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Diagnosis and Pharmacotherapy of Bipolar Depression in Adults
Overview
Join Dr Goldberg as he reviews factors that impact the diagnosis of bipolar disorder and current treatments for bipolar depression in adults.
Learning Objectives
- Use appropriate tools to assess patients with depression for signs of bipolarity
- Individualize treatment approaches for patients with bipolar depression
Target Audience
Psychiatrists, Psychiatric Nurse Practitioners and Physician Assistants, and Primary Care Physicians
Abstract
Approximately 60% of patients with bipolar disorder (BD) who present with depression are misdiagnosed as having recurrent unipolar depression, which may lead to inappropriate treatment and potential worsening of symptoms. Several factors may interfere with a positive screen and an accurate BD diagnosis—especially substance use disorders. By facilitating effective communication with patients, implementing diagnostic criteria, and using assessment tools, clinicians can accurately identify the often subtle indicators of the disorder and recommend individualized treatment. Whichever pharmacologic is prescribed, it is important to tailor treatment for patients with BD by considering the disease course, potential adverse effects, and comorbidities.
From the Series: Individualizing Treatment Selection for Pediatric and Adult Patients With Bipolar Depression
To cite: Goldberg JF. Diagnosis and pharmacotherapy of bipolar depression in adults. J Clin Psychiatry. 2021;82(4):SU120014BR1C.
To share: https://doi.org/10.4088/JCP.SU120014BR1C
© Copyright 2021 Physicians Postgraduate Press, Inc.
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Support Statement
Supported by an educational grant from Sunovion Pharmaceuticals Inc.
Learning Objective
After completing this educational activity, you should be able to:
- Use appropriate tools to assess patients with depression for signs of bipolarity
- Individualize treatment approaches for patients with bipolar depression
Release, Review, and Expiration Dates
This brief report activity was published in June 2021 and is eligible for AMA PRA Category 1 Credit™ through June 30, 2023. The latest review of this material was June 2021.
Statement of Need and Purpose
Because the symptoms of bipolar depression and unipolar depression overlap, clinicians too often misdiagnose bipolar depression as unipolar depression. As a result, patients often wait years for an accurate diagnosis. During this period, patients are either not being treated or are receiving treatments that may worsen symptoms. Education is needed, therefore, on accurately identifying bipolar disorder, including risk factors and warning signs, and assessment strategies that can help them detect often subtle indicators of bipolarity. Additionally, clinicians are not comfortable with treatment options for pediatric bipolar depression, and few up-to-date guidelines and rigorous clinical trial data in this population are available. Also, as youths with bipolar disorder age out of pediatric systems, they are losing contact with mental health care, and providers are failing to ensure continuity of care with adult facilities. Therefore, clinicians need education on current evidence for the safety and efficacy of treatments for pediatric bipolar depression to enable them to select a regimen most likely to alleviate a patient’s symptoms without causing an undue burden of side effects. They also need education on the unique needs of transition-age patients with bipolar disorder and information on how to coordinate the transition from pediatric to adult mental health services. Often in adults, clinicians prescribe inappropriate treatment for patients with bipolar depression. Moreover, many clinicians fail to use measurement-based care to assess whether treatment changes are necessary. Clinicians have had fewer treatment choices for bipolar depression than for bipolar mania and need education on how to manage symptoms with evidence-based options. Education on how to use assessment tools to monitor treatment outcomes for bipolar disorder would be beneficial. This activity was designed to meet the needs of participants in CME activities provided by the CME Institute of Physicians Postgraduate Press, Inc., who have requested information on bipolar depression.
Disclosure of Off-Label Usage
Dr Goldberg has determined that, to the best of his knowledge, divalproex, carbamazepine, lumateperone, aripiprazole, ziprasidone, risperidone, pramipexole, ketamine, esketamine, levothyroxine, N-acetylcysteine, transcranial magnetic stimulation are not approved by the US Food and Drug Administration for the treatment of bipolar depression, and lamotrigine is not approved to treat bipolar mania or acute bipolar depression.
Review Process
The faculty members agreed to provide a balanced and evidence-based presentation and discussed the topics and CME objectives during the planning sessions. The faculty’s submitted content was validated by CME Institute staff, and the activity was evaluated for accuracy, use of evidence, and fair balance by the Chair and a peer reviewer who is without conflict of interest.
Acknowledgment
This activity is derived from the teleconference series “Individualizing Treatment Selection for Pediatric and Adult Patients With Bipolar Depression,” which was held in October and November 2020 and supported by an educational grant from Sunovion Pharmaceuticals Inc. The opinions expressed herein are those of the faculty and do not necessarily reflect the opinions of the CME provider and publisher or the commercial supporter.
Faculty Affiliation
Joseph F. Goldberg, MD
Icahn School of Medicine at Mount Sinai, New York
Financial Disclosure
The faculty for this CME activity and the CME Institute staff were asked to complete a statement regarding all relevant personal and financial relationships between themselves or their spouse/partner and any commercial interest. The Accreditation Council for Continuing Medical Education (ACCME) defines a commercial interest as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The ACCME defines relevant financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. The CME Institute has resolved any conflicts of interest that were identified. No member of the CME Institute staff reported any relevant personal financial relationships. Faculty financial disclosure is as follows:
Dr Goldberg is a consultant for Otsuka, Sunovion, Sage, and BioXcel; has received honoraria from Allergan, Intra-Cellular, Web MD, and Sunovion; is a member of the speakers/advisory boards for Allergan, Intra-Cellular, Sunovion, Otsuka, and BioXcel; and has received royalties from American Psychiatric Publishing and Cambridge University Press.
The Chair for this activity, Robert L. Findling, MD, MBA, is a consultant for Acadia, Adamas, Afecta, Akili, Alkermes, Allergan, Arbor, Axsome, Gedeon Richter, Genentech, Idorsia, Intra-Cellular, Luminopia, Lundbeck, MedAvante-ProPhase, Neurim, Noven, Nuvelution, Otsuka, PaxMedica, Q BioMed, Receptor Life Sciences, Roche, Signant Health, Sunovion, Supernus, Syneos, Takeda, Teva, and Tris; has received grant/research support from Akili, Allergan, Lundbeck, National Institutes of Health, Neurim, Patient-Centered Outcomes Research Institute, Pfizer, Roche, Sunovion, Supernus, SyneuRx, and Takeda; has received honoraria from the American Academy of Child and Adolescent Psychiatry; is a member of the speaker/advisory board for Tris; and has received other financial or material support from the American Psychiatric Press.
Accreditation Statement
The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit Designation
The CME Institute of Physicians Postgraduate Press, Inc., designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.
To obtain credit for this activity, study the material and complete the CME Posttest and Evaluation.
Available Credit
- 1.00 AMA PRA Category 1 Credit™
- 1.00 Participation