Symptoms and Characteristics of Youth Hospitalized for Depression: Subthreshold Manic Symptoms Can Help Differentiate Bipolar from Unipolar Depression

2021 ◽  
Author(s):  
Anna Van Meter ◽  
Christoph U. Correll ◽  
Wasiq Ahmad ◽  
Morganne Dulin ◽  
Ema Saito
Keyword(s):  
Unipolar Depression ◽  
Manic Symptoms

Mood Disorders

2017 ◽  
Author(s):  
Hasan A Baloch ◽  
Jair C. Soares
Keyword(s):  
Bipolar Disorder ◽  
Mood Disorders ◽  
Gray Matter ◽  
Affective Disorders ◽  
Unipolar Depression ◽  
Diagnosis And Treatment ◽  
Bipolar Spectrum ◽  
Manic Symptoms ◽  
Lifetime History ◽  
History Of

Affective disorders are among the most common disorders in psychiatry. They are generally classified according to the persistence and extent of symptoms and by the polarity of these symptoms. The two poles of the affective spectrum are mania and depression. Bipolar disorder is characterized by the presence of the mania or hypomania and often depression. Unipolar depression is defined by depression in the absence of a lifetime history of mania or hypomania. These differences are not merely categorical but have important implications for the prognosis and treatment of these conditions. Bipolar disorder, for example, is better treated using mood-stabilizing medication, whereas unipolar depression responds optimally to antidepressant medications. In addition, prognostically, unipolar depression may sometimes be limited to one episode in a lifetime, whereas bipolar disorder is typically a lifelong condition. The course of both conditions, however, is often chronic, and frequently patients can present with unipolar depression only to later develop manic symptoms. A thorough understanding of both conditions is therefore required to treat patients presenting with affective symptomatology. This chapter discusses the epidemiology, etiology and genetics, pathogenesis, diagnosis, and treatment of unipolar depression and bipolar disorder. Figures illustrate gray matter differences with lithium use and the bipolar spectrum. Tables list the pharmacokinetics of commonly used antidepressants and medications commonly used in the treatment of bipolar disorder. This review contains 2 figures, 2 tables, and 136 references.

Mania following antidepressant discontinuation in depression: two case reports

2017 ◽  
Vol 25 (6) ◽  
pp. 617-621 ◽  
Author(s):  
Cecilia Sze Nga Kwok ◽  
Leslie Eng Choon Lim
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Tricyclic Antidepressants ◽  
Standard Treatment ◽  
Late Onset ◽  
Case Reports ◽  
Asian Population ◽  
Unipolar Depression ◽  
Chinese Patients ◽  
Manic Symptoms ◽  
History Of

Objective: Antidepressant-induced mania and an antidepressant discontinuation syndrome are well documented, whereas mania occurring after antidepressant cessation has been infrequently reported. Method: We describe antidepressant discontinuation-related mania in two Chinese patients, as well as a review of the literature on this phenomenon in unipolar depression. Results: A 72-year-old man and a 65-year-old woman had late-onset depression with vascular risk factors, but no personal or family history of mood disorders. Manic symptoms started after stopping escitalopram and venlafaxine during depressive relapse, and resolved with the initiation of olanzapine and valproate. In the literature, 29 episodes of antidepressant discontinuation-related mania were reported. Tricyclic antidepressants were most frequently implicated, followed by selective serotonin reuptake inhibitors. There was spontaneous resolution of manic symptoms in half of the cases. Conclusion: This is the first report of antidepressant discontinuation-related mania in an Asian population, in the setting of late-onset depression. This phenomenon is rare and is amenable to standard treatment.

Mood Disorders

2010 ◽  
Author(s):  
Hasan A Baloch ◽  
Jair C. Soares
Keyword(s):  
Bipolar Disorder ◽  
Mood Disorders ◽  
Gray Matter ◽  
Affective Disorders ◽  
Unipolar Depression ◽  
Diagnosis And Treatment ◽  
Bipolar Spectrum ◽  
Manic Symptoms ◽  
Lifetime History ◽  
History Of

Affective disorders are among the most common disorders in psychiatry. They are generally classified according to the persistence and extent of symptoms and by the polarity of these symptoms. The two poles of the affective spectrum are mania and depression. Bipolar disorder is characterized by the presence of the mania or hypomania and often depression. Unipolar depression is defined by depression in the absence of a lifetime history of mania or hypomania. These differences are not merely categorical but have important implications for the prognosis and treatment of these conditions. Bipolar disorder, for example, is better treated using mood-stabilizing medication, whereas unipolar depression responds optimally to antidepressant medications. In addition, prognostically, unipolar depression may sometimes be limited to one episode in a lifetime, whereas bipolar disorder is typically a lifelong condition. The course of both conditions, however, is often chronic, and frequently patients can present with unipolar depression only to later develop manic symptoms. A thorough understanding of both conditions is therefore required to treat patients presenting with affective symptomatology. This chapter discusses the epidemiology, etiology and genetics, pathogenesis, diagnosis, and treatment of unipolar depression and bipolar disorder. Figures illustrate gray matter differences with lithium use and the bipolar spectrum. Tables list the pharmacokinetics of commonly used antidepressants and medications commonly used in the treatment of bipolar disorder. This review contains 2 figures, 2 tables, and 135 references.

scholarly journals Unrecognised bipolar disorder in primary care patients with depression

2011 ◽  
Vol 199 (1) ◽  
pp. 49-56 ◽  
Author(s):  
Daniel J. Smith ◽  
Emily Griffiths ◽  
Mark Kelly ◽  
Kerry Hood ◽  
Nick Craddock ◽  
...  
Keyword(s):  
Primary Care ◽  
Bipolar Disorder ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Psychosocial Functioning ◽  
Unipolar Depression ◽  
Major Depressive ◽  
Manic Symptoms ◽  
History Of ◽  
Primary Care Patients

BackgroundBipolar disorder is complex and can be difficult to diagnose. It is often misdiagnosed as recurrent major depressive disorder.AimsWe had three main aims. To estimate the proportion of primary care patients with a working diagnosis of unipolar depression who satisfy DSM–IV criteria for bipolar disorder. To test two screening instruments for bipolar disorder (the Hypomania Checklist (HCL–32) and Bipolar Spectrum Diagnostic Scale (BSDS)) within a primary care sample. To assess whether individuals with major depressive disorder with subthreshold manic symptoms differ from those individuals with major depressive disorder but with no or little history of manic symptoms in terms of clinical course, psychosocial functioning and quality of life.MethodTwo-phase screening study in primary care.ResultsThree estimates of the prevalence of undiagnosed bipolar disorder were obtained: 21.6%, 9.6% and 3.3%. The HCL–32 and BSDS questionnaires had quite low positive predictive values (50.0 and 30.1% respectively). Participants with major depressive disorder and with a history of subthreshold manic symptoms differed from those participants with no or little history of manic symptoms on several clinical features and on measures of both psychosocial functioning and quality of life.ConclusionsBetween 3.3 and 21.6% of primary care patients with unipolar depression may have an undiagnosed bipolar disorder. The HCL–32 and BSDS screening questionnaires may be more useful for detecting broader definitions of bipolar disorder than DSM–IV-defined bipolar disorder. Subdiagnostic features of bipolar disorder are relatively common in primary care patients with unipolar depression and are associated with a more morbid course of illness. Future classifications of recurrent depression should include dimensional measures of bipolar symptoms.

Diagnosis, classification, and differential diagnosis of mood disorders

2020 ◽  
pp. 681-690
Author(s):  
S. Nassir Ghaemi ◽  
Sivan Mauer
Keyword(s):  
Differential Diagnosis ◽  
Scientific Evidence ◽  
Unipolar Depression ◽  
Depressive Illness ◽  
Manic Depressive Illness ◽  
Bipolar Illness ◽  
Manic Symptoms ◽  
Manic Depressive ◽  
Biological Aspects ◽  
Depressive Subtypes

This chapter discusses DSM and non-DSM definitions and approaches to mood illness. Before 1980, the concept of manic–depressive illness (MDI) meant both bipolar illness and recurrent unipolar depression. Evidence on diagnostic validators since 1980 has not strengthened that claim and may be interpreted to support the original MDI concept, that is, that bipolar illness and unipolar depression are part of the same overall disease (MDI). As a corollary, the concept of major depressive disorder (MDD) may represent a spectrum of different depressive subtypes: mixed (depression with manic symptoms), melancholic, pure, vascular, and neurotic depression. Each subtype differs from the other, based on diagnostic validators of course, genetics, and biological aspects and/or treatment effects. The scientific evidence for this heterogeneity of MDD appears to weaken the claim dating to DSM-III in 1980 that this condition is a different diagnosis/illness from bipolar disorder. The differential diagnosis of mood conditions is described.

Mood Disorders

2017 ◽  
Author(s):  
Hasan A Baloch ◽  
Jair C. Soares
Keyword(s):  
Bipolar Disorder ◽  
Mood Disorders ◽  
Gray Matter ◽  
Affective Disorders ◽  
Unipolar Depression ◽  
Diagnosis And Treatment ◽  
Bipolar Spectrum ◽  
Manic Symptoms ◽  
Lifetime History ◽  
History Of

Affective disorders are among the most common disorders in psychiatry. They are generally classified according to the persistence and extent of symptoms and by the polarity of these symptoms. The two poles of the affective spectrum are mania and depression. Bipolar disorder is characterized by the presence of the mania or hypomania and often depression. Unipolar depression is defined by depression in the absence of a lifetime history of mania or hypomania. These differences are not merely categorical but have important implications for the prognosis and treatment of these conditions. Bipolar disorder, for example, is better treated using mood-stabilizing medication, whereas unipolar depression responds optimally to antidepressant medications. In addition, prognostically, unipolar depression may sometimes be limited to one episode in a lifetime, whereas bipolar disorder is typically a lifelong condition. The course of both conditions, however, is often chronic, and frequently patients can present with unipolar depression only to later develop manic symptoms. A thorough understanding of both conditions is therefore required to treat patients presenting with affective symptomatology. This chapter discusses the epidemiology, etiology and genetics, pathogenesis, diagnosis, and treatment of unipolar depression and bipolar disorder. Figures illustrate gray matter differences with lithium use and the bipolar spectrum. Tables list the pharmacokinetics of commonly used antidepressants and medications commonly used in the treatment of bipolar disorder. This review contains 2 figures, 2 tables, and 136 references.

Mood Disorders

2017 ◽  
Author(s):  
Hasan A Baloch ◽  
Jair C. Soares
Keyword(s):  
Bipolar Disorder ◽  
Mood Disorders ◽  
Gray Matter ◽  
Affective Disorders ◽  
Unipolar Depression ◽  
Diagnosis And Treatment ◽  
Bipolar Spectrum ◽  
Manic Symptoms ◽  
Lifetime History ◽  
History Of

Affective disorders are among the most common disorders in psychiatry. They are generally classified according to the persistence and extent of symptoms and by the polarity of these symptoms. The two poles of the affective spectrum are mania and depression. Bipolar disorder is characterized by the presence of the mania or hypomania and often depression. Unipolar depression is defined by depression in the absence of a lifetime history of mania or hypomania. These differences are not merely categorical but have important implications for the prognosis and treatment of these conditions. Bipolar disorder, for example, is better treated using mood-stabilizing medication, whereas unipolar depression responds optimally to antidepressant medications. In addition, prognostically, unipolar depression may sometimes be limited to one episode in a lifetime, whereas bipolar disorder is typically a lifelong condition. The course of both conditions, however, is often chronic, and frequently patients can present with unipolar depression only to later develop manic symptoms. A thorough understanding of both conditions is therefore required to treat patients presenting with affective symptomatology. This chapter discusses the epidemiology, etiology and genetics, pathogenesis, diagnosis, and treatment of unipolar depression and bipolar disorder. Figures illustrate gray matter differences with lithium use and the bipolar spectrum. Tables list the pharmacokinetics of commonly used antidepressants and medications commonly used in the treatment of bipolar disorder. This review contains 2 figures, 2 tables, and 136 references.

Bipolar I and II versus unipolar depression: Clinical differences and impulsivity/aggression traits

2015 ◽  
Vol 30 (1) ◽  
pp. 106-113 ◽  
Author(s):  
K. Dervic ◽  
M. Garcia-Amador ◽  
K. Sudol ◽  
P. Freed ◽  
D.A. Brent ◽  
...  
Keyword(s):  
Depressive Episode ◽  
Life Time ◽  
Unipolar Depression ◽  
Demographic Variables ◽  
Manic Symptoms ◽  
Depressed Patients ◽  
Bipolar Ii ◽  
Trait Impulsivity ◽  
History Of ◽  
Distinguishing Features

AbstractObjective:To investigate distinguishing features between bipolar I, II and unipolar depression, and impulsivity/aggression traits in particular.Methods:Six hundred and eighty-five (n = 685) patients in a major depressive episode with lifetime Unipolar (UP) depression (n = 455), Bipolar I (BP-I) disorder (n = 151), and Bipolar II (BP-II) (n = 79) disorder were compared in terms of their socio-demographic and clinical characteristics.Results:Compared to unipolar patients, BP-I and BP-II depressed patients were significantly younger at onset of their first depressive episode, and were more likely to experience their first depressive episode before/at age of 15. They also had more previous affective episodes, more first- and second-degree relatives with history of mania, more current psychotic and subsyndromal manic symptoms, and received psychopharmacological and psychotherapy treatment at an earlier age. Furthermore, BP-I and BP-II depressed patients had higher lifetime impulsivity, aggression, and hostility scores. With regard to bipolar subtypes, BP-I patients had more trait-impulsivity and lifetime aggression than BP-II patients whereas the latter had more hostility than BP-I patients. As for co-morbid disorders, Cluster A and B Personality Disorders, alcohol and substance abuse/dependence and anxiety disorders were more prevalent in BP-I and BP-II than in unipolar patients. Whereas the three groups did not differ on other socio-demographic variables, BP-I patients were significantly more often unemployed that UP patients.Conclusion:Our findings comport with major previous findings on differences between bipolar and unipolar depression. As for trait characteristics, bipolar I and II depressed patients had more life-time impulsivity and aggression/hostility than unipolar patients. In addition, bipolar I and II patients also differed on these trait characteristics.

scholarly journals Mixed features in bipolar disorder

CNS Spectrums ◽  
2016 ◽  
Vol 22 (2) ◽  
pp. 134-140 ◽  
Author(s):  
Eva Solé ◽  
Marina Garriga ◽  
Marc Valentí ◽  
Eduard Vieta
Keyword(s):  
Bipolar Disorder ◽  
Diagnostic Category ◽  
Specific Treatment ◽  
Unipolar Depression ◽  
Manic Symptoms ◽  
Dsm 5 ◽  
Increased Risk ◽  
Mixed Features ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Mixed affective states, defined as the coexistence of depressive and manic symptoms, are complex presentations of manic-depressive illness that represent a challenge for clinicians at the levels of diagnosis, classification, and pharmacological treatment. The evidence shows that patients with bipolar disorder who have manic/hypomanic or depressive episodes with mixed features tend to have a more severe form of bipolar disorder along with a worse course of illness and higher rates of comorbid conditions than those with non-mixed presentations. In the updated Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5), the definition of “mixed episode” has been removed, and subthreshold nonoverlapping symptoms of the opposite pole are captured using a “with mixed features” specifier applied to manic, hypomanic, and major depressive episodes. However, the list of symptoms proposed in the DSM–5 specifier has been widely criticized, because it includes typical manic symptoms (such as elevated mood and grandiosity) that are rare among patients with mixed depression, while excluding symptoms (such as irritability, psychomotor agitation, and distractibility) that are frequently reported in these patients. With the new classification, mixed depressive episodes are three times more common in bipolar II compared with unipolar depression, which partly contributes to the increased risk of suicide observed in bipolar depression compared to unipolar depression. Therefore, a specific diagnostic category would imply an increased diagnostic sensitivity, would help to foster early identification of symptoms and ensure specific treatment, as well as play a role in suicide prevention in this population.

Suicidal Behavior in German Adolescents

2015 ◽  
Vol 43 (1) ◽  
pp. 39-45 ◽  
Author(s):  
Joana Straub ◽  
Ferdinand Keller ◽  
Nina Sproeber ◽  
Michael G. Koelch ◽  
Paul L. Plener
Keyword(s):  
Suicidal Behavior ◽  
Suicide Attempts ◽  
Depression Scale ◽  
Epidemiological Studies ◽  
Present Sample ◽  
Manic Symptoms ◽  
Symptoms Of Depression ◽  
Adolescent Sample ◽  
History Of ◽  
Sum Scores

Objective: Research in adults has identified an association between bipolar disorder and suicidal behavior. This relationship, however, has been insufficiently investigated in adolescents to date. Methods: 1,117 adolescents from 13 German schools (mean age = 14.83, SD = .63; 52.7% females) completed an extended German version of the Center for Epidemiological Studies Depression Scale (CES-D), which assesses depressive and manic symptoms during the last week, as well as the Self-Harm Behavior Questionnaire (SHBQ) for the assessment of lifetime suicidal behavior. Results: In the present sample 39.4% of the girls and 23.1% of the boys reported lifetime suicidal thoughts and 7.1% of the girls as well as 3.9% of the boys a lifetime history of suicide attempts. 18.7% of the adolescent sample revealed elevated symptoms of depression and 9% elevated levels of mania symptoms. Elevated sum scores of depression and mania were associated with a higher number of suicidal ideations and suicide attempts. A block-wise regression analysis revealed that sum scores of depression and mania predicted suicidal ideations best. Concerning suicide attempts, the best predictors were age as well as depression and mania sum scores. Conclusions: Suicidal behavior was reported more often when adolescents demonstrate symptoms of mania as well as symptoms of depression than when they demonstrate only depressive symptoms. The presence of bipolar symptoms in adolescents should alert clinicians to the heightened possibility of suicidal behavior.

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