Larry O. Sanders, MD. PC
BIPOLAR DEPRESSION
more likely if:
1. Early age of onset.
2. Abrupt onset and resolution
3. Excess sleep when depressed.
4. Excess appetite and weight gain while depressed.
5. "Misadventures with SSRIs"
6. Family History of Bipolar Disorder.
"Genetic Testing"
Eight studies have shown that genetic testing has almost no ability to determine which medication is best for you. The causes of Depression stem from more than just genes.
Depression is effected by over 100 genes, but even more by adverse life events. Adverse life events are more likely to cause depression than genes. Adverse life events effect which genes are turned on and which are turned off. It's called Epigenetics. No current test can measure this. It is far more rapid and effective to determine which medication will work for you by the type of symptoms you have, not what a genetic test shows. Only an experienced practitioner can determine through Personalized Medicine.
UNIPOLAR DEPRESSION more likely if:
1. Onset of first depression after age 25-30.
2. Insidious onset and resolution of depression.
3. Sleep less than when depressed, especially "Early Morning Awakening".
4. Loss of appetite and weight loss when depressed.
5. Rapid and enduring response to SSRIs.
6. Family history of Major Depression.
Symptoms of Depression
What Type of Depression is it?
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Depression is the most common cause of disability in both the United States and the world. In most studies, Depression causes more morbidity (suffering, impairment) than any other medical condition. In the landmark STAR*D trial, where patients were treated in a real world setting, of the 3,707 people in the study, researchers found 1,030 sub-types of Depression! And 500 of these people had their own unique subtype! That is why SSRIs have limitations. They get about 1/3 of people well, but leave the remaining 2/3 with symptoms. Two studies have shown that if you have any remaining symptoms, you relapse five times faster! Depression also greatly increases your risk of physical illnesses, especially cardiovascular disease (Heart Attacks and Strokes). Depression can increase inflammatory factors in your body and make other conditions worse. So getting fully well and staying fully well is vital to your whole body health.
A huge challenge in treating depression is not only to determine the sub-type of depression, but also ruling out Bipolar Depression, which can appear very similarly to Major Depression. Approximately one-third to one-fourth of Depressions are Bipolar Depression. Bipolar Disorder is a complex condition that involves fluctuation in both energy and mood. Persons with Bipolar Disorder will have occasional Manic or Hypomanic symptoms, but the MOST COMMON PROBLEM IS DEPRESSION. Surprisingly, most people who have Bipolar Disorder suffer Depressive symptoms far more often and far earlier than Manic or Hypomanic symptoms. Bipolar Depression and Unipolar Depression appear very similar, but THEY MUST BE TREATED DIFFERENTLY. Medications for Major Depression (SSRIs and SNRIs) can make Bipolar Disorder MUCH WORSE! If you or a loved one has found that SSRIs or SNRIs have not worked, have stopped working or the condition has gotten worse over time, please seek the help of an experienced psychiatrist who is up to date and specializes in the treatment of all Mood Disorders. Sadly, many practitioners are not.
There are no tests to distinguish Bipolar Depression from Unipolar Depression. However, your history and symptoms provides important clues. Depressions are more likely Bipolar Depression if the onset of depression is before age 25, and especially if the onset of Depression was in childhood or teenage years. Depression which began after 30 years of age ore more likely Unipolar Depression. Bipolar Depression is more likely if depressive symptoms tend to have an abrupt onset and resolve rather quickly. Unipolar Depression usually has slower onset and resolution. People who sleep excessively when depressed are more likely Bipolar Depression; whereas in Unipolar Depression people tend to sleep less. Family history is useful in distinguishing between the two.
Bottom Line: you must have a proper evaluation and proper follow up to be certain you are receiving proper treatment. Anything less puts you or your loved ones at great risk.