Tipsheet: Bipolar Depression Versus Unipolar Depression

Tipsheet: Bipolar Depression Versus Unipolar Depression
Published on Psychiatric Times  (
Tipsheet: Bipolar Depression Versus Unipolar Depression August 19, 2014

Milder forms of bipolar disorder are something that I see frequently in my office. Most of my patients become quite concerned and even alarmed when I discuss this diagnosis with them. Chronic recurrent depression is often bipolar II. As a board certified sub-specialized psychiatrist, I can tell if certain symptoms and history are important in making this diagnosis; see if any of these items sound familiar to you. Most of my patients think I’m talking about a disorder that involves crazy. Instead, it really is a disorder of mood variation which is important to diagnose. Diagnosis means a treatment plan which is very different from the treatment plan for major depressive disorder. Clarification of the diagnosis is treatment that allows my patients to become well, possibly for the first time in their lives.

Given the greater frequency of depression than manic episodes in bipolar disorder, what clues
indicate bipolar disorder rather than unipolar depression? The Tipsheet below lists factors that may
help identify bipolar depression.

■ Prepubertal onset of symptoms
■ Brief duration of depressed episodes
■ High frequency of depressed episodes
■ Seasonal pattern
■ Postpartum symptom onset
■ Multiple antidepressant failures
■ Nonresponse to antidepressant treatment
■ Rapid response to antidepressant treatment
■ Erratic response to antidepressant treatment
■ Dysphoric response to antidepressant treatment with agitation and insomnia
■ Family history of bipolar disorder
■ History of unstable interpersonal relationships
■ Frequent vocational problems
■ Frequent legal problems
■ Alcohol and drug use

■ Bipolar I disorder, with episodes of full-blown mania, is usually easier to diagnose than bipolar II disorder, with episodes of subtler hypomania
■ Recognizing that the primary mood state may be irritability rather than euphoria increases the likelihood of diagnosis
■ Focusing more on overactivity than mood change further improves diagnostic accuracy
■ Bipolar disorder is associated with a significantly elevated risk of suicide
■ Bipolar patients often use highly lethal means for suicide

■ Early age at disease onset
■ The high number of depressive episodes
■ History of antidepressant-induced mania
■ Traits of hostility and impulsivity

Further reading:
•Effective Personalized Strategies for Treating Bipolar Disorder,” by Stephen V. Sobel, MD, from
which this Tipsheet was adapted.
•Successful Psychopharmacology: Evidence-Based Treatment Solutions for Achieving Remission, by
Stephen V. Sobel, MD (New York; WW Norton; 2012).

See also psychiatryuplugged: Bipolar Disorder, It’s a Mood Thang

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