Early Diagnosis and Management of Bipolar Disorder(Symposium/Depression-Its Diagnostic Issues and the Knack of Treatment)

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  • Tanaka Teruaki
    Department of Psychiatry, Wakkanai City Hospital:Department of Psychiatry, Hokkaido University Graduate School of Medicine
  • Koyama Tsukasa
    Department of Psychiatry, Hokkaido University Graduate School of Medicine

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Other Title
  • 双極性障害の早期診断と治療(シンポジウム:うつ病の診断・治療上の問題点とコツ,2008年,第49回日本心身医学会総会(札幌))
  • 双極性障害の早期診断と治療
  • ソウキョクセイ ショウガイ ノ ソウキ シンダン ト チリョウ

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Abstract

Recent reports indicate that bipolar disorder is frequently misdiagnosed as unipolar depression, leading to inappropriate use of antidepressants. Early identification of bipolar disorder is one of the key points in managing depression in the primary care setting. Although it is difficult to differentiate bipolar and unipolar types of depression due only to depressive symptoms, atypical and manic features in the depressive episode may give some dues to the diagnosis of bipolar disorder. The clinician needs to check carefully evidence of past spontaneous (hypo) mania which is required to diagnose bipolar disorder, because of underreporting or lack of information on the (hypo) manic episodes. Alternatively, some self-reported questionnaires may be also useful in screening patients with bipolar disorder in a primary care practice. Moreover, bipolar disorder commonly has concomitant personality and substance abuse disorders, and is complicated by the presence of one or more comorbid disorders. It is preferable to estimate "bipolarity", especially a family history of bipolar disorder and antidepressant-induced (hypo) mania, from the viewpoint of bipolar spectrum. In the pharmacotherapy of bipolar disorder, mood stabilizer is recommended as a first-line treatment regardless of the types of mood episodes. Despite widespread antidepressant treatment for both unipolar and bipolar depression in a clinical practice, some recent reports suggest that antidepressants are not effective for the treatment of bipolar depression. Considering that antidepressants for bipolar depression may induce a manic switch or rapid cycling, the clinician would have to pay careful attention to the use of antidepressants in bipolar disorder.

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