Understanding Treatment for Bipolar Depression vs. Unipolar Depression

With the stigma around mental illness gradually lifting over the last couple decades, depression sufferers are sharing more candidly than ever about their challenges. Most people know that depression typically presents with symptoms of sadness or marked loss of interest in activities, and can widely range in severity. And, some may know that depression can present with other physical and cognitive symptoms such as feelings of guilt or unfounded worthlessness, decreased energy, changes to sleeping patterns, diminished concentration, fluctuations in appetite or weight, and feelings of being slowed down. But many people don’t realize depression is actually a major symptom of several disorders.

Of the depressive disorders, there are two main camps: unipolar depression and bipolar depression. While there can be a lot of overlap, it may be helpful to understand the difference if you’re considering getting help for your depression symptoms. The typical approaches to treatment for bipolar disorder do include some of the strategies used in the treatment for unipolar depression (considerable research shows that therapy for depression is effective across the two main types), but there are some important differences.

So how is bipolar depression different from unipolar depression, and what can that tell us about treating bipolar disorder? Unipolar depression is called “unipolar” because it refers to the presence of only depressive mood symptoms–or, to one emotional “pole.” Bipolar, on the other hand, refers to two “poles”--depressive symptoms, and episodes of mania or hypomania. Manic and hypomanic episodes are periods where a person may feel invigorated with energy and have difficulty sleeping. They may also experience ideas of grandiosity, make impulsive decisions, or engage in uncharacteristically risky behavior. These periods must last at least several days, and may even last several months. While some sufferers report enjoying their hypomanic symptoms, their symptoms of depression can be severe, making treatment for bipolar depression important.

A key distinctive feature of bipolar vs unipolar depression is that unipolar depression does not have those periods of mania. Unipolar depression, often called major depressive disorder, involves persistent feelings of sadness or loss of interest as well as multiple other symptoms listed above for at least two weeks. Without treatment, however, depression can last for several months or even years.

What Causes Depression?

While there are some differences in what researchers speculate causes bipolar vs unipolar depression, there are some commonalities across mood disorders. Clinicians often use what’s known as the biopsychosocial model to describe the factors that influence mental health. This model tells us that biological, psychological, and social factors each influence us while being intertwined and affecting each other, further complicating things.

Biologically, researchers have identified genetic and physiological components that may make some people more prone to depression, such as inherited differences in how parts of the brain distribute serotonin receptors and manage the absorption of neurotransmitters like serotonin.This is what psychiatrists target when they prescribe medications such as SSRIs. Different medications are used in unipolar and bipolar depression treatment–but regardless of the particular medication, the best results are obtained when medication is combined with therapy.

There is a genetic component to bipolar vs unipolar depression, with bipolar showing a higher degree of heritability. Albeit, this difference is extremely slight and we are not aware of specific genes that cause these differences. To make matters even more interesting, psychosocial factors can influence genetic expression–meaning they may “turn on/off” certain genes related to mood disorders!

When looking at the psychological and social factors behind depression, researchers examine factors such as how an individual processes their emotions and utilizes coping methods to dampen the impact of stress from life events. They also consider economic, environmental, and cultural factors. These psychosocial elements require a holistic approach to treatment that can be tailored to an individual’s specific needs. Medication alone cannot address the underlying psychosocial triggers of either bipolar or unipolar depression, and this is where various therapeutic modalities and approaches can provide significant benefits.

Therapy as a Treatment for Unipolar & Bipolar Depression

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a common tool used in bipolar and unipolar depression treatment plans, and one of the therapy practices I specialize in. “CBT” refers to a number of approaches that all aim to challenge maladaptive distortions in an individual’s perspective, and teach helpful strategies that create a more realistic and balanced view of themselves, others and the world. These therapies can be used alone or in conjunction with medication to treat many mental health disorders in addition to depression, such as anxiety, personality disorders, substance abuse disorders, and more.

The word “cognitive” in cognitive behavioral therapy refers to thinking processes–specifically, it refers to how therapists help clients address maladaptive beliefs and the thoughts that stem from them. Depression sufferers often minimize positive events (“I got the job, but it was a fluke”), overgeneralize negative events (“I always mess things up”), and/or catastrophize (“This vacation is probably going to be a disaster”). During CBT, clients become better able to notice these emotionally-draining thought habits and redirect them in a positive way.

The “behavioral” component of CBT is some form of behavioral activation–the use of behaviors to improve mood and reduce anxiety over time. Once clients become aware of their harmful thought patterns and gain tools to combat them, therapists help them engage in meaningful activities that inspire joy, interrupt harmful thoughts, reduce anxiety and ease depression.

The combined focus on thoughts and behaviors is part of what makes CBT effective. And, the skills learned in these therapies can last a lifetime, making it especially helpful in the treatment of bipolar depression and chronic unipolar depression, which are typically a lifelong diagnoses.

Psychodynamic Therapy

When comparing bipolar vs unipolar depression, psychodynamic psychotherapy is another strategy that has shown to be beneficial across both conditions. This approach focuses on the connections between depression and unconscious conflict, past events, and relationships. With the psychodynamic approach, I help clients explore their past life events such as traumas and challenging relationships that may be influencing their current thoughts and feelings. This exploration allows clients to bring unconscious pain to the surface, where it can be addressed in a way that allows us to engage in more flexible responses to problems so that we can feel better. Psychodynamic therapy is perhaps the oldest form of psychotherapy, and is widely regarded as effective in the treatment of mood disorders. This technique is also particularly helpful for understanding conflict in couples therapy.

Humanistic Therapy

Humanistic therapy is another approach to bipolar and unipolar depression treatment that helps address the conflicts people feel about themselves and their relationships. The humanistic approach is rooted in the philosophical belief that each individual has dignity and value. Therapists operating from a humanistic perspective use empathy to guide clients towards the discovery of their inherent worthiness and right to a fulfilling life. This perspective has informed my approach as a therapist; I provide an emotionally-safe environment and unconditional positive regard for clients that is essential for supported self-reflection. Clients and I work together to discover new perspectives and develop plans for personal growth.

Family Systems Therapy

When studying bipolar vs unipolar depression, researchers have found that both conditions can lead to significant interpersonal dysfunction and conflict. Mental health conditions place strain on relationships, so treatment approaches that consider the added stress of these dynamics are useful in lessening depressive symptoms. Family Systems Therapy can help depression sufferers and their loved ones communicate, change their perspective, develop better coping tools, and address relationship dynamics that may be worsening symptoms. Family Systems Therapy is an especially effective intervention in the treatment of bipolar depression due to the added challenges that manic episodes can cause socially, sexually, and financially. Using Family Systems Therapy, I work with clients and their loved ones to improve communication skills and while changing the dynamic of their relationship to better meet the needs of everyone in the family system. We improve the family dynamic when we empower the depression sufferer and their loved ones with useful, effective skills.

Reach Out for Support

If you are concerned about your mental health, you are already making the right step by seeking out help. I am a Licensed Marriage and Family Therapist who specializes in several forms of therapy. My approach to treatment is personalized to my individual client while being based in research and evidence drawn from large populations of clients. I have extensive experience with depression as well as various other conditions and strive to foster a nonjudgmental environment for personal growth. My office is located in Playa Vista, widely serving Mar Vista, Culver City, and the surrounding areas in West Los Angeles.

If you feel more comfortable speaking from your own home, I also offer teletherapy for California residents. Contact me at Erik Anderson Therapy & Counseling to schedule a consultation.