Presentations of depression in bipolar illness

Robert M. Post, Kirk D. Denicoff, Gabriele S. Leverich, Lori L. Altshuler, Mark A. Frye, Trisha M. Suppes, Paul E. Keck, Susan L. McElroy, Ralph Kupka, Willem A. Nolen, Heinz Grunze, Jorg Walden

Research output: Contribution to journalReview articlepeer-review

16 Scopus citations


In this paper, a variety of components and treatment characteristics of bipolar depression are addressed. In a large sample of intensively and naturalistically treated outpatients with bipolar illness, daily prospective ratings for 1 year showed that the total time spent depressed exceeded time spent manic by a factor of three, indicating that the depressive phases of bipolar illness in this sample were more problematic and treatment-resistant than the manic phases. Two-thirds of these patients remained substantially impaired by their illness and only one-third had minimal symptoms for the entire year. New data on discontinuation of effective adjunctive antidepressant treatment, in a small subgroup of patients initially responsive for 2 months, suggests that discontinuation may increase the risk of relapse into depression. Different patterns of treatment-resistance to mood stabilizers are discussed, including the possibilities of tolerance development and discontinuation-induced refractoriness. The characteristic phenomenological presentation and neurocognitive deficits of bipolar depression are briefly outlined. The occurrence of an earlier age of onset of depression and bipolar illness are discussed in relation to cohort and anticipation mechanisms and their possible association with the development of treatment-resistance.

Original languageEnglish (US)
Pages (from-to)142-157
Number of pages16
JournalClinical Neuroscience Research
Issue number3-4
StatePublished - Dec 2002


  • Anticipation
  • Bipolar
  • Depression
  • Early onset
  • Refractoriness
  • Tolerance

ASJC Scopus subject areas

  • Neuropsychology and Physiological Psychology
  • Neurology
  • Clinical Neurology
  • Psychiatry and Mental health
  • Biological Psychiatry


Dive into the research topics of 'Presentations of depression in bipolar illness'. Together they form a unique fingerprint.

Cite this