The clinical diagnosis of bipolar depression
‘Bipolar depression is not a specific type of depression, with most episodes phenotypically weighted to melancholic or psychotic depression. In order to improve our understanding of the etiology and management of bipolar depression, sub-typing heterogeneity should be constrained. A ‘top-down’ approach to delineate specific sub-typing characteristics is suggested, allowing consideration as to whether ‘bipolar depression’ differs in expression across bipolar I (BPD I) and II (BPD II) disorders. Current diagnostic systems employ imprecise criteria to differentiate sub-types of BPD, disallowing ‘top-down’ studies seeking to identify prototypical bipolar depression features.
We describe a categorical ‘isomer’ model, assisting discrimination between bipolar subtypes and unipolar depressive disorders. In essence, the respective presence or absence of psychotic features differentiates BPD I from BPD II, with a core elevated mood/energy construct delineating BPD from unipolar disorders. Our model allows a ‘top-down’ approach to clinical diagnosis, versus the questionable validity of the bipolar spectrum ‘soft signs’ approach.
KeywordsDepressive Episode Bipolar Depression Manic Episode Unipolar Depression Psychotic Feature
Unable to display preview. Download preview PDF.
- 1.Parker G, Hadzi-Pavlovic D (eds): (1996) Melancholia: A disorder of movement and mood. Cambridge University Press, New YorkGoogle Scholar
- 2.American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. (DSM-IV). APA, Washington DCGoogle Scholar
- 3.Parker G, Manicavasagar V (eds): (2005) Modelling and managing the depressive disorders. Cambridge University Press, CambridgeGoogle Scholar
- 4.World Health Organization (1992) International statistical classification of diseases and related health problems. Tenth revision (ICD-10). WHO, GenevaGoogle Scholar
- 7.Mitchell P, Sengoz A(1996) Phenotypic expression of melancholia contrasted for those with bipolar and unipolar illness courses. In: G Parker, D Hadzi-Pavlovic (eds): Melancholia: A disorder of movement and mood. Cambridge University Press, New York, 172–178Google Scholar
- 8.Phelps J (2008) The bipolar spectrum. In: G Parker (ed.): Bipolar II disorder. Modelling, measuring and managing. Cambridge University Press, Cambridge, 15–45Google Scholar
- 10.Jamison KR (2005) Exuberance: The passion for life. Vintage Books, USAGoogle Scholar
- 17.Thase ME, Frank E, Kornstein SG, Yonkers KA (2000) Gender differences in response to treatments of depression. In: E Frank (ed.): Gender and its effects on psychopathology. American Psychiatric Press, Washington DC, 103–129Google Scholar