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Unipolar disorder : Depression

What is depression?

Depression is first and foremost a serious affliction with many painful consequences. It is a reversible and curable illness but in many cases, it is also a recurring one.

Depression is treated on a psychological level as well as with drugs.

A depressive episode can exhibit various symptoms:

  • Melancholic mood and/or feelings of sadness
  • Loss of interest or pleasure in all activities 
  • Suicide ideation or attempts
  • Slowing of mental faculties, slower thought processes
  • Slowing of motor faculties, less physical activity
  • as well as outward physical signs such as changes in eating and sleeping habits.

Attention given to depressive episodes as part of the development of a bipolar disorder is relatively recent.

The frequency of depressive episodes, as well as their duration and lingering after-effects, have an important and devastating impact on overall functioning, quality of life, socio-professional integration, and family stability. There is a close correlation between suicide risk and frequency and duration of depressive and mixed state episodes.


How to find out if a depressive state indicates the onset of a bipolar disorder ?

Bipolar depression is under-diagnosed during a depressive episode, and 1/3 of bipolar depressions are misdiagnosed as unipolar.

Over-prescription of antidepressants can lead to thymic instability (i.e. mood instability), can induce manic and hypomanic episodes (“manic reaction”), or be the cause of cycle accelerations. The later this disorder is treated, the higher the risk of resistance against treatment, repercussions on socio-professional and family life, and suicide.

Considering the prevalence of bipolar disorders and the gravity of prognosis difficulties, testing for signs of bipolarity should be standard with every depressive occurrence.

Testing parameters should be expanded so as to make diagnosis easier :

  • Family history should not be limited to determining mood disorders in immediate or extended family members. Other things to look for are alcoholism, behaviour disorders, eccentricity, suicides or attempted suicides, anxiety disorders, eating disorders, and obsessive compulsive disorders.
  • The following signs may demonstrate mood disorders that could lead to a diagnosis of bipolar disorder : periods of euphoria and excitability, excessive spending sprees, eccentric behaviour, run-ins with the law, alcoholism, risk-taking behaviour or overindulgence, violent or aggressive outbursts, the idea of a break from previous state, of changes such as “turning over a new leaf”, changes in personality, and mood reactions to antidepressants previously prescribed.
  • In women, mood disorders between giving birth and the return of their menstrual cycles can trigger bipolarity.
  • Early signs of onset at adolescence or at young adulthood are indicators to watch for because unipolar disorders begin at a later age.
  • Other diagnosis indicators include a hyperthymic temperament (constant cheerful mood) characterised by hyperactivity, hypersyntonia, many projects on the go, and over-friendliness. Other personality traits that are often found in bipolar patients : hypersensitivity, dependence, seeking intense sensations...
  • Symptoms of bipolar depression may present one or more characteristics : psychotic symptoms, changes in circadian rhythm with major morning psychomotor inhibition that wanes towards the end of the day, atypical symptoms of depression : hypersomnia, hyperphagia, psychomotor inhibition that can be so severe as to block thoughts altogether, and emotional instability.

Other symptoms that are not specific to bipolarity but are often observed are : irritability, aggressiveness, angry reactions, over-sensitivity, emotional deterioration that can lead to an incapability to cry and/or to express negative feelings.


Differences between unipolar and bipolar disorder

  Unipolar disorder Bipolar Disorder
Age of onset Later Early
Frequency of episodes + +++
Beginning and end of the episode Progressive Acute
Sleep Decreased Decreased
Appetite Decreased Decreased
Slowdown - ++
Stability of mood - ++
Psychotic symptoms - ++
Affective blunting - ++
Original character - ++
Family history Lows Bipolar Disorder
Personal history Lows Mania, alcoholism
Personality Disorders - ++
Postpartum disorders - ++
Anxiety ++ -
Somatic complaints ++ -
Duration of the episode ++ +


Reader information: This article is based on discussions and texts from the Medical Comitee – Last update : 03/25/2012

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