Posted by Phillipa on August 8, 2011, at 20:45:16
Before a doc should prescribe antidepressants patients should be screened family history wise and other. Phillipa
From Medscape Medical News
Bipolar Disorder Underlying Major Depression May Be Missed
Laurie Barclay, MDAuthors and Disclosures
August 8, 2011 The diagnosis of bipolar disorder may be missed in patients presenting with a major depressive episode, according to the results of a cross-sectional diagnostic study reported in the August issue of the Archives of General Psychiatry.
"Major depressive disorder, the most common psychiatric illness, is often chronic and a major cause of disability," write Jules Angst, MD, from the Division of Psychiatric Research, Zürich University Psychiatric Hospital in Zürich, Switzerland, and colleagues from the Bipolar Disorders: Improving Diagnosis, Guidance and Education (BRIDGE) Study Group. "Many patients with major depressive episodes who have an underlying but unrecognized bipolar disorder receive pharmacologic treatment with ineffective regimens that do not include mood stabilizers."
The goal of this study from the multicenter, multinational, transcultural BRIDGE initiative was to assess the frequency of bipolar disorder symptoms in patients presenting for treatment of major depressive episodes. The investigators identified 5635 adults seen at community and hospital psychiatry departments for an ongoing major depressive episode. Criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) and previously described bipolarity specifier criteria were used to examine the prevalence of bipolar disorder. Logistic regression allowed determination of variables associated with bipolarity, with significant associations defined as an odds ratio greater than 2 and P < .001.
DSM-IV-TR criteria for bipolar disorder were met by 903 patients (16.0%; 95% confidence interval [CI], 15.1% - 17.0%), and bipolarity specifier criteria were met by 2647 patients (47.0%; 95% CI, 45.7% - 48.3%). When both sets of criteria were applied, there were significant associations with bipolarity for a family history of mania or hypomania and multiple past mood episodes. When only the bipolarity specifier was used, there were also significant associations for manic/hypomanic states during treatment with antidepressant drugs, current mixed mood symptoms, and comorbid substance use disorder.
"The bipolar-specifier criteria in comparison with DSM-IV-TR criteria were valid and identified an additional 31% of patients with major depressive episodes who scored positive on the bipolarity criteria," the study authors write. "Family history, illness course, and clinical status, in addition to DSM-IV-TR criteria, may provide useful information for physicians when assessing evidence of bipolarity in patients with major depressive episodes. Such an assessment is recommended before deciding on treatment."
Limitations of this study include lack of random selection of participating centers, widely varying rates of hospitalized patients across countries, retrospective assessment of hypomanic symptoms, cross-sectional design, and lack of a healthy control group.
"[W]e recommend that, among patients with MDEs [major depressive episodes], the presence of bipolar features, including all those with significant predictive value reported in this study, should be investigated carefully before a decision is made to prescribe antidepressants," the study authors conclude. "If patients exhibit bipolar symptoms that impair everyday functioning, treatment with a mood stabilizer or an atypical antipsychotic may be useful. Treatment approaches for MDD [major depressive disorder] and bipolar disorder differ substantially."
sanofi-aventis supported this study and paid per-patient fees to all investigators who recruited patients.
Arch Gen Psychiatry.
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