Differences between unipolar depression and bipolar depression

Both major (or unipolar) depression and bipolar disorder are currently included in the general category of mood disorders. However, these are different problems, and must be identified as such.

Unfortunately, it can be difficult to differentiate between the symptoms of major depression and 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 receive their corresponding diagnosis , which inevitably delays the articulation of therapeutic programs aimed at promoting their emotional stability and quality of life. This is due to the fact that the expression of the depressive phases of bipolar disorder and that of major depression is similar, despite the fact that the treatment for the one and the other is absolutely different.

An essential 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 the symptoms of a manic phase were experienced. In fact, this circumstance by itself would confirm the diagnosis of bipolar disorder. The problem is that such episodes (and hypomaniacs) are more difficult to report than depressive episodes, since they are perceived (equivocally) as less disabling.

Furthermore, bipolar disorder often presents concomitantly with a series of problems that mask it not only with major depression, but also with other physical and / or mental health conditions, such as anxiety or substance dependence. In this line, some investigations refer that the diagnostic certification can be extended five years or more, with the complications that this delay could derive.

One of the most relevant, undoubtedly, occurs when a person with bipolar disorder is offered an indication pharmacological treatment ( SSRI , for example) for major depression. In these cases, there may be an increased risk of a shift towards manic episodes induced by the chemical properties of the substance, or an acceleration in the clinical mood swings, which aggravate the organic and psychosocial circumstances of the underlying pathology.

The most important thing, in this case, is to carry out an exhaustive analysis of personal and family history. This information, together with the detailed assessment of the symptoms that are present at the present time, will make it possible to combine the necessary data for a thorough decision-making on the real mental state and to provide a treatment (pharmacological and psychotherapeutic) that offers benefits to the person. .

Next, we propose a set of “signs” suggestive that depressive symptoms may not be related to an underlying major depression , but to the depressive phase of a bipolar disorder that has yet to show its true face. None of them, by itself, is sufficient to obtain absolute certainty; rather, they provide relevant information as a whole in terms of probability, which must be complemented by rigorous clinical judgment.

1. Previous episodes of major depression

Major depression is a disorder that tends to occur recurrently throughout life , so most people who have suffered it on occasion will suffer from it again with a high probability in the future. However, such relapses are much more frequent in the specific case of bipolar disorder, where the depressive symptom appears periodically but is very difficult to predict (acute episodes lasting longer than those of maniacs or hypomaniacs).

It is therefore important to inquire into personal history, in order to outline the evolution of the mood over the years, and to determine the possible existence of vital periods in the past in which depression could have been suffered. Therefore, it is also an ideal time to explore the possible history of manic symptoms. In the event that the latter are detected, it would be crucial to suspect bipolar disorder and avoid the use of any antidepressant drug.

2. Presence of atypical depressive symptoms

Although depression tends to occur with sadness and inhibition in the ability to feel pleasure ( anhedonia ), together with a reduction in the total time spent sleeping (insomnia in its different subtypes) and a loss of appetite, it can sometimes manifest itself through what is known as atypical symptoms. These symptoms are different from those that would be predictable in those who are depressed , but they are frequent in depressive phases of bipolar disorder.

These symptoms include hypersomnia (increased perceived need for sleep) , increased appetite, excessive irritability, restlessness or inner nervousness, physiological hyperreactivity in difficult environmental circumstances, fear of rejection, and an increased sense of physical fatigue. and mental. All of them assume, as a whole, a differential pattern with respect to that of major depression.

3. Recurrent depressive episodes before age 25

A careful review of personal history can objectify the appearance of a first depressive episode before 25 years of age . It is not unusual for symptoms of depression to be expressed during the adolescent stage, despite being masked behind an impervious facade of irritability. These premature episodes are also more common in bipolar disorder.

It is therefore important that the person make an analysis of the emotion they experienced during this period of their life, since the externalizing nature of depression in adolescence tends to obscure the precision of the family environment to inform about the true emotions that were at their disposal. basis (thus prioritizing overt behavior). In some cases, such anger can be attributed to “things of the age”, detracting from the relevance or transcendence of the experience.

4. Brevity of depressive episodes

Depressive episodes of bipolar disorder are shorter than major depression as a separate entity (which often lasts for six months or more). Therefore, it is considered that the confirmed presence of three or more depressive episodes during life, especially when they occurred in youth 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 reason for suspicion , since it is a health problem that has relevant genetic components. Thus, the immediate family of a person with bipolar disorder should be especially cautious when they suffer from what may appear to be major depression, as this could actually be a depressive stage of bipolar disorder. Regarding the differences between unipolar depression and bipolar depression, family history is key.

For this reason, when they go to a health professional for treatment, they must report this background, because together with other data, it could contribute very significantly to the differential diagnosis. It is estimated that type I bipolar disorder occurs in 0.6% of the world population, but it is much more common among first-degree relatives of those who suffer from it.

However, it is also possible that it is a major depression, so the professional himself must avoid expectations that cloud his judgment.

6. Rapid onset of depressive symptoms in the absence of stressors

Major depression tends to be the affective result of the experience of an adverse event , which involves significant losses for the person in relevant areas of his life, being identified as the time point from which there was a notable change in experience internal. This clear cause-and-effect relationship can be traced relatively simply in major depression, and when the triggering event is resolved a frank improvement in emotional state tends to occur.

In the case of bipolar disorder, the most common is that depressive symptoms arise without the person being able to identify an obvious reason for it, and that it also becomes established very quickly. Therefore, it seems that it sprouts inadvertently, which also generates a certain feeling of loss of control over mood fluctuations.

7. Presence of psychotic symptoms

Depression can occasionally acquire psychotic overtones , characterized by delusional guilt or hallucinations whose content is consistent with the negative emotional state. This form of depression is more frequent in the context of bipolar disorder, and is therefore a reason for suspicion. Impulsiveness, when coexisting with depression, points in the same direction as these symptoms.

On the other hand, it is essential to keep in mind that the presence of psychotic symptoms together with depression may be part of a schizoaffective condition , which must also be ruled out during the diagnostic process.

Important considerations

The ability to report on emotional states is key for the diagnosis of bipolar disorder to be made. In case you suspect you are suffering from it, consider your personal and family history, as well as the presence of the indicated signs, to speak with the specialist who treats you. Today there are therapeutic strategies, both pharmacological and psychological, that can help you enjoy a full life even with bipolar disorder.

Given the importance of early detection of bipolar disorder, the risk factors that have been contemplated in this article are continuously subject to review and analysis , in order to determine their real scope and find other useful indicators for this purpose.


by Abdullah Sam
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