My Experience with Bipolar Depression vs. MDD

I used to feel like there was a revolving door in my emotional guesthouse. A joyless, listless version of me wandered in like a vagrant, stayed a while and left. There was enough time to tidy up my mess and have some peace before a charming, risk-taking bad boy version burst through the door. These bipolar guests took control, ran the show, and they all had bad manners. Without psychiatric and therapeutic support to manage my extreme highs and lows, every depressive episode cycled to a hypomanic episode. Sometimes there were periods of a balanced mood post-depression, but hypomania always arrived next. 

• What is Bipolar disorder?

Now that I have become educated about bipolar disorder cycles, I recognize some important distinctions between bipolar depression and unipolar depression, also known as major depressive disorder. Bipolar disorder is easily confused with depression because it often includes depressive episodes. However, there are some key differences: 

• Bipolar disorder tends to recur on a somewhat regular basis. In a typical cycle, a depressive episode will sometimes end abruptly, followed by hypomania, then followed by another depressive episode. They may be weeks to months apart, but the cycle continues. Does it sound exhausting? It is.
• With depression there is no “up” period. Unipolar depression may feel like a pervasive sense of hopelessness, worthlessness, loss of enjoyment and a decreased ability to manage day-to-day tasks. Depression may slowly creep in, hang around for several days or weeks and have a glacial quality.
• Bipolar disorder always includes symptoms of mania or hypomania. The shorter-lived cycling between hypomanic or manic episodes and repetitive depressive episodes may be an indication of a bipolar spectrum disorder, not a unipolar depression disorder. 
• While clinical depression cannot evolve or “turn into” bipolar disorder, a person previously diagnosed with depression may actually have a type of bipolar disorder. If you’re unsure whether your experience is one of unipolar depression or bipolar disorder, please consult a therapist and psychiatrist for a full psychological evaluation. Don’t self-diagnose.

Before I received an accurate diagnosis, it seemed I had a string of depressive episodes. It’s possible that some hypomanic cycles were milder and went unnoticed. The early experience of hypomania didn’t usually affect me much, if at all. I might feel cheerful, well-rested after just 4 hours of sleep, focused and on top of the world. After a depressive cycle, this wouldn’t seem like a problem. Hypomania felt kind of awesome at times…nothing like how manic episodes are depicted in movies. In the past, hypomanic episodes would sneak by because I didn’t know what the early signs were. I thought, Hmm…I have been feeling absolutely awful for the past four days. Today I feel better…much better just overnight. This quick turnaround isn’t usually associated with unipolar depression. It felt wonderful until it became too much to handle.

My bipolar depressive episodes were more noticeable because they were short-lived, intense and sucked my energy quickly—sometimes in a matter of hours. By contrast, once the first episode of major depressive disorder has occurred, recurrent episodes will usually begin within 5 years of the initial episode. On average, those with a history of MDD will have 5 to 9 separate depressive episodes in their lifetime.

Another difference is that antidepressants made my depression cycles worsen, which then made hypomania’s impact worse when the pendulum swung in the opposite direction. When I was prescribed a mood stabilizer instead of antidepressant medication, I experienced a steady return to emotional balance within a couple of months. 

Before finding the right medication, and before mindfulness practices and talk therapy, I would sustain a level mood for several weeks. But the balanced mood would escalate to a level of unstable emotional intensity not found in MDD. This time period of gradual, intensifying hypomanic symptoms is called the “bipolar prodrome.” The prodrome period can be weeks to months long, making it harder to recognize. 

The most common prodromal symptoms tend to be a sudden elevated mood, overly positive self-talk, decreased need for sleep, increased activity, compulsive spending, hypersexuality, and obsessive, grand ideas. For a while, friends may not notice I’m off balance. I seem confident and purpose-driven. I’m extroverted, charming, quick witted, and I get stuff done. However the prodrome can shift suddenly in a few hours or a few days to unmanageable high-flying moods and poor choices, followed by the depressive shift to a loss of energy, motivation, self-worth, and a flat emotional affect. Unipolar depression is characterized by a slower, pervasive experience of worsened mood without the highs of a manic cycle. 

While these two have similar qualities, they’re different enough to have distinct diagnostic criteria in the DSM-5. Unipolar depression and bipolar depression share the same symptoms with three main differences: 

1. Bipolar depression is more episodic than unipolar.
2. Bipolar depression is always on the edge of mania. 
3. Due to the mania risk, bipolar depression treatment differs from unipolar depression treatment. 

Here are some steps that will help a mental health provider offer you an informed diagnosis:

• Make a list of what you’re experiencing, when and for how long. Rate the severity of the symptoms on a scale of 1 to 5, with 1 being the least intense and 5 having the most impact on your functioning. Track this list for at least a month, if possible.
• Ask your friends, family or someone you trust to tell you what they notice. An external view is important, because both depression and bipolar disorder tend to draw a person inward, away from self-awareness.
• Note changes to your appetite; quantity and quality of food; sleep; use of substances like cigarettes, alcohol, caffeine and other drugs; and the motivation to do daily tasks before, during and after an episode of depression. There may be important clues that will help your provider offer an accurate diagnosis.
• When depression subsides, do you return to a balanced mood for a significant amount of time (months or years), or does your mood become gradually euphoric, intense, impulsive and unmanageable for you and those around you?
• Consider asking a psychiatrist to give you an assessment for both major depressive disorder and bipolar spectrum disorder before a diagnosis and regimen of medication.

With medication and interpersonal and social rhythm therapy (ISRT), my depressive and hypomanic episodes become fewer and less intense. When they subside, life becomes more manageable. I am reconnected with myself, others and the environment. I have more patience. I wake up feeling calm and well-rested from at least 7 hours of sleep. I make healthy meals, find time for rest and play and hit the gym after work. I’ll be in bed by 11 instead of 2 a.m. and drift off in 5 minutes. I don’t feel like a superhero. I simply feel like me again.

It’s not always this way; medication isn’t a magic wand. I still have occasional episodes, however, they’re less intense and don’t last as long. The tools I’ve learned have helped me trust my moods as authentic and less worrisome. My emotional life has improved from drastic and exhausting travel between the north and south poles to living in a balanced, temperate emotional climate near the equator. Whether your diagnosis is unipolar depression or bipolar disorder, finding the best tools will make a big difference in living a healthy, emotionally balanced life. That’s something both of these disorders have in common.