Imagine a patient presents to you with: depressed mood, low energy, disrupted sleep, and a loss of interest in activities they used to enjoy.
What’s your next move?
A. Start an antidepressant
B. Reassess in 4 weeks
C. Start a mood stabilizer
D. Consider bipolar as a differential diagnosis
If you said D, you’re on the right track! This bipolar vs unipolar depression consideration is one that experienced PMHNPs and new providers alike benefit from revisiting.
Why We Don’t Jump to Treatment
Patients often show up with some version of the classic depression picture – dysregulated sleep, low mood, anhedonia. But here’s the issue: if we immediately reach for a prescription pad—whether it’s an antidepressant or a mood stabilizer—we may miss something critical.
- Answer A: Starting an antidepressant without full assessment may seem logical, but it’s premature.
- Answer B: Simply reassessing in four weeks is passive. We have more to do now.
- Answer C: Starting a mood stabilizer is again jumping to treatment and it might not be the right one.
That leaves us with Answer D: Consider bipolar disorder as a differential diagnosis. It’s the only next step that prompts more assessment before making a treatment decision.
Why Considering Bipolar vs Unipolar Depression Matters
Making a clear bipolar vs unipolar depression distinction early can save months (or years!) of mismanagement. Without exploring a bipolar differential diagnosis, we risk misdiagnosing patients with unipolar depression—especially since bipolar depression often looks nearly identical to major depressive disorder on the surface. This diagnostic overlap and the risk of misdiagnosis are well-documented in psychiatric literature, such as a 2014 review highlighting common challenges in differentiating bipolar disorder from unipolar depression.
Considering bipolar disorder as a possible diagnosis forces us to ask more questions, explore history in detail, and gather information on symptoms like:
- Past hypomanic or manic episodes
- Family psychiatric history
- Course and severity of past mood changes
- Response to prior antidepressants
This is why structured frameworks—assessment → diagnosis → treatment—are crucial. We can’t skip steps.
Get Closer to Confident Diagnosing
If you answered this Psych Sage quiz question correctly (or not!), keep going. Testing your knowledge through short, clinical cases builds stronger diagnostic skills over time.
👉 Want more insight into how to confidently assess, diagnose, and treat mental health disorders? Sign up for my free Master Mental Health training on diagnosing and treating mental disorders.