Depression

Depressive symptoms are almost always present in people suffering from MDI. Depressive symptoms can vary in severity, type and duration, occurring in alternation with manic/hypomanic symptoms, in combination with them, or in their absence. Different forms or subtypes of MDI can be identified. Different types of depression have been described from a subtle, lingering form called Dysthymia to the short-lived depressive phases of Cyclothymia or the full-blown Major Depression in its recurrent, chronic or Atypical forms. For a review on Depression, see Preskorn.

During a depressed phase a person may:
 feel "blue, sad or down" for most of the day, almost every day;
 feel worthless or guilty every day, or nearly every day;
 cry a lot -- often or for no apparent reason;
 loose interest in or feel little pleasure during all or most daily activities, almost every day;
 experience trouble sleeping and/or sleeping too much;
 feel weak, tired or lack energy almost every day;
 be unable to concentrate;
 have trouble making decisions, nearly every day;
 gain or loose weight without wanting to;
 think often about death or suicide.

DEPRESSION SIGNS SYMPTOMS
ACTIVITY INACTIVE RESTLESS/RUSHED
DECREASED SPEECH QUIET
DULL APATHY
GREATER NEED FOR SLEEP LETHARGY
WITHDRAWAL LOW SEXUAL DRIVE

COGNITION LACKS INTEREST BORED
POOR CONCENTRATION CONFUSION
INDECISIVE DOUBTS
POOR SELF ESTEEM SELF BLAME

MOOD SAD DOWN
TEARFULNESS TEARFULNESS
DESPONDENT DESPONDENT

Depression is by far the most common diagnosis given to people with MDI, as it is almost always the reason for seeking treatment in those suffering from the forms of MDI without Mania. Studies of depression in the primary setting confirm this trend. (Manning)

The symptoms are usually those of an Atypical Depression. The bias of many clinicians towards diagnosing Depression and the relative ease of diagnosing Depression with DSM Criteria has allowed many patients with MDI to be diagnosed as “Unipolar”.

In a large study of patients diagnosed with DSM IV Major Depression (Hantouche), 40% were re-diagnosed as MDI on the basis of a semi-structured interview eliciting hypomanic symptoms -- information obtained by further questioning of patients and significant others or based on observed Hypomania.