Can antidepressants make bipolar worse?

Yes. Antidepressants without mood stabilizer coverage can trigger manic or hypomanic episodes ('switching'), accelerate the frequency of mood cycling, and potentially worsen the long-term course. This is one of the main reasons correct diagnosis matters.

How do doctors test for bipolar disorder?

There's no blood test or brain scan for bipolar. Diagnosis is clinical — based on a thorough psychiatric evaluation that includes detailed history of mood episodes, family history, and behavioral patterns. Screening tools like the MDQ help identify people who need full evaluation.

Can you have bipolar disorder and major depression?

The diagnoses are mutually exclusive — if you have bipolar disorder, your depressive episodes are classified as 'bipolar depression,' not separate major depressive disorder. However, the lived experience of a bipolar depressive episode is essentially identical to a major depressive episode.

What if my doctor says I have depression but I think it's bipolar?

Advocate for yourself. Share your concerns, bring the specific observations that concern you (family history, antidepressant reactions, episodic pattern, periods of elevated mood). If your doctor dismisses these without thorough evaluation, seeking a second opinion from a psychiatrist is appropriate.

Bipolar Disorder vs Depression: Why Getting the Right Diagnosis Matters

Roughly 40% of people with bipolar disorder are initially misdiagnosed with unipolar depression, and the average delay to correct diagnosis is 5-10 years, per a study in the Journal of Clinical Psychiatry. This isn't a trivial error. Treating bipolar depression with antidepressants alone — without a mood stabilizer — can trigger manic or hypomanic episodes, accelerate mood cycling, and worsen the long-term course of the illness. Getting the diagnosis right changes everything about the treatment plan.

Why Misdiagnosis Happens

People with bipolar disorder spend far more time depressed than manic or hypomanic. In Bipolar I, the ratio is roughly 3:1 depression to mania. In Bipolar II, it's closer to 39:1. So the depressed state is what brings people to the doctor, and during a depressive episode, bipolar depression looks identical to unipolar depression — same sadness, same fatigue, same cognitive fog, same sleep and appetite disruption.

Hypomania, the signature of Bipolar II, is easy to miss because it often feels positive. Increased energy, productivity, confidence, creativity — these don't prompt people to complain. In fact, hypomania is frequently the state people describe as "feeling like myself" or "having a good week." Unless the clinician specifically asks about periods of elevated mood, decreased sleep need, and increased activity, hypomania goes undetected.

How to Tell Them Apart

Clinical Clues That Suggest Bipolar

Early onset: Depression starting before age 25, especially in the teens, has higher rates of bipolar conversion than later-onset depression.

Family history: Bipolar disorder in first-degree relatives is one of the strongest risk factors. If your parent or sibling has bipolar, your risk is 10x the general population.

Atypical features: Hypersomnia (sleeping too much), leaden paralysis (heavy limbs), increased appetite, and rejection sensitivity are more common in bipolar depression than unipolar.

Antidepressant response: Antidepressants that make you feel wired, agitated, activated, or "too good" — or that trigger insomnia and racing thoughts — may be revealing underlying bipolarity. This includes feeling great for a few weeks then crashing.

Episodic pattern: Distinct, time-limited episodes of depression with clear recovery between them (versus chronic, persistent depression) suggest bipolarity.

Psychotic features: Depression with psychotic symptoms (hallucinations, delusions) is more likely bipolar than unipolar.

What to Tell Your Doctor

If you suspect bipolar disorder, bring your history rather than just your current symptoms. Write down: periods of unusually high energy or productivity, times you needed significantly less sleep and felt fine, impulsive decisions (spending, relationships, career changes) you made during "up" periods, your age at first depression, family psychiatric history, and your response to any antidepressants.

Questionnaires like the Mood Disorder Questionnaire (MDQ) screen specifically for lifetime hypomania. It's not diagnostic alone, but it flags people who need further evaluation.

Treatment Differences

This is why the distinction matters:

Unipolar depression: SSRIs/SNRIs are first-line treatment, with or without therapy. No mood stabilizer needed.

Bipolar depression: Mood stabilizers (especially lamotrigine) or specific atypical antipsychotics (lurasidone, quetiapine) are first-line. Antidepressants are used cautiously, always with a mood stabilizer, and often avoided entirely in Bipolar I. Lithium provides foundational mood stabilization.

If you've tried multiple antidepressants without adequate response — or if antidepressants produce unusual effects — request a thorough evaluation for bipolarity before adding yet another antidepressant to the regimen.

The Stakes

Misdiagnosed bipolar treated as unipolar depression follows a predictable pattern: initial antidepressant response, then activation or switching, then dose increases or medication changes that further destabilize mood, then years of "treatment-resistant depression" that isn't treatment-resistant at all — it's the wrong treatment for the right diagnosis.

Getting the correct diagnosis can be transformative. People who've struggled for years with "depression" sometimes stabilize quickly once a mood stabilizer is introduced. That relief — "this is what it was the whole time" — is both validating and motivating.

If you're navigating anxiety symptoms alongside depression, note that anxiety is common in both conditions but may present differently. And consistent sleep patterns support stability regardless of diagnosis.