The clinical diagnosis of bipolar depression

  • Gordon B. Parker
  • Kathryn Fletcher
Part of the Milestones in Drug Therapy book series (MDT)


‘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.


Depressive Episode Bipolar Depression Manic Episode Unipolar Depression Psychotic Feature 


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Copyright information

© Birkhäuser Verlag/Switzerland 2009

Authors and Affiliations

  • Gordon B. Parker
    • 1
  • Kathryn Fletcher
    • 2
  1. 1.Black Dog InstitutePrince of Wales HospitalSydneyAustralia
  2. 2.School of PsychiatryUniversity of New South WalesSydneyAustralia

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