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27 Clues to Distinguish
Bipolar from Unipolar Depression
In a First Episode Depression
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Henry Nasrallah, M.D.
1. Family history of mania/hypomania – high in bipolar depression, low unipolar
2. Family history of depression – high in both
3. Age of onset of depression – Teens and 20’s in bipolar, >30 unipolar
4. Gender ratio – equal males/females in bipolar, 3x higher in females in unipolar
5. Substance abuse – high in bipolar, lower in unipolar
6. Seasonality – common in bipolar, occasional in unipolar
7. Post partum episodes – more common in bipolar, less common in unipolar
8. Episode onset pattern – often sudden in bipolar, gradual onset unipolar
9. Episode frequency – high in bipolar, low in unipolar
10. More than 3 recurrences of episodes – typical in bipolar, unusual in unipolar
11. Rapid symptom remission – typical in bipolar, unusual in unipolar
12. Brief depressive episode < 3 months – common in bipolar, less common unipolar
13. Psychotic features < 35 – more common in bipolar, less common in unipolar
14. Psychomotor activity – retardation>agitation in bipolar, agitation > retardation in
unipolar
15. Appetite and wt – often increased in bipolar, typically decreased in unipolar
16. Sleep disturbance – hypersomnia>insomnia in bipolar, Insomnia>hypersomnia in
Unipolar
17. Treatment refractory depression – more common in bipolar, less common in
unipolar
18. Loss of antidepressant efficacy/worsening – more common in bipolar, less
common in unipolar
19. Risk of antidepressant-induced mania, hypomania or mixed states – high in
bipolar, low to minimal in unipolar
20. Comorbid anxiety – very common in bipolar, less common in unipolar
21. History of legal problems – more common in bipolar, less in unipolar
22. Easily offended and overly sensitive – more common in bipolar than unipolar
23. Irritability/angry temperament – more common in bipolar
24. History of several marriages/divorces – more common in bipolar
25. History of high scholastic/professional achievements – more common in bipolar
26. Wearing loud/colorful clothing – more common in bipolar\
27. Medical comorbidities (migraine, asthma, ulcers, HBP, chronic fatigue, psoriasis)
more common in bipolar. Bipolar II – up to 60% co-occuring migraine
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