Bipolar Depression vs. “Regular” Depression: What’s the Difference?
Updated: 10/20/2025
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TL;DR
Bipolar depression looks similar to unipolar depression. However, there are key differences that impact diagnosis and (most importantly) treatment.
Both share the same symptoms (hopelessness, sadness, fatigue). However, bipolar depression often involves other symptoms too, like irritability and a history of hypomania or mania.
Because of this, it’s vital to get an assessment and diagnosis by a mental health professional.
When we talk about depression, most people think of classic symptoms: lack of motivation, persistent sadness, hopelessness, and sleeping too much. But not all depression is the same. For those with bipolar disorder, depression shows up differently than it does in major depressive disorder (MDD) or unipolar depression.
Why does this matter? When bipolar depression is mistaken for “regular” depression, the consequences can be serious: misdiagnosis, medication that only worsens things, and delayed treatment.
Let’s explore how bipolar depression is different from major depression, and why recognizing the difference matters.
1. What is Bipolar Depression?
Bipolar depression refers to the depressive phase of bipolar disorder. Bipolar is a mood disorder characterized by alternating episodes of depression and mania or hypomania.
Related: Everything You Need to Know About Bipolar Disorder
During a depressive episode, someone with bipolar disorder may look very similar to someone with unipolar depression. However, the presence (or history) of mania or hypomania is the distinguishing feature.
2. Symptoms: Similar but Not the Same
Bipolar and unipolar depression share many of the same core symptoms:
Persistent sadness or emptiness
Low energy or fatigue
Feelings of worthlessness
Changes in appetite or sleep
Difficulty focusing or concentrating
Loss of interest in things you used to enjoy
Thoughts of death or suicide
But research shows some subtle but important differences in how these symptoms appear in bipolar depression:
Earlier age of onset: The average age of onset for bipolar disorder is around 18. For unipolar depression, it’s mid-20s to 30s.
More mood reactivity: Mood more likely to dip in response to negative events or rise in response to positive ones.
More hypersomnia (sleeping too much) rather than insomnia
More irritability and agitation
Increased psychomotor retardation (feeling physically slowed down)
Higher likelihood of psychotic features
According to research, people with bipolar depression tend to have more severe depressive episodes. They are also at a higher risk for suicide than those with major depressive disorder.
3. Treatment Differences Matter
Treating bipolar depression is not the same as treating major depressive disorder or another type of deprssion.
Antidepressants are the go-to treatment for MDD. However, they can be risky for bipolar disorder. In some cases, they may:
Cause rapid cycling (frequent mood shifts)
Trigger a manic or hypomanic episode
Worsen overall mood stability
Instead, the first-line treatments for bipolar depression often include:
Mood stabilizers (e.g., lithium, lamotrigine)
Atypical antipsychotics (e.g., quetiapine, olanzapine-fluoxetine, lurasidone)
Psychotherapy (such as dialectical behavioral therapy (DBT) or cognitive behavioral therapy (CBT)
Studies have found that combining mood stabilizers with targeted psychotherapy is more effective in reducing relapse than medication alone.
Getting a correct diagnosis from a licensed therapist or psychiatrist is so important because treatment for major depressive disorder can make bipolar symptoms worse if the bipolar component is missed. It can cause rapid cycling or mania.
4. Course of Illness and Functioning
The course of illness tends to be different in those who have bipolar. Bipolar depression tends to be disruptive and recurrent than unipolar depression.
Stronger genetic component
More frequent hospitalizations
Higher risk of co-occurring substance use disorders
Greater functional impairment, even between episodes
People with bipolar disorder often spend more time in depressive states than manic ones, especially in Bipolar II. That’s part of what makes it harder to diagnose—manic symptoms may be infrequent, brief, or overshadowed by long periods of depression.
5. What to Watch For
If you or someone you love is dealing with recurring depressive episodes, it may be worth asking:
Have your moods ever shifted suddenly or dramatically?
Have you ever felt so energized that you didn’t need to sleep for days?
Have there been times you made big plans or took risks that didn’t feel like you?
Have you had periods where your thoughts were racing, you talked more than usual, or you felt unusually confident?
These questions can help uncover a pattern that might indicate bipolar depression.
Related: Do I Have Bipolar Disorder? Quiz Online
Final Thoughts
Bipolar depression can look a lot like major depressive disorder on the surface—but it is different. The good news is that with the right diagnosis and care, people with bipolar disorder can build fulfilling lives.
If you suspect you or a loved one might be living with bipolar depression, speak with a mental health professional familiar with mood disorders. A correct diagnosis is the first step toward targeted, effective treatment—and ultimately, toward stability and hope.
Frequently Asked Questions (FAQs)
Can bipolar be mistaken as depression?
Yes, the most common misdiagnosis for bipolar disorder is major depressive disorder (unipolar depression). Up to 75 percent of people with bipolar disorder who are misdiagnosed are diagnosed with depression.
How to tell if you're bipolar or just depressed?
The best way to tell if you have bipolar disorder is to reach out to a licensed therapist or psychiatrist for an evaluation and diagnosis.
Is bipolar depression worse than major depression?
The scientific research indicates that bipolar depression has a reduced life expectancy and significantly higher suicide risk compared with major depressive disorder, so correct diagnosis and the right treatment are both critical.
Sources
Yang, R., Zhao, Y., Tan, Z., Lai, J., Chen, J., Zhang, X., Sun, J., Chen, L., Lu, K., Cao, L., & Liu, X. (2023). Differentiation between bipolar disorder and major depressive disorder in adolescents: from clinical to biological biomarkers. Frontiers in human neuroscience, 17, 1192544. https://doi.org/10.3389/fnhum.2023.1192544
