Depression and bipolar disorder not so different

New research into the nature of mood disorders has found that bipolar disorder and recurrent depression are not as different as we tend to treat them.

Individuals with bipolar disorder experience severe shifts in mood between depression and mania recurring throughout their lives. Similarly, those with recurrent depression experience multiple episodes of depression throughout life.

Until now, we have treated these disorders as two separate diseases with different treatment strategies. Now, new research from Johns Hopkins School of Medicine and George Washington University in the US is creating an argument for reclassifying the conditions.

According to these doctors, treating bipolar disorder and recurrent unipolar depression as different diseases results in misdiagnosis and ineffective treatment.

With the exception of a lack of true manic episodes, recurrent unipolar depression is very similar to bipolar disorder. Unipolar depression can have many symptoms generally associated with bipolar disorder including agitation, racing thoughts, overspending and psychotic symptoms.

Similarly, unipolar and bipolar disorders can occur in the same families and some studies suggest there are no significant differences between the disorders with regard to familial rates.

Researchers believe these two illnesses may actually be different manifestations of the same disease and may benefit from similar treatments.

Individuals with recurrent unipolar depression are usually treated in the same way as those who experience only one or two bouts of depression in their lives. Antidepressant medication and cognitive behaviour therapy are prescribed.

However, those with bipolar disorder are prescribed a mood stabilizing medication such as lithium and divalproex sodium and are not put on antidepressants alone. It is increasingly common for a combination of medication to be used since no one medication seems to be equally effective for both depression and mania. Treatment with antidepressants in the absence of a mood stablilizer puts a bipolar patient at risk of cycling out of depression and into mania, or creates instability of mood.

Doctors involved in this research say that a person who experiences multiple depressive episodes beginning in early adulthood will likely respond best to the same medical and clinical treatment as someone with bipolar disorder. Research spanning 17 years shows recurring depression is more similar to bipolar disorder than it is to single episode depression. Doctors involved in the study say lithium should be seen as a medication to prevent mood cycling rather than something only to be used for bipolar disorder.

As research discovers more about these disorders, they seem much less black and white than was initially assumed. We are likely to continue seeing evidence of this overlap between conditions in future neuroimaging studies and genetic findings.

Matters are further complicated when you consider other illnesses that often co-exist with depression or bipolar disorder. There is some overlap in symptoms with personality disorders, ADHD, anxiety disorders, substance abuse disorders and various impulse control disorders. All the overlap and subtleties in each individual's illness leave plenty of room for the art of medicine. There is by no means one cut and dry strategy for best treating any particular set of symptoms.

Okanagan Clinical Trials currently has ongoing studies in both unipolar and bipolar depressions. To learn more about these studies or to schedule a free, no obligation medical assessment, contact our office.


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