Moods During Depressive Episodes Differ in Bipolar and Major Depressive Disorders

woman with two moods
woman with two moods
Researchers explored the differences between bipolar and major depressive disorders, regardless of whether or not a history of manic or hypomanic episodes is established.

 The number and types of mood spectrum symptoms experienced in a major depressive disorder (MDD) differ from bipolar disorder (BD), according to study results published in Bipolar Disorders.

The study recruited patients from 3 Italian university medical centers. The resulting 145 patients with BD and 155 patients with MDD met the Diagnostic and Statistical Manual of Mental Disorders criteria for major depressive episode and completed the Mood Spectrum‐Self‐Report‐Last Month (MOODS-SR-LM) questionnaire.

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During a major depressive episode, patients with BD scored higher on the following domains of the MOODS-SR-LM than the MDD group members: mood depressive (mean ±standard deviation, 16.9±5.4 vs 15.5±5.2; P =.029), mood manic (7.3±5.8 vs 4.7±4.7; P <.001), energy depressive (6.6±2.4 vs 5.7±2.8; P =.018), energy manic (3.0±2.3 vs 2.1±2.3; P =.003), cognition depressive (15.0±6.6 vs 12.4±6.6; P =.005), cognition manic (2.6±3.5 vs 1.7±2.6; P =.005), and rhythmicity (16.0±5.7 vs 14.8±6.5; P =.236).

When evaluating the MOODS-SR-LM responses, patients with BD were more likely to endorse mood spectrum symptoms such as rapid changes between happiness and sadness; difficulty performing daily activities; low attention span; making important choices very quickly; and irritability, depression, or mania related to alcohol or other substance use.

Investigators noted that the MOODS-SR-LM does not capture the duration of symptom occurrence or whether symptoms were isolated or clustered over the month prior to completing the assessment.

“There are differences between BD and MDD in terms of the number and type of mood spectrum items that are endorsed during a MDE [major depressive episode], which may help to identify patients with BD when a retrospective assessment of a history of mania or hypomania is not possible or not reliable,” investigators wrote. “A high number of patients with BD and a considerable number of patients with MDD endorsed several items in the manic section of the mood, energy, and cognition domains, thus confirming the centrality of mixed features in patients with mood disorders and the need for a unitary, dimensional, descriptive and dynamic approach to MDD and BD,” they concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Cuomo A, Aguglia A, Aguglia E, et al. Mood spectrum symptoms during a major depressive episode: differences between 145 patients with bipolar disorder and 155 Patients with major depressive disorder. Arguments for a dimensional approach [published online October 20, 2019]. Bipolar Disord. doi:10.1111/bdi.12855