A Urine Test to Distinguish Between Bipolar Disorder and Major Depressive Disorder

Basically 6 metabolites in urine can be used to determine whether a person has bipolar d/o (BPD) or major depressive disorder (MDD) depending on the levels of the metabolites. If this is really valid, it is a valuable test, as BPD patients cannot be put on anti depressants (like MDD patients can) because they will be pushed into full blown mania. This would be a really great diagnostic tool!


Bipolar disorder (BD) is a complex debilitating mental disorder that is often misdiagnosed as major depressive disorder (MDD). Therefore, a large percentage of BD subjects are incorrectly treated with antidepressants in clinical practice. To address this challenge, objective laboratory-based tests are needed to discriminate BD from MDD patients. Here, a combined gas chromatography–mass spectrometry (GC–MS)-based and nuclear magnetic resonance (NMR) spectroscopic-based metabonomic approach was performed to profile urine samples from 76 MDD and 43 BD subjects (training set) to identify the differential metabolites. Samples from 126 healthy controls were included as metabolic controls. A candidate biomarker panel was identified by further analyzing these differential metabolites. A testing set of, 50 MDD and 28 BD subjects was then used to independently validate the diagnostic efficacy of the identified panel using an area under the receiver operating characteristic curve (AUC). A total of 20 differential metabolites responsible for the discrimination between MDD and BD subjects were identified. A panel consisting of six candidate urinary metabolite biomarkers (propionate, formate, (R*,S*)2,3-dihydroxybutanoic acid, 2,4-dihydroxypyrimidine, phenylalanine, and β-alanine) was identified. This panel could distinguish BD from MDD subjects with an AUC of 0.913 and 0.896 in the training and testing sets, respectively. These results reveal divergent urinary metabolic phenotypes between MDD and BD. The identified urinary biomarkers can aid in the future development of an objective laboratory-based diagnostic test for distinguishing BD from MDD patients.

9 thoughts on “A Urine Test to Distinguish Between Bipolar Disorder and Major Depressive Disorder

  1. Wow, that’s fantastic!!! Good work digging up the research for us. I tell you, if this had been around 30 (or more!) years ago, my life would had a completely different outcome. I would not have suffered for many years, would have enjoyed all the amazing things in my life…I’m very pleased that the coming generations who are unfortunate enough to have to live with these dreadful illnesses will at least be spared the horrors most of us have experienced, being pounded with antidepressants, none of which worked, and some of which did us palpable harm, such as tipping us into mania, or perhaps simply rendering us nonfunctional due to oversedation as the dose was pushed up and up because “it wasn’t working.” Oh, sorry, I caught myself being bitter right there. Well, I am, for myself and you and anyone else who has been caught in this trap. So, thank you so,so much for sharing this. It gives me hope.

    Liked by 1 person

    • This is one hell of an illness to deal with so to be misdiagnosed and mis medicated, if we can avoid that, it really would be a major milestone in treatment. And I understand the bitterness completely, I too as you know, was pushed into full blown mania by antidepressants which unmasked my bipolar d/o. Who knows how things would have progressed if they would have put me on Lithium even when I was initially in a severe depression.

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      • With an annualized mortality rate of 20%, bipolar disorder kills more people than all cancers combined. In the young adult age bracket, suicide is now second after “accidents” as cause of death. At least it was last year, I haven’t looked at the morbidity and mortality stats for the past calendar year yet. Unforgivable that so many young people are suffering, yet get labeled as “trouble makers” and shunted into the wrong systems, Anna even if they are identified and diagnosed, they have to deal with stigma…And wrong meds.

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      • Those stats are horrifying! Stigma, misdiagnosis, mis and maltreatment not to mention treatment resistance. Pretty bleak outlook. We are going something with our blogs. At least are educating people about mental illness.

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  2. Depression tends to run in families, which may bolster the theory that chemical imbalances are somehow involved. However, major depressive disorder
    social and psychological problems may also be suspect, the result of child abuse, neglect, severe marital conflict or divorce, death of a parent, or other familial disturbances may also contribute to the onset of depression.

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    • I think genetic and psychosocial factors are involved in depression. You may not manifest depression or any illness, if the biochemical/physiological stressed in your life are very low! So the environment definitely affects our genes.


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