The nature of bipolar depression: implications for the definition of melancholia.
OBJECTIVE
To examine if melancholic depression is over-represented in those with 'bipolar depression' and, if confirmed, to use that phenomenon to assist the clinical definition of melancholia.


METHODS
We contrast 83 bipolar and 904 unipolar depressed patients on three melancholic sub-typing systems (DSM, Clinical and CORE system) and compare representation of their clinical depressive features.


RESULTS
By all three melancholic sub-typing systems, the bipolar patients were more likely to receive diagnoses of 'melancholia' and of psychotic depression. To the extent that this differential prevalence of depressive sub-types was reflected in varying patterns of clinical features, we so indirectly identified a set of items defining 'melancholia'. By such a strategy, melancholia was most clearly distinguished by behaviourally-rated psychomotor disturbance. While a number of 'endogeneity symptoms' were significantly over-represented, logistic regression analyses refined the set to psychomotor disturbance (both as a symptom and as a sign) and pathological guilt. We also established a distinctly higher prevalence of bipolar depression in those where a refined diagnosis of melancholia was made.


CONCLUSIONS
Bipolar depression appears to be more likely to be 'melancholic' in type, thus providing an indirect strategy for the clinical definition of melancholia.
Parker
G
G
Mood Disorders Unit, Prince of Wales Hospital, Randwick, and School of Psychiatry, University of New South Wales, 2031, Randwick, Australia.
Roy
K
K
Wilhelm
K
K
Mitchell
P
P
Hadzi-Pavlovic
D
D
D000328:Adult; D001714:Bipolar Disorder / Q000145:classification / Q000175:diagnosis* / Q000523:psychology; D003866:Depressive Disorder / Q000145:classification / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011594:Psychometrics; D015203:Reproducibility of Results