Distinguishing Bipolar Disorder from Major Depressive Disorder

Bipolar Bozukluk ile Majör Depresif Bozukluğu Ayırt Etme

It could be difficult to distinguish bipolar disorder (BD) from major depressive disorder (MDD) during depressive periods. A misdiagnosis could lead to delays in effective treatment, or an exposure to false treatment.

Psychomotor retardation or agitation, cognitive disorders, mood changes, or psychosis can be among the more prevalent disorder characteristics observed in BD. Furthermore, even though the disorder can start in the peripartum period or at early ages, none of those factors are sufficient to guarantee a bipolar diagnosis. An attentive and systematic assessment for current or past manic or hypomanic symptoms, enables accurate diagnoses. 

Although clinically different, it has been proven that it is particularly difficult to distinguish bipolar depression, and more specifically, the depressive phase of bipolar type 2 (BP-2), from MDD. It is not surprising that it is difficult to distinguish BP-2 in a cross-sectional manner, considering the fact that a great majority of BP-2 patients apply for treatment when they are in depression, and not when they are hypomanic. In general, while the main focus is on the treatment and prevention of manic/hypomanic attacks in BD, the MDD treatment focuses solely on depressive symptoms and on the prevention of depression.

The earlier the start of the mood periods is, the bigger the concerns should be for a bipolar progress. The gender distribution of mood disorders also represents an area of difference between MDD and BD.

The fact that MDD differs from BP-2 can be particularly significant, in that women experience these disorders more frequently than men do. A study put forward that panic-like nervousness in the form of “temper tantrums”, is more prevalent in BD than it is in unipolar depression. Atypical neurovegetative symptoms (hypersomnia and hyperphagia) can be more common in BP-2 depressive periods. In another study, it was shown that BP-2 patients, when compared to MDD, had more suicidal tendencies, and that they had higher levels of psychomotor discomfort and agitation.

Misdiagnosis and false treatment could be prevented by distinguishing these two disorders in a more effective manner.

An individual gets diagnosed with bipolar disorder type 1 if he has at least one manic period, and with bipolar disorder type 2 if he has at least one depression and hypomania period.

REFERENCES:
Vöhringer, PA ve Perlis, RH (2016). Bipolar Bozukluk ve Majör Depresif Bozukluğu Ayırım. Kuzey Amerika Psikiyatri Klinikleri, 39 (1), 1-10. doi: 10.1016 / j.psc.2015.10.001

Prof. Dr. Kemal Arıkan
Psychiatrist