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What is The Difference Between Major Depression and Bipolar Depression?

Once in a while all of us feel sad or discouraged. But if this blue mood does not go away and bothers you day by day more than two weeks, you are having depression.

Ten percent of people have depression at some time in their lives. Most often it happens in people between the ages of 24 and 44 years. Women suffer from depression twice often than men do. Important point about depression is that it is not just a feeling of hopelessness and sadness, but is a condition that needs to be treated. Without proper diagnose and treatment depression may get worse.

Depression is a type of mental illness or mood disorder with such symptoms as feelings of guilt, sadness, worry, helplessness, fear and lowered self-esteem. Depressed persons have no interest in life and very often do not see any reason to live "that" life any longer, tending to kill themselves. There are many types and subtypes of depression. Major depression is one of the types, and is also referred to as clinical depression, biological or endogenous depression. It is also called ‘unipolar’. Bipolar depression is another type of it and also called manic-depressive illness.

Is there any different between major depression and bipolar depression? Huge difference, some sources state. In clinical presentation, in symptoms and of course in treatment.

Major depressive disorder – this is a primary psychiatric disorder characterized by the presence of either a depressed mood or lack of interest to do usual activities occurring on a daily basis for at least two weeks. Also persons afflicted with this disorder have feelings of hopelessness and worthlessness, cry very often, and have low or absence of appetite, concentration, energy and low sex drive. They become socially withdrawn and very often do not want to go on living, if the disorder is left untreated for a long time. In some time some of the patients may become homicidal, may hear voices (having hallucinations), or develop some other symptoms of psychosis.

Bipolar disorder – this is a type of primary psychiatric disorder characterized by the presence of major depression (major depressive disorder) and episodes of mania that last for at least a week. In this type of depression patients show signs opposite of the depression described above. They are often full of energy, very loud and talkative, show sings of extreme happiness or irritability. Despite absence of enough sleep (they do not actually need it) patients are very energetic in the morning. What do they do instead of sleep? Just name it. Typing sms, making phone calls, washing up or washing cars, reading (or writing books), and starting new projects, very often unrealistic and unreasonable. They believe that they are special and have powers (someone may think that he (she) is the "Chosen One"). The same enthusiasm and hyperability is seen in sex, they want to make love several times a day.

To sum up, the difference is enormous, so the treatment is different as well. While major depression requires antidepressant, manic-depression needs a mood stabilizer (for example valproic acid, lithium, olanzapine, risperidone, quetiapine and other antipsychotics). In case of bipolar depression it is better to avoid antidepressants (antidepressants can make the condition worse, as these drugs can precipitate a switch to manic episode), although there are some exceptions to the rule. The difference can be better viewed in the table.

Major depression
Bipolar depression

If someone experiences a pattern of depressive symptoms

If your life is characterized by depressive and manic states

Attitude to life

feelings of hopelessness, patient has low interest to do usual activities

Extremely happy and too excited
Very low, the patient feels socially withdrawn

Pretty high, the patient feels like he (she) can do everything

Rest, sleep

Always tired, very often has troubles with sleep and if sleeps – doesn’t get rest from it.

It feels like he (she) doesn’t need to sleep at all

doesn’t want to work

Full of ideas (very often impossible ones), enthusiasm to do bold crazy things

Almost no interest in sex

Mood stabilizer (and sometimes antidepressants with low tendency to cause a switch to mania, such as bupropion)


Understanding the difference is very important for the doctor in planning treatment. Only your psychologists can understand the type of it for the further treatment.

Interesting to know, that some sources state there is no evidence that antidepressants do induce mania, and absence of safety data (in treating bipolar depression with antidepressants) doesn't automatically mean it isn't safe. More over, the division to these two types was made to suggest different ways of treatment. And as some medications (such as Lamictal) were tested on bipolar patients and not depressed patients, and some of them (such as Zoloft) - in depressed patients and not bipolar patients.

However, if suggest that depression is depression it might reasonably be expect that any medication for depression will work anyway. So, the only right way for you (either you or your doctor accept the differences between these types or not) is to accept the very treatment your doctor is prescribing you, even if it is not indicated for that specific condition. Also important to know, that there are no such definition as ‘moderate depression’ or ‘little depression’, any time the condition interfere with your life, relationships, happiness, productivity or other aspects of your life – find professional help. 

Valentyna Ant.

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