Tipsheet: Bipolar Depression Versus Unipolar Depression

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 unipolar depression.

TIPSHEET: FACTORS THAT SUGGEST BIPOLAR DEPRESSION RATHER THAN UNIPOLAR 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

OTHER TIPS

■ 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

FACTORS THAT MAY CONTRIBUTE TO BIPOLAR DISORDER

■ 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).