Bipolar depression: phenomenological overview and clinical characteristics.
OBJECTIVE
There has been increasing interest in the depressed phase of bipolar disorder (bipolar depression). This paper aims to review the clinical characteristics of bipolar depression, focusing upon its prevalence and phenomenology, related neuropsychological dysfunction, suicidal behaviour, disability and treatment responsiveness.


METHODS
Studies on the prevalence of depression in bipolar disorder, the comparative phenomenology of bipolar and unipolar depression, as well as neuropsychology and brain imaging studies, are reviewed. To identify relevant papers, a literature search using MEDLINE and PubMed was undertaken.


RESULTS
Depression is the predominant mood disturbance in bipolar disorder, and most frequently presents as subsyndromal, minor or dysthymic depression. Compared with major depressive disorder (unipolar depression), bipolar depression is more likely to manifest with psychosis, melancholic symptoms, psychomotor retardation (in bipolar I disorder) and 'atypical' symptoms. The few neuropsychological studies undertaken indicate greater impairment in bipolar depression. Suicide rates are high in bipolar disorder, with suicidal ideation, suicide attempts and completed suicides all occurring predominantly in the depressed phase of this condition. Furthermore, the depressed phase (even subsyndromal) appears to be the major contributant to the disability related to this condition.


CONCLUSIONS
The significance of the depressed phase of bipolar disorder has been markedly underestimated. Bipolar depression accounts for most of the morbidity and mortality due to this illness. Current treatments have significant limitations.
Mitchell
Philip B
PB
School of Psychiatry, University of New South Wales and Mood Disorders Unit, Black Dog Institute, Prince of Wales Hospital, Sydney, NSW, Australia. phil.mitchell@unsw.edu.au
Malhi
Gin S
GS
D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D013406:Suicide, Attempted / Q000706:statistics & numerical data*