Differences Between Unipolar Depression and Bipolar Depression

Both major (or unipolar) depression and bipolar disorder are currently included in the general category of mood pathologies. However, these are different problems, 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 who suffer 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 is due to the fact that the expression of the depressive phases of bipolar disorder and 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 bipolar disorder would be possible, would be the clear evidence that at some point in the past the person went through the symptoms of a manic phase. In fact, this circumstance in itself would allow the diagnosis of bipolar disorder to be confirmed. The problem is that such episodes (and hypomanic ones) are reported with greater difficulty than depressive ones, since they are perceived (equivocally) as less disabling.

In addition, bipolar disorder often co-occurs with a number of problems that mask not only major depression, but also other physical and/or mental health conditions, such as anxiety or substance dependence. Along these lines, some research reports that diagnostic certification can be delayed for five years or more, with the complications that could arise from this delay.

One of the most relevant, without a doubt, occurs when the person with bipolar disorder is offered pharmacological treatment (SSRI, for example) for major depression. In these cases, an accentuated risk of turning towards manic episodes induced by the chemical properties of the substance can be observed, or an acceleration in the clinical swings of mood, 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 current time, will allow us to combine the necessary data for making thorough decisions about the real mental state and provide a treatment (pharmacological and psychotherapeutic) that offers benefits to the person.

Below we propose a set of “signs” suggesting that depressive symptoms may not be related to underlying major depression, but with the depressive phase of a bipolar disorder that has not yet shown its true face. None of them, by themselves, is sufficient to obtain absolute certainty; but rather they together provide relevant information in terms of probability, which must be complemented with 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 from it on some 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 occurs periodically but is very difficult to predict (acute episodes lasting longer than manic or hypomanic episodes).

It is therefore important to investigate personal history, in order to outline the evolution of mood over the years, and determine the possible existence of vital periods in the past in which one could have suffered from depression. This 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), along 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 are known as atypical symptoms. These symptoms are different from those that would be expected in someone who is depressed but they are common in depressive phases of bipolar disorder.

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

3. Recurrent depressive episodes before age 25

A considered review of personal history can identify 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 though they were masked behind an impermeable façade of irritability. These premature episodes are also more common in bipolar disorder.

It is therefore important for the person to 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 accuracy of the family environment to inform about the true emotions that were at their disposal. base (therefore prioritizing overt behavior). In some cases, such anger can be attributed to “things of age”, subtracting relevance or significance from the experience that was experienced.

4. Brevity of depressive episodes

Depressive episodes of bipolar disorder are shorter than major depression as a stand-alone entity (which often lasts 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. Therefore, immediate family members of a person with bipolar disorder should be especially cautious when suffering from what may appear to be major depression, as this could actually be a depressive stage of bipolar disorder. When it comes to the differences between unipolar depression and bipolar depression, family history is key.

Therefore, when they go to a health professional to receive treatment, they must report this history, since together with other data it could contribute very importantly 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 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 emotional result of experiencing an adverse event, which entails significant losses for the person in relevant areas of their life, identified as being the time point from which a notable change occurred in the internal experience. This clear cause-and-effect relationship can be traced relatively easily in major depression, and when the triggering event is resolved, a clear improvement in emotional state tends to occur.

In the case of bipolar disorder, the most common thing is that depressive symptoms arise without the person being able to identify an obvious reason for it, and that it also sets in very quickly. It therefore seems to arise 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 congruent with the negative emotional state. This form of depression is more common in the context of bipolar disorder, and is therefore a reason for suspicion. Impulsivity, when it coexists with depression, points in the same direction as these symptoms.

Besides, It is essential to keep in mind that the presence of psychotic symptoms together with depression can be part of a schizoaffective condition which will also have to be discarded during the diagnostic process.

Important considerations

The ability to report emotional states is key for the diagnosis of bipolar disorder to be made. If 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 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 continually subject to review and analysis with the purpose of determining its real scope and finding other useful indicators for this purpose.