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date: 27 February 2021

Abstract and Keywords

There has been speculation about the relationship between depression and mania for centuries. Modern psychiatry and psychology have mostly viewed these as different subtypes within a “family” of mood disorders. Conceptual models of comorbidity provide an opportunity to re-examine the association between depression and other pathological mood states. We examine the evidence pertaining to rates of “comorbidity,” which, in this case, refer to the lifetime occurrence of depression and hypomanic, mixed, or manic episodes in the same individual. We explore factors that could contribute to artifactual comorbidity. We also examine data pertaining to similarities or differences in phenomenology, longitudinal course, associated features, family history, and treatment response. Multiple factors are likely involved in the comorbidity of depression and hypomania or mania, and the problems of poor reliability and inconsistent diagnostic definitions and methodology attenuate the significance of most research findings. However, evidence appears sufficient to conclude that not all depression is on the bipolar spectrum, that bipolar features moderate the course and outcome of depressive illness, and that depression and bipolar disorder most likely involve a blend of some shared and some specific mechanisms. Research and clinical work both will advance substantially by more systematically assessing for potential bipolar features “comorbid” with depression and following how these factors change the trajectory of depression over time.

Keywords: bipolar disorder, mania, hypomania, mixed mood, depression, comorbidity

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