Differences between unipolar depression and bipolar depression

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

Unfortunately, it can be difficult to tell the difference between the symptoms of major depression and those of an episode. depressive disorder associated with bipolar disorder, although this distinction is essential to avoid complications future.

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 affective stability and their quality of life. This is due to the fact that the expression typical of the depressive phases of bipolar disorder and that of major depression is similar, despite the fact that the treatment for one and the other is absolutely different.

An essential difference between the two, from which an accurate identification of the disorder would be possible bipolar, would be clear evidence that at some point in the past you went through the symptoms of a phase manic. In fact, this circumstance by itself would allow the diagnosis of bipolar disorder to be confirmed. The problem is that such episodes (and hypomaniacs) are referred to with greater difficulty than depressive ones, since they are perceived (wrongly) as less disabling.

In addition, bipolar disorder often occurs concomitantly with a number of problems that mask it not only with major depression, but also other physical and / or mental health conditions, such as anxiety or dependence on substances. Along these lines, some research reports that diagnostic certification can take five years or more, with the complications that may arise from this delay.

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

The most important thing, in this case, is to carry out a thorough analysis of personal and family history. This information, together with the detailed assessment of the symptoms that are present at the present time, will allow us to combine the necessary data to a thorough decision-making on the real mental state and 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 underlying major depression.But with the depressive phase of bipolar disorder that has not yet shown its true face. None of them, by itself, is sufficient to obtain absolute certainty; rather, they provide as a whole relevant information in terms of probability, and that will have to be complemented with a rigorous clinical judgment.

1. Previous episodes of major depression

Major depression is a disorder that tends to recur throughout lifeTherefore, most of the people who have suffered it at some time will suffer it again with high probability in the future. However, such relapses are much more frequent in the specific case of bipolar disorder, where the depressive symptom is It presents periodically but very difficult to predict (acute episodes of duration greater than that of manic or hypomanic).

It is therefore important to inquire into personal history, in order to sketch the evolution of the state of mind as over the years, and determine the possible existence of vital periods in the past in which it was possible to suffer depression. 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 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, sometimes manifested by what are known as symptoms atypical. These symptoms are different from those that would be expected in someone who is depressed, but they 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, hyperresponsiveness physiological in difficult environmental circumstances, fear of rejection and the accentuated sensation of physical fatigue and mental. All of them suppose, as a whole, a differential pattern with respect to that of major depression.

3. Recurrent depressive episodes before age 25

A careful review of the personal history can objectify 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, despite being masked behind a waterproof facade of irritability. These premature episodes are also more common in bipolar disorder.

It is therefore important that the person make an analysis about the emotion that he experienced during this period of his life, since the externalizing nature of depression in the adolescence tends to obscure the precision of the family environment to inform about the true emotions that were at its base (thus prioritizing the behavior manifests). In some cases, such anger can be attributed to "things of age", reducing relevance or significance to the experience that was going through.

4. Brevity of depressive episodes

The depressive episodes of bipolar disorder are shorter than major depression as a separate entity (which often lasts for six months or more). For this reason, it is considered that the confirmed presence of three or more depressive episodes during life, especially when they occurred in youth and were short-lived (three months or less), they may be suggestive of a disorder bipolar.

5. Family history of bipolar disorder

The presence of a family history of bipolar disorder can be a reason for suspicion, as it is a health problem that has relevant genetic components. Thus, the immediate family members of a person with bipolar disorder should be especially cautious when suffering from it. that in appearance could be a major depression, as this could actually be a depressive stage of the disorder bipolar. When it comes to 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 antecedent, since together with other data it could contribute in a very important way to the diagnosis differential. Type I bipolar disorder is estimated to occur 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 professional himself should 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 experiencing an adverse event, which supposes significant losses for the person in relevant areas of her life, identifying itself as the time point from which there was a notable change in the 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 depressive symptoms arise without the person is able to identify an obvious reason for it, and that it is also established very quickly. It seems therefore that it springs up inadvertently, which also generates a certain feeling of loss of control over mood fluctuations.

7. Presence of psychotic symptoms

Depression can occasionally take on tinges psychotic, characterized by delusional guilt or hallucinations whose content is congruent with the negative emotional state. This form of depression is more common in the context of bipolar disorder, and therefore is a reason for suspicion. Impulsivity, when coexisting with depression, points in the same direction as these symptoms.

On the other hand, it is essential to bear in mind that the presence of psychotic symptoms together with depression can be part of a schizoaffective picture, which will also have to be ruled out during the diagnostic process.

Important considerations

The ability to report emotional states is key to a 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 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 its real scope and to find other useful indicators for this purpose.

Bibliographic references:

• Dervic, K., García-Amador, M., Sudol, K., Freed, P., Brent, D.A., Mann, J.J. … Oquendo, M.A. (2015). Bipolar I and II versus unipolar depression: Clinical differences and impulsivity / aggression traits. 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.