-harm, suicidal thoughts or attempts

Typically, a person must have symptoms every day for two weeks or longer to be diagnosed with depression.

People with depression are also more likely to have anxiety disorders. While people with bipolar disorder can experience anxiety, conditions like generalized anxiety disorder are more common in people with depression.

Overlapping Symptoms

There are many symptoms that are common to depression and bipolar disorder. When a person with a type of bipolar disorder is experiencing a depressive episode, it can look (and feel) very much like a classic bout of depression.

People with depression or bipolar disorder can experience low mood, trouble sleeping, changes in appetite, and problems focusing. They are also at risk of self-harming, including suicide.

One of the primary ways to distinguish bipolar disorder from depression is the presence of manic symptoms, but a person may seek treatment for their depressive symptoms before they have experienced a manic episode.

Sometimes, people do not recognize that they have had an episode of mania—especially with a more subtle, hypomanic episode.

Substance Use

Substance abuse can complicate mental illness diagnosis in a number of ways. A person who is using substances may exhibit behaviors or symptoms that look like bipolar disorder.

Misdiagnosis can occur if a provider does not know the person is using substances, but some research has suggested bipolar disorder may be misdiagnosed even when a clinician is aware of a person's history of substance use.

Alternatively, people who are using drugs or alcohol may not be correctly diagnosed with bipolar disorder if their symptoms are attributed to substance use.

Substance use disorders frequently co-occur with many mental illnesses, including bipolar disorder and depression.

Getting the Right Treatment

One of the potential complications of misdiagnosis is that bipolar disorder and depression need different treatments. Unfortunately, antidepressants, the treatment of choice for depression, may not work for people with bipolar disorder.

In fact, when people with bipolar disorder take certain antidepressants, their symptoms can become worse. Their mood may become unstable and they may have an increase in the frequency of manic episodes. If a person has not had a manic episode yet, these medications may trigger them to experience one (which can actually help a clinician make a diagnosis of bipolar disorder as opposed to depression).

Rather than antidepressants, most people with bipolar disorder need treatment with mood-stabilizing drugs, such as lithium.

Reducing the Risk of Misdiagnosis

Clinicians can take several steps to ensure they are making an accurate diagnosis. The risk of misdiagnosis is still present, but it can be reduced. If you are working with a doctor or mental health professional, these are just a few approaches to your assessment they may use to help them provide the most accurate diagnosis possible.

History Taking

A doctor or mental health professional will start by asking a person about their symptoms, however, it can be difficult for people to explain their feelings or note patterns. It can be helpful for a doctor to talk to your loved ones, as they may have noticed changes in your behavior or made other observations about your mood—some of which you may not even be aware of.

Clinicians may make a special point to ask about the symptoms associated with mania, such as elevated mood, irritability, or reckless behavior.

It's also important to ask about a family history of mental illness. If a person has a first-degree relative with bipolar disorder or a history of manic episodes, they are at a higher risk for bipolar disorder. If someone has not been formally diagnosed but experienced a manic episode after starting an antidepressant, that may also indicate bipolar disorder rather than depression.

Asking questions about the onset of symptoms is also helpful. The symptoms of bipolar disorder tend to start abruptly and make come on earlier (teens or early 20s). Depression may be more gradual and can develop throughout the lifespan.

People with bipolar disorder also tend to experience change or "recovery" of symptoms (from low mood to feeling better, for example) more quickly than people with depression. In general, people with depression do not experience alternating moods—they feel "low" most or all of the time. These bouts of depression also tend to last for long periods of time, whereas people with bipolar disorder may have shorter bouts of depression.

Diagnostic Tools

The Mood Disorder Questionnaire, the Bipolar Spectrum Diagnostic Scale, and the Hypomanic Personality Scale are some of the diagnostic instruments used to screen for bipolar disorder. These tools focus on questions about potential mania and hypomania symptoms, which are important for distinguishing between a diagnosis of bipolar and unipolar depression.

Clinicians will also want to find out if a person has experienced any symptoms of psychosis, such as hallucinations. While psychotic symptoms can occur in other mental health disorders, it's one feature that can help distinguish between bipolar disorder and depression.

Follow-Up

Your doctor or mental health professional may want you to try mood charting to help keep track of your symptoms. This practice can be especially helpful for detecting episodes of hypomania and tracking the frequency of mood swings.

You may be asked to keep a log of your mood after starting an antidepressant. If you develop new symptoms (such as mania) or worsening symptoms after starting these medications, it may indicate that you have bipolar disorder rather than depression.

Staying in contact with your mental health care team while you are in the process of being diagnosed or starting treatment is important, especially if you are trying medications. In some cases, antidepressants can make symptoms of depression worse. If you are under the age of 25, the risk of suicidal thoughts can increase—which is why antidepressants have a black box warning from the FDA.

If you, or your loved ones, notice a change in your behavior that is worrisome, talk to your doctor or psychiatrist. They may decide you need another type of treatment.

Do not stop or take less of the antidepressant you have been prescribed unless you are being supervised by your doctor or psychiatrist. If you want to stop taking a medication or switch to a new prescription, ask your doctor how to safely reduce your dose to avoid withdrawal.

A Word From Verywell

Even when a doctor or mental health professional is thorough in assessing your symptoms and history, misdiagnosis can still happen. You can help by being as accurate and detailed as you can when reporting your symptoms to a clinician. If the diagnosis you have been given doesn't feel like the right fit it's important that you express these concerns to your health care team. It may help to be assessed by another practitioner. Your mental health and wellbeing depend on receiving an accurate diagnosis and having access to the treatment that best suits your needs.

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