Bipolar Depression is not Unipolar Depression

The depressive state of Bipolar usually lasts much longer than the manic or hypomanic state, and is often more severe. There appear to be a number of subtle
differences between unipolar depression and
bipolar depression, which often results in the misdiagnosis of bipolar. Below is an excerpt from http://www.mcmanweb.com/article-221.htm.


Alan Swann MD of the University of Texas, Houston at the 2000 APA annual meeting observed that those with bipolar depression are more likely to manifest psychomotor retardation and have atypical features (such as excessive eating and sleeping) than patients with unipolar depression. According to Dr Swann, bipolar depressions are characterized by greater episode frequency, earlier onset, greater co-occurring substance abuse, and a more equal gender ratio.

Philip Mitchell MD of the University of New South Wales at the 2003 Fifth International Conference on Bipolar Disorders cited a 2000 Australian study of 83 bipolar depressed and 904 unipolar depressed patients that found bipolar patients were more likely to be melancholic (69 vs 37 percent), and were significantly more likely to demonstrate psychomotor disturbance and guilt. A 2001 study by Dr Mitchell of 270 depressed patients found those with bipolar were less tearful than those with unipolar depression, but felt more worthless, exhibited greater loss of pleasure, and experienced more subjective restlessness, leaden paralysis, and hypersomnia than their unipolar counterparts.

Significantly, in the words of Dr Swann, "the differing biological properties of unipolar and bipolar depression suggest that treatments that were originally intended for unipolar depression may not be optimal for bipolar depression."

These distinctions tend to be lost on the average clinician. A survey by the Depression and Bipolar Support Alliance of 400 of its members found that of those who reported having bipolar disorder, 60 percent disclosed that their initial diagnosis was major depression.

From a patient’s perspective, the implications are enormous. According to a study by S Nassir Ghaemi MD of Harvard et al appearing in the October 2000 Journal of Clinical Psychiatry, it took bipolar I patients nearly six years and bipolar II patients 11.6 years from first contact with the mental health system to achieve a correct diagnosis