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Bipolar Depression And Manic Depression: Where they differ?


Depression is a psychological state of mind where an individual may have an elevated or a decreased mood for prolonged periods of time. During the episodes of depression a person feels low, with decreased or increased appetite, insomnia or feeling sleepier, talking or walking too slowly or quickly that is noticeable by others. The person will also be characterized by decreased laugh at things which are enjoyable to others, for a period of at least two weeks. In severe conditions a person with depression can commit self harm and suicides.

Various psychiatric conditions like the mood disorders are associated with the state of depression either in the form of major depressive disorder or in the form of anxious depression. Mood disorders represent a group of disorders that are featured by primary disturbances of mood. They include the major depressive disorder (where a person suffers from at least two weeks of depressed mood), dysthymia (a state of chronic depression), bipolar disorder (having either abnormally elevated or depressed mood, cognition or energy levels that are unpredicted from their normal state) and seasonal affective disorders (depressive episodes linked to seasons).

From a molecular point of view, depression and mood disorders have been related to the brains reward and punishment centres namely the ventral tegmentum and nucleus accumbens. These centres and their associated neurons (nerve cells) are supposed to release certain neurotransmitters called serotonin, which attaches to the post synaptic receptors and maintains the mood of an individual or provides feelings of pleasure and happiness. However during the phases of depression the presynaptic serotonin receptors actively reuptake the serotonin molecules and hence leads to a decreased mood as serotonin availability in synapse decreases.

Bipolar disorders as described are a group of mood disorders where a person experiences sudden fluctuations in mood where episodes of excitement/joy and episodes of sadness co-exist. Bipolar disorder was earlier called manic depression, however currently there are other forms of bipolar disorder also and hence manic depression forms a category of broad range of bipolar disorders. A closer comparison of bipolar depression and manic depression is discussed in the following table:

Bipolar Depression Mania Depression
General Feature Sudden fluctuations in mood with episodes of high and low mood Is a form of bipolar disorder where there are always episodes of mania featured primarily by episodes of high mood.
Association with major depressive Episode May or may not be associated with major depression Always associated with major depression
Categorization and Classification Categorized as Bipolar 1 Disorder, Bipolar 2 Disorder, Cyclothymic disorder and Bipolar Disorder NOS(not otherwise specified) It represents the Bipolar 1 disorder, hence manic depression is no more used interchangeably with bipolar disorders as there can be other forms of bipolar disorder
Presence of hypomania and hyper mania Major depressive episodes are accompanied by hypomanic episodes Episodes of mania are usually characterized by either hyper mania or hypomania as mixed traits.
Nature and duration of the depression The hypomanic episodes mimics manic depression but are less intense and short lasting The depressive episode usually lasts for several weeks and months and features intense symptoms of mania that usually lasts long
Whole body functioning The body can show normal functioning between episodes of depression The body can show normal functioning between episodes of depression
Influence of seasons on depression severity Symptoms may be related to seasonal changes Symptoms may be related to seasonal changes
Nature of mood fluctuations Mood fluctuations may be regular or irregular with no defined frequency Mood fluctuations are always associated with fixed regular intervals.
Sub category special features In case of bipolar disorder of NOS category, only hypomanic episodes occur and there is total absence of depression Depression is always associated with hyper mania or hypomania
Presence of suicidal tendency Yes Yes
Restraining and prevention of suicidal tendency Suicidal tendency may or may not be easy to prevent Suicidal tendency is always difficult to prevent
Neurotransmitters involved Serotonin Serotonin
Management According to various forms starting from lithium supplements to selective serotonin re-uptake inhibitors (SSRI). Primarily treated with SSRI’s as depression is always present


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References :

[0]Murray ED, Buttner N, Price BH. (2012) Depression and Psychosis in Neurological Practice. In: Neurology in Clinical Practice, 6th Edition. Bradley WG, Daroff RB, Fenichel GM, Jankovic J (eds.) Butterworth Heinemann

[1]Rusch, Nicolas; Angermeyer, Matthias C.; Corrigan, Patrick W. (2005). "Mental Illness Stigma: Concepts, consequences, and initiative to reduce stigma". European Psychiatry: 529–539


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