If a patient has a major depressive episode, it’s possible the treating doctor will miss an additional diagnosis of bipolar disorder.
That’s the finding from a recent diagnostic study which was recently reported in the August issue of the Archives of General Psychiatry, a leading journal.
The danger of this missed diagnosis is that quite often, the major depressive order will be treated but the underlying mood disorder won’t be addressed without recognizing the need for mood stabilizing medication, according to the author of the study, Dr. Jules Angst of the Zürich University Psychiatric Hospital in Zürich, Switzerland.
The study aimed to look at the rate of bipolar disorder in people with major depressive disorder, and found that out of over 5,000 patients with at least one major depressive episode, at least 900 met the DSM-IV criteria for bipolar disorder and over 2,500 patients displayed the bipolar specifier criteria. Looking at both sets of criteria led researchers to conclude an additional 31% of the subjects showed signs of bipolar disorder, which could go untreated if physicians looked only at the major depression symptoms.
The study authors noted that the study had certain limitations, including disparate rates of hospitalization of patients from different countries, absence of randomly selected participating treatment centers, and no healthy control group.
What can you take away from this study? According to Dr. Angst, the treatment protocols for major depressive disorder and bipolar disorder differ significantly, so if you’re being treated for major depression, it’s important that your provider check for symptoms of bipolar disorder as well. The study in AGP notes: “If patients exhibit bipolar symptoms that impair everyday functioning, treatment with a mood stabilizer or an atypical antipsychotic may be useful.”
Dr. Guy Goodwin, from the University of Oxford (UK), was asked for a comment on the study by MedScape, a medical information website that published the above-linked report on the study. He commented that the loosening of bipolar’s defining criteria might be appropriate to include an increase in patient activity and to shorten the amount of time such increased activity lasts. This would almost certainly increase the number of bipolar diagnoses in patients with major depressive disorder.