Types of Depression More Frequent in Bipolar than in Unipolar Affective Illness: Results of the Polish DEP-BI Study

Abstract

Background: The aim of the study was to assess the relative frequency of various kinds of depression in patients with bipolar and unipolar affective illness. The study was performed in the framework of the DEP-BI project aimed at assessing the prevalence of bipolar disorders among depressive outpatients treated by psychiatrists in Poland. Methods: Eight-hundred and eighty patients (237 male, 643 female) participated in the study. The patients were classified into the following diagnostic categories: bipolar affective illness type I, type II, bipolar spectrum disorder and unipolar affective illness. The various kinds of depression in each group were assessed by means of a semistructured questionnaire added to the diagnostic interview. Results: In the group of bipolar patients, a significantly higher frequency of psychotic depression in male compared to female patients was observed. Male bipolar patients compared with unipolar depressed ones had significantly more episodes of psychotic depression (odds ratio, OR, 4.29) and atypical depression (hypersomnia and hyperphagia; OR 2.82), and those with bipolar spectrum had more episodes of treatment-resistant depression (OR 2.56). Female bipolar patients compared with unipolar depressed ones had significantly more frequently an early onset of depression (before 25 years; OR 2.95) and postpartum depression (OR 2.48). On the other hand, the percentage of agitation, irritability, distractibility, thought racing and panic attacks during depression was not different in patients with bipolar and unipolar affective illness either in males or females. Conclusions: Some kinds of depression occur with a higher frequency in patients with bipolar compared to unipolar affective illness. The occurrence of a given type of depression may constitute an aid for the diagnosis of bipolar illness. The results of this study did not confirm the concept of bipolar mixed depression based on the presence of anxiety symptoms occurring during the depressive episode. The limitation of our study may be the lack of formal criteria or a structured interview to assess the symptoms occurring during depressive episodes.

Atypical features in depression: Association with obesity and bipolar disorder

“…Each item has 4 possible answers, ranging from 0 to 3 where 0 ¼lack of symptom and 3 ¼extreme severity of that symptom. All the symptoms of atypical depression were more severe in bipolar depression than in other subtypes of depression that may correspond to the results of our studies showing higher prevalence of such symptoms of atypical depression as hypersomnia and hyperphagia in bipolar spectrum patients compared with unipolar ones (Rybakowski et al, 2005(Rybakowski et al, , 2007. In our present study, also other features of atypical depression such as leaden paralysis and increased weight gain as well as hypersomnia, increased appetite and rejection sensitivity were more often seen in bipolar patients.…”

“…In other studies, depression with atypical features (according to DSM-IV) has been estimated to be two times more likely in bipolar II than in unipolar patients (Benazzi, 2000(Benazzi, , 2003. In a Polish DEP-BI study, the most prominent symptoms of atypical depression, such as hypersomnia and hyperphagia were significantly more frequent in unipolar than in bipolar depressed patients (Rybakowski et al, 2005(Rybakowski et al, , 2007. Recently, hypersomnia has been recognized as an important clinical feature of bipolar depression (Forty et al, 2008) and some authors consider atypical depression as part of a broadly defined "bipolar spectrum" (Perugi et al, 1998(Perugi et al, , 2003Akiskal and Pinto, 1999;Akiskal and Benazzi, 2005).…”

Dyadic Adjustment Among Healthy Spouses of Bipolar I and Ii Disorder Patients

“…It should be also noted that in most analyses manic (BD type I) and hypomanic (BD type I and BD type II) phases are included into the same comparative group, which results in a lack of differentiation between the serious consequences of mania and potentially positive aspects of hypomania (Beentjes et al 2012). Depressive episodes also have a dissimilar course and during remission in particular BD subtypes the different subclinical symptoms may be present (Judd et al 2003, Rybakowski et al 2007). One can conclude that these issues have a significant impact on the perception of the ill life-partners by healthy spouses, and thus may be associated with dyadic adjustment as well.…”

Bipolar II disorder as a risk factor for postpartum depression

“…In particular, women with a diagnosis of Bipolar disorder (BD) have a high risk to develop a mood episode after giving birth (Freeman and Gelenberg, 2005;Leibenluft, 1996). This risk is even greater than the one reported in women with Major depressive disorder (MDD) (Kim et al, 2008;Rybakowski et al, 2007;Viguera et al, 2011). A large epidemiological study found that BD is the psychiatric illness that contributes more to a psychiatric readmission during the 12 months Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/jad after childbirth (Munk-Olsen et al, 2009).…”