Major Depressive Disorder vs. Bipolar Depression (EHM)

Depressive phase of a cyclical condition

• Cyclical Nature. One of the hallmark features of bipolar disorder is the presence of mood cycles that include at least one episode of mania or hypomania. The depressive phase in bipolar disorder is one part of these cycles, which means that a person with bipolar disorder experiences significant mood swings from highs (mania or hypomania) to lows (depression).
• Symptoms. During the depressive phase, individuals may experience deep sadness, hopelessness, loss of energy, sleep disturbances, changes in appetite, difficulty concentrating, feelings of worthlessness or guilt, and thoughts of death or suicide. These symptoms can be severe and significantly impact daily functioning.
• Response to treatment. Individuals with bipolar depression might respond differently to antidepressants compared to those with MDD. There's a risk that antidepressants can trigger mania or rapid cycling in people with bipolar disorder, so mood stabilizers or antipsychotic medications are often used as part of the treatment plan.
• Diagnostic considerations. The diagnosis of bipolar disorder involves identifying a history of manic or hypomanic episodes in addition to depressive episodes. The depressive episodes alone can be challenging to distinguish from MDD without a thorough psychiatric evaluation.

Major Depressive Disorder (Severe Depression)

• Symptoms. Symptoms of severe depression can overlap significantly with those of the depressive phase of bipolar disorder, including profound sadness, loss of interest in almost all activities, significant weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, feelings of worthlessness or excessive guilt, diminished ability to think or concentrate, and recurrent thoughts of death or suicide.
• Response to treatment. Treatment for MDD typically includes antidepressants, which are generally effective for unipolar depression. Psychotherapy, especially cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT), is also an essential component of treatment.
• Diagnostic considerations. Diagnosing MDD requires the presence of depressive symptoms for at least two weeks, with significant distress or impairment in social, occupational, or other important areas of functioning. It's crucial to rule out bipolar disorder to avoid the risk of triggering manic episodes with antidepressant treatment.

• Mood cycles. The most distinguishing feature is the presence of manic or hypomanic episodes in bipolar disorder, which are absent in MDD.
• Treatment response. Bipolar disorder requires careful management to avoid triggering mania, often involving a combination of mood stabilizers and antipsychotic medications, while MDD is primarily treated with antidepressants.
• Diagnostic criteria. A diagnosis of bipolar disorder is contingent upon the history of manic/hypomanic episodes, whereas the absence of such episodes characterizes MDD.

• Depressed mood. Most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). Example: A person might report feeling "down" or "hopeless" on most days, or they might be observed crying frequently without an apparent reason.
• Inability to take pleasure. Markedly diminished interest or pleasure. In all, or almost all, activities most of the day, nearly every day (as indicated by subjective account or observation). Example: An individual who used to enjoy painting and socializing with friends now finds no pleasure in these activities and spends most days in bed. Weight loss or gain. Significant weight loss When not dieting or weight gain, or decrease or increase in appetite nearly every day. Example: A person might lose considerable weight because they no longer desire to eat or start overeating as a form of comfort, leading to weight gain.
• Insomnia or hypersomnia. Nearly every day. Example: Someone may struggle to fall asleep or stay asleep (insomnia) or sleep much more than usual (hypersomnia), even during the day.
• Psychomotor agitation or retardation. Nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down). Example: A person might pace around restlessly (agitation) or move unusually slowly, taking longer to speak or react (retardation).
• Fatigue or loss of energy. Nearly every day. Example: Despite getting enough sleep, an individual may feel exhausted, finding even small tasks overwhelmingly tiring.
• Feelings of worthlessness or excessive or inappropriate guilt. Nearly every day (not merely self-reproach or guilt about being sick). For example, a person may irrationally blame themselves for past events or believe they are worthless despite evidence to the contrary.
• Diminished ability to think or concentrate, or indecisiveness. Nearly every day (either by subjective account or as observed by others). Example: Making everyday decisions becomes difficult, or a person may need help focusing on work or school tasks.
• Recurrent thoughts of death (not just fear of dying). Recurrent suicidal ideation without a specific plan, a suicide attempt, or a specific plan for committing suicide. Example: An individual might frequently think about death or contemplate suicide, even if they haven't devised a plan to carry it out.

Additional Criteria

Genetic and heritage-related factors

• Genetic vulnerability. MDD has a heritable component, with studies indicating that if one identical twin has depression, the other has a 70% chance of also experiencing the condition at some point in life. Specific genes associated with neurotransmitter systems, such as serotonin and dopamine, have been linked to increased risk.
• Epigenetic modifications. Epigenetics involves changes in gene expression without altering the DNA sequence. Environmental stressors, such as trauma or prolonged stress, can lead to epigenetic changes that affect the functioning of genes involved in the stress response, potentially increasing vulnerability to depression.
• Gene-environment interaction. The interplay between genetic predispositions and environmental factors (such as early life stress, trauma, or ongoing stressors) is crucial in determining the risk of developing MDD. Individuals with specific genetic profiles may be more sensitive to the effects of these environmental stressors.

How to compete with and minimize the occurrence of major depression 

• Physical Activity. Regular exercise has been shown to have a protective effect against depression. It boosts endorphins and other neurochemicals that enhance mood. Example: Incorporating a daily 30-minute walk or a preferred physical activity into your routine can significantly impact mood regulation.
• Nutrition. A balanced diet that includes omega-3 fatty acids, fruits, vegetables, and whole grains can support brain health and reduce the risk of depression. Example: Prioritizing meals that incorporate fatty fish like salmon and various colorful fruits and vegetables can promote overall well-being.
• Environmental Management. A clean, organized living space can reduce stress and enhance a sense of control. Example: Setting aside time each week to tidy up living and work spaces can help create a more calming environment.
• Sleep Hygiene. Quality sleep is crucial for emotional and psychological resilience. Establishing a regular sleep schedule and a bedtime routine can improve sleep quality. Example: Setting a consistent bedtime, avoiding screens an hour before sleep, and creating a relaxing pre-sleep routine such as reading or meditation.
• Avoidance of negative influences. Reducing exposure to toxic relationships and negative media can decrease stress and improve mood. Example: Setting boundaries with individuals who consistently drain your energy or limiting exposure to distressing news.
• Stress Management techniques. Approaches such as mindfulness, meditation, and yoga have been shown to reduce stress and may lower the risk of depression. For example, Practicing daily mindfulness exercises or attending regular yoga classes can help manage stress levels.
• Social Support. Maintaining a supportive network of friends and family can provide a buffer against stress and reduce the risk of depression. Example: Regularly scheduling time with friends and family, whether in person or virtually, can enhance feelings of connectedness and support.
• Cognitive-behavioral strategies. Challenging negative thought patterns and engaging in positive activities can improve mood and combat depressive symptoms. For example, Keeping a gratitude journal where you note down three things you're grateful for each day can shift focus from negative to positive aspects of life.