Bipolar or Depressed? Commonly Overlooked Clues

by Louise
(Sydney, Australia)

We are often told that the way to distinguish depression (as in unipolar depression) from bipolar depression is to look for other symptoms in the patient, in particular to search for clues about the presence or absence of mania.

By now it is well known that bipolar disorder is often misdiagnosed - or just plain missed. One of the most common misdiagnoses is to make the mistake of seeing only depression rather than bipolar disorder. Further, we are also told that the way to tell the difference between the two is the presence or absence of mania.

However, there are other important diagnostic clues that are well researched but not well known. As a result they are all too often overlooked.

As it turns out, bipolar depression differs from unipolar depression in some important ways. Understanding these differences can aid accurate diagnosis, even before we embark on the "hunt for mania".

One key feature - which really comes as no surprise - is that bipolar depression is characterised by more variability in symptoms, as opposed to the more predictable unipolar depression.

Here is a summary of differences from some of the studies to date:

BIPOLAR DEPRESSION is more likely to feature:

1. Comorbid substance abuse.

2. Irritability and/or hostility.

3. Psychotic features.

4. Unstable, fluctuating moods.

5. Symptoms vary from episode to episode for a single individual, with a greater variety of symptoms overall.

UNIPOLAR ("Ordinary", "Simple" or Classic") DEPRESSION is more likely to feature:

1. Physical symptoms with a range of physical complaints such as pain sensitivity or unexplained pains.

2. Anorexia and/or appetite loss and/or weight loss.

3. Anxiety and agitation.

4. Insomnia.

5. Less variability in symptoms. Tends more towards the stereotypical cliche of a depressed person.

Research has also revealed some clinical differences between Bipolar I and Bipolar II depression, but that is a topic for another day . . .