Differences between unipolar depression and bipolar depression

These two mood disorders have commonalities, but also major differences.

Both major (or unipolar) depression and bipolar disorder are now included in the general category of mood disorders. However, they are distinct problems, and should 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 depressionaccording to the current state of knowledge, in order to shed light on this relevant issue.

Differences between unipolar depression and bipolar depression

Many people suffering from 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 inevitably delays the articulation of therapeutic programs aimed at promoting their affective 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, although the treatment for one and the other is quite different.

An essential difference between the two, from which an accurate identification of bipolar disorder would be possible, would be the clear evidence that at some point in the past one went through the symptoms of a manic phase. In fact, this circumstance alone would confirm the diagnosis of bipolar disorder. The problem is that such episodes (and hypomanic episodes) are more difficult to report than depressive episodes, as they are (misleadingly) perceived as less disabling.

In addition, bipolar disorder often presents concomitantly with a number 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. Along these lines, some studies report that diagnostic certification can be delayed by five years or more, with the complications that this delay may cause.

One of the most relevant, undoubtedly, occurs when the person with bipolar disorder is offered pharmacological treatment (SSRIs, for example) indicated for major depression. In these cases there may be an accentuated risk of turning 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 perform an exhaustive analysis of the personal and family history. This information, together with a 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.

We then propose a set of "signs" suggesting that depressive symptoms may not be related to an underlying major depression, but rather to the depressive phase of the illness.but to the depressive phase of a bipolar disorder that has not yet shown its true face. None of them, by itself, is sufficient to obtain absolute certainty; rather, they all provide relevant information in terms of probability, which must be complemented with a rigorous clinical judgment.

1. Previous episodes of major depression

Major depression is a disorder that tends to occur recurrently throughout life.Most people who have suffered from it at one time or another will most likely suffer from it again in the future. However, such relapses are much more frequent in the specific case of bipolar disorder, where the depressive symptom occurs periodically but is very difficult to predict (acute episodes lasting longer than manic or hypomanic episodes).

It is therefore important to inquire into personal history, in order to outline the evolution of mood over the years, and to determine the possible existence of periods in the past in which depression may have occurred. It is also, therefore, 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 drugs.

2. Presence of atypical depressive symptoms

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

These symptoms include hypersomnia (increased perceived need for sleep), increased appetite, excessive irritability, inner restlessness or nervousness, physiological hyper-reactivity to difficult environmental circumstances, fear of rejection and a heightened sense of physical and mental fatigue. All of these together represent a differential pattern with respect to that of major depression.

3. Recurrent depressive episodes before 25 years of age

A careful review of the personal history may point to the appearance of a first depressive episode before the age of 25.. It is not unusual for symptoms of depression to be expressed during adolescence, even if they are masked by an impermeable facade of irritability. These premature episodes are also more common in bipolar disorder.

It is therefore important that the person makes an analysis of the emotion experienced during this period of his or her life, as the externalizing nature of depression in adolescence tends to obscure the accuracy of the family environment in reporting the true emotions that were at its base (thus prioritizing overt behavior). In some cases, such anger may be attributed to "things of the age", thus reducing the relevance or transcendence of the experience being experienced.

4. Brevity of depressive episodes

The depressive episodes of bipolar disorder are shorter than major depression as an independent entity (which is often prolonged). (which often lasts for six months or more). Therefore, it is considered that the confirmed presence of three or more depressive episodes during a lifetime, 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.The presence of a family history of bipolar disorder may be a cause for suspicion, as this is a health problem with relevant genetic components. Thus, immediate family members of a person with bipolar disorder should be especially cautious when experiencing what may appear to be major depression, as this may actually be a depressive stage of bipolar disorder. Regarding the differences between unipolar depression and bipolar depression, family history is key.

Therefore, when they go to a health professional for treatment, they should report this history, as, together with other data, it could contribute significantly to the differential diagnosis. It is estimated that bipolar disorder type I occurs in 0.6% of the world's 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 practitioner should avoid expectations that cloud his or her 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 patient.which involves significant losses for the person in relevant areas of his or her life, being identified as the time point from which a notable change in the internal experience occurred. This clear cause and effect relationship can be traced with relative simplicity in major depression, and when the triggering event is resolved, there tends to be a clear improvement in the emotional state.

In the case of bipolar disorder, it is most common for depressive symptomatology to arise without the person being able to identify an obvious reason for it, and it also sets in very quickly. It therefore appears to emerge unnoticed, which also generates a certain feeling of loss of control over mood fluctuations.

7. Presence of psychotic symptoms

Depression may occasionally acquire psychotic overtones, characterized by delusional guilt or hallucinations whose content is congruent with the negative emotional state. This form of depression is more frequent in the context of bipolar disorder, and is therefore a cause for suspicion. Impulsivity, 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 disorder, which must also be ruled out during the diagnostic process.which will also have to be ruled out during the diagnostic process.

Important considerations

The ability to report emotional states is key to the diagnosis of bipolar disorder. 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 talk to the attending specialist. Nowadays there are therapeutic strategies, both pharmacological and psychological, that can help you enjoy a full life even if you suffer from bipolar disorder.

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