As a consequence of this dichotomy in the diagnostic nomenclature, research in mood disorders tends to focus on either bipolar disorder as a whole, failing to account for episode polarity in bipolar disorder, or unipolar depression. Epidemiology of affective categories. Goikolea, Jos M Nunes GP, Jr, Tufik S, Nobrega JN. The strongest methodology, however, is to include a drug wash-out period before symptom assessment, to ensure that symptoms are not merely the manifestation of the differing drug treatments used for bipolar and unipolar disorders. Researchers have a responsibility to develop and critically evaluate approaches to diagnosing a clinically meaningful syndrome of depression which most clinicians will recognise from their everyday work as something that is highly morbid (even life-threatening) and, usually, in need of treatment. Ashworth CM, Blackburn IM, McPherson FM. We divide studies into those that focus on cognitive styles during depression, during remission, and cognitive styles that predict depression. By studying mania and depression as separate disorders, rather than as bipolar and unipolar disorders, the field can tease apart processes that are similar and unique between these phenomena that with the current nomenclature is not probable. This assumption that bipolar and unipolar depressions are distinct has continued to guide research for almost 30 years. Journal of the American Association of Nurse Practitioners. Nevertheless, more recent findings have been much more inconsistent. Cross-national epidemiology of major depression and bipolar disorder. Taking treatment trials as an example, it is interesting to speculate that many previous trials of antidepressants for major depression may have been compromised because they included patients with major depressive disorder with subdiagnostic (but clinically important) features of bipolar disorder. Strik, W. The performance of depressed and manic patients on some repertory grid measures: A longitudinal study. Johnson SL, Winters R, Meyer B. Findings for sleep (Brockington et al., 1982; Giles, Rush, & Roffwarg, 1986; Kuhs & Reschke, 1992; Mitchell et al., 2001), anger (Beigel & Murphy, 1971; Brockington et al., 1982; Gurpegui et al., 1985), psychomotor retardation (Mitchell et al., 1992, 2001; Parker, Roy, Wilhelm, Mitchell, & Hadzi-Pavlovi, 2000), psychosis (Beigel & Murphy, 1971; Black & Nasrallah, 1989; Breslau & Meltzer, 1998; Brockington et al., 1982; Guze, Woodruff, & Clayton, 1975; Mitchell et al., 2001; Parker et al., 2000), melancholia (Coryell et al., 1989; Endicott et al., 1985; Parker et al., 2000), and mood reactivity (Brockington et al., 1982; Mitchell et al., 2001; Parker et al., 2000) were not consistent across studies. Although results across methodologies were not consistent, appetite loss (Gurpegui, Casanova, & Cervera, 1985) and agitation (Beigel & Murphy, 1971; Katz et al., 1982) have each been found to be more prevalent in unipolar depression than bipolar depression within three studies that included a drug washout period. Both theory and empirical observations of mood disorders point to the importance of regulatory deficits involving dopamine or norepinephrine (Depue & Zald, 1993; Ebert & Berger, 1998; Gottschalk, Bauer, & Whybrow, 1998; Howland & Thase, 1999; Prange, Wilson, Lynn, Alltop, & Stikeleather, 1974; Spoont, 1992; Winters, Scott, & Beavers, 2000). Mathews R, Li PP, Young LT, Kish SJ, Warsh JJ. Emamghoreishi M, Schlichter L, Li PP, Parikh S, Sen J, Kamble A, et al. Donnelly EF, Murphy DL, Goodwin FK. Marchesi, C. DSM-5 Changes: Implications for Child Serious Emotional Disturbance, The Role of Exercise in Preventing and Treating Depression, Distinctions between bipolar and unipolar depression, Feeling sad most days or having a chronic low mood, Not enjoying activities that used to bring you pleasure, Finding it difficult to experience joy or happiness, Experiencing thoughts of suicide or self-harm, Depressed mood (or irritable mood in children), Little to no interest in activities that used to give you pleasure, A noticeable change in appetite or weight, An inability to stop moving (agitation) or acting extremely sluggish, Low energy, inability to concentrate, and fatigue, Feelings of intense worthlessness, self-blame, and guilt, Trouble thinking clearly or making everyday decisions, Having a family member with depression (heredity is a contributor in 35% of cases), Differences in brain chemistry and neurology, Having other mental health conditions, including social anxiety disorder and panic disorder, Being a woman (women are two times as likely to be diagnosed with depression), Having other medical conditions, especially if you are an older person, Selective serotonin reuptake inhibitors (SSRIs), Serotonin-norepinephrine reuptake inhibitors (SNRIs), Atypical antidepressants (bupropion or mirtazapine). In the following sections, we review the current research on cognitive styles, with a focus on those styles associated with depression, rather than mania. We begin with a discussion of clinical phenomenology, with separate consideration of the course of disorder and symptomatology. In addition, a comparison of currently depressed unipolar and bipolar patients revealed no differences in terms of symptom severity or social impairment (Dorz, Borgherini, Conforti, Scarso, & Magni, 2003). Unipolar depression is a term used interchangeably with major depressive order, and is characterized by continuous feelings of sadness, low mood, feelings of worthlessness, lack of interest in activities you used to enjoy, as well as suicidal ideation. Although people with bipolar disorder do not obtain elevated scores on standard measures of defensiveness (Donnelly & Murphy, 1973; Donnelly, Murphy, & Goodwin, 1976), some have argued that measures of attributional style, or how an individual would interpret negative life events, may invoke less defensiveness (Lyon et al., 1999). Lau, Jennifer Y. F. The next sections compare the specific psychosocial findings in unipolar and bipolar depression. Deicken RF, Fein G, Weiner MW. and Malhi, Gin S. As a consequence, it appears likely that there will be a slightly broader definition of hypomania - and therefore bipolar disorder - within DSM-5 (www.dsm5.org). Hence, rates of life events do appear elevated before the onset of bipolar depressive episodes. Other issues are likely to handicap the interpretation of retrospective studies. Stress factors in affective diseases. Cognitivebehavioral therapy for bipolar disorder. Roy-Byrne P, Post RM, Uhde TW, Porcu T, Davis D. The longitudinal course of recurrent affective illness: Life chart data from research patients at the NIMH. Unfortunately, these studies do not distinguish between bipolar disorder with and without depression. Unipolar refers to the idea that there is only one "pole," or side, to your abnormal mood state. The least stringent studies did not control for or assess potential group differences on demographic, symptom, or treatment characteristics. Third, one would expect that psychosocial triggers of depression would be less pronounced in bipolar than unipolar depression. Unipolar depression is characterized by feelings of depression that are persistent, intense, and that make it challenging for you to function normally or relate to others. Low dimensional chaos in bipolar disorder? Chou, Tina Excessively low DA activity is posited to be the hallmark of depression, and considerable evidence supports this perspective in unipolar depression, including recent studies using a D-amphetamine challenge (see Naranjo, Tremblay, & Busto, 2001, for a review). Depending upon type depression person is facing at a time; the unipolar depression symptoms may vary as below: These studies launched a series of studies examining mood-congruent and mood-dependent memory (Blaney, 1986; Bower, 1981). Interpersonal and social rhythm therapy prevents depressive symptoms in patients with bipolar I disorder. In: LAbate L, editor. Psychopathology and the marital dyad. As described above, neurobiological theories of affective disorders focus on deficits in the regulation of the catecholamines DA and NE. Limosin, Frdric The NE system has been conceptualized as one part of the hypothalamic-pituitary-adrenocortical stress response system. Klein DN, Lewinsohn PM, Rohde P, Seeley JR, Durbin CE. Su, Ming-Hsiang Results of the National Depressive and ManicDepressive Association 2000 survey of individuals with bipolar disorder, Is insight in mania state-dependent? However, there are a set of methodological issues that may have precluded the ability to accurately assess maladaptive cognitive styles during remission. Clin Psychol Rev. Although much research has compared unipolar and bipolar disorders, the majority of these studies have focused on bipolar disorder as a whole, without differentiating mania and depression. Motivation, emotion, and goal direction in neural networks. For many years, the assumption was that unipolar depression is a reaction to life stressors, whereas bipolar depression is an unfolding of endogenous, biological processes. the contents by NLM or the National Institutes of Health. How Depression Is Diagnosed According to the DSM-5, Moderate Depression: Symptoms, Treatment, and Coping, What Influences Your Mood?and How to Improve Your Mood, Psychomotor Retardation: Symptoms, Causes, Treatment, What to Know About Lamictal (Lamotrigine), Daily Tips for a Healthy Mind to Your Inbox. Despite the many parallels, one set of striking differences emerges. Fall-off in the reporting of life events. At this stage, the field remains focused on identifying correlates of episodes, which are then hoped to help reveal mechanisms that will guide course. National Institute of Mental Health (NIMH). A classification based on an understanding of pathogenesis still lies some years in the future. Angst J. Developing detailed diagnostic assessments which take account of the symptom profile and course of depressive episodes, similar to the probabilistic approach suggested by Mitchell et al, could potentially identify young adults with depression who may be at high risk of bipolar disorder. Farisse, Jean Instead, a distinct set of biological (Chiaroni et al., 2000; El-Mallakh, Li, Worth, & Peiper, 1996; Johnson, Winters, & Meyers, in press), personality (Meyer, Johnson, & Carver, 1999; Strakowski, Stoll, Tohen, Faedda, & Goodwin, 1993; von Zerssen, 1996; Young et al., 1995), and life event (Johnson, Sandrow et al., 2000; Malkoff-Schwartz et al., 1998) variables appear to predict mania. Depressed mood: A person feels sad or depressed for the majority of the day on most days. Many studies in this field, including our initial publications, have focused on episodes. This means that a substantial proportion of patients currently diagnosed as having major depressive disorder may qualify for a bipolar disorder diagnosis. Akiskal HS, Pinto O. We turn towards a review of course parameters and psychosocial triggers next. Nevertheless, the onset of depression was not examined separately. The https:// ensures that you are connecting to the Here, we broaden the question to include the evidence from studies of course and of psychosocial triggers. Unipolar and bipolar depression: different or the same? Total loading time: 0 Ingram, Bernet, & McLaughlin, 1994). In: Frankiel RV, editor. Both preclinical and clinical studies suggest that dopamine activity increases in response to sleep deprivation. Guo, Fanjia Testing this will require more careful longitudinal research. Affect, cognition, and change: Re-modelling depressive thought. DeRubeis RJ, Crits-Christoph P. Empirically supported individual and group psychological treatments for adult mental disorders. Unipolar depression: diagnostic and therapeutic recommendations from Among participants with a history of hypomania, those with no history of depression did not differ from normal controls in terms of negative cognitive style. Perris H. A study of bipolar and unipolar recurrent depressive psychoses. L-tryptophan in mania. As such, we focus our review on articles that specifically compare episodes of depression within unipolar and bipolar disorders. Dorz S, Borgherini G, Conforti D, Scarso C, Magni G. Depression in inpatients: Bipolar vs. unipolar. 2020. 2014;14:107. doi:10.1186/1471-244X-14-107, Cuellar A, Johnson S, Winters R. Distinctions between bipolar and unipolar depression. Essential papers in psychoanalysis. Salvador, Raymond One way in which genetic vulnerability may manifest itself is in brain pathology associated with mood disorders. One way to assess regulatory strength in patients with affective disorders is to provide a challenge to the underlying neurobiological systems; low regulatory strength would be reflected in a larger response to challenge. Serotonin function and the mechanism of antidepressant action: Reversal of antidepressant-induced remission by rapid depletion of plasma tryptophan. Mundler, Olivier Categorizing episodes by polarity, then, might obscure relatively common depressive symptoms within a manic episode. The current nomenclature of bipolar and unipolar disorders has resulted in research that compares these disorders as a whole, without considering depression separately from mania within bipolar disorder. Biogenic amines and affective disorders. Similarly, CSF levels of the 5-HT metabolite 5-HIAA of patients with both unipolar and bipolar depression were significantly lower than healthy controls matched for sex, age, and body weight (Asberg et al., 1984). Maes M, Meltzer HY. A. Prozac B. Imipramine C. Haldol D. Lithium D.