In the last three years, Philip Mitchell has received an honorarium from AstraZeneca for a presentation. He has not served on any pharmaceutical industry advisory board over that period. Gin Malhi has served on advisory boards for GlaxoSmithKline, Wyeth and Eli Lilly, and received honoraria from Pfizer, AstraZeneca, Organon and Lundbeck in the last 3 years. He has also been the recipient of an Eli Lilly Young Investigator Bipolar Research Award.
Bipolar depression: phenomenological overview and clinical characteristics
Article first published online: 12 NOV 2004
Volume 6, Issue 6, pages 530–539, December 2004
How to Cite
Mitchell, P. B. and Malhi, G. S. (2004), Bipolar depression: phenomenological overview and clinical characteristics. Bipolar Disorders, 6: 530–539. doi: 10.1111/j.1399-5618.2004.00137.x
- Issue published online: 12 NOV 2004
- Article first published online: 12 NOV 2004
- Received 8 October 2003, revised and accepted for publication 14 June 2004
- bipolar depression;
- bipolar disorder;
Objectives: There has been increasing interest in the depressed phase of bipolar disorder (bipolar depression). This paper aims to review the clinical characteristics of bipolar depression, focusing upon its prevalence and phenomenology, related neuropsychological dysfunction, suicidal behaviour, disability and treatment responsiveness.
Methods: Studies on the prevalence of depression in bipolar disorder, the comparative phenomenology of bipolar and unipolar depression, as well as neuropsychology and brain imaging studies, are reviewed. To identify relevant papers, a literature search using MEDLINE and PubMed was undertaken.
Results: Depression is the predominant mood disturbance in bipolar disorder, and most frequently presents as subsyndromal, minor or dysthymic depression. Compared with major depressive disorder (unipolar depression), bipolar depression is more likely to manifest with psychosis, melancholic symptoms, psychomotor retardation (in bipolar I disorder) and ‘atypical’ symptoms. The few neuropsychological studies undertaken indicate greater impairment in bipolar depression. Suicide rates are high in bipolar disorder, with suicidal ideation, suicide attempts and completed suicides all occurring predominantly in the depressed phase of this condition. Furthermore, the depressed phase (even subsyndromal) appears to be the major contributant to the disability related to this condition.
Conclusions: The significance of the depressed phase of bipolar disorder has been markedly underestimated. Bipolar depression accounts for most of the morbidity and mortality due to this illness. Current treatments have significant limitations.