Depressive episodes in bipolar disorder may be similar to those in major depressive disorder or may present as part of a mixed state characterized by distressing combinations of depression and mania or hypomania (irritability, racing thoughts, anxiety, suicidal thoughts, and aggressive impulses). Patients with bipolar disorder who present with a depressive episode may be misdiagnosed as having major depressive disorder because they may often underreport hypomanic and manic symptoms, perceiving such features to be closer to well-being than illness. A family history of bipolar disorder can assist in making the correct diagnosis.