Major (or unipolar) depression and bipolar disorder are currently included in the general category of mood disorders. However, these are different issues, and they must be identified as such.
Unfortunately, it can be difficult to differentiate the symptoms of major depression from those of a depressive episode associated with bipolar disorder, although this distinction is essential to avoid future complications.
In this article we will review the main differences between unipolar depression and bipolar depression, According to the current state of knowledge, in order to shed light on such a relevant issue.
Differences between unipolar depression and bipolar depression
Many people with bipolar disorder (type I or type II) take years to be diagnosed., This inevitably delays the articulation of therapeutic programs aimed at promoting their emotional stability and quality of life. This is because the expression of the depressive phases of bipolar disorder and that of major depression are similar, although the treatment of the other two is absolutely different.
A key difference between the two, from which an accurate identification of bipolar disorder would be possible, would be clear evidence that at some point in the past it has been going through the symptoms of a manic phase. In fact, this circumstance alone would confirm the diagnosis of bipolar disorder. The problem is that these episodes (and the hypomanic ones) are more difficult to mention than the depressive ones, because they are perceived (equivocally) as less disabling.
Additionally, bipolar disorder often concomitantly presents a number of issues that mask it not only with major depression, but also with other physical and / or mental health issues, such as anxiety or substance abuse. In this sense, some research reports that diagnostic certification can take up to five years or more, with complications that may result from this delay.
One of the most important, without a doubt, occurs when the person with bipolar disorder is offered pharmacological treatment (SSRIs, for example) as an indication of major depression. In these cases, there may be an increased risk of turning to manic episodes induced by the chemical properties of the substance, or an acceleration of clinical fluctuations in mood, which worsen the organic and psychosocial circumstances of the pathology.
The most important thing, in this case, is to make a comprehensive analysis of personal and family history. This information, as well as the detailed evaluation of the symptoms which present themselves at the present time, will make it possible to unite the data necessary for a decision-making because it is necessary on the real mental state and to contribute to a treatment (pharmacological and psychotherapeutic) which provides benefits for the person.
Below, we offer a set of “signs” that suggest depressive symptoms may not be related to an underlying major depression.But with the depressive phase of bipolar disorder that has yet to show its true face. None of them alone is sufficient to obtain absolute certainty; but as a whole they provide relevant information in terms of probability, which will need to be supplemented by a rigorous clinical trial.
1. Previous episodes of major depression
Major depression is a disorder that tends to recur throughout life.So, most of the people who have suffered from it at some time will suffer from it again with a high probability in the future. However, relapses are much more frequent in the specific case of bipolar disorder, where the depressive symptom occurs periodically but very difficult to predict (acute episodes lasting longer than manic or hypomanic).
It is therefore important to investigate personal history, in order to describe the evolution of mood over the years, and to determine the possible existence of vital periods in the past when depression may have occurred. . So this is also the perfect time to find out the possible history of manic symptoms. In the event that these are detected, it would be crucial to suspect bipolar disorder and avoid the use of any antidepressant medication.
2. Presence of atypical depressive symptoms
Although depression usually occurs with sadness and an inhibition of the ability to experience pleasure (anhedonia), with a reduction in the total time spent asleep (insomnia in its various subtypes) and loss of appetite, it can sometimes be manifested by what are called atypical symptoms. These symptoms are different from those you would expect in a depressed person.But are common in the depressive stages of bipolar disorder.
These symptoms include hypersomnia (a perceived increased need for sleep), increased appetite, excessive irritability, inner restlessness or nervousness, physiological hyperresponsiveness to difficult environmental circumstances, fear of rejection. and the heightened feeling of physical and mental fatigue. All together represent a differential pattern from major depression.
3. Recurrent depressive episodes before the age of 25
A weighted examination of personal history can objectify the appearance of a first depressive episode before the age of 25. It is not uncommon for symptoms of depression to appear in adolescence, even if they were masked after an impervious facade of irritability. These premature episodes are also more common in bipolar disorder.
This is why it is important for the person to make an analysis of the emotion they felt during this period of their life, as the externalized nature of depression in adolescence tends to obscure the accuracy of the environment. family to account for the real emotions that were at its basis (thus prioritizing overt behavior). In some cases, such as angry, they can be attributed to “things of the time”, which reduces the relevance or importance of the lived experience.
4. Brief depressive episodes
Depressive episodes of bipolar disorder are shorter than major depression as an independent entity (Which often lasts six months or more). Therefore, it is considered that the confirmed presence of three or more depressive episodes during the lifetime, especially when they occurred in young people and were of short duration (three months or less), may be suggestive of bipolar disorder.
5. Family history of bipolar disorder
The presence of a family history of bipolar disorder may be a cause for suspicionAs this is a health problem which has relevant genetic components. Therefore, direct parents of someone with bipolar disorder should be especially careful when they are suffering from what may appear to be major depression, as it could in fact be a depressive stage of bipolar disorder. As for the differences between unipolar depression and bipolar depression, family history is essential.
Therefore, when they go to a healthcare professional for treatment, they should report this background, because together with other data it could contribute very significantly to the differential diagnosis. Type I bipolar disorder is estimated to occur in 0.6% of the world’s population, but it is much more common in first-degree relatives of those who have it.
However, it is also possible that it is a major depression, so the professional himself should avoid expectations that cloud his opinion.
6. Rapid onset of depressive symptoms in the absence of stressors
Major depression tends to be the emotional result of experiencing an adverse event, Which means significant losses for the person in relevant areas of their life, identifying themselves as the moment from which there has been a change remarkable in internal experience. This clear cause-and-effect relationship can be traced with relative simplicity in major depression, and when the triggering event is resolved, a marked improvement in emotional state tends to occur.
In the case of bipolar disorder, the most common is that the depressive symptoms occur without the person being able to identify an obvious reason, and in addition, it sets in very quickly. So it seems to crop up inadvertently, which also generates a certain feeling of loss of control over mood swings.
7. Presence of psychotic symptoms
Depression can sometimes acquire psychotic tints, characterized by delusional guilt or hallucinations the content of which is consistent with the negative emotional state. This form of depression is more common in bipolar disorder, and is therefore a cause for suspicion. Impulsivity, when coexisting with depression, works in the same direction as these symptoms.
On another side, it is essential to keep in mind that the presence of psychotic symptoms alongside depression can be part of a schizoaffective picture, Which should also be ruled out during the diagnostic process.
The ability to signal emotional states is the key to diagnosing bipolar disorder. If you think you have it, take your personal and family history into account, as well as the presence of the signs indicated, to speak to the specialist treating you. Today, there are therapeutic strategies, both pharmacological and psychological, that can help you enjoy a full life while suffering from bipolar disorder.
Given the importance of early detection of bipolar disorder, the risk factors that have been considered in this article are continuously subject to review and analysis, In order to determine its real perimeter and to find other useful indicators for this purpose.
Dervic, K., García-Amador, M., Sudol, K., Freed, P., Brent, DA, Mann, JJ … Oquendo, MA (2015). Bipolar I and II versus unipolar depression: clinical differences and traits of impulsivity / aggression. European Psychiatry, 30 (1), 106-113.
Leyton, F. and Barrera, A. (2010). The differential diagnosis between bipolar depression and monopolar depression in clinical practice. Journal of Chilean Medicine, 138 (6), 773-779.