About Bipolar Disorder in Adult Patients

Bipolar Depression Is Commonly Misdiagnosed in Adults1


Unipolar depression is the most common misdiagnosis, followed by anxiety disorders, schizophrenia, personality disorders, and substance- or alcohol-abuse disorders1

  • Depressive symptoms of unipolar depression are the same as those of bipolar depression2

Many adult patients wait more than 10 years from the onset of symptoms to receive an accurate diagnosis of bipolar disorder1,3

Screening tools such as the Mood Disorder Questionnaire (MDQ) and Composite International Diagnostic Interview (CIDI) 3.0 have been developed to help clinicians uncover a history of mania to differentiate bipolar depression from unipolar depression4,5

Depression Is Often Seen at the Onset of Bipolar Disorder in Adult Patients6

On average adult patients with bipolar disorder experience 3 times more depression than mania7

In some cases adult patients may experience depressed moods without mood elevation for 5 or more years8

Symptoms of mania may be overlooked or underreported9,10

 

Antidepressants May Be Ineffective for Bipolar Disorder in Adult Patients10-12

Treatment for bipolar disorder in adult patients most often starts with antidepressants, despite limited evidence of effectiveness10-12

Use of antidepressants in bipolar disorder:

  • May be ineffective, resulting in multiple-drug treatment failure10,11
  • May induce an affective switch to mania or hypomania10,11
  • Non-response to antidepressants may be an indicator of bipolar disorder; therefore, it may be useful for adult patients who are not responding to treatment with antidepressants to be screened for bipolar disorder11

Only a few FDA-approved agents are indicated for the treatment of bipolar depression10

 

References:

  1. Hirschfeld RM, Lewis L, Vornik LA. Perceptions and impact of bipolar disorder: how far have we really come? Results of the National Depressive and Manic-Depressive Association 2000 survey of individuals with bipolar disorder. J Clin Psychiatry. 2003;64(2):161-174.
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC:  American Psychiatric Association; 2013.
  3. Baldessarini RJ, Tondo L, Baethge CJ, Lepri B, Bratti IM. Effects of treatment latency on response to maintenance treatment in manic-depressive disorders. Bipolar Disord. 2007;9(4):386-393. 
  4. Hirschfeld RM, Williams JB, Spitzer RL, et al. Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. Am J Psychiatry. 2000;157(11):1873-1875. 
  5. Kessler RC, Ustün TB. The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res. 2004;13(2):93-121.
  6. Suppes T, Leverich GS, Keck PE, et al. The Stanley Foundation Bipolar Treatment Outcome Network. II. Demographics and illness characteristics of the first 261 patients. J Affect Disord. 2001;67(1-3):45-59.
  7. Judd LL, Akiskal HS, Schettler PJ, et al. The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry. 2002;59(6):530-537.
  8. Perlis RH. Misdiagnosis of bipolar disorder. Am J Manag Care. 2005;11(9 suppl):S271-S274.
  9. Anderson IM, Haddad PM, Scott J. Bipolar disorder. BMJ. 2012;27;345:e8508. doi: 10.1136/bmj.e8508.
  10. Muzina DJ, Colangelo E, Manning JS, Calabrese JR. Differentiating bipolar disorder from depression in primary care. Cleve Clin J Med. 2007;74(2):89, 92, 95-99.
  11. Manning JS. Tools to improve differential diagnosis of bipolar disorder in primary care. Prim Care Companion J Clin Psychiatry. 2010;12(suppl 1):17-22. doi: 10.4088/PCC.9064su1c.03.
  12. Baldessarini RJ, Leahy L, Arcona S, Gause D, Zhang W, Hennen J. Patterns of psychotropic drug prescription for U.S. patients with diagnoses of bipolar disorders. Psychiatr Serv. 2007;58(1):85-91.