The Clinical Features of Bipolar Depression: A Comparison With Matched Major Depressive Disorder Patients
J Clin Psychiatry 2001;62(3):212-216
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Despite a resurgence of interest in
the treatment of bipolar depression, there have been few
controlled studies of the clinical characteristics of this
condition. Identification of any distinctive clinical
"signatures" of bipolar depression would be helpful in
determining treatment options in the clinical setting.
Method: From a cohort of 270 inpatients and
outpatients assessed in detail during a DSM-IV major depressive
episode, 39 bipolar I disorder patients were identified and
closely matched with 39 major depressive disorder patients for
gender, age, and the presence or absence of DSM-IV melancholic
subtype. Patients were compared on a broad range of parameters
including the Hamilton Rating Scale for Depression (depression
severity), 54 depressive symptoms, the Newcastle Endogenous
Depression Diagnostic Index, 3 family history items, 2 physical
health items, the CORE scale (psychomotor disturbance), and 5
Results: Although the bipolar patients were no
more severely depressed than the major depressive disorder
controls, they were more likely to demonstrate
psychomotor-retarded melancholic and atypical depressive features
and to have had previous episodes of psychotic depression. These
findings were largely duplicated even when the population was
confined to those with DSM-IV melancholia.
Conclusion: The clinical admixture of
psychomotor-retarded melancholic signs and symptoms,
"atypical" features, and (less frequently) psychosis
may provide a "bipolar signature" in clinical scenarios
when there is uncertainty concerning the polarity of a depressive