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Apr 23, 2021
5 min read

Unipolar depression: what you need to know

Major depression with long periods of intense sadness is called unipolar depression. When manic phases accompany it and people swing from elation to sadness and back, it’s called bipolar disorder. The two conditions share the same depressive symptoms and can be challenging for some family doctors to diagnose.

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Reviewed by Felix Gussone, MD

Written by Robert Roy Britt

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Comedian Russell Brand has it. Mariah Carey was in self-denial about it for years. Bipolar disorder, a stark mix of depressing lows and manic highs that come in waves, is serious, dramatic, and can be debilitating if left untreated.

Meanwhile, popular accounts of bipolar disorder often leave another related, common condition in the shadows: unipolar depression, which lacks the manic phase. Rather than waves of emotions, a person with unipolar depression is stuck in a trough of sadness and hopelessness. It, too, can be diagnosed and treated.

Symptoms of depression

Major depression strikes about 10% of adults in the United States in a given year, and some 21% are affected during a lifetime (Hasin, 2018). But it’s thought that most people who deal with depression of either type are not diagnosed accurately or aren’t diagnosed as early as they should be (Rosenberg, 2017).

Depression causes essentially the same symptoms, whether it’s associated with the lows of bipolar disorder (also called manic-depressive disease) or unipolar depression. If you have clinical depression, you’ll be well beyond just being sad or blue for a few days. You’ll experience at least five of these symptoms for at least two consecutive weeks (American Psychiatric Association, DSM-5, 2013):

  • Sadness or depressed mood most of the day
  • Loss of interest or pleasure in normal activities
  • Weight gain or loss
  • Poor sleep or oversleeping
  • Fatigue or loss of energy
  • Pacing, fidgeting, or other purposeless activity
  • Slowed movement or speech
  • Guilt or a sense of worthlessness
  • Difficulty thinking, concentrating, or making decisions
  • Recurring thoughts of death or suicide

If you’re truly depressed, you’ll feel unable to deal with the symptoms, and you’ll experience a sense of self-loathing or worthlessness.

Understanding unipolar depression

Depression can be a mood, a syndrome, or a mental disorder, but only when diagnosed based on the above symptoms is it formally considered a major depressive disorder (Lyness, 2021). 

Diagnosed depression is “a serious medical illness that negatively affects how you feel, the way you think and how you act” (American Psychiatric Association, 2013). If it does not involve notable manic phases, it’s called unipolar depression, which in turn is broken down into two main types, again with the same underlying symptoms:

  • Major depressive disorder: Characterized by at least one episode that includes five or more of the symptoms noted above for at least two straight weeks (Lyness, 2021)
  • Persistent depressive disorder: Lasts for two years or more, rather than being episodic (Harvard, 2019). 

The depression symptoms of unipolar depression and the depression associated with the lows of  bipolar disorder are essentially the same. This can mean that some people are diagnosed with unipolar depression even though they may experience “a little bit of mania.” Consequently, diagnoses sometimes evolve from unipolar to bipolar. This misdiagnosis can lead to many patients receiving the wrong treatments (Rosenberg, 2017).

How bipolar disorder differs from unipolar depression

People with bipolar disorder swing periodically from the opposite moods of joy and happiness at the high pole to extreme sadness at the low pole. This latter phase will look a lot like unipolar depression. The distinctions are not always so cut-and-dried, however. 

Highs can come with extreme irritability for some people, and there can be stretches of feeling more balanced between the poles. There’s no universally set cycle, and some people will experience highs and lows at the same time (Jain, 2021). 

Bipolar disorder is marked by more short-term mood variability (Cuellar, 2004). In manic phases, a person might feel overly confident and excited, but those feelings can suddenly turn to confusion, even anger. Most people with bipolar disorder are in the depressed phase longer than the manic phase (Tondo, 2017). 

While unipolar depression can emerge at any point in life, bipolar disorder typically shows up during one’s teen years or early adulthood. There are two main types (American Psychiatric Association, 2013):

  • Bipolar I: Manic episodes last at least a week or are so severe that hospitalization is required. Depressive stretches typically last two weeks, and symptoms of the manic and depressive phases sometimes overlap.
  • Bipolar II: Similar cycles, but manic episodes are not full blown.

Some people experience a third variation marked by longer cycles, lasting two years or more, with less severe symptoms.

Treatments for depression

Major depression and bipolar disorder are both caused by some combination of genetics, brain biology, and environmental and experiential factors, but the exact mix is not fully understood (Jain, 2021).

Treatments for the two conditions are similar in some respects and often include a combination of medication and talk therapy. Sometimes cognitive behavioral therapy can help a person acknowledge negative thoughts and behaviors and try to change them. 

While people with unipolar depression often benefit from antidepressants, someone with bipolar disorder usually needs mood stabilizers or antipsychotic drugs (such as olanzapine, risperidone) as well. Bipolar disorder is a lifelong illness requiring continued treatment.

Psychiatrists often prescribe antidepressant medication to treat depressive episodes in bipolar disorder, and combine that drug with a mood stabilizer to prevent triggering a manic episode (NIH, n.d.). The gold standard for bipolar disorder is a mood stabilizer called lithium, and some studies have found that 50%-70% of patients treated with lithium show a reduction in mania (Jain, 2021).

Nobody should self-diagnose serious conditions like depression and mania. And nobody should look to celebrities for cures to their own mood swings. But if you feel sad or blue and the feeling persists beyond a few days, and you feel powerless to shake it, take one cue from the celebs: Seek professional care.

References

  1. American Psychiatric Association. What Is Depression? Retrieved from https://www.psychiatry.org/patients-families/depression/what-is-depression
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, American Psychiatric Association, Arlington, VA, 2013. Retrieved from: https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596
  3. Cuellar, Amy. Distinctions between bipolar and unipolar depression. Clinical Psychology Review, May; Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2850601
  4. Hasin DS, Sarvet AL, Meyers JL, et al. Epidemiology of Adult DSM-5 Major Depressive Disorder and Its Specifiers in the United States. JAMA Psychiatry 2018; 75:336. Retrieved from https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2671413
  5. Jain A, Mitra P. Bipolar Affective Disorder. [Updated 2021 Feb 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558998/
  6. Jeffrey M Lyness (2021). Unipolar depression in adults: Assessment and diagnosis. Retrieved 04/2021 from https://www.uptodate.com/contents/unipolar-depression-in-adults-assessment-and-diagnosis
  7. National Institute of Mental Health, Bipolar Disorder https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
  8. Rosenberg, Jamie. The Effects of Misdiagnosing Depression With Mixed Features as Unipolar Depression, American Journal of Managed Care. 2017 https://www.ajmc.com/view/the-effects-of-misdiagnosing-depression-with-mixed-features-as-unipolar-depression
  9. Tondo, L., Vázquez, G. H., & Baldessarini, R. J. (2017). Depression and Mania in Bipolar Disorder. Current neuropharmacology, 15(3), 353–358. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5405618/
  10. American Psychiatric Association. What Is Depression? Retrieved from https://www.psychiatry.org/patients-families/depression/what-is-depression
  11. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, American Psychiatric Association, Arlington, VA, 2013. Retrieved from: https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596
  12. Cuellar, Amy. Distinctions between bipolar and unipolar depression. Clinical Psychology Review, May; Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2850601
  13. Hasin DS, Sarvet AL, Meyers JL, et al. Epidemiology of Adult DSM-5 Major Depressive Disorder and Its Specifiers in the United States. JAMA Psychiatry 2018; 75:336. Retrieved from https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2671413
  14. Jain A, Mitra P. Bipolar Affective Disorder. [Updated 2021 Feb 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558998/
  15. Jeffrey M Lyness (2021). Unipolar depression in adults: Assessment and diagnosis. Retrieved 04/2021 from https://www.uptodate.com/contents/unipolar-depression-in-adults-assessment-and-diagnosis
  16. National Institute of Mental Health, Bipolar Disorder https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
  17. Rosenberg, Jamie. The Effects of Misdiagnosing Depression With Mixed Features as Unipolar Depression, American Journal of Managed Care. 2017 https://www.ajmc.com/view/the-effects-of-misdiagnosing-depression-with-mixed-features-as-unipolar-depression
  18. Tondo, L., Vázquez, G. H., & Baldessarini, R. J. (2017). Depression and Mania in Bipolar Disorder. Current neuropharmacology, 15(3), 353–358. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5405618/