Major Depression:

Depressive disorders are characterized by mood swings into protracted periods of low mood, which returns to normal ("euthymic") functioning. To meet Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM IV) criteria for a major depressive disorder (major depression), a person must have 2 weeks or more of a depressed mood or loss of interest accompanied by additional depressive symptoms of depression, such as diminished appetite, poor sleep and decreased energy. Dysthymic disorder is characterized by at least 2 years of a depressed mood for more days than not, accompanied by additional depressive symptoms that do not meet criteria for a major depressive episode. Depressive disorder "Not Otherwise Specified" (NOS) is a term used for disorders with depressive features that do not meet criteria for major depressive disorder. An example is premenstrual dysphonic disorder.

A lifetime history of major depression is nearly twice as common in women as in men. Gender differences in the prevalence of depression begin in early adolescence and persist through the mid-50s. The female-to-male ratio appears even higher for particular forms of depression, such as "atypical" depression in which the depressed mood is accompanied by increased sleep, increased appetite and rejection sensitivity.

Bipolar Disorder:

Bipolar disorder is characterized by mood shifts into both depression and mania, alternating with periods of normal mood. A manic episode is characterized as a distinct period during which there is an abnormal and persistently elevated, expansive or irritable mood, lasting at least one week or longer, which is sufficiently severe to cause marked impairment in social or occupational functioning or to require hospitilization.

In Bipolar II disorder, a person has major depressive episodes alternating to hypomanic rather than manic episodes. Hypomanic episodes are characterized by a distinct period during which mood is abnormally or persistently elevated, lasting less than 1 week. In contrast to a manic episode, a hypomanic episode is not severe enough to cause marked impairment in social or occupational functioning or to require hospitalization.

Cyclothymia is the third form of bipolar disorder. It describes mood shifts into hypomania and mild depression. Depressions are not severe enough to meet criteria for major depressive disorder.

Bipolar disorders occurs about equally for men and women, with a lifetime rate of 1.0% in women and 0.8% in men. However, rapid-cycling bipolar disorder and antidepressant-induced cycling have been reported to occur more frequently in women. Bipolar II disorder also may be more common in women. Compared with men, women with bipolar disorder tend to experience more depressive and fewer manic episodes in their lifetimes and are at great risk for postpartum mood episodes.



Symptoms of major depression include feelings of sadness, loss of interest in normally pleasurable activities, changes in appetite and sleep, loss of energy and problems with concentration and decision-maiking. Episodes of dysthymia resemble depression but are milder and often last longer.

Bipolar depression often consists of symptoms of increased appetite, increased need for sleep and a feeling of lethargy, while unipolar depressive symptoms consist of decreased sleep, decreased appetite and anxiety.

Women are twice as likely as men to experience unipolar depression. While bipolar disorder occurs equally in women and men, women are more likely than men to spend a greater proportion of their ill time in a depressive rather than a manic state. Although the onset of these disorders can occur at any age, many individuals experience their first episode of unipolar depression or bipolar depression between the ages of 25 and 44.

Depression or depressive symptoms can take a toll on work and home roles or functions. Persons with depression often feel easily overwhelmed, find it difficult to make decisions and are irritable with coworkers or family members.

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Dr. Mark Frye is the associate professor of the Bipolar Research Program at UCLA. He is also the medical advisor to the UCLA chapter of the National Depressive & Manic Depressive Association.

A graduate of the University of Minnesota, he received his psychiatric training at the UCLA Neuropsychiatric Institute. As Chief Resident, he was presented with the Outstanding Teaching Award. Dr. Frye joined the faculty at UCLA in 1998 as the associate director of the UCLA and West LA Veterans Administration Mood Disorders Research Programs.

That same year, he completed a four-year Research fellowship at NIMH. As the Unit Director of Biological Psychiatry Branch Clinical Research, his work focused on the neurobiology of depression and bipolar illness as well as the development of new treatment options.

He is an active author, publishing more than 50 papers in peer-reviewed publications such as the American Journal of Psychiatry, Journal of Affective Disorders, Journal of Chilincal Psychiatry and the Journal of Clinical Psychopharmacology and Biological Psychiatry.

The recipient of several awards, his clinical research interests are: new treatment development in bipolar disorder and depression, brain imaging of mood disorders, neuro-endocrinology of mood disorders and cardiac disease. Back to top

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Q: I have bipolar illness and am depressed. I am worried that if I take an antidepressant medication, it may cause me to have a manic episode. What should I do?

A: For some people with bipolar depression, anti depressants may trigger a switch to hypomania or mania. If this occurs, it is usually within the first 1-2 months after starting the antidepressant. However, in the majority of cases, antidepressants do not trigger such a switch.

Depression can be quite debilitating and usually requires antidepressant medication. Research is underway on alternative approaches for treating bipolar depression, including psychotherapy (if the depression is mild), light therapy, omega 3-fatty acids and rTMS (Transcranial Magnetic Stimulation).

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For people with bipolar illness recently successfully treated with an antidpressant for a depressive episode, the risk of depression relapse may be increased by the common clinical practice of discontinuing the antidepressant soon after remission. While guidelines for treating patients with bipolar depression recommend discontinuing antidfepressants within six months after remission of depression, few studies have assessed the implications of this strategy on the risk for depressive relapse.

This study examined the effect of antidepressant discontinuation or continuation on risk for depressive relapse in a clinical sample of bipolar subjects recently successfully treated for an acute depressive episode. Continuing antidepressants for at least one year after remission of a depressive episode may protect against relapse into depression and does not appear, in our sample, to increase risk for manic relapse. Concerns regarding a risk of switching into mania may actually interfere with establishing an optimal treatment paradigm for bipolar depression.

Our study suggests that when a person with bipolar depression is successfully treated with an antidepressant in addition to a mood stabilizer, removal of the antidepressant may increase the likelihood of a relapse.

Method: Eighty-four subjects with bipolar disorder successfully treated for an index episode of depression with the addition of an antidepressant to an ongoing mood stabilizer were followed prospectively for one year after successful treatment. The risk of depressive relapse in 43 subjects who stopped antidepressant medications within six months after improvement was compared to the risk of depressive relapse in 41 subjects who continued taking antidepressants for more than six months after improvement.

Results: Analysis indicated that patients who discontinued antidepressants within the first six months after successful treatment experienced a significantly shorter period of time before depressive relapse over the length of follow-up compared with those who continued treatment with an antidepressant for more than six months after successful treatment. At one-year after a successful antidepressant response, 71% of the antidepressant medication discontinuation group had relapsed compared to 41 % of the antidepressant medication continuation group. At one-year follow up, 15 of the 84 subjects (18%) had experienced a manic relapse; over the length of follow up, only 6 of these subjects of whom were taking an antidepressant at the time of manic relapse.

Conclusions: The risk of depressive relapse in patients with bipolar illness was significantly associated with discontinuing antidepressants soon after remission. The risk of manic relapse was not significantly associated with continuing use of antidepressant medication and, overall, was substantially less than the risk of depressive relapse. Maintenance of antidepressant treatment in combination with a mood stabilizer may be warranted in some patienst with bipolar disorder.