Many individuals struggle with mood and anxiety disorders. Among mood disorders, two major mental health conditions stand out: Bipolar Disorder and Major Depressive Disorder (commonly known as depression). Distinguishing between these two conditions requires the expertise of a skilled psychiatrist or clinical psychologist. Here are seven key differences:
1. Bipolar Disorders Involve Episodes of "Highs" and "Lows"
- Bipolar 1: Mania involves extreme highs that are often very noticeable. For example, individuals may believe they are divine figures, such as God or Buddha, and feel they possess magical powers. They may also experience auditory hallucinations or delusions. These individuals typically require little to no sleep, may engage in risky behaviours (e.g., I once treated a patient who jumped into the Singapore River), and can become highly agitated.
- Bipolar 2: Hypomania is subtler and less obvious. Family and friends may mistakenly believe that someone with Bipolar 2 is simply unusually happy. These individuals may spend excessively, pursue new business ideas, experience an increased sex drive, and function on just a few hours of sleep. Many individuals with Bipolar 2 actually prefer the mildly elevated mood of hypomania over the depressive episodes that follow.
- Depression: Unlike bipolar disorder, depression does not include elevated episodes. Individuals with depression typically experience persistent low mood, changes in sleep and appetite, difficulty concentrating, low energy, and feelings of meaninglessness.
2. Bipolar Disorders Have Stronger Genetic Links
Bipolar disorders are among the most heritable mental health conditions, with heritability estimates reaching up to 80%, significantly higher than schizophrenia and depression.
In contrast, depression has a more multifactorial origin, with heritability estimated at 30-50%. Both genetic and environmental factors contribute to its onset. Personality traits (e.g., perfectionism or anxiety) and life stressors (e.g., workplace pressure, academic exams, or relationship difficulties) are also significant contributors.
3. Medications Are More Effective Than Therapy for Bipolar Disorders
For bipolar disorders, medications typically play a more critical role than therapy. During a manic episode, hospitalization may be necessary to ensure the individual’s safety and prevent harm to their reputation (e.g., walking naked in public, believing they are invisible). Mood stabilizers help regulate mood and restore balance.
While therapy remains valuable—especially Interpersonal and Social Rhythm Therapy (IPSRT), which helps individuals regulate their routines, particularly sleep—medication is often the primary treatment. This is why many private psychologists do not advertise treatment for bipolar disorder.
4. Antidepressants Should Be Used Cautiously in Bipolar Disorder
Antidepressants are commonly prescribed for depression and anxiety. However, when used alone for Bipolar 1, they can trigger mania. While antidepressants may be used in certain cases, psychiatrists must carefully weigh the risks and benefits, closely monitoring the individual’s response. Often, an additional medication, such as a mood stabilizer or antipsychotic, is prescribed to mitigate the risk of triggering mania or hypomania.
5. Depression Is More Common Than Bipolar Disorder
In Singapore, the prevalence of depression is estimated at 6.2%, according to the Singapore Mental Health Study. In contrast, the global prevalence of bipolar disorder is much lower, at around 2.4%.
6. Bipolar Disorders Can Present as Depression
Bipolar disorders often emerge in the late teens or early twenties and can initially present as depression. This may lead to misdiagnosis, as the manic or hypomanic episodes may not appear until a year or two later. It is crucial for psychiatrists to carefully evaluate symptoms, particularly when treatment for depression does not yield expected results.
On the whole, individuals with bipolar disorder spend more time in a depressive state than in an elevated state.
7. Many Individuals with Bipolar Disorder May Have Been Misdiagnosed with Depression
If a person diagnosed with depression shows poor response to antidepressants and therapy, it is essential for the psychiatrist to reassess the diagnosis. Some individuals with bipolar disorder may experience subtle or brief manic or hypomanic episodes that could be easily overlooked. A thorough re-evaluation can help ensure an accurate diagnosis and appropriate treatment plan.
Seeking professional guidance is key to accurate diagnosis and effective treatment. If you're experiencing persistent mood fluctuations or have concerns about whether your symptoms align with depression or bipolar disorder, our team of experienced psychiatrists and psychologists at Private Space Medical is here to help. Reach out today to schedule a consultation and take the first step toward a better understanding of your mental health.
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Dr Victor Kwok
Senior Consultant Psychiatrist
Senior Consultant Psychiatrist
