Major, or unipolar, depression is characterized by persistent periods of sadness, without the high manic phases of bipolar depression. While depression can be triggered by life events, major depression extends beyond the normal periods of sadness experienced after disappointing or traumatic life events. Bipolar disorder (sometimes called manic depressive) is different. If you have it, you have extreme mood swings.
You experience periods of depression (similar to those of MDD). But you also have periods of great ups and downs. Bipolar disorder and major depressive disorder are mood disorders. They are similar in that both include periods when you feel a bad mood or lack of activity in daily activities.
Bipolar disorder, formerly called manic-depressive disorder, has periods of mania; depression doesn't. Both are serious mental disorders, different criteria for diagnosis, and both have effective treatments. Major depressive episodes are characteristic of both major depressive disorder and bipolar disorder. Diagnostic criteria are based on the characteristics, of course, the presence or absence of manic or hypomanic episodes to distinguish between the two diagnoses.
In some cases, however, patients report no history of mood elevation; in others, patients who appear to be in a depressive episode simply have not experienced a manic episode (1,. Initial misdiagnosis is common (3—), and late or inadequate treatment can be associated with consequences, such as change to mania, precipitation of a mixed state, more frequent mood episodes, or an overall poorer outcome (7—. Depression in Patients With Bipolar Disorder (BE) Presents Significant Clinical Challenges. As a predominant psychopathology, even in treated EB, depression is associated not only with excess morbidity, but also with mortality from concurrent general medical disorders and a high risk of suicide.
In EB, the risks of medical disorders, such as diabetes or metabolic syndrome and cardiovascular disorders, and the associated mortality rates are several times higher than those of the general population or with other psychiatric disorders. The SMR for suicide with EB reaches 20 times higher than the rates of the general population and exceeds rates with other major psychiatric disorders. In EB, suicide is strongly associated with mixed (agitated-dysphoric) and depressive phases, depressed time and hospitalization. Lithium May Reduce Suicide Risk in EB; Clozapine and Ketamine Require More Testing.
The treatment of bipolar depression is much less researched than unipolar depression, particularly for long-term prophylaxis. The short-term efficacy of antidepressants for bipolar depression remains controversial and they are at risk of clinically worsening, especially in mixed states and with rapid cycles. Evidence for the effectiveness of lithium and anticonvulsants for bipolar depression is very limited; lamotrigine has long-term benefits, but valproate and carbamazepine are not adequately tested and carry high teratogenic risks. Evidence is emerging of the short-term efficacy of several modern antipsychotics (such as cariprazine, lurasidone, olanzapine-fluoxetine and quetiapine) for bipolar depression, even with mixed characteristics, although they are at risk of adverse metabolic and neurological effects.
It seems prudent that antidepressants, especially tricyclic and some SNRIs, are used with great caution for bipolar depression, especially in patients with BD-I, and may be avoided altogether with a history of mood swings during antidepressant treatment, mixed symptoms occur (Tondo et al. Bipolar depression is the leading cause of morbidity in patients with bipolar disorder (Baldessarini et al. All available pharmacological treatments used for bipolar depression have limited efficacy and are at risk of adverse metabolic or neurological effects. The bipolar depression study was a multicenter, parallel, double-blind, randomized, placebo-controlled clinical trial conducted in 13 countries to compare the efficacy and safety of olanzapine and the combination of olanzapine and fluoxetine with placebo.
Bipolar disorder is characterized by mood swings that fluctuate between depressive lows and manic highs. Double-blind, placebo-controlled study of quetiapine and paroxetine as monotherapy in adults with bipolar depression (EMBOLDEN II). Bipolar disorder with mixed characteristics is a complex presentation in which an episode of manic or depressive mood is complicated by the presence of subsyndromic but clinically significant symptoms of the opposite pole. Individually, the burdens of bipolar disorder include premature mortality from medical comorbidities and suicide, long-term dysfunction and disability, psychosocial impairment, loss of work productivity, cognitive impairment, and decreased quality of life (Miller et al.
As such, depressive symptoms should always arouse a suspicion of bipolar disorder and trigger proper in-clinic evaluation and screening for both conditions. Given their central position in the healthcare network and their prominent role in diagnosing and treating patients, NPs have the opportunity to improve mental health services in family practice by being better informed and sharing their experience with primary care colleagues in order to optimize treatment of all patients with bipolar disorder. Although the DSM IV diagnostic criteria for major depressive episodes in the context of UD and PA II are identical, studies suggest subtle differences between symptom profiles in all disorders. Efficacy of the combination of olanzapine and olanzapine-fluoxetine in the treatment of bipolar I depression.
There are no specific diagnostic tests available to help your doctor determine if you have bipolar disorder or depression. In all cases, patients with bipolar disorder should undergo thorough examinations to detect all medical comorbidities, including overlapping endocrine, rheumatological or inflammatory diseases, as they should be considered part of the disease presentation and treated in a coordinated manner. All patients with depressive symptoms should be screened for bipolar disorder (Manning, 200), which should be ruled out before considering a diagnosis of unipolar depression. .
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