Clinical and evolution particularities of the depressive episode in bipolar affective disorder

Abstract

In bipolar affective disorder, depressive episodes account for approximately 70–75% of the symptomatic time and contribute significantly to patient dysfunction and delayed diagnosis. These episodes are frequently misidentified as unipolar depression requiring a differentiated and structured clinical approach. The aim of the study is to analyze the literature data regarding clinical manifestations and the evolution of depressive symptoms in both unipolar and bipolar depression. In order to achieve the proposed aim of study, a narrative review of the accessible scientific literature from databases of PubMed, Google Scholar, Medscape from the last five years was analyzed, regarding the clinical-evolutive particularities of the depressive episode in bipolar disorder of unipolar disorder, was performed. The literature sources studied revealed the following data: in 40- 60% of patients bipolar affective disorder begins with a depressive episode. Atypical symptoms such as hypersomnia, hyperphagia, extreme fatigue, vegetative symptoms were presented in 50-70% of them. The symptom like psychomotor inhibition was found in 30-50% of patients with bipolar depression, and psychotic symptoms accompanied depression in 15-30%. The response to antidepressant treatment was inconstant, with a risk of turning to manic episodes in 20-40% of cases. Guidelines recommend using mood stabilizers and avoiding antidepressant monotherapy. The depressive episode in bipolar affective disorder has a distinct clinical identity, reflected by an increased prevalence of atypical symptoms and affective comorbidities . Recognizing these features allows early interventions and increases patients' quality of life.