Differences in Treatments between Depression and Bipolar Disorder

November 29, 2023

Differences in Treatments between Depression and Bipolar Disorder

Drug treatment through antidepressants is known to be very effective for severe depression that interferes with daily life. While cognitive behavioral therapy is recommended as a primary treatment for mild or moderate major depressive disorder (hereinafter referred to as depression), drug treatment plays a very important role for depression that severely disrupts daily life. Then, should we proceed with drug treatment quickly when suspected of depression? While we often talk about depression as a common cold of the mind, why is the diagnosis of depression carefully made under the judgment of a psychiatrist?

This is because there are cases where antidepressants shouldn't be taken even though one is depressed. Of course, it is well proven that when diagnosed with depression, the symptoms of depression, lack of motivation, sleep and appetite problems improve when antidepressants are taken regularly over a sufficient period.

Antidepressant consumption triggers a manic phase

However, depression does not only occur in major depressive disorder. It can also occur in a disorder called bipolar disorder (also known as manic depression). The problem here is that if a patient with bipolar disorder takes antidepressants, a manic phase may occur soon. In fact, bipolar disorder refers to a state where the balance between depression and hyperthymia is broken. What happens when one side is suppressed in such a state? Our body quickly changes to a state of mania.

Symptoms of depression suggesting bipolar disorder

Although depression and bipolar disorder both have the similarity that they can cause depression, the causes and clinical aspects of both disorders are different and the methods of treatment also differ, so it is very important to distinguish between the two disorders and make an accurate diagnosis. Then, what signs suggest that depression stems from bipolar disorder when feeling depressed? The following can be summarized:

  • Experiencing periods of hyperthymia and excessive energy in the past.
  • Having a family member diagnosed with bipolar disorder in first-degree relations.
  • Having a congenital hyperthymic or hypersensitive temperament.
  • The onset of depression occurred before the age of 25.
  • Recurrent depression more than 3 times.
  • Experiencing a brief depression within 3 months.
  • Having experienced postnatal depression.
  • Diagnosed with depression, but eating and sleeping more.
  • Diagnosed with depression, but showing positive emotions (joy, happiness).
  • Diagnosed with depression, but being restless and active.

Pharmacological treatment of bipolar disorder requires mood stabilizers

In case of showing such a clinical course, a more detailed diagnosis is needed. It is a good idea to actively share these contents with your doctor if possible. If diagnosed with bipolar disorder and not depression, you should take 'mood stabilizers' instead of 'antidepressants'. Mood stabilizers, as the name suggests, enhance the ability to regulate mood. In other words, it helps maintain balance between depression and hyperthymia.

Differentiating between Depression and Bipolar Disorder is Difficult

However, it is not easy to distinguish between depression and bipolar disorder. Typically, when visiting the hospital for the first time with depression, diagnosis is made differently depending on the presence or absence of past mania or hypomania, but this process is not easy, and over half of the patients with bipolar disorder start with depression as their first illness experience, and it takes an average of more than 6 years for the manic phase to occur after this. In fact, 10-20% of patients diagnosed with major depressive disorder ultimately experience a manic phase and the diagnosis may change to bipolar disorder.

Such difficulty makes it hard for psychiatrists to differentiate between depression and bipolar disorder. Therefore, it is important to visit a hospital and receive an evaluation rather than making a rough self-diagnosis. If there's even a slight suspicion, it's important to seek help with an open mind.

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