Misdiagnosed with Depression? It Could Be Bipolar Disorder
What’s worse than getting diagnosed a mental health condition? Being misdiagnosed with the wrong one. Some mental health conditions look and feel so much alike, it’s difficult even for professional clinicians to tell them apart.
That’s certainly the case for bipolar disorder (BD) and major depressive disorder (MDD). As many as 60% of people with bipolar disorder who visit psychiatry clinics are mistakenly diagnosed with depression, research has found.
Unfortunately, bipolar disorder misdiagnosis too often leads to inappropriate treatments, increased risk of worsening of symptoms, and delay in getting the right care. Early and accurate diagnosis of BD is critical for initiating successful treatment and attaining better outcomes.
Here, you’ll learn about the key differences in symptoms between the two disorders, as well as an innovative tool called brain SPECT imaging, which greatly increases the likelihood of getting an accurate diagnosis, the right treatment, and a better outcome.
The good news is that with the correct diagnosis and treatment, people with bipolar disorder or depressive disorder do get better.
Up to 60% of patients with bipolar disorder who visit psychiatry clinics are mistakenly diagnosed with depression.
JENNA’S STORY: WHEN ANTIDEPRESSANTS BACKFIRE
Let’s take a look at a real-world example. Jenna is a college athlete whose depression diagnosis masked bipolar disorder.
As a college freshman, Jenna was a competitive track and field athlete who loved spending her days in her running shoes. By the time she reached her sophomore year, however, things had changed. She was filled with sadness, felt like she had no energy, and had lost interest in training.
When she mentioned it to her primary care doctor, she was diagnosed with depression and given a prescription for antidepressants.
The medication boosted her mood—a lot! She felt like she was on top of the world. It filled her with so much energy, she felt invincible and began training all day and staying up all night doing her homework.
She also became sexually aggressive, hitting on the other track athletes even though she had a steady boyfriend. She even came on to her coach multiple times, which didn’t go over well and ended up with her almost getting kicked off the team.
What went wrong?
Related: The Hidden Signs of Bipolar Disorder Even Doctors Can Miss
WHY BIPOLAR DISORDER IS SO OFTEN MISDIAGNOSED AS DEPRESSION
Jenna had been misdiagnosed with depression. In reality, she had a form of bipolar disorder, formerly known as manic-depressive disorder. People with bipolar disorder display dramatic swings in mood, energy, and activity levels, going from depressive episodes to manic episodes in a cyclical pattern.
The antidepressants Jenna took not only failed to work, but they were also making her worse by triggering a manic episode.
Jenna’s misdiagnosis and experience is not unique. In a study analysis on bipolar disorder misdiagnosis, researchers noted that BD gets mistaken as depression because it typically starts with a depressive episode, and a patient is diagnosed before a manic or hypomanic episode occurs.
Additionally, research has found that bipolar disorder in women tends to manifest with more depressive episodes, which may increase their risk of being misdiagnosed with depression.
Another reason why bipolar disorder misdiagnosis occurs has to do with how mania appears in the patient.
Bipolar disorder’s manic episodes are characterized by:
- Abnormally elevated mood
- Inflated self-esteem
- Decreased need for sleep
- Increase in goal-oriented activity
- Grandiose notions, ideas, or plans
- Increased talking or pressured speech
- Racing thoughts
- Inability to “turn off the mind”
- Poor-judgment leading to increased risk-taking behavior
- Hypersexuality or hyper-religiosity
- Excessive appetite
- Inappropriate social behavior
- Irritability or aggression
- Delusions or hallucinations
When mania symptoms are mild and less severe, it’s called hypomania. An individual who has hypomanic episodes may feel like they have better energy than usual and a brighter mood but not so much that they engage in risky behavior.
When asked about mania in a clinical setting, they may not perceive these periods of improved mood and energy as manic.
Press Play to Learn the Early Signs of Bipolar Disorder
In this video, Amen Clinics psychiatrist Dr. Jay Faber discusses mood swings, sleep changes, and energy levels that might indicate bipolar disorder.
Click below to tune in.
WHAT DEPRESSION AND BIPOLAR HAVE IN COMMON
While they are distinct disorders, depression and bipolar disorder are both mood disorders and have depressive symptoms in common.
Let’s look at depression vs bipolar disorder.
Depression
Depression is characterized by persistent feelings of sadness, hopelessness, and loss of interest or pleasure in activities. It can significantly impact a person’s daily life, affecting their feelings, thoughts, behaviors, and physical well-being.
It’s more common than BD. An estimated 21 million adults in the US had at least one major depressive episode—about 8.3% of all adults, according to recent data. It is more common in females.
Bipolar Disorder
On the other hand, bipolar disorder (also called manic depression) is characterized by pronounced shifts in mood, energy, and activity levels—just what Jenna experienced.
An individual with BD cycles through these moods, which vary from periods of intense highs (mania or hypomania) to dark lows (depression).
These highs and lows are much more intense than the typical ups and downs of life that we all experience. An estimated 2.8% of U.S. adults had bipolar disorder in the past year, data indicates. About 82% of people with BD are seriously impaired, and 17.1% are moderately impaired.
Depression and Bipolar Disorder: Shared Symptoms
A depressed person and an individual with bipolar disorder in a depressive episode will exhibit depressed symptoms, which may include any number of the following:
- Persistent low or sad mood
- Sleeplessness
- Feelings of guilt
- Decreased energy levels
- Difficulty maintaining concentration
- Decreased or changes in appetite
- No longer find pleasure in activities once enjoyed (anhedonia)
- Increased or decreased psychomotor activity
- Recurrent suicidal ideation/acts of self-harm/suicide attempt
Thus, if you have bipolar disorder and are experiencing a depressive episode, it may look just like depression.
As we saw with Jenna, when a person with bipolar disorder gets misdiagnosed with depression, they will typically be treated with antidepressants. However, antidepressants and bipolar disorder are not good together. Without mood stabilizers, they are linked to poor outcomes for BD patients, in most cases.
A misdiagnosis of depression and antidepressant treatment will increase the risk of manic episodes in approximately 30% to 40% of people with bipolar disorder, studies have found. This was proven to be true in Jenna’s case.
MANIC AND HYPOMANIC SYMPTOMS THAT SET BIPOLAR APART
Because manic and hypomanic symptoms are not characteristic of major depressive disorder, they offer one of the best ways to discern BD from depression. The problem is, as mentioned, hypomania can be challenging to identify.
Hypomania and mania both involve episodes of increased energy and elevated mood, but they are very different in severity and the impact they make on one’s daily life.
Let’s take a closer look at hypomania vs mania.
Hypomania
Hypomania may involve many of the manic symptoms listed above, with a couple of exceptions. Typically, the symptoms appear in a milder form than mania.
It does not involve psychosis and only minimal disruption to one’s daily functioning, if there’s any disruption at all. It typically does not require hospitalization. Experts say that a good measure is a noticeably different mood than usual.
Mania
Mania is a highly disruptive, intense experience that often requires hospitalization and may involve psychosis. The elevated mood can also come with irritability and its increased energy is often coupled with lots of activity.
Mania typically lasts at least one week but can continue for several months, and even up to a year, if left untreated.
Although mania and hypomania symptoms offer valid biomarkers to distinguish BD from depression, research reports that there’s not enough information available to clinicians about the harder-to-detect hypomania symptoms.
Studies have also found that bipolar disorder patients typically lack insight about their own mania or hypomania symptoms. This adds to the issue of misdiagnosis, delayed diagnosis, and poor outcomes.
THE DANGERS OF THE WRONG TREATMENT
When a person with bipolar disorder is misdiagnosed with depression, it can be downright dangerous. Antidepressants may work well for depression, but antidepressants and bipolar disorder can be a bad combination.
For example, they can trigger manic episodes, worsen instability, and delay effective treatment. Research indicates that people with BD who take antidepressants are believed to have an increased risk of rapid cycling.
Rapid cycling is when an individual with BD has at least four episodes of affective illness in one year, with two months of full or partial remission in between, or a switch to the opposite pole. In some cases, rapid cycling is associated with greater resistance to treatment and worse outcomes.
Currently, treatment guidelines recommend bipolar disorder patients take antidepressants together with a mood stabilizer. However, when the wrong treatment delays successful bipolar disorder management with mood stabilizers, it may increase the risk of lithium resistance. This is known to occur as a person has more episodes.
Appropriate treatment is critical for those with bipolar disorder as it can reduce suicide risk. And when it is caught early in children and adolescents, it can reduce the risk of substance abuse as they grow older.
Accurate and early diagnosis can make a marked difference in outcomes for those struggling with this mental health disorder.
Related: The Surprising Differences Between Bipolar 1 and Bipolar 2
UNDERSTANDING THE FOUR TYPES OF BIPOLAR DISORDER
Like so many mental health conditions, bipolar disorder is not a simple or single condition. It manifests in different ways.
Mental health experts have identified at least four types of bipolar disorder.
The types are distinguished by the severity of the symptoms (yet all four types are equally serious):
- Bipolar 1 disorder (also called bipolar I disorder) is considered the most severe form of the condition.
- Bipolar 2 disorder (also called bipolar II disorder) has hypomania symptoms that are frequently misdiagnosed, according to a special 2023 report. Bipolar 2 symptoms are more common in women, research has found, and it is the type of bipolar disorder Jenna had.
- Cyclothymic disorder exhibits the presence of numerous periods of hypomanic and depressive symptoms for at least two years in adults (one year in children and adolescents).
- Bipolar disorder not otherwise specified is a catch-all subtype used when symptoms don’t fall into established patterns. It’s typically given when an individual experiences mood fluctuations (mania and depression) characteristic of BD, but don’t exactly meet the diagnostic criteria for one of the other bipolar diagnoses.
The good news is that bipolar disorder responds well to proper treatment, but knowing an individual’s type is essential for developing the right medication and therapeutic approach.
THE TURNING POINT: GETTING A BRAIN-BASED DIAGNOSIS
The turning point for Jenna was when she decided to visit Amen Clinics to get a brain scan to find out what was really happening in her brain.
Amen Clinic’s brain SPECT imaging, which measures blood flow and activity in the brain, can reveal differences in brain activity patterns between individuals with bipolar disorder and those with clinical depression.
Jenna’s SPECT scan for bipolar disorder, along with a complete personal history and other assessments, pointed to bipolar 2 disorder. Knowing her condition type helped develop a treatment plan personalized for her needs.
With the proper treatment and good compliance, Jenna’s moods stabilized, and she eventually became a successful and well-liked track and field coach at her alma mater.
WHY SEEING THE BRAIN CHANGES EVERYTHING
For many patients, visualizing their brain scan helps them accept their diagnosis, stay compliant with treatment, and feel empowered to heal.
In Jenna’s case, seeing her brain scan helped her understand that her condition was real, so it encouraged her to take her medication regularly. Compliance is a problem for many people with bipolar disorder because when they start to feel better, they don’t believe they have a problem at all and often stop taking their medication.
For Jenna, as with many people, seeing was believing.
FAQ
At Amen Clinics, we see this often especially in young adults and women. If your depression treatment has made you feel wired, impulsive, or emotionally unstable, it may be time to take a deeper look.
Yes. In many cases, antidepressants can trigger manic or hypomanic episodes in people with undiagnosed bipolar disorder. That’s why proper diagnosis is so critical before beginning treatment for bipolar disorder.
We combine brain SPECT imaging with an in-depth evaluation of your biological, psychological, social, and spiritual history. This approach helps us identify the right diagnosis and tailor treatment to your brain type.
Mood disorders, such as depression or bipolar disorder, and other mental health conditions can’t wait. At Amen Clinics, we provide personalized, science-backed treatment plans designed to target the root causes of your symptoms. Our 360-approach includes brain SPECT imaging, clinical evaluations, innovative therapeutic techniques, medications (when necessary), and holistic lifestyle recommendations to promote the health of your brain, body, and mind. Speak to a specialist today at 888-288-9834 or visit our contact page here.
Amen Clinics
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National Institute of Mental Health, https://www.nimh.nih.gov/health/statistics/major-depression, Accessed June 20, 2025
National Institute of Mental Health, https://www.nimh.nih.gov/health/statistics/bipolar-disorder, Accessed June 20, 2025
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Hui Shen, Li Zhang, Chuchen Xu, Jinling Zhu, Meijuan Chen, Yiru Fang – Analysis of Misdiagnosis of Bipolar Disorder in An Outpatient Setting: Shanghai Archives of Psychiatry 2018;30(2):93-101.
Glick ID. Undiagnosed Bipolar Disorder: New Syndromes and New Treatments. Prim Care Companion J Clin Psychiatry. 2004;6(1):27-33.
Suppes, T., Swartz, H. A., & Schley, S. (2023). Special Report: Bipolar Disorder II—Frequently Neglected, Misdiagnosed. Psychiatric News, 58(03).