How do I know the difference, and how do I get better?
The purpose of this post is to help you figure out whether you have depression or a bipolar disorder. We’ll look at three types of depressive disorders and the experiences of three different patients. You may find you relate to one of these individuals and their struggles.
Ashley, Jennifer, and Robert all have episodes of depression that can last from weeks to months. During these times, they have low energy and can barely drag themselves out of bed. Everything seems like a chore, and things often feel insurmountable. They lack motivation to do anything beyond what absolutely has to be done as well as to try anything new. They have a lot of trouble concentrating and making decisions. Nothing gives them any pleasure, and they withdraw from social interaction.
Ashley feels sluggish and slowed down. She oversleeps, overeats and gains weight. Robert, on the other hand, feels constantly agitated and loses weight because his appetite has decreased. He has insomnia which includes difficulty falling asleep and early morning waking, with an inability to fall all back asleep.
Ashley, Robert, and Jennifer are all consumed with guilty feelings and negative thoughts about themselves. They feel worthless, that life has lost all meaning, and entertain thoughts of suicide.
Ashley, when she is not depressed, leads a pretty normal life. She enjoys her work, her friends and her family. She gets involved in things that interest her. Her energy is good and she sleeps and eats well. Jennifer and Robert have periods of normalcy like this too, but there are differences.
In addition to periods of depression, Jennifer has manic episodes at times. During manic episodes, she can go days without sleeping but never feels tired and has amazing energy. She feels absolutely euphoric and is convinced that she can do anything. Her thoughts flit rapidly from one thing to another, and it is difficult to follow her rapid speech. She feels hypersexual, wears a lot of makeup, dresses provocatively, is promiscuous and engages in risky behavior. She thinks that a famous celebrity is in love with her, and she maxes out her credit cards buying clothes and jewelry that she feels she needs so this celebrity will go out with her. She starts writing her memoir about their great love affair, which she is convinced will be a bestseller. After a few weeks, Jennifer’s euphoria turns into irritability and anger. She begins to lash out at people, and the police are called when she creates a scene at a coffee shop after her credit card is declined. Jennifer is hospitalized after this manic episode.
Robert doesn’t have manic episodes on the same level as Jennifer’s, but he does have occasional hypomanic episodes. During hypomanic periods, he needs less sleep but feels very energized. His mood is elevated, and he feels great. He becomes more social and hyper-talkative. He becomes extremely productive at work and does a lot of projects at home. He exudes self-confidence and eagerly volunteers to single handedly lead a time-consuming fundraiser for an organization he supports. He begins to get on people’s nerves a bit because he is intrusive and over-talkative, but he functions well enough to keep his job and not alienate friends and family.
Even though all three of these fictitious patients may come to treatment complaining of depression, they do not have the same diagnosis and treatment will be different.
Ashley’s diagnosis is Major Depressive Disorder, Jennifer’s is Bipolar I Disorder and Robert’s is Bipolar II Disorder. Taking a comprehensive history and arriving at an accurate diagnosis is essential for helping each of these patients manage their illness and function optimally. This positive outcome can be achieved for each of them with the right combination of medication and therapy.
When talking with a patient about their history, it is important to determine if they have had only depressive episodes like Ashley or if there have been mood swings to the other extreme. With a patient like Jennifer whose functioning has been most severely impaired and her life affected by her mania with job losses and fractured relationships, it is easier to see the extreme mood change. Jennifer has a history of hospitalizations, mostly for her manic episodes.
Ashley and Robert may also have been hospitalized, but it will likely have been for suicidality when they are severely depressed.
Robert’s hypomania, though it may have caused him to overcommit himself both timewise and financially, does not impair his functioning to the extent that he would need to be hospitalized. Bipolar II Disorder, as in Robert’s case, is harder to diagnose because patients often don’t recognize hypomanic episodes for what they are and don’t report them. Many patients tend to like the high feeling they get from being hypomanic, and they are reluctant to have it dampened so they rarely come for treatment during these episodes.
Donna Templeton, PMHNP, has over twenty years of experience as a psychiatric mental health nurse practitioner in both inpatient and outpatient settings. She’s seen and successfully treated many patients with Major Depressive Disorder, Bipolar I and Bipolar II Disorders. Donna’s here to work with you to manage your illness and get your life back on the right track. If you see aspects of yourself in any of the stories above, make an appointment to come in and talk.