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Differentiating Depression and Bipolar Depression M. Joyce Sasse DNP APRN PMHNP-BC PMHCNS-BC
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Page 1: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Differentiating Depression and Bipolar Depression

M. Joyce Sasse DNP APRN PMHNP-BC PMHCNS-BC

Page 2: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

About BHECN

The Behavioral Health Education Center of Nebraska (BHECN, pronounced “beacon”) was created by the Legislature to

address the shortage of behavioral health professionals in rural and underserved areas. BHECN recruits & educates students in

behavioral health and trains & retains professionals in the workforce.

By increasing the number of behavioral health professionals, improving accessibility of behavioral health care, and building

competence of the workforce, we are improving the health of all Nebraskans.

Learn more at unmc.edu/bhecn

Keep up with the latest

events and trainings from BHECN:

facebook.com/BHECN

Page 3: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

About the Mental & Behavioral Health Care Webinar Series

Individual webinars will focus on common psychiatric disorders using a holistic

approach to include cultural awareness, spirituality, interdisciplinary collaboration,

psychopharmacology, and principles of recovery.

Page 4: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Acknowledgements

BHECN would like to acknowledge the collaboration with the American Psychiatric

Nurses Association, NE Chapter (APNA-NE) in the development and implementation

of this educational series.

Learn more at: www.apna.org

Page 5: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Differentiating Depression and Bipolar Depression

M. Joyce Sasse DNP APRN PMHNP-BC PMHCNS-BC

Page 6: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Conflict of Interest Disclosure

Dr. Sasse is the president and sole owner of Joyce K Sasse NP, PC, which

manages her private psychiatric practice, consulting, and educational nursing

activities.

Dr. Sasse has no other financial interests or conflicts with other organizations or

entities that will detract from the balance, independence, objectivity, or scientific

rigor of this program.

Page 7: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Off-Label Use of Medications

Dr. Sasse will mention off-label uses for medications in her lecture

Handouts for this program can be downloaded under the “Handouts” tab in your

GoToWebinar gray control box

Handouts clearly label any off-label use of medications, recourses, and other

information for the participants.

Page 8: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Poll Question

Is the following statement true or false?

People who commit suicide are mentally ill.

Page 9: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Depression in General

In the U.S., 6-12% of the population will suffer from depression sometime during its

life.

Suicide is the eighth-leading of cause of death in the U.S.

Almost all people who complete a suicide have a diagnosable mental disorder with or

without substance abuse, and substance abuse is often a form of self- medicating

depression.

(Andrew 2014)

Page 10: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Suicide

In 2005, suicides accounted for 1.4% of all deaths worldwide. This statistic is low

because many suicides go unreported for many reasons.

Sadly, over 60% of people who commit and complete suicide have seen a doctor

within 30 days of the event.

(Andrew 2014)

Page 11: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Depression

People with depression are more likely to suffer from:

• Type 2 diabetes and cardiovascular disease

• Unipolar depression. (Unipolar depression is projected to be the second-leading

cause of disability worldwide.)

(Andrew, 2014)

Page 12: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Unipolar Depression

66% of people with depression don’t know they have a treatable illness and don’t

look for treatment.

50% of persons diagnosed with major depression receive any kind of treatment.

20% of those individuals receive treatment that meets current practice guidelines.

(Gonzales, Vega, Williams et al. 2010)

Page 13: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Bipolar Depression

Lifelong prevalence of Bipolar Disorder in the U. S. is between 3.7% and 3.9%.

• Bipolar Disorder Type I (BPI) (1.0%)

• Bipolar Disorder Type II (BPII) (1.1%)

• Sub-threshold Bipolar Disorders (2.4-4.7%)

• International prevalence (5-7%)

(Soreff, 2015)

Page 14: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Bipolar Depression

15% of all persons suffering from Bipolar disorders will commit suicide

36.3% risk of suicide–25% of all completed suicides

(American Psychiatric Association, 2013)

Page 15: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Poll Question

Is the following statement true or false?

Science is close to isolating the two genes that control

depressive and manic behaviors.

Page 16: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Isn’t All Depression the Same?

“Modern genomics suggests that the spectrum is not a single disease, but a

complex of hundreds if not thousands of different diseases, with overlapping

genetic, epigenetic, and biomarkers as well as clinical symptoms and functional

outcomes.”

(Stahl 2013)

Page 17: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Brain SPECT Scans

Page 18: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Chromosome 12

Page 19: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Chromosome 10

Two genetic variants on Chromosome 10 found in women with recurrent Major

Depressive Disorder: one near SIRT1 & one at LHPP

In a further analysis of women with severe MDD, a stronger genetic signal

appeared at SIRT1

(Cai, Chang, Li, & Li, et al. 2015)

Page 20: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Depression Odds

50% Unipolar Depression

2% Bipolar I Disorder

15% Bipolar II Disorder

33% Bipolar Spectrum Disorder

(Stahl 2013)

Page 21: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

How to Tell Them Apart

Depression is the common subset of symptoms between Unipolar and Bipolar

Spectrum Disorders.

Symptomatic persons of both disorders spend most of their time in the depressed

state.

Depression is the symptom that most often brings the person in for treatment.

(LeBano 2015)

Page 22: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar
Page 23: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Information Sources

Family History/Genetics

Close Family Members

Age of Onset of Symptoms

Response to Psychiatric Medications

Symptom Observation and Questions

Tests: Young Mania Rating Scale, Hamilton Depression Scale, et al

(Hegerl, Bottner, Holtschmodt-Taschner, et al, 2008, Stahl 2013,Vieta, Sanchez-

Moreno, Lahuerta, et al 2008, Zimmerman, Ruggero, Chelminski & Young 2008)

Page 24: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Social History

Social History (Environmental Influences, Moves and Reasons, Housing Conditions)

Military Hx

Family Dynamics/Demographic and Historical Information

Parents

Siblings

Married

Children

Significant Other

Friends

Losses in Last 12 Months

Spiritual Preference

Page 25: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Social History

Environmental Influences, Moves and Reasons, Housing Conditions

• What in your background from childhood, school or your past brings you here

today

• Or can help me understand you better,

• Or help me understand the problems you bring today better

Page 26: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Birth/Adoptive Family

Family Dynamics/Demographic and Historical Information

• Parents:

– Names, where they live, and if the patient has emotional attachment to them

• Siblings:

– How many, birth order, and if the patient has emotional attachment to them

Page 27: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Nuclear Family

Married: Spouse, marital status, number of children from this marriage , and if

any, their whereabouts

Children: First name and ages

Significant Other: Name and how long together

Page 28: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Outside Attachments

Friends: Do you have any friends that you consider your emotional support

group?

Losses in Last 12 Months

Spiritual Preference

Page 29: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Mental Health History

Family Hx

Hospitalizations

Past Tx: Medication

Therapy

Current Symptoms

Current Tx

Psychiatrist

Therapist

Page 30: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Family Psychiatric History

In your blood-related family, have there been any members who:

• Had psychiatric diagnoses from medical providers?

• Received treatment with psychiatric medications?

• Been hospitalized for psychiatric reasons?

• Had possible undiagnosed mental health problems?

Page 31: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Psychiatric Hospitalizations

Have you ever been hospitalized overnight for psychiatric reasons?

• What was your diagnosis or the reason for the admission?

• Did you receive any medication or special treatments?

• Do you know the name of the doctor who treated you at the hospital?

Page 32: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Past Treatment: Medication

What psychiatric medications have you been on in the past?

• How did each of these work for you?

• What are you current psychiatric medications?

• How are your current psychiatric medications working for you?

Page 33: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Past Treatment: Therapy

Have you seen a Therapist or a Counselor?

• Where and when?

• Why did you see the therapist or a counselor?

• Are you currently in therapy or counseling?

• If so, for what reason(s)?

Page 34: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Current Psychiatric Symptoms

Begin with Historical Questions

• When was the first time you ever remember being depressed?

• What caused it?

• How long did that episode last?

• How many other depressive episodes have you had?

Page 35: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Current Psychiatric Symptoms

During those depressed episodes, did you ever have an abrupt change of mood

where you were giddy/happy or hyper-irritable?

• Did the mood change period go on for two days, one week, or longer?

• During that period, did you have an inflated self-esteem or grandiosity?

• Did you have a decreased need for sleep without loss of energy?

Page 36: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Current Psychiatric Symptoms

During those depressed episodes, did you ever have an abrupt change of mood

where you were giddy/happy or hyper-irritable?

• Did you have an increase in goal-directed activity?

• Were you more talkative than usual, talking faster than usual, or did you talk

to more people than usual?

• Did you have ideas race through your head that went so fast, you could not

keep up with them?

Page 37: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Current Psychiatric Symptoms

During those depressed episodes, did you ever have an abrupt change of mood

where you were giddy/happy or hyper-irritable?

• Were you more distractible than usual?

• Did you feel more distractible than usual, use more alcohol or drugs, or did

you feel more agitated than usual?

• Did you have a high involvement in risky behaviors or do things that were

fun but could have resulted in painful consequences?

Page 38: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Current Psychiatric Symptoms

In the past two weeks, have you:

• Been depressed most of the day, most every day?

• Had a markedly diminished joy or interest in all or almost all activities, or

can you still find joy in life?

• Been able to perform all of your daily activities without a struggle?

Page 39: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Current Psychiatric Symptoms

In the past two weeks, have you:

• Had a change in appetite or change in weight that you did not plan?

• Had any trouble with sleeping: falling asleep, waking during the night, or

waking up early?

• Have you awakened refreshed?

Page 40: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Current Psychiatric Symptoms

In the past two weeks, have you:

• Felt fatigued or had a loss of energy nearly every day?

• Felt agitated nearly every day?

• Had feelings of worthlessness or excessive guilt?

Page 41: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Current Psychiatric Symptoms

In the past two weeks, have you:

• Had trouble with thinking, concentration, memory, or the ability to make

decisions?

• Had recurrent thoughts about death, suicidal ideations, or a plan to commit

suicide? Have you ever attempted suicide?

Page 42: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Current Psychiatric Symptoms

In the past two weeks, have you:

• Had any homicidal thoughts or plans?

• Had panic attacks, anxiety attacks, or constant feelings of anxiety? If so:

-What are the symptoms?

-What triggers them?

-What helps them to get better?

Page 43: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Current Psychiatric Symptoms

Continue asking questions to cover:

• Obsessive-Compulsive Disorder

• Eating Disorder

• Hallucinations

• Derealization

• Self-Harm

-Do you feel the need to cut, burn, or self-harm in any way to reduce internal pain or distress?

Page 44: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Poll Question

Is the following statement true or false?

Alcoholism is a disease that is regulated by one’s

genetic makeup.

Page 45: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Substance Abuse History

Family CD Hx:

Client Use: alcohol, street drugs or abuse of prescription drugs

• Drug of Choice

• First Use

• Last Use

Page 46: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Substance Abuse History

Client Use:

• Do you feel you have a problem with drugs or alcohol?

• Treatment History

• Collateral Information

Page 47: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Further Information

Have the patient take some of the objective tests

Ask the patient for permission to speak to family members for further information

Page 48: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Medication Treatment

Antidepressants

Lithium

Antipsychotics

Anticonvulsants

Others

Page 49: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Antidepressants

SSRIs

SNRIs

SSNRIs

Other

TCAs-Tri & Tetracyclics

MAOIs

Page 50: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Lithium

Effective for mania and prevention of mania

Somewhat effective with depression

Stabilizes mood

Helps prevent suicide in bipolar disorder

Augmenting agent for unipolar depression (off-label)

Page 51: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Antipsychotics

Atypicals

• Aripiprazole

• Quetiapine

• Lurasidone

• Respiradone

• Paliperidone

• Olanzapine and Olanzapine + Fluoxetine

• Ziprazidone

• Asenapine

Page 52: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Anticonvulsants

Valproate

Carbamazepine

Lamotrigine

Oxcarbazepine

Topiramate

Zonisamide

Gabapentin & Pregabalin

Levetiracetam

Page 53: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Others

Ketamine

Nimodipine-Calcium Channel Blockers

Benzodiazepines

Folate

(Bipolar Network News, 2015, Stahl, 2013)

Page 54: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Case:30 year old male; c/o stress and depressionMood:

Depressed and his affect is irritable.

Psychosocial:

States he is unmarried, h/o 1 divorce; 2 failed long term relationships; no children; lives alone in a rented apartment

Has always lived in this city. Father divorced his mother when he was 10. Had trouble paying attention in school; has difficulty with remembering things. Graduated from high school. Was better at sports than with academic work. Did not do well in college and dropped out after his first semester. Is a plumber's assistant in a family owned business.

Psych Hx:

Has never been on any psychiatric medications. Was evaluated when he was younger and it was suggested that he take medication for Attention Deficit Disorder. His father refused to let him take the medication so he did not receive or take them.

Family History:

Positive for a mother with bipolar disorder, a maternal aunt with bipolar disorder, his father suffered from what his mother thought was attention deficit hyperactivity disorder and his older brother has depression and moodiness.

Was first depressed when he was 8 years old and he saw his parents fighting. His depression has been off and on through his whole life with varying severity. Wonders if there is any reason for him to be alive but denies any suicide attempts. Has times when he will become very irritable and angry-these episodes will last for 3-4 days. During these time he will not be like himself, When those days are over he is more depressed than ever.

Page 55: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Poll Question

What else do you want to find out to help you make a

differential diagnosis(es) for James ?

Page 56: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

References

American Psychiatric Association. (2013).Bipolar and related disorders. In American Psychiatric Association, Diagnostic and statistical

manual of mental disorders fifth edition (pp 123-154). Arlington, VA: American Psychiatric Publishing.

American Psychiatric Association. (2013).Depressive Disorders. In American Psychiatric Association, Diagnostic and statistical manual of

mental disorders fifth edition (pp 155-188). Arlington, VA: American Psychiatric Publishing.

Andrew, L.B. (2014). Depression and suicide. Medscape. Retrieved from http://emedicine.medscape.com/article/805459-overview#a2

Aziz, R., Lorberg, B., & Tampi. (2006, December). Treatments for late-life bipolar disorder. American Journal of Geriatric

Pharmacotherapy, 4(4) pp347-364

Page 57: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Andrew, L.B. (2014). Depression and suicide. Medscape. Retrieved from

http://emedicine.medscape.com/article/805459-overview#a2

Bipolar Network News.(2012, October) A genetic Risk factor for bipolar disorder: The CACNA1C gene.

Bipolar Network News. Retrieved from http://bipolarnews.org/index.php?s=Nimodipine

Bipolar Network News.(2012, October) A genetic Risk factor for bipolar disorder: The CACNA1C gene.

Bipolar Network News. Retrieved from http://bipolarnews.org/index.php?s=Nimodipine

Bipolar Network News.(2015, April) Gene CACNA1C is associated with early-onset bipolar disorder.

Bipolar Network News. Retrieved from http://bipolarnews.org/index.php?s=Nimodipine

Cai, N., Chang, S, Li, Y., Li, Q., Hu, J., Liang, J., Song, L., Kretzschmar, W., Gan, X., Nicod, J.,

Rivera, M., Deng, H., Du, B., Li, K., Sang, W., Gao, J., Gao, S., Ha., Ho H.Y., Hu, C., Hu, Z.,

Huang, G., Jiang, G., Jiang, T., Jin, W., Li. G., Li, K., Li, Y., Li, Y., Li, Y., Lin, YT., Liu, L., Liu, T., Liu,

Y., Liu, Y., Lu, Y., Lv. L., Meng, H., Qian, P., Sang, H., Shen, J., Shi, J., Sun, J., Tao, M., Wang, G.,

Wang, G., Wang, J., Wang, L., Wang, X., Wang, X., Yang, H., Yang L., Yin, Y., Zhang, J., Zhang, K.,

Sun, N., Zhang, W., Zhang, X., Zhang, Z., Zhong, H., Breen, G., Wang, J., Marchini, J., Cgen, Y.,

Xu, Q., Xu, X., Mott, R., Huang, G., Kendler, K., & Flint, J. (2015, May) Molecular signatures of

major depression. Current Biology, 25(9) pp1146-1156

Citrome, L (2014, December) Treatment of bipolar depression: Making sensible decisions. CNS

Spectrum, 19, pp4-12

Page 58: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Gonzalez, H.M., Vega, W.A., Williams, DR., Tarraf W., West, B.T., & Neighbors, H.W. (2010, January).

Depression care in the United Stated: Too little for too few. Archives of General Psychiatry, 67(1)

pp37-46

Hallowell, L.(Sen. Ed.). (2016) Nursing 2106 drug handbook. Philadelphia, PA: Wolters Kluwer

Hegerl,U., Bottner, A.C., Holtschmidt-Taschner, B., Born, C., Seemuller, F., Scheunemann, W.,

Schutze, M., Grunze, H., Henkel, V., Mergl, R., & Angst, J. (2008, July). Onset of depressive

episodes is faster in patients with bipolar versus unipolar depressive disorder: evidence from a

retrospective comparative study. Journal of Clinical Psychiatry, 69(7), pp1075-1080

Le Bano, L. (2015, July). How to differentiate bipolar disorder from unipolar depression. Psych

Congress Network. Retrieved from http://www.psychcongress.com/article/how-differentiate-bipolar-

disorder-unipolar-depression-12483.

O’Donovan, C., Garnham, J., Hajeck, T., & Alda. (2008, April). Antidepressant monotherapy in pre-

bipolar depression; Predictive value and inherent risk. Journal of Affective Disorders, 107(1-3)

pp293-298

Papolos, D., Mattis, S., Golshan, S., & Molay, F.(@009, November). Fear of harm, a possible

phenotype of pediatric bipolar disorder: A dimensional approach to diagnosis for genotyping a

psychiatric syndromes. Journal of Affective Disorders, 118(1-3) pp28-38

Page 59: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Rosa, A., Andreazza, A., Kunz, M., Gomes, F., Santin, A., Sanchez-Moreno, J., Colom, F., Vieta, E., &

Kapczinski, F. (2008, April). Predominant polarity in bipolar disorder: Diagnostic implications.

Journal of Affective Disorders, 107(1-3) PP45-51

Smith, D., Griffiths, E., Kelly, M., Hood, K., Craddock, N., & Simpson, S. (2001, July). Unrecognized

bipolar disorder in primary care patients with depression. British Journal of Psychiatry, 199(1) pp

49-56

Soreff, S., (2015). Bipolar affective disorder. Medscape. Retrieved from

http://emedicine.medscape.com/article/286342-overview#a5

Stahl, S.M. (2013). Mood Disorders. In S. M. Stahl, Stahl’s essential psychopharmacology,

Neuroscientific basis and practical application (pp 237-283). New York, NY: Cambridge University

Press.

Stensland, M., Schultz, J. & Frytak, J. (2008, May), Diagnosis of unipolar depression following initial

identification of bipolar disorder: A common and costly misdiagnosis. Journal of Clinical Psychiatry,

69(5), pp749-758

Vieta,E., Sanchez-Moreno, J., Lahuerta, J., Zaragoza, S., (2008, April) Subsyndromal depressive

symptoms in patients with bipolar and unipolar disorder during clinical remission. Journal of

Affective Disorders, 107(1-3) 169-174.

Zimmerman, M., Ruggero, C.J., Chelminski, I., & Young, D. (2008, June). Is bipolar overdiagnosed?.

Journal of Clinical Psychiatry, 69(6) 935-940.

Page 60: Differentiating Depression and Bipolar Depression€¦ · Depression People with depression are more likely to suffer from: • Type 2 diabetes and cardiovascular disease • Unipolar

Images

CACNA1C Gene- Bipolar Network News October 30, 2012

SPECT scans of the brain-Brain Matters Imaging Centers 2007


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