New tool identifies those at risk of bipolar disorder

May 23 2006

According to a new study researchers have identified five predictors for bipolar disorder risk in patients who have been unsuccessfully treated with antidepressants.

The researchers say the significant risk factors of bipolar disorder among patients already diagnosed with major depression were anxiety, feelings of people being unfriendly, family history of bipolar disorder, a recent diagnosis of depression, and legal problems.

The study also found that forty-three percent of patients who responded positively to any three risk factors, screened positive for bipolar disorder using the Mood Disorder Questionnaire (MDQ), a validated screener for bipolar disorder.

Possibly of more importance was that one-third of patients whose medication for their depression was not right for them, had been told by a doctor they had anxiety and screened positive for bipolar disorder.

The researchers say that based on these findings, a brief assessment tool has been produced that can be used to identify bipolar disorder risk.

According to Joseph R. Calabrese, M.D., Professor of Psychiatry, Case Western Reserve University and the Director of the Mood Disorders Program, University Hospitals of Cleveland, bipolar depression can be difficult for both patients and doctors to identify because the symptoms are often confused with major depression.

Dr. Calabrese says the five predictors identified in the study may help physicians better assess a patient's risk for bipolar disorder, which could lead to more effective treatment.

The study findings support previous research that suggests nearly half of all patients who have bipolar disorder will first be diagnosed with major depression.

Inappropriate treatment due to misdiagnosis can have a harmful effect on patients and potentially makes the illness harder to treat; antidepressants alone have been shown to induce mania or hypomania (a mild form of mania) in some patients with bipolar depression.

Furthermore, people with untreated bipolar disorder can experience a greater frequency of manic and depressive episodes, causing significant disruption in their personal and professional lives.

Many experts say people with bipolar disorder can face up to ten years of coping with symptoms before getting an accurate diagnosis but all agree that for people suffering from depression it is essential they talk to their doctors about other experiences and symptoms over their lifetime.

It seems it is only too common for many patients with bipolar disorder to receive an incorrect diagnosis, meaning years are lost to an illness that can be successfully managed when correctly diagnosed and treated.

The researchers believe the predictors identified in their study may help physicians and patients identify depression associated with bipolar disorder rather than unipolar mood disorder.

For the study psychiatrists from community and private practice clinic settings randomly selected patients who were unsuccessfully treated with antidepressants.

Patients self-reported demographics, family history, co-morbid health status, alcohol/drug use, legal problems, and current depression using the Centers for Epidemiologic Studies Depression (CES-D) scale.

Screening for bipolar disorder was self-reported using the Mood Disorder Questionnaire (MDQ), a validated screening instrument for Bipolar I and II disorders.

Of the 602 patients enrolled in the study, 18.6% screened positive for bipolar disorder using the MDQ and the researchers were able to identify five significant variables associated with bipolar disorder risk: people were unfriendly, co-morbid anxiety, depression diagnosis within five years, family history of bipolar disorder, and legal problems.

Researchers concluded that over one-third of patients who felt people were unfriendly as well as co-morbidly anxious were at risk for bipolar disorder.

These two clinical features and recent depression onset, bipolar disorder family history and legal problems may prove useful indicators of bipolar disorder risk among patients with major depression who have been unsuccessfully treated with antidepressants.

Bipolar disorder, also known as manic-depressive disorder, is a serious medical illness that can affect a person's ability to feel a normal range of moods.

People with bipolar disorder have extreme shifts in thoughts, energy, mood, and behavior.

A person's mood may swing between "highs" (called mania) and "lows" (called depression); in between mood swings, a person may have few or no symptoms.

Many people experience bipolar depression more frequently than the "highs" or mania and some people with bipolar disorder experience years of having only depressed periods.

Bipolar disorder is a lifelong condition that can usually be treated and managed effectively with proper medication, education, and support but may be misdiagnosed, most often as major depression.

Inappropriate treatment due to misdiagnosis could have a harmful effect on patients potentially making the illness harder to treat.

When left untreated, bipolar disorder can worsen and patients can experience a greater frequency of "highs" and "lows."

The research was presented this week at an annual meeting of the American Psychiatric Association in Toronto, Canada.

For more information on bipolar disorder and to download the assessment tool derived from the study, go to http://www.sayhowyoufeel.com/ , a web site sponsored by GlaxoSmithKline.