Bipolar depression

Depressive episodes as well as subsyndromal depressive symptoms dominate the course of bipolar disorder and are highly associated with the high morbidity and mortality of this disease. Clinical and epidemiologic characteristics can be helpful for the adequate diagnostic classification of a depressive syndrome: An early age at onset, first grade relatives presenting bipolar disorder, rapid onset of depressive symptomatology, comorbidity with an anxiety disorder or substance abuse as well as symptoms of atypical depression are significantly more frequent in bipolar depressive patients than in unipolar patients. Treatment of bipolar depression should always be initiated with an antidepressive effective mood stabilizer. Antidepressants show only limited benefits in bipolar depression and hold the risk of induction of mania or cycle acceleration. However, this phenomena seems to be more pronounced in specific groups of antidepressants like tricyclics than for example in SSRI's. Other non-pharmacological, biological treatments like sleep deprivation and electroconvulsive therapy are also highly effective in treating bipolar depression as well as the implementation of disorder specific psychotherapeutic treatments.