Differentiating Melancholic vs. Atypical Depressive Symptoms in BP Depression
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Q:  Differentiating Melancholic vs. Atypical Depressive Symptoms in BP Depression


I have a question about mood reactivity.  I was diagnosed Bipolar I, and depending upon what article one reads, bipolar depression is primarily atypical, melancholic, or a mixture of both types.  My personal experience is as follows:  when severely depressed, I have no reactivity, nothing makes me feel better; however, when moderately depressed I exhibit mood reactivity, responding to good or happy things.  What is your view on differentiating melancholic versus atypical depressive symptoms in bipolar depression? 

Many thanks,


Dear Mr. G. --

I love it when people read down to this level of detail. Unfortunately, you have put your finger on a messy spot. This came up in a meeting of the International Society for Bipolar Disorders, their "Committee on Diagnosis". There was open disagreement in that meeting on this issue. Does bipolar disorder differentiate itself from unipolar depression and the quality of depressive symptoms?

As you have understood correctly from your reading, atypical features (low energy, increased sleep, increased eating and "mood reactivity" are thought to be a marker of bipolar depression: not diagnostic of bipolar disorder, but statistically associated with it.

By contrast, "melancholic" features are generally associated with unipolar depression. It is even recognized as a subtype of Major Depression. This includes a lack of enjoyment of activities usually found pleasurable (although that feature, sometimes called "anhedonia", is a core ingredient in most conceptions of depression of all kinds). I am not a student of the history of the terminology here, but as you appear to be pointing out, "mood reactivity" is rather the opposite of this anhedonia.

With that review, to your observations:  frankly, I think these distinctions have little value in differentiating one kind of mood problem from another. So the fact that a person with a probable "bipolar disorder" could find himself having two different forms of depression, one bipolar and one supposedly more "unipolar", does not surprise me nor trouble me.

Thank you for demonstrating that some people can educate themselves to the level of sophistication of the mood specialists.

Dr. Phelps

 

Published December, 2007
 
 

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