Mitchell Philip B, Malhi Gin S
School of Psychiatry, University of New South Wales and Mood Disorders Unit, Black Dog Institute, Prince of Wales Hospital, Sydney, NSW, Australia.
Bipolar Disord. 2004 Dec;6(6):530-9. doi: 10.1111/j.1399-5618.2004.00137.x.
There has been increasing interest in the depressed phase of bipolar disorder (bipolar depression). This paper aims to review the clinical characteristics of bipolar depression, focusing upon its prevalence and phenomenology, related neuropsychological dysfunction, suicidal behaviour, disability and treatment responsiveness.
Studies on the prevalence of depression in bipolar disorder, the comparative phenomenology of bipolar and unipolar depression, as well as neuropsychology and brain imaging studies, are reviewed. To identify relevant papers, a literature search using MEDLINE and PubMed was undertaken.
Depression is the predominant mood disturbance in bipolar disorder, and most frequently presents as subsyndromal, minor or dysthymic depression. Compared with major depressive disorder (unipolar depression), bipolar depression is more likely to manifest with psychosis, melancholic symptoms, psychomotor retardation (in bipolar I disorder) and 'atypical' symptoms. The few neuropsychological studies undertaken indicate greater impairment in bipolar depression. Suicide rates are high in bipolar disorder, with suicidal ideation, suicide attempts and completed suicides all occurring predominantly in the depressed phase of this condition. Furthermore, the depressed phase (even subsyndromal) appears to be the major contributant to the disability related to this condition.
The significance of the depressed phase of bipolar disorder has been markedly underestimated. Bipolar depression accounts for most of the morbidity and mortality due to this illness. Current treatments have significant limitations.
双相情感障碍的抑郁发作期（双相抑郁）越来越受到关注。本文旨在综述双相抑郁的临床特征，重点关注其患病率、现象学、相关神经心理功能障碍、自杀行为、残疾情况及治疗反应性。
对双相情感障碍中抑郁发作的患病率、双相抑郁与单相抑郁的比较现象学，以及神经心理学和脑成像研究进行综述。为确定相关论文，使用MEDLINE和PubMed进行了文献检索。
抑郁是双相情感障碍中主要的情绪障碍，最常表现为亚综合征性、轻度或心境恶劣性抑郁。与重度抑郁症（单相抑郁）相比，双相抑郁更易伴有精神病性症状、抑郁性症状、精神运动迟缓（双相I型障碍）及“非典型”症状。为数不多的神经心理学研究表明双相抑郁患者的损害更严重。双相情感障碍的自杀率很高，自杀观念、自杀未遂和自杀死亡大多发生在该病的抑郁发作期。此外，抑郁发作期（即使是亚综合征性的）似乎是导致该病相关残疾的主要因素。
双相情感障碍抑郁发作期的重要性被明显低估。双相抑郁是该病导致发病和死亡的主要原因。目前的治疗存在显著局限性。
