Differences Between Unipolar Depression and Bipolar Depression

A detailed explanation of unipolar and bipolar depression plus increased risk of suicide with bipolar depression.

It's easy to be confused over the differences between unipolar depression and bipolar disorder depression as they often look so similar! They share the symptoms of sadness, hopelessness, pessimism, anxiety and sleep problems, but at some point, unipolar depression and bipolar depression go off in very different directions.

It is important to make this distinction because the treatments for the two depressions are very different. Failure to make an accurate diagnosis can result in treatments that are ineffective or that can even make the condition worse.

This article will cover the sometimes subtle and often not so subtle symptoms of each type of depression and then give management tips that can be used for bipolar depression. For the purpose of this article, I will refer to unipolar depression as depression and bipolar disorder depression as bipolar depression.

Please note that this article is an extension of the articles The Gold Standard of Treating Depression and The Gold Standard of Treating Bipolar Disorder.

Mood Disorders 101

I'm a big believer that all of us who have mood disorders or know someone who does, need to understand the definition of the illnesses before dealing with symptoms. Mood disorders make it difficult for a person to regulate their moods- which is why so many people with depression often hear that they should just get control of their emotions and not be so sensitive and negative!

There are two types of mood disorders: unipolar depression and bipolar disorder. Both are considered genetic disorders and they share many symptoms. There is also a form of depression called situational depression, where a person becomes depressed due to a specific event and then goes back to a stable mood once the event and its aftermath is over. This article focuses on unipolar depression and bipolar depression.

What Are the Main Differences between the Two Depressions?

The biology of these disorders is different, effective treatments are different, and in some respects, the symptoms are also different. Both forms of depression can be very severe and carry a risk of suicide. However, the underlying difference is that people with bipolar depression also experience episodes of either mania or hypomania.

If you imagine a puzzle with a hundred pieces, depression itself would take up half of the pieces in Bipolar Depression. The rest would be puzzle pieces that represent bipolar disorder symptoms that can go along with the depression including mania, a high level of anxiety, aggression, ADHD and OCD symptoms, psychosis, rapid cycling, agitation, and often mixed episodes. Outside of mania, advanced depression can share a lot of these symptoms, but it's quite rare.

Diagnostic Differences

Most cases of bipolar depression often have excessive sleeping and a lot of daytime fatigue. There is an increased appetite and weight gain. In contrast, people with depression tend to wake up often throughout the night and may also experience early morning awakening (e.g. waking up at 4:30 and being unable to return to sleep. Although some people who experience depression may have increases in appetite and weight gain, it is more common to have a loss of appetite and weight loss. Bipolar depression is much more likely to be accompanied by stronger symptoms of anxiety. One-half to two-thirds of people with bipolar depression have a co-occurring anxiety disorder such as obsessive-compulsive disorder, panic disorder or social anxiety disorder. And, of course, this is all complicated with the extra symptoms such as mania and psychosis that come with bipolar depression. Treatment-wise, the main difference is how a person with bipolar depression responds to medications.

Sherri's Bipolar Depression Story

I asked Sherri, a 40-year-old woman with bipolar disorder, to describe the difference between depression and bipolar depression:

For me, BIPOLAR depression comes with not only depression but psychosis. I start to see things that aren't there and hear things that aren't heard, like my name called over-and-over-again. I see mice running across the floor. I hear my name projected over the loudspeaker at the grocery store. I smell burning rubber in my apartment. With BIPOLAR depression, I suffer these hallucinations and extreme paranoia. I feel like someone out there is trying to get me. I often have to cross the street if I see someone suspicious. With clinical depression, it's different. Those who experience usually only feel really down and hopeless. I feel BIPOLAR is much worse because of the psychosis. I was diagnosed with depression before I ever had mania, so I've lived with this a long time.

Suicide in Depression and Bipolar Depression

According to Dr. John Preston, the coauthor of our books on mood disorders, the suicide rates differ greatly between the two depressions. Here are the statistics:

The lifetime suicide rate for depression is 9%. In contrast, the suicide rate for bipolar depression is 20%. Statistics regarding mood disorders and suicide have been so behind the reality of the illnesses for a long time, so these numbers can be quite shocking. The bipolar depression suicide rate reflects the fact that having a myriad of symptoms, including mixed mania, agitation, OCD, anxiety and psychosis, can make a person extremely uncomfortable and desperate, along with being depressed. Dr. Preston points out that when a person is in a mixed state (episodes where depression, mania and possibly psychosis occur at the same time), they have more energy and drive to actually try suicide. People who try to kill themselves want to end pain. They don't want to end their lives, which is why so many more try than succeed.

Comprehensive information on suicide and suicidal thoughts here.