In addition, bipolar disorder has more phases than major depressive disorder, including mania, hypomania and depression. But in terms of severity, neither disorder is worse or better than the other. 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. There's no way to tell which one is worse than the other. Both major depression and bipolar depression are difficult to control for several reasons.
However, bipolar depression is more episodic than unipolar, which can be stressful for both the individual and the people around them. 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 depression is the leading cause of morbidity in patients with bipolar disorder (Baldessarini et al.
A misdiagnosis such as unipolar depression is more likely to occur if a patient is evaluated early in the course of the illness because the first episodes of mood in bipolar disorder are likely to be depressive. Individuals with BD-I experienced a higher number of lifetime MODs, had the worst quality of life, and received significantly more treatment for DEM than subjects with BD-II and MDD. In all cases, patients with bipolar disorder should undergo extensive screening 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. Tension continues between clustered mood syndromes and the separation of several depressive and bipolar subtypes, and considering a “spectrum of disorders ranging from more or less pure depression to archetypal BD, leading to profound therapeutic ambiguities (Cuellar et al.
Up to 64% of clinical encounters with depression occur in primary care, with misdiagnoses of bipolar depression common in both primary care and psychiatry. Lithium was included as the third arm of an acute bipolar depression trial designed primarily to test quetiapine, with little benefit (Table (Young et al. As the main unresolved disease in treated EB, bipolar depression is associated with excess morbidity, as well as mortality from concurrent general medical disorders and a very high suicide risk. In a non-depressed state, bipolar patients showed greater brain activity (compared to depressed patients) in a region called the dorsolateral prefrontal cortex, which is involved in the active regulation of emotions.
Primary care physicians and PNs working in family care and PMHNPs working in psychiatric settings play a key role in screening, identifying and treating patients with bipolar disorder. Major depressive disorder should only be diagnosed when bipolar disorder has been ruled out by historical and contemporary screening, as misdiagnosis often results in inadequate antidepressant monotherapy treatment and delays the start of effective treatment. Although studies of the pathophysiology of bipolar disorder have produced several hypotheses, the neurobiological mechanisms underlying bipolar disorder remain largely unknown. This suggests that the brains of bipolar patients had to work harder than those of depressed patients to achieve the same level of emotional control, Ruhe said.
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. Case-control analysis of the impact of pharmacotherapy on prospectively observed suicide attempts and completed suicides in bipolar disorder. Effects of antipsychotics, antidepressants and mood stabilizers on the risk of physical illness in people with schizophrenia, depression, or bipolar disorder. .
