Abstract
Major Depressive Disorder (MDD) and bipolar disorder (BD) are different disorders. However, they have significant similarities that often cause misdiagnosis. MDD, BD, and the misdiagnoses have significant adverse impact on individuals’ lives and should be addressed correctly for positive patient outcomes. Through a review of the previous literature, this research explores the similarities and differences between MDD and BD and provides evidence-based treatments for both. The findings indicate that MDD and BD have similarities such as depressive symptoms and increasing suicidal risk. MDD and BD are different in that BD involves the presence of manic and hypomanic episodes. Vortioxetine is recommended as the evidence-based treatment for MDD especially for patients with partial response to SSRI and SNRI treatments. On the other hand Lithium combined with second-generation antipsychotics (SGAs) is recommended for BD.
Major Depressive Disorder and Bipolar Disorder
Depression is one of the most common disorders globally, with significant harm on social, personal, and labour well-being. One type of depression diagnosis is Major Depressive Disorder (MDD) (Menezes et al., 2022). Here, MDD is explored in relation to bipolar disorders (BD). This research is important because MDD and BD have similar symptoms, with about 12-20% of BD patients getting misdiagnosed as having MDD during their initial treatment year (Menezes et al., 2022). A correct diagnosis is vital for positive patient outcomes following treatment. Therefore, with the understanding that MDD and BD are distinct disorders, the similarities and differences of the two are explored, and evidence-based treatment plans are provided for both.
Brief Synopsis of Major Depressive Disorder
As explained above, MDD is a specific type of diagnosis within the broader category of depression diagnoses. According to Bains and Abdijadid (2023), the World Health Organization ranked MDD as the third cause of the global disease burden in 2008 and predicted that the disease will rank first by 2030. MDD is included in DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders) as a distinct diagnosis. According to the DSM-5 criteria, the symptoms for MDD include: persistently depressed or low mood, feelings of worthlessness and guilt, decreased interest in pleasurable activities, poor concentration, lack of energy, changes in appetite, sleep disturbances, agitation or psychomotor retardation, or suicide ideation. An MDD diagnosis is given when one has five of the stipulated symptoms (Bains & Abdijadid, 2023). Additionally, for one to be diagnosed with MDD, one of the five evident symptoms must be anhedonia, which results in occupational and social impairment or depressed mood. A history of a hypomanic or manic episode must be ruled out to diagnose an individual with MDD.
Brief Synopsis of Bipolar Disorder
Bipolar disorder (BD) is one of the top causes of disability worldwide. It is characterized by chronically occurring episodes of hypomania or mania that alternate with depression. BD is often misdiagnosed initially, given its similarities with MDD. Some various Bipolar and related disorders include Bipolar I disorder, bipolar II disorder, cyclothymic disorder, and other specified or unspecified bipolar and related disorders. BD is often hard to recognize since its symptoms overlap with other psychiatric disorders (Jain & Mitra, 2023). Nevertheless, NHS (2023) asserts that BD is characterized by extreme mood swings ranging from extreme highs (mania) to extreme lows (depression).
During a period of depression, a person with BD may have various symptoms. The symptoms may include hopelessness, lacking energy, sadness, or irritability, feeling worthless, self-doubt, guilt and despair, losing interest in daily activities, difficulties sleeping, and suicidal thoughts (NHS, 2023). On the other hand, NHS (2023) says that the manic symptoms in an individual with BD include feeling full of energy, feeling elated or overjoyed, getting distracted easily, being delusional or hallucinating, feeling self-important, talking very quickly, being easily irritated, and saying things out of character that others see as harmful or risky.
Similarities Between MDD and BD
The above synopses of MDD and BD reveal that the two share several similarities. One is that both disorders have depressive episodes that are characterized by low mood. Another similarity is that individuals with MDD and BD are at an increased risk of suicidal thoughts and behaviours. MDD and BD are also similar in that feelings of worthlessness, guilt, and poor concentration characterize them. Sleeping disturbances and difficulties sleeping are also indicators of both MDD and BD and poor concentration is also a characteristic of both disorders. These similarities are significant and are the reason for misdiagnoses for patients with BD.
Differences Between MDD and BD
The primary difference between MDD and BD concerns hypomania and mania. According to Bains and Abdijadid (2023), a history of a hypomanic or manic episode must be ruled out to diagnose an individual with MDD. On the other hand, BD is characterized by chronically occurring episodes of hypomania or mania alternating with depression (Jain & Mitra, 2023). The symptom patterns between the two disorders are, therefore, different, with the predominant MDD symptoms being those of depression, such as feelings of guilt, low mood, changes in appetite, lack of energy and sleep patterns (Bains & Abdijadid, 2023). BD entails cyclical mood changes whereby, during hypomanic and manic episodes, an individual can experience increased self-esteem, impulsivity, and increased activity levels, and these are followed by depressive episodes (Jain & Mitra, 2023). These differences are vital in making the correct diagnosis. Another critical difference between MDD and BD is in the treatment approaches. Below is a discussion of evidence-based treatments for both.
Evidence-Based Treatment for MDD
The FDA-approved medications for treating MDD include SSRIs such as sertraline, SNRIs such as venlafaxine, serotonin modulators such as vortioxetine, and atypical antidepressants. Other MDD treatments include psychotherapy and electroconvulsive therapy (Bains & Abdijadid, 2023). While SSRIs are often used as the first-line treatment for MDD, an evidence-based treatment approach for MDD is vortioxetine. Fagiolini et al. (2021) conducted a primary study that investigated the effectiveness of vortioxetine in emotional blunting for patients with partial responses to SSRI and SNRI treatments. The study’s participants included patients with MDD with partial responses to SSRI and SNRI monotherapy after getting treated for six weeks or more. These patients were switched to 8 weeks of vortioxetine treatment at 10-20 mg daily. The findings of the study indicated that vortioxetine 10-20 mg effectively improved overall functioning, emotional blunting, energy and motivation, and depressive symptoms in patients with MDD (Fagiolini et al., 2021). Therefore, the study proves that vortioxetine can be used for patients with partial response to SSRI and SNRI treatments.
Evidence-Based Treatment for Bipolar Disorder
An evidence-based treatment approach for bipolar disorder is using lithium combined with second-generation antipsychotics (SGAs). Liu et al. (2020) examined the therapeutic effects of lithium combined with SGAs (clozapine, quetiapine, olanzapine, and risperidone) for treating manic episodes in patients with BD. The study found that combining lithium with SGAs for treating BD is efficacious in improving the manic symptoms of patients with BD. Lithium incorporated with quetiapine was found to have advantages in terms of the speed of effectiveness of treating BD and in minimal incidences of adverse effects. Jain and Mitra (2023) say that when possible, patients with BD should be provided with a calming environment with minimal stimuli during treatment.
Conclusion
Major Depressive Disorder and bipolar disorder are two different disorders. However, they have some similarities. This research has found that the similarities between the two are that they increase the risk of suicidal thoughts and behaviours, feelings of worthlessness, guilt, and poor concentration, and sleeping disturbances or difficulties. However, MDD and BD are different in that BD entails manic and hypomanic episodes alternating with depressive symptoms, while MDD is characterized by depressive symptoms without a history of mania or hypomania. An evidence-based treatment approach for people with MDD is vortioxetine, which can be used for patients with partial response to SSRI and SNRI treatments, and BD can be treated using lithium combined with SGAs.
References
Menezes, I. C., von Werne Baes, C., Fígaro-Drumond, F. V., Dias Macedo, B. B., Bueno, A. C., Lacchini, R., … & Juruena, M. F. (2022). Differential Diagnosis of Major Depressive Disorder and Bipolar Disorder: Genetic and Hormonal Assessment and the Influence of Early-life Stress. Brain Sciences, 12(11), 1476.
Bains, N., & Abdijadid, S. (2023, April 10). Major depressive disorder (nursing). In StatPearls [Internet]. StatPearls Publishing.
Jain, A., & Mitra, P. (2023, February 20). Bipolar Affective Disorder. In StatPearls [Internet]. StatPearls Publishing.
NHS. (2023, January 3). Symptoms – bipolar disorder. Retrieved October 7, 2023, from https://www.nhs.uk/mental-health/conditions/bipolar-disorder/symptoms/
Fagiolini, A., Florea, I., Loft, H., & Christensen, M. C. (2021). Effectiveness of vortioxetine on emotional blunting in patients with major depressive disorder with inadequate response to SSRI/SNRI treatment. Journal of Affective Disorders, 283, 472-479.
Liu, Y., Liang, J., Xia, Q., Zhou, X., & Xie, X. (2020). Effects of Lithium Combined with Second-Generation Antipsychotics for the Treatment of Manic Episodes in Patients with Bipolar Disorder: A Naturalistic Study in China. Neuropsychiatric disease and treatment, pp. 2623–2632.
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