Phenomenology, clinical profile, and substance use of patients with unipolar and bipolar depression – A cross-sectional comparative study

Abstract

Background: A comparison of the clinical course and symptom profile of unipolar (UP) and bipolar (BP) depression reveals many similarities as well as subtle differences between the two syndromes. Phenomenological and clinical features that would distinguish BP from UP depression can help in appropriate and early treatment. This could, in turn, influence the choice of treatment, clinical course, and outcomes. Misdiagnosing BP depression as a major depressive disorder early may result in manic switch and/or rapid cycling. Most of the published literature in this area is from the Western world. We, therefore, aimed to study phenomenology, clinical factors, and substance use among patients with BP and UP depression. This study would potentially contribute to the existing literature and help in better diagnosis and treatment. Aim and Objectives: The aim of this study was to assess the clinical profile and substance use among patients with UP and BP depression and to determine the predictors of bipolarity. Materials and Methods: Fifty patients with BP and 50 with UP depression who satisfied the International Classification of Diseases, tenth edition criteria were included in our study. We assessed our participants using the Hamilton Rating Scale for Depression, Brief Psychiatric Rating Scale, Alcohol Use Disorders Identification Test, Fagerstrom Test for Nicotine Dependence, and a self-designed, semi-structured pro forma for obtaining sociodemographic, clinical, and substance use profiles. Results: Younger males with a greater number of episodes, earlier onset of illness, greater number of hospitalizations, and higher psychotic symptoms were found in our BP depression group. Logistic regression identified male gender, family history of substance use, history of alcohol dependence, ideas of guilt, forgetfulness, psychomotor agitation, deliberate self-harm, delusion, and hallucinations as predictors of bipolarity (odds ratio = 2.97; 2.25; 9.06; 2.45; 2.43; 16.97; 7.11; 9.33; and 11.46, respectively). Conclusions: Young male individuals with a history of substance use, psychotic symptoms, and psychomotor agitation should be carefully evaluated for bipolarity. We need prospective studies with a large sample size to identify early clinical markers of bipolarity.