The significance of distinguishing unipolar depression and depressive episodes in bipolar affective disorder: Case report

Abstract

Introduction. Mood disorders are the most prevalent mental disorders, divided into unipolar depression and bipolar affective disorders. Bipolar affective disorders manifest as mania, hypomania, mixed episodes, and depressive episodes, with depressive episodes occurring much more frequently. Hypomanic/ manic episodes often remain unrecognized by patients, their families, and even physicians due to insufficiently available heteroanamnestic data. It is crucial to raise awareness of the importance of thorough history taking, as therapy differs significantly between unipolar depression and bipolar affective disorder. The aim of this study is to emphasize the importance of distinguishing unipolar depression from depressive episodes in bipolar affective disorder and establishing an accurate diagnosis. Case presentation: We present a case of a 73-year-old female patient who has been undergoing outpatient psychiatric treatment for the past twenty years, diagnosed with recurrent depression. During her last hospitalization, she presented to the clinic accompanied by her children, who reported significant changes in her emotions and behavior, accompanied by paranoid-interpretative delusional ideas. Overall, this description corresponds to a manic psychotic episode within the framework of bipolar affective disorder. Further heteroanamnestic data revealed the patient's history of regularly seeking medical help when experiencing low mood and impaired functioning on a daily basis. However, episodes of hypomania, characterized by elevated mood, logorrhea, increased activity, decreased need for sleep, and the absence of accompanying fatigue, were perceived simply as her good mood by both her family members and herself. Consequently, the patient was perceived as having a recurrent depressive disorder, leading to therapy with antidepressants only, while in fact, the lack of data led to the oversight of bipolar affective disorder. Conclusion: From the presented case, we conclude that timely distinction and accurate diagnosis of these two disorders are crucial for prescribing appropriate therapy and preventing the occurrence of "switching" into mania.