Bipolar Disorder Diagnosis Dilemma

Depression treatment different than bipolar disorder therapies

(RxWiki News) Proper diagnosis of bipolar disorder and depression should include an extensive patient evaluation.  Doctors need access to information regarding details about one's moods, psychotic thoughts, manic periods and family history.

Early diagnosis of individuals with bipolar disorder is not just an academic exercise. It is of vital importance as the treatment for depression and those with bipolar disorder require different protocols. 

"Giving antidepressants to bipolar disorder patients may magnify their symptoms."

After patient interviews, Roy H. Perlis, M.D., M.Sc., of Massachusetts General Hospital and Harvard Medical School, and colleagues studied 4,041 adults with depression where the first of four phases of treatment was taking citalopram, an antidepressant.

In this study prior to their treatment, the adults presenting with depression were interviewed about their feelings and if they had any unusually strong feelings not based in reality like espionage, special magical powers or plots being built against them.

A large number, 33 percent, of the patients had experienced at least one of these psychotic-like episodes. Over the course of treatment, this 33 percent group were less likely to have their symptoms lifted. In other words, they were more likely to not improve.

Patients were then asked if they had any manic episodes during their depression. A solid 38 percent had at least one manic episode. Patients who disclosed a tendency toward irritability were also more likely to not improve.

However, patients who reported a family history of bipolar disorder and a personal history of manic symptoms were able to improve during the study.

Moreover, patients who reported shorter episodes of duration, which is suggested to be a risk marker for bipolar disorder, in fact had a greater chance to have their symptoms improve in the program.

To assess the association between features of bipolar disorder and the outcomes of treatment for depression, Roy H. Perlis, M.D., M.Sc., of Massachusetts General Hospital and Harvard Medical School, Boston, and colleagues studied 4,041 adults with a diagnosis of depression.

Patients were treated with the antidepressant citalopram, followed by up to three next-step treatments as needed depending on their response.

After patient interviews, Roy H. Perlis, M.D., M.Sc., of Massachusetts General Hospital and Harvard Medical School, Boston, and colleagues studied 4,041 adults with depression whose first phase of treatment was taking citalopram, an antidepressant.

The study concluded that most patients presenting with a major depressive episode without prior mania, unrecognized bipolarity does not appear to be a major determinant of treatment resistance.

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Review Date: 
April 8, 2011