There is also better evidence from twin studies that the familial elevation is genetic. Molecular genetic evidence of different genes could confirm the distinction, but this evidence is not yet clearcut.

There is a different sex ratio in bipolar disorder, equal or nearly so, possibly a more equal social class distribution, and some association with milder cyclothymic disorder, although the full status of more recent work on cyclothymia still requires confirmation by validating studies. Treatment response differs, with #selleck products keyword# a better response to maintenance lithium and possibly to anticonvulsants, although in unipolars the evidence is not yet adequate. More manic episodes occur on antidepressants. Bipolar disorder has an earlier Inhibitors,research,lifescience,medical onset than severe unipolar disorder, and tends to be more recurrent. Onsets in women are not uncommonly postpartum, particularly in the case of mania. The present review mainly concerns unipolar depression. There have been a number of recent reports comparing

bipolar and unipolar Inhibitors,research,lifescience,medical depressions.22-24 In addition to the history features indicated above, bipolar depressions have variously been reported to show more of the following symptom features compared with unipolar: more retardation, hypersomnia, anxiety, mood lability, psychotic features (especially when the age is under 35); less evidence of sad mood, and various somatic complaints. However, often the pictures Inhibitors,research,lifescience,medical are indistinguishable. Psychotic depression and melancholia/somatic syndrome The greatest controversy of a previous era concerned a dualistic theory of depression, with a dichotomy between what was variously termed psychotic or endogenous depression on the one hand, and neurotic or reactive depression on the other. Starting

in the later 1920s, and throughout the 1930s, Inhibitors,research,lifescience,medical fierce debates took place, particularly in British psychiatry, between those advancing a dualistic view and those taking a unitary stance, viewing all depressions as part of a single disorder, without any clear separation into subtypes.15 The debate subsided with the greater preoccupations of World War II, and reappeared others in the form of empirical studies using multivariate statistics in the 1960s.16 Terminology was confused. The term “psychotic” refers to a severe disorder with delusions and hallucinations, “neurotic” to a milder disorder without these, and often with the connotation of a vulnerable personality. “Endogenous” and “reactive” refer in this context to absence or presence of life stress.