Approximately 7 million adults in the United States—about 2.8% of the adult population—experience bipolar disorder each year, according to the National Institute of Mental Health (NIMH). Despite its prevalence, there are still many misconceptions about the condition, which I aim to clarify.
To start, it’s important to distinguish bipolar disorder from major depressive disorder. You cannot be diagnosed with both—it’s one or the other. While both conditions involve episodes of depression, bipolar disorder is defined by the presence of mania or hypomania in addition to depressive episodes. This difference is crucial because the treatment strategies differ significantly. If bipolar disorder is treated the same way as major depressive disorder—especially with antidepressants alone—it can actually make things worse.
Bipolar disorder includes:
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Episodes of mania, which involve an elevated or irritable mood, increased energy, decreased need for sleep, racing thoughts, risk-taking behaviors, and in some cases, hallucinations or delusions. These episodes can significantly impair daily functioning and may require hospitalization.
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Periods of hypomania, which are milder than full mania and don’t usually require hospitalization, but still involve increased energy, elevated mood, and impulsivity that can disrupt work, relationships, and overall stability.
Patients rarely seek psychiatric care while they’re in a manic or hypomanic state. Most present for treatment when depressed, which can make diagnosis more challenging. That’s why it’s essential for a trained mental health provider to assess the full picture—especially if you’ve ever experienced elevated energy, decreased sleep, or impulsivity that was out of character during certain periods of your life.
I use a patient-centered, evidence-based approach that includes a detailed clinical interview, a review of personal and family psychiatric history, and validated screening instruments to assist in making an accurate diagnosis. Once a diagnosis is established, we work together to develop a long-term treatment plan focused on mood stabilization and relapse prevention.
Bipolar Disorder vs. Major Depressive Disorder
| Feature: Mood Episodes | Bipolar Disorder: Alternates between depression and mania or hypomania | MDD: Only depressive episodes |
| Feature: Mania/Hypomania Present | Bipolar Disorder: Yes – defining feature of diagnosis | MDD: No |
| Feature: Depressive Episodes | Bipolar Disorder: Yes – similar to MDD but part of a broader mood cycle | MDD: Yes – core component of the disorder |
| Feature: Mania | Bipolar Disorder: Elevated, expansive, or irritable mood with significant impairment | MDD: Not present |
| Feature: Hypomania | Bipolar Disorder: Milder elevation in mood and energy, does not require hospitalization | MDD: Not present |
| Feature: Common Presentation | Bipolar Disorder: Often presents during depression; past mania/hypomania may not be recognized | MDD: Presents with persistent low mood, loss of interest, fatigue, etc. |
| Feature: Treatment Approach | Bipolar Disorder: Requires mood stabilizers or atypical antipsychotics; antidepressants used cautiously | MDD: Antidepressants often first-line |
| Feature: Risk of Misdiagnosis | Bipolar Disorder: High – especially if mania/hypomania not disclosed or identified | MDD: Lower – clearer symptom pattern |
| Feature: Worsening with Antidepressants Alone | Bipolar Disorder: Possible – can trigger mania or rapid cycling | MDD: Unlikely – may be effective |
If you are struggling with symptoms of depression but have also experienced periods of increased energy, impulsive decisions, or changes in sleep that don’t match your baseline, you may be dealing with bipolar disorder. Proper diagnosis is essential—and treatment can make a profound difference.
You don’t have to navigate this alone. Let’s work together to understand what you’re experiencing and build a care plan that brings lasting stability and support.