Can Depression Turn Into Bipolar Disorder?

Bipolar Disorder and Depression: Understanding the Difference

Can Depression Turn Into Bipolar Disorder?

Bipolar disorder is easily confused with depression because it can include depressive episodes. The main difference between the two is that depression is unipolar, meaning that there is no “up” period, but bipolar disorder includes symptoms of mania.

To differentiate between the two disorders, it helps to understand the symptoms of each one.

Symptoms of depression

The essential feature of major depressive disorder is a period of two weeks during which there is either depressed mood most of the day nearly every day or loss of interest or pleasure in nearly all activities. Other potential symptoms include:

  • Significant weight loss when not dieting or weight gain and changes in appetite
  • Insomnia or hypersomnia nearly every day
  • Psychomotor agitation or retardation nearly every day
  • Fatigue or loss of energy nearly every day
  • Feelings of worthlessness or excessive guilt
  • Impaired ability to think or concentrate, and/or indecisiveness
  • Recurrent thoughts of death, recurrent suicidal ideation without a plan, or a suicide attempt or suicide plan

The symptoms of major depressive disorder cause significant distress or impairment in social, occupational, or other areas of functioning. To meet the diagnostic criteria for major depressive disorder, there should be no history of a manic episode or a hypomanic episode.

Symptoms of bipolar disorder

Although bipolar disorder can include the above depressive symptoms, it also includes symptoms of mania. Bipolar disorder is characterized by mood swings that fluctuate between depressive lows and manic highs.

A manic episode is described as a distinct period of abnormally and persistently elevated, expansive, or irritable mood and increased goal-directed activity or energy, lasting at least one week.

Symptoms of mania include:

  • Inflated self-esteem or grandiosity
  • Decreased need for sleep
  • More talkative than usual or pressure to talk
  • Flight of ideas, racing thoughts
  • Distractibility
  • Increase in goal-directed activity
  • Excessive involvement in potentially reckless activities (usually involving drugs, money, or sex)

With bipolar disorder, the mood episode is severe enough to cause marked impairment in social or occupational functioning or to require hospitalization to avoid self-harm.

Types of bipolar disorder

There are two types of bipolar disorder and two closely-related disorders. Understanding the different types of bipolar disorder can help distinguish between bipolar disorder and depression.

  • Bipolar I disorder: This is diagnosed when a patient has had at least one manic episode, regardless of whether or not there has been a depressive episode.
  • Bipolar II disorder: This diagnosis is given when a patient has had at least one depressive episode and a period of elevated mood referred to as hypomania. Bouts of hypomania are not as extreme as mania and are shorter lived. Patients with Bipolar II tend to experience longer depressive episodes and shorter states of hypomania. Patients often seek treatment during the depressive episode, as the hypomanic symptoms might not impact functioning as much.
  • Cyclothymic disorder: The essential feature of cyclothymic disorder is a chronic, fluctuating mood disturbance involving numerous hypomanic symptoms and periods of depressive symptoms that are distinct from each other. The hypomanic symptoms do not meet the full criteria for a hypomanic episode and the depressive symptoms do not meet the full criteria for a depressive episode.
  • Unspecified bipolar disorder: This diagnosis may be given when there is clinically-significant abnormal mood elevation that doesn’t match the full criteria for the other three disorders. These disorders are usually substance-induced or associated with other conditions.

Treatment for bipolar and depression

Left untreated, both bipolar disorder and major depressive disorder can have a major impact on social and occupational functioning. Both include the risk of suicide. The good news is that both conditions are treatable. Combination treatment often works best in both cases. Possible treatment modalities include:

  • Talk therapy
  • Cognitive behavioral therapy
  • Family therapy (involvement of family members increases success)
  • Medication management (including antidepressants and/or mood stabilizers)

Patients with both depression and bipolar disorder respond well to highly structured routines. Creating a routine helps patients know what to expect and follow through with medication management independently.

American Psychological Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, American Psychiatric Publishing, Washington, D.C., 2013.


Bipolar Disorder (Manic-Depressive Disorder): Symptoms & Treatments

Can Depression Turn Into Bipolar Disorder?

Most individuals with bipolar disorder spend three times the amount of time in the depressed phases than in the manic phases. Bipolar Disorder

Bipolar disorder, also called «manic-depressive» disease, is a mental illness that causes people to have high and low moods.

People with this illness have periods of feeling overly happy and joyful (or irritable) or of feeling very sad or feeling normal. Because of the highs and the lows – or two poles of mood – the condition is referred to as «bipolar” disorder.

However, patients’ moods may not necessarily follow a cyclic pattern, and sometimes the highs and lows can be experienced at the same time (mixed state). The hallmark of bipolar illness is the occurrence of the manic episode.

In fact, by definition, to meet the criteria for bipolar disorder, patients must have at least one manic episode in their lifetime with or without ever experiencing a depressive episode.

The word “hypomania” or “manic” describes the periods when the person feels overly excited and confident. These feelings can quickly turn to confusion, irritability, anger, and even rage.

The word “depressive” describes the periods when the person feels very sad or depressed. Because the symptoms are similar, sometimes people with bipolar depression are incorrectly diagnosed as having major depression.

This is why it is especially important to screen for mania.

Most individuals with bipolar disorder spend three times the amount of time in depressed phases than in manic phases.

Who experiences bipolar disorder?

Bipolar disorder usually begins in older teens and young adults, with at least half of all cases appearing before age 25.

Children and adolescents, however, can develop this disease in more severe forms and often in combination with attention deficit hyperactivity disorder (ADHD).

Some studies have indicated that bipolar depression is genetically inherited, occurring more commonly within families.

While bipolar disorder occurs equally in women and men, women are more ly to meet criteria for bipolar II disorder. (With bipolar II, patients experience both depressive and hypomanic episodes, but do not experience the severe manic episodes seen in bipolar I.

) Women with bipolar disorder may switch moods more quickly – this is called «rapid cycling.» Varying levels of sex hormones and activity of the thyroid gland in the neck, together with the tendency to be prescribed antidepressants, may contribute to the more rapid cycling seen in women.

Women may also experience more periods of depression than men.

An estimated 60 percent of all people with bipolar disorder have drug or alcohol dependence. It has also been shown to occur frequently in people with seasonal depression and certain anxiety disorders, post-traumatic stress disorder (PTSD).

A definite cause for any type of depression is difficult to determine but include:

  • Genetics
  • Changes in the brain
  • Environmental factors stress and major life changes

More research is being done to determine the relationship that these factors have in bipolar disorder, how they may help prevent its onset, and what role they may play in its treatment.

What are the symptoms of bipolar disorder?

The changing mood states do not always follow a set pattern, and depression does not always follow manic phases. A person may also experience the same mood state several times before experiencing the opposite mood. Mood changes can happen over a period of weeks, months, and sometimes even years.

An important aspect of the mood changes are that they are a departure from the person’s regular self and that the mood change is sustained for a long period of time.

It may be many days or weeks in the case of mania and many weeks or months in the case of depression.

Shorter periods of mania or depression may be an indicator of more severe episodes in the future but are usually not enough to diagnose a person with bipolar disorder.

The severity of the depressive and manic phases can differ from person to person and in the same person at different times. Symptoms of mania (“the highs”) include:

  • Excessive happiness, hopefulness, and excitement
  • Sudden changes from being joyful to being irritable, angry, and hostile
  • Restlessness
  • Rapid speech and poor concentration
  • Increased energy and less need for sleep
  • High sex drive
  • Tendency to make grand and unattainable plans
  • Tendency to show poor judgment, such as deciding to quit a job
  • Drug and alcohol abuse
  • Increased impulsivity

Some patients can become psychotic, seeing and hearing things that aren't there and holding false beliefs from which they cannot be swayed. In some instances they see themselves as having superhuman skills and powers, or think they are god-.

The symptoms of bipolar depression are the same as those of major depression and include:

  • Sadness
  • Loss of energy
  • Feelings of hopelessness or worthlessness
  • Loss of enjoyment from things that were once pleasurable
  • Difficulty concentrating
  • Uncontrollable crying
  • Difficulty making decisions
  • Irritability
  • Increased need for sleep
  • Insomnia or excessive sleep
  • A change in appetite causing weight loss or gain
  • Thoughts of death or suicide
  • Attempting suicide

Patients with depression can also become psychotic and hear things or have delusions.

A diagnosis of bipolar disorder is made only by taking careful note of symptoms, and their severity, length, and frequency. The most telling are periods of hypomania or mania. Reviewing history from close friends and family is often very helpful to distinguish bipolar disorder from major depression.

If you or someone you know has symptoms of bipolar disorder, see your family healthcare provider or a psychiatrist. A referral may then be made to an appropriate mental health expert.

A thorough medical evaluation should be performed. Your doctor will ask questions about your personal and family history of mental illness. You may also be asked to complete a mood disorders or depression-screening questionnaire. This is a series of questions that you will be asked to answer verbally or in writing.

Bipolar disorder is a long-term illness that requires management throughout a person's life. People who have numerous (four or more) episodes of mood changes (rapid cycling) in a year can be much more difficult to treat. Medication is the primary form of treatment, but the additional use of psychotherapy or «talk» therapy is sometimes recommended to help prevent future episodes.

There are many drugs available to treat bipolar disorder.

Proposed guidelines for treatment options are the three main phases of bipolar disorder, which include the acutemanic/mixed mood states, acute major depressive episodes, and finally the continuation/maintenance phase. As a general rule, avoiding antidepressants and taking two mood stabilizers has proven to be an effective strategy for most patients.

Mood-stabilizing drugs

Lithium (brand names Eskalith®, Lithobid®, Lithonate®) is a mood-stabilizing drug. It has proven helpful in controlling mania and depression and preventing depression and manic episodes.

Lithium will reduce symptoms of mania within two weeks of starting therapy, but it may take weeks to months before the condition is completely controlled.

Thus other drugs antipsychotic drugs or antidepressant drugs may also be used to help control symptoms.

Common side effects of lithium include:

  • Frequent need to urinate
  • Weight gain
  • Increased thirst
  • Slight trembling of the hands
  • Nausea

Thyroid and kidney problems are a concern, so your doctor will monitor the function of your thyroid and kidneys as well as monitor the levels of lithium in your blood since levels can easily become too high.

Anything that lowers the level of sodium in the body, such as switching to a low-sodium diet, heavy sweating, fever, vomiting, or diarrhea may cause a buildup of lithium in the body and toxicity.

Be aware of these conditions and alert your doctor if you are on lithium and experience them.

The following are signs of a lithium overdose. Call your doctor immediately or go to the nearest emergency room if you experience:

  • Blurred vision
  • Irregular pulse
  • Extremely fast or slow heartbeat
  • Difficulty breathing
  • Confusion
  • Convulsions
  • Dizziness
  • Severe trembling
  • Need to pass large amounts of urine
  • Uncontrolled eye movements
  • Double vision
  • Unusual bruising or bleeding

Antiseizure medications

Valproate (Depakote®) is an antiseizure medicine also effective for controlling mania. It is also effective for people with rapid-cycling bipolar disorder.

The drug has some side effects, can cause inflammation of the liver and can decrease the amount of platelets (blood cells needed for blood to clot) that the body makes so your doctor will monitor levels of valproate as well as liver function and platelet counts.

Common side effects of valproate include:

  • Sedation
  • Stomach cramps
  • Diarrhea
  • Indigestion
  • Nausea
  • Weight gain
  • Slight trembling of hands

Other antiseizure medicines often used to treat bipolar disorder include carbamazepine (Tegretol®) and lamotrigine (Lamictal®). Lamotrigine is used alone or in combination with other mood stabilizer medications.

It is more effective at treating the depressed phase of bipolar and/or as a mood stabilizer to reduce «cycling.» Lamotrigine is available as a generic drug.

It is very well tolerated and is free of side effects for most patients.

Serious side effects of lamotrigine you should report to your doctor include:

  • Rash
  • Worsening depression or suicidal thoughts
  • Flu- symptoms, such as body aches or swollen glands

Atypical neuroleptics

This class of medications is sometimes classified as antipsychotics but is also effective in treating bipolar disorder mania and depression.

These include medications such as olanzapine (Zyprexa®), quetiapine (Seroquel®), aripiprazole (Abilify®), lurasidone (Latuda®), ziprasidone (Geodon®), Iloperidone (Fanapt®), brexpiprazole (Rexulti®), cariprazine (Vraylar®), clozapine (Clozaril®), risperidone (Risperidol®) among others.

Common side effects of these medications include:

  • Tremors
  • Muscle spasms/contractions
  • Involuntary movements
  • Weight Gain
  • Increased glucose and lipids
  • Sedation
  • Irregular, jerky movements; rigidity; slowness of movement (symptoms known as extrapyramidal symptoms)

Most people with bipolar disorder take more than one medication. In addition to a mood stabilizer, patients may take a medication for agitation, anxiety, insomnia, or depression.

Many antidepressants can be used with mood stabilizing drugs to manage the depression of bipolar disorder. If used alone, an antidepressant can push a person with the condition into a manic state.

Additional treatment options

Other treatment options your doctor may consider include:

  • Stimulants are sometimes used to treat depression.
  • Thyroid medications can act mood stabilizers. Studies have shown positive results in reducing symptoms in female patients with hard-to-treat, rapid-cycling bipolar disorder.
  • Light therapy uses a light box that gives off a bright light similar to natural sunlight. It can be used to treat depression.
  • Electroconvulsive therapy (ECT) passes electric current through the brain to treat severe depression.
  • Transcranial magnetic stimulation uses a short electromagnetic coil to pass electric current into the brain; used to treat depression in patients in whom medication has not worked and is an alternative to ECT.
  • Vagus nerve stimulator is a device implanted under the skin that sends electrical pulses through the vegas nerve (a nerve that runs from the brainstem through the neck and down to each side of the chest and abdomen). The pulse has been found helpful in treating depressive symptoms.
  • Ketamine treatment, given intravenously, along with other medicines has been shown to be helpful in treating bipolar depression.

There is no known method to prevent bipolar disorder. Because its exact cause has not yet been determined, it is especially important to know its symptoms and seek early intervention.

Regular and continued use of medication can help reduce episodes or mania and depression. Some people who experience bipolar disorder may become suicidal.

By knowing how to recognize these symptoms, there is a better chance for effective treatment and finding coping methods that may prevent long periods of illness, extended hospital stays, and suicide.

For most people, a good treatment program can stabilize severe moods and provide effective symptom relief. Treatment that is continual has proven more effective in preventing relapses. Those who also have a substance abuse problem may need more specialized treatment.

Last reviewed by a Cleveland Clinic medical professional on 01/27/2018.



Bipolar Disorder

Can Depression Turn Into Bipolar Disorder?

Bipolar disorders are one of several medical conditions called depressive disorders. Depressive disorders affect the way a person's brain functions.

Depressive disorders are widespread. In the United States alone, it's estimated that more than 17.4 million adults have a depressive disorder each year. That works out to about 1 every 7 people, so there's a good chance that you or someone you know is dealing with a depressive disorder.

Bipolar disorder goes by many names: manic depression, manic-depressive disorder, manic-depressive illness, bipolar mood disorder, and bipolar affective disorder are medical terms for the same condition.

Bipolar disorder is classified into four different types:

  1. Bipolar I
  2. Bipolar II
  3. Cyclothymic Disorder
  4. Bipolar Disorder Not Otherwise Specified

Mental health experts separate the condition into these four types because the symptoms of bipolar disorder show up differently in different people. When doctors know what type someone has, they can tailor treatment to that person's specific needs.

How Does It Affect People?

Bipolar disorder affects both men and women. For many people, the first symptoms show up in their early twenties. However, research has shown that the first episode of bipolar disorder is occurring earlier: It often shows up in adolescence, and even children can have the disorder.

Recent research suggests that kids and teens with bipolar disorder don't always have the same behavioral patterns that adults with bipolar disorder do.

For example, kids who have bipolar disorder may experience particularly rapid mood changes and may have some of the other mood-related symptoms listed below, such as irritability and high levels of anxiety.

But they may not show other symptoms that are more commonly seen in adults.

Because brain function is involved, the ways people with bipolar disorder think, act, and feel are all affected. This can make it especially difficult for other people to understand their condition. It can be incredibly frustrating if other people act as though someone with bipolar disorder should just «snap it,» as if a person who is sick can become well simply by wanting to.

Bipolar disorder isn't a sign of weakness or a character flaw; it's a serious medical condition that requires treatment, just any other condition.

What Are the Signs and Symptoms?

A person with bipolar disorder will go through episodes of mania (highs) and at other times experience episodes of depression (lows). These aren't the normal periods of happiness and sadness that everyone experiences from time to time. Instead, the episodes are intense or severe mood swings, a pendulum that keeps arcing higher and higher.

Symptoms of mania include:

  • racing speech and thoughts
  • increased energy
  • decreased need for sleep
  • elevated mood and exaggerated optimism
  • increased physical and mental activity
  • excessive irritability, aggressive behavior, and impatience
  • poor judgment
  • reckless behavior, excessive spending, making rash decisions, and erratic driving
  • difficulty concentrating
  • inflated sense of self-importance

Symptoms of depression include:

  • loss of interest in usual activities
  • prolonged sad or irritable mood
  • loss of energy or fatigue
  • feelings of guilt or worthlessness
  • sleeping too much or inability to sleep
  • drop in grades and inability to concentrate
  • inability to experience pleasure
  • appetite loss or overeating
  • anger, worry, and anxiety
  • thoughts of death or suicide

In adults, episodes of mania or depression usually last for weeks or months, although they can be shorter in length. In children and adolescents, though, these episodes can be much shorter, and a kid or teen can even go back and forth between mania and depression throughout the day.

Episodes of mania or depression may happen irregularly and follow an unpredictable pattern or they may be linked, with a manic episode always following a period of depression, or vice versa. Sometimes episodes have a seasonal pattern. Mania in the spring, for example, may be followed by depression in the winter.

Between episodes, someone with bipolar disorder usually returns to normal (or near-normal) functioning. For some people, though, there is little or no «break period» between their cycles. These mood swing cycles can change slowly or rapidly, with rapid cycling between mania and depression being much more common in women, children, and adolescents.

Some people with bipolar disorder turn to alcohol and drugs because they feel temporarily better when they're high. But using alcohol and drugs can have disastrous results for people with bipolar disorder. Substance abuse can actually make the symptoms worse, as well as making the condition hard for doctors to diagnose.

What Causes Bipolar Disorder?

Doctors and scientists don't know the exact cause of bipolar disorder, but they think that biochemical, genetic, and may all be involved.

It's believed this condition is caused by imbalances in certain brain chemicals called neurotransmitters.

If the neurotransmitters aren't in balance, the brain's mood-regulating system won't work the way it should.

Genes also play a role. If a close relative has bipolar disorder, a person's risk of developing the condition is higher.

This doesn't mean, though, that if you have a relative with bipolar disorder you will automatically develop it! Even in studies involving identical twins raised in the same home, one twin sometimes had bipolar disorder whereas the other did not. Researchers are now working on identifying the gene or genes involved in bipolar disorder.

Environmental factors may play a role in bipolar disorder. For some teens, stresses such as a death in the family, their parents' divorce, or other traumatic events could trigger a first episode of mania or depression. Sometimes, going through the changes of puberty can set off an episode. In girls, symptoms can be tied to their monthly menstrual cycle.

How Is Bipolar Disorder Diagnosed?

Most people with bipolar disorder can be helped — but a psychiatrist or psychologist must first diagnose the disorder. Sadly, many people with the condition are never diagnosed or are not diagnosed properly.

Without proper diagnosis and treatment, the disorder can become worse.

Some teens with undiagnosed bipolar disorder can end up in a psychiatric hospital or residential treatment center, in the juvenile justice system, abusing drugs, or committing suicide.

Because children and teens with bipolar disorder do not usually show the same patterns of behavior as adults who have the condition, a mental health professional will observe a teen's behavior carefully before making a diagnosis.

This includes getting a complete history of the person's past and present experiences. Family members and friends can also provide helpful insights into the person's behavior.

The doctor may also want a teen to have a medical exam to rule out other conditions.

Diagnosing bipolar disorder can be difficult. As yet, there aren't any laboratory tests a brain scan or blood test that will diagnose it.

In teens, bipolar disorder can sometimes be mistaken for illnesses schizophrenia and posttraumatic stress disorder, attention deficit hyperactivity disorder (ADHD), and other depressive disorders.

That's why a complete, detailed history is so important.

How Do Doctors Treat It?

Although there's no cure for bipolar disorder, treatment can help stabilize moods and help the person manage and control symptoms. other teens with long-lasting medical conditions (such as asthma, diabetes, or epilepsy), teens with bipolar disorder need to work closely with their doctors and other medical professionals to treat it.

This team of medical professionals, together with the teen and family, develop what is called a treatment plan.

Teens with bipolar disorder will probably receive medication, such as a mood stabilizer, from a psychiatrist or other medical doctor.

A psychologist or other type of counselor will provide counseling or psychotherapy for the teen and his or her family. Doctors will watch the symptoms closely and offer additional treatment advice if necessary.

Living With Bipolar Disorder

Teens normally face ups and downs with school, family, work, and friends. Dealing with bipolar disorder at the same time is a very difficult challenge. One 16-year-old reader who was diagnosed with bipolar disorder at 14 wrote to us about the experience:

«I had mood swings that were the worst anyone could have ever seen. My poor parents thought I hated them, but really I was sick and didn't even realize it.

But now I am on medications for my disorder and I live a pretty normal life. My family and friends support me, and they, along with my therapist, have helped me get to the point where I am today.

I just want other teens to know that even though it is hard at times to be bipolar, things will get better.»

If you've been diagnosed with bipolar disorder, taking your medications as prescribed, reporting any changes in how you feel or function, and participating in therapy will be key to living a successful life.

In addition to treatment, making a few lifestyle changes, such as reducing stress, eating well, and getting enough sleep and exercise can help someone who is living with the condition.

And many teens find it helps to join a support network such as a local support group for people with bipolar disorder.


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